Anecdotally, I have been a massive consumer of salt for my entire life. I consume almost no sugar; I have no attraction to eating food that is sweet and therefore do not eat it. Insulin resistance, and its myriad side effects, are not a major risk factor for me.
I would argue that my risk factors are probably driven by factors associated with salty food that have nothing to do with sodium consumption per se. My blood pressure (and blood sugar) is essentially perfect after decades of absurd sodium consumption. However, as an example, a lot of salty food is deep fried and so there are other relevant consumption biases. Salt and sugar are not uniformly distributed throughout our food. My current (Pacific Northwest) diet of lean protein and fatty fish plus fresh vegetables has not exactly been detrimental as far as I can tell, even though it is loaded with salt.
The new study, which tracked more than 100,000 people from 17 countries over an average of more than three years, found that those who consumed fewer than 3,000 milligrams of sodium a day had a 27% higher risk of death or a serious event such as a heart attack or stroke in that period than those whose intake was estimated at 3,000 to 6,000 milligrams. Risk of death or other major events increased with intake above 6,000 milligrams.
What are the chances that there are many other confounding factors? The first one that comes to mind is that people with extremely low sodium intakes may also be the same ones who are malnourished because they can barely afford food.
Isn't it also plausible that many people on low-sodium diets were at risk of heart attack or stroke already (and that's why they were on the low-sodium diet)? Interesting result, for sure, and it'll be interesting to see the follow-up studies.
> It makes a bit of sense really. Fat and salt has always been part of the human diet, but large quantities of refined sugar are very recent.
That kind of reasoning is very much flawed. Why would the diet of x years ago be relevant versus having a better diet nowadays ? For all we know, our ancestors were eating berries and much less meat than we do, yet we seem to live longer those days and yet we ingest substances (such as medicines) that were not part of the human diet before.
Actually, that line of reasoning does not make sense at all. That's why we run clinical studies. To find out answers.
- big factor in longer life spans are the advances in medicine last 150 years
- our increase in meat consumption and cooked meat goes ways back and likely tied to our (threefold) increase in brain size
We have been eating meat for a long time, but the quantity of meat eaten since the second half of the 20th century is unprecedented. We are eating way more meat than before, that's for sure.
>he quantity of meat eaten since the second half of the 20th century is unprecedented.
That's not true at all. We're eating more meat than we did 100 years ago sure. But looking back significantly further than that, it's estimated that hunter gatherers got about 65% of their calories from animals, compared to much less than 20% we get today.
I'll check you references later, but I'm wondering where the hunter gatherers got so much meat before they had industrial meat factories that we have - it cost much more energy before to either hunt or breed animals than it does now, it was not a viable proposition to eat as much meat as it is now. It just does not make sense to me at all. Besides, percentages is one thing, absolute intakes are another, too.
EDIT: Besides, I can tell you from what I know on how people were living 50-70 years ago (grandfathers for example) that meat was expensive during their youth and that they only ate it once or twice a month, certainly not every single day like we do now. So I'm not sure where you got the impression people ate so much meat in the early 1900s while it defies all conversations I had with people who lived in that era.
> So I'm not sure where you got the impression people ate so much meat in the early 1900s
I said this in the comment you're replying too "We're eating more meat than we did 100 years ago sure". I'm agreeing with your assertion that we eat more meat than we did 100 years ago. 100 years ago we ate significantly less meat than our hunter gatherer ancestors did.
>I'll check you references later, but I'm wondering where the hunter gatherers got so much meat before they had industrial meat factories that we have
They didn't need industrial farms because there were far fewer people. They hunted animals, which were relatively abundant. Meat is much more calorie dense than most plants.
Hunter gatherers didn't have agriculture, so many of the plants we eat today weren't yet domesticated. They lacked entire categories of food that we have today.
The largest percentage of daily caloric intake today comes from grains--hunter gathers didn't farm grains, so they had to get the largest share of their calories from something else--meat.
>Besides, percentages is one thing, absolute intakes are another, too.
An average adult male can't live long term with fewer than around 2000 calories per day (A very active hunter gatherer would require a far amount more than 2000 per day). The average American male eats about 2700 calories per day.
Let's take the lower end estimate for 2000 calories per day for a hunter gatherer. At 65%, meat accounts for 1300 calories per day.
At 20% of 2700 calories, an average American male gets 540 calories per day from meat.
So 1300 for the hunter gatherer vs 540 for the average American male. Almost 3 times as much. Even in absolute numbers, the hunter gatherer at much more meat.
"But looking back significantly further than that", says the GP. Our bodies are mostly what they are based on thousands of years ago (or more), not hundreds. In other words, the 1900s are irrelevant.
It cost a lot of time/energy to hunt, for sure. But that's basically all they did. And reading descriptions of say, the Americas before European colonisation, meat was plenty despite industrial breeding, or any breeding at all.
> For all we know, our ancestors were eating berries and much less meat than we do
That's not very likely and there are plenty of studies that back me up here [1]. For a simple explanation as to why that's not likely look at the calorie counts for berries [2]. You'd have to eat about 10 pounds (~4.5 kg) of blackberries a day to get 2000 calories. There are other more calorie dense non-animal foods like nuts, but most likely around 65% of a hunter gatherer's calories came from meat [1]. This is much more than the amount of protein consumed by the average American today, who gets less than 20% of his or her calories from meat [3].
>yet we seem to live longer those days
Most of the improvement in average lifespan is a result of the drastic decline in infant mortality rate. Hunter gatherers regularly lived into their 70s [4] and when you account for the decline in infant mortality the difference isn't as great as most people imagine. The combination of reduced infant mortality, medical care, and relative safety of civilization are what accounts for our increased lifespan. It's very likely (almost certain given the obesity numbers) that our modern diet is driving the numbers down below what they should be given our other advances.
> That's why we run clinical studies. To find out answers.
Yes it is, and those studies are showing that too much sugar (and most of western civilization eats too much sugar) leads to metabolic syndrome which leads to heart attacks. The debate is on whether sugar does this because it directly causes insulin resistance, or if it is just very calorie dense and thus eating too much simply causes weight gain, or if it reduces satiety and actually causes you to eat more.
I'm not saying eating like a hunter gatherer is necessary for your health, and sure we need to do research--I'm not sure why you think I implied that we didn't. However, it seems logical (again the research we have done backs me up here) that our bodies may not be adapted to handle something we've never eaten in anywhere near the quantities we eat now--specifically the fructose in sugar.
I'm pretty sure we will. At the end of the day it's the amount of each that's consumed that matters. As the old adage goes, everything is fine in moderation.
There was actually a study done a while back looking if sugar causes "hyperactivity" in children. You know your typical cliché "kids ate cake, and now they are so hyper running around".
And I believe they found that sugar does not cause hyperactivity, but somehow discovered that it helped either remember events better or learn new things.
Now looking back I think I had experienced that myself -- I remember my mom made some strawberry jam and I was eating it with a spoon for whatever reason, and it was while studying for a final oral exam in history (this is a different country, were we had to memorize and answer all 50 or so questions and then we'd be questioned on it orally by student). Anyway that one instance, out of many instances in years before before and after, I was remembering and at much higher rate. At least high enough to be noticeable to me.
Seeing the study years later kind of confirmed it.
The cochrane review (https://www.ncbi.nlm.nih.gov/pubmed/21735439) already pointed in this direction, namely that although a reduced salt diet reduced blood pressure, that reduction was not correlated with decreased mortality in this case. Looking at sodium consumption without taking into account potassium consumption also appears to be a major issue with lots of previous salt studies. We had people recommend putting 1500mg (DASH diet level) in MealSquares, but we feel confident not going below the 2400mg level for health.
Soylent ran into issues by including around a gram of salt in their 1.0 version with people getting dizzy from too little sodium in the diet. They're now suggesting adding some extra.
This one appears to be useful because it has some concrete numbers. Because otherwise how would you define moderation? What is moderation to one is excess to another. Here we at least have "less than X and more than Y appears to be harmful", which is some actionable information.
Edit: actually, my opinion on "everything in moderation" is even stronger: I consider it a useless advice. Because, where do you even begin? Should you use some salt in your cooking? But how much? Or should you use none, because there is already some present in foods you buy? Or should you actively avoid foods that have already some salt added?
And it ends up like this: everyone thinks that he eats X in moderation, while anyone who eats less X is just unnecessary resticting himself, and anyone who eats more X is a glutton.
Or consider, would you say "smoking in moderation is okay and healthful"? And if not, how do we know that there are no substances consumed as foods that act in a similar way - hurt us even taken in moderation?
And stop trying to avoid food. Try adding healthy things to your diet instead. When I can't have something it just makes me want it more. The more healthy stuff you put in there the less room you'll have for crap.
IMHO it is damn near impossible to cut salt out of your diet in America unless you prepare everything you eat from scratch. Salt is everywhere.
This sort of study makes me feel better about my intuition of what to do when my doctor told me to cut back on the salt, though: stop letting myself use it as a seasoning, think a few times before grabbing a snack whose entire purpose is to shovel salt into my mouth, but still eat things that had salt involved in their preparation. My blood pressure has gone from "why are you not keeling over right now" to "slightly elevated" thanks to this.
The research was funded through a variety of public, private and corporate sources, according to PHRI.
Until I know who funded the research, I'm taking the results with a grain of salt.
Do populations with high sodium intake also have other lifestyle factors that influence mortality and morbidity? Is it really the sodium that's causing the differences found in the study or are there other factors?
How many times have we seen corporations fund research designed to support their interests and then selectively publish the results that are favorable to them?
Would you view the research in a different light if you knew it was funded by PepsiCo, McDonalds, Sara Lee and Campbell Soup Company?
Why aren't the funders disclosed along with the results?
considering the role sodium and potassium ions play (http://en.wikipedia.org/wiki/Sodium_in_biology#Animals), it isn't surprising that too low of them is bad. Of course it is already well known that too much of them bad also.
"Sodium is an essential nutrient that regulates blood volume, blood pressure, osmotic equilibrium and pH;..."
doesn't it sound like it better be not too low and not too much ? :)
If you're a proponent of low sodium then you don't believe the amount of sodium you advocate is "too low", you believe it's correct, and that the standard amount is "too high".
Come on, some common sense is needed. Salt is required by our bodies, too little and we die, too much and the same thing. Same goes for fat, sugar, vitamins, minerals, etc...
This isn't even new knowledge... Our bodies need various proteins, sugars and minerals in certain quantities - call the fucking press...
As I've commented on similar articles in the past, it's not enough to "just know" things; science has to prove them, repeatedly, in multiple ways. Sure it's tedious and repetitive, but it's absolutely essential to lay a solid foundation for the next generation of research.
One only has to look into history - where there have been epidemics and people have died from lacking salt in their diet in various salt-deficient places.
As an aside, there's also a reason that iodine is required to be added to salt and various stable products in some countries.
Animals seek salt because they need it, as did ancient humans to the present day, saying humans need salt is like saying humans need water, or protein, or vitamin B.
It's not like salt is some new chemical we know nothing about - we've known about it for at least 10,000 years (probably longer). It's nice and all that now we know you should have between 3000 and 6000 mg per day (which is higher than what agencies recommend, but apparently around the average consumption in many places anyway), but come on...
Also, there's a reason athletes drink liquids with electrolytes in them (salt is one) - because the effects of a deficiency of salt and other electrolytes is known...
You know what would be super helpful? If scientists came up with a rating system that described how confident they were in the results from a study. That way the public would know how much weight they should give the results.
Independent body who runs a well-controlled double blinded study? A+
Biased organization who runs an analysis of questionable observational data with barely passible statistical significance? F
They already do this for cancer therapies. NCCN gives rating that describe how much evidence exists for a given therapy.
Scientists do in fact report how confident they are in their findings. Read original sources, most of them say things like "in X% of observed cases there was a Y% of Z over the course of T with confidence level of P".
But that sells a lot less clicks than "SCIENCE SAYS LOW SALT IS BAD FOR YOU OMG"
The truth of the matter is that the general public shouldn't be reading scientific publications, because without the context of the intended audience, reasoning about what you read is incredibly difficult or impossible. This is doubly true for 'science journalists' who so very rarely are educated to be able to correctly translate and very often distill a paper into an incorrect and baiting article with only the tiniest shreds of truth.
The confidence rating you mention has little value to the general public, and even among scientists, the value of 'p-value' is questionable and the matter of occasional debate.
examine.com does that, they list level of confidence (A - "Robust research conducted with repeated double blind clinical trials" to D - "Uncontrolled or observational studies only") with a percentage value for consensus and a rating of the magnitude of the effects.
I would argue that my risk factors are probably driven by factors associated with salty food that have nothing to do with sodium consumption per se. My blood pressure (and blood sugar) is essentially perfect after decades of absurd sodium consumption. However, as an example, a lot of salty food is deep fried and so there are other relevant consumption biases. Salt and sugar are not uniformly distributed throughout our food. My current (Pacific Northwest) diet of lean protein and fatty fish plus fresh vegetables has not exactly been detrimental as far as I can tell, even though it is loaded with salt.