WebMD: Low-Salt Diet May Not Cut Heart Risk
WebMD: Low-Salt Diet May Not Cut Heart Risk
Salt has become a serious factor in my life in the last two and a half years since I was diagnosed with CRF, HTN, and a couple of secondary problems. Salt turns me into a huge sponge … literally. I can gain more than five pounds of water weight in one day if I eat nachos or something that is very salty.
I have to question whether to put a lot of stock in the study which came up with those results …
Since it’s WebMD, and not Medscape, the study is addressed in only general, lay-man’s terms, so it’s really hard to tell how they actually got their information. I suspect that the reason that those who cut down on the salt had a higher death rate was because they had a medical reason to cut back on the salt to begin with, and the medical reason predisposed them to the health crisis which ultimately caused their demise.
For example: my nephrologist wants me to avoid all salt, because my body can’t deal with it. I have existing medical problems which could cause me to have a stroke, or some other medical crisis, at any time. So, if I were included in this study, I would be one of those who stopped using salt in my diet. If my high blood pressure were to go out of control, which it occasionally does for no apparent reason, and I were to have a stroke, it would be because of my preexisting condition - not because I cut salt out of my diet.
In fact, I suspect that cutting salt out of my diet would even forestall the stroke to more or less of a degree.
Or perhaps the study involved a certain group of people with a genetic predisposition for heart disease and strokes who happened to eat a diet low in salt because of regional or cultural traditions … again, it wouldn’t be because they avoided salt - but rather because of their genetic predisposition.
The idea that following my nephrologist’s recommendation to not eat salt could make me 37% more likely to have a stroke seems, well, hard to believe … but if it’s really so, I’m going to feast on nachos, pickles and olives, potato chips, salted nuts, and some nice hot buttered and salted home-grown popcorn!!!
I believe that publishing that sort of study for non-medical people, using non-medical generalities, can be a dangerous thing … I believe that we should perhaps take the results of that study with a grain of, *ahem* … salt!
I would like to ask the physicians who visit my blog to comment on this study … I’d like a bit of insight …
March 12th, 2006 at 10:39 pm
these studies drive lay people, like me, who have a little knowledge insane.
If there is a clear cut basis … I eat nachoes, and I swell up, and gain weight … then who cares what the studies say.
If my nephrologist has recommended that I avoid salt ..then who cares what the studies say.
However, because the studies have said … everybody and their Aunt Suzy will be telling me, as I pass up on the chips served at the church dinner, that the studies say they’re perfectly fine!
I tell them doc says no … and they’ll say my doc is wrong, ’study’ says so.
I tell them I swell up like a balloon, they’ll say my ankles are wrong, ’study’ says so.
I personally don’t have salt issues. (That I’m aware of…that is.)
However, you have no idea how many people tell me that I’d be cured of lupus if I didn’t have diet pop, or that it’s just the powder in the latex gloves I’m allergic to not the latex … because ’study’ says so.
WELL … I’m truly allergic to latex thank you, and when I cut aspertame out of my diet for 2 years, all I did was increase my weight and insulin (metabolic syndrome) .. um …thank you for the advice.
While study’s are important, and information is important, what my body tells me and what my doctor tells me is far more important to me than any study could tell me … unless the study is offering a cure for my diseases!
March 12th, 2006 at 11:45 pm
I love your answer! :-)
Yes indeed - a bit of common sense! It doesn’t take much going on between the ears to realize that when something affects you noticeably, chances are that, at least for you, the study is moot …
That sort of thing really annoys me … and that’s why I posted. I’ve seen any number of these “studies,” and have watched people do some pretty risky things because of them.
In reality, I ignore that sort of thing. What’s healthy for you today will be proven deadly in some study a decade hence. Pointless to worry about it! I think we can tell when we get into stuff that doesn’t agree with us … and if the medico tells us to lay off it besides, there’s double the reason to wise up.
But all of that’s from a patient’s perspective. I hope that some of my medical friends will weigh in on this …
March 13th, 2006 at 8:14 pm
Hey Moof…
I’m familiar with CRF because we use this term in our field, but I am not familiar with HTN.
What is it?
Question:
Do you make yourself drink a measured amount of water every day?
We manage a great number of CRF patients by giving them SQ fluids. Extra fluids gives them more hydration than what they are taking in on their own. We also recommend that owners increase the moist food that they feed them (once again, to increase fluid intake). Bottom line: push more fluids through the kidneys.
I don’t know how CRF is managed in humans. I am just wondering.
Thanks for letting us in on this.
Gives me steering during my prayer time.
later…
March 13th, 2006 at 10:35 pm
Hey TJ … didn’t post this as a prayer request, honest … *LOL* … just used myself as an example to make a point.
CRF is managed (slowed) with special diets until the kidney(s) stop functioning, and then the diet changes, and dialysis begins, or the patient recieves a transplant. Secondary problems are managed individually, according to what each one is. HTN means hypertension; it usually goes right along with CRF.
No, I don’t drink a particular amount of liquids each day. I know that once dialysis begins, patients are only allowed a set amount of fluids.
Once you have the secondary stuff managed, and have gotten used to the meds, it’s not really all that bad to live with. I just miss my salty foods … ;-)
March 13th, 2006 at 10:45 pm
Drink more water then other fluids, God created it as the perfect cleansing liquid, just as it cleanes you on the outside, it cleanses you on the in side.
Moof, I wished you had not posted the pix of pop corn………..(yes, I’m heading into the kitchen to nuke a package of Show Time with butter, to which I will squrt some cheap yellow mustard on) What?..well I did it as a kid when I got to go to the picture show and it never killed me.
March 14th, 2006 at 1:13 pm
Hypertension… Ok, makes sense. The kidney regulates so many things, blood pressures being one of them.
Are your special diets low in proteins? We do that also… lower the protein intake.
Sorry… here I am trying to doctor you.
later…
March 14th, 2006 at 3:38 pm
Hey TJ …
One of the diets I’m on is called the “Dash diet” … low protein. Actually my diets are restricting everything but my carbs, sweets and fats. I was compensating with starches for a while, and my triglycerides went crazy … so … now I’m down to fats. The joke around here is that I can only have “air and a stick of unsalted butter.” ;-)
However, when they take everything away from you, you still have to eat … so, with the last food group gone, I decided that all food groups were back in by default. I just try to be reasonable. I hardly ever eat meat anymore though, because it no longer appeals to me, or settles well … and salt has some pretty obvious and immediate effects.
Once a patient’s kidneys fail and they begin dialysis, they have to up their protein intake, and restrict their fluids.
You’re sweet TJ, but you don’t want to try to “doctor” me, believe me. I don’t make a very good patient. When I still had a PCP, he used to tell everyone he sent me to that I “hated doctors.” I don’t, of course, but I don’t communicate well with them nose-to-nose, and I never managed to disabuse him of that notion. >:-)
March 14th, 2006 at 3:44 pm
It has long been my impression in reviewing numerous studies in the field of high blood pressure and CHF that there are salt responders and non-salt responders. There is no test to tell the difference between the two, so I simply ask the patient to try to restrict salt and wait to see if he or she gets better. If not, I let the issue drop, and try to control symptoms another way. A lot of medicine is trial and error.
The major fault I see in the study is that it simply surveys patients to see how much salt they are using. Patients tend to stretch the truth about such things. McDonald’s is the busiest restaurant in my town but you would never know it if you asked my patients what they are eating. I would take any study pretaining to diet and health that relies of patient self-reporting, well, with a grain of salt.
But one warning: a lot of people dismiss medical researh that runs counter to common sense (like the idea that increased salt reduces strokes). This is dangerous, because many of the most startling discoveries in scientific history started out that way, as a experimental result that didn’t make sense. We don’t know everything. Knowledge is always being refined, and sometimes long held ideas are tossed out.
We learn something when we discover that an idea is false, even though that knowledge may not be as flashy as the discovery that a new idea is true.
March 14th, 2006 at 6:48 pm
Dr. Hebert, thank you for visiting me, and taking the time to write a comment.
The thought that overlooking ideas which seem to run counter to common sense could be dangerous makes sense … and frankly, I don’t think I’ve ever seen it in that light before. I thank you for opening my mind to a new idea.
There’s another “tempest” going through the blogs right now … the one about statins. Have you seen Dr. Crippin’s post?
You know, as a patient with a chronic illness, it worries me that so many learned professionals disagree on these subjects. I’m not sure if perhaps what we’re seeing is that that one position or the other is right, or that these medications and dietary restrictions are simply a mixed bag of blessings and banes - and you have to take the bad with the good.
We’re in a time of serious discovery … but we still have so much to learn. Sometimes, I feel like one little guinea pig in a very large lab. Is that why they call it a “medical practice?” >;o)
March 17th, 2006 at 7:57 pm
OK Moof, I could not help but pipe in regarding this observational study of sodium intake and cardiovascular outcomes.
Observational studies are never meant to be definitive. They are only of value in pointing toward areas that might be worth researching i the future.
Observational studies are plagued with innacuracies in almost every way. Data collection using recall of individuals surveyed is highly variable.
The better studies involved prospective , multi center, double blinded, randomized control trials. These studies are expensive and usually they are financed by wall street financed drug companies that have the money to pay for multi-milllion dollar trials.
there are many examples in the literature where observational studies results were found to be in error when randomized double blinded prospective trials were later done.
Beyond the technical epidemiologic and statistical flaws in human studies ( which there are MANY), there are the flaws in that accompany the human condition…honest mistakes, rushed analysis, poor editorial oversight, fear, etc….
Despite these pitfalls there are many outstanding researchers and reasearch findings.
The usual thing I do is to wait 6-12 months after a study is published. In most journals there are letters to the editor which will either point out major flaws of a prior study. These reviews that come after the article is published are often times more valuable than the original research.
To an untrained eye, this might seem very discouraging..but this is the way biological science works;
a hypothesis is formulated, data is collected then analyzed, the hypothesis is supported or not supported. then the study is published …subjected to scrutiny…and then begins a long process of re-study and re- publication. Contradictory results/claims are the norm.
hmm…Thus we see yet another example of the fickleness of human thought.
my take:
High salt intake, indeed may not have deleterious effects on people who have normal heart and kidney function.
High salt intake with a person who already has HTN, chronic renal insufficiency or chronic heart failure can be very damaging.
I would doubt any physician would promote a high salt diet for any individual in the latter situation.
respectfully,
nd…
March 17th, 2006 at 9:08 pm
ND … if you’re the ND who debated faith and reality with me several months back, then I must say that I’m very happy to see you again.
Thank you for dropping in and leaving a comment.
Everything you’ve said makes a tremendous amount of sense, and your final advice is exactly what I was thinking.
I have a serious problem with places like WebMD, which are trusted by those who are not knowledgeable in medicine, when they publish that sort of article, because it’s misleading to those who don’t know how to interpret it. Now there are going to be a slew of hypertensives putting salt back on the table - and probably not mentioning it to their physicians.
Please drop in again - we haven’t seen you since January. You’ve been missed!
March 17th, 2006 at 11:38 pm
WebMD is doing what most other media outlets are doing..they sensationalize issues in order to gain a wider audience to gain a wider market share. Currently the webMD
web page features three ads surrounding the salt article,
one ad promting GE products, another touting coca cola and finally a pharmaceutical company pushing their pill.
To be fair…on the final page of the salt article they provide comments of a nutrition expert who places this article in the proper context. ( Too bad they chose the last page…but as is true with most media outlets sensational presentations get the most attention …and dollars. )
I think the best sites include http://www.cdc.gov and http://www.nih.gov
……these seem to be more concerned with presenting and explaining the data in proper context.
March 18th, 2006 at 5:20 pm
Dr. ND … thank you again for dropping in and putting all of this in a balanced context!
I have to wonder why WebMD is so “sensationalist” … being that it’s the “common man’s version” of Medscape. The only real worth I’ve ever found for WebMD has been the Message Boards - but even there, you need to be very cautious.
Mescape, on the other hand, carries some very interesting and detailed information. It’s even good fodder for non-medical people who are willing to do some research on whatever they don’t understand.