I know I am a bit of a nut case but I like to keep the records so I know how I am doing and how often I can break the rules. There is ABSOLUTELY no question that sodium is important (for me). But sodium is just part of it. Hi potassium (vegetables and fruit), regular aerobic exercise and moderation in the consumption of alcohol are also very, very important. It would be a mistake to try and do it with just low sodium.

It is very easy to eat a low sodium diet if you are willing to bake your own bread and prepare your own meals. I eat 0 processed food. And I mean 0. If I follow my own rules I maintain a steady BP of about 127/77 with a resting heart rate of 45 (I do a lot of aerobics.) I can eat a high sodium diet for 1 day and I go up to about 134. Sometimes I do that on a Saturday night if I go to a party. I don’t worry about breaking the rules for 1 day. That’s life and one of the advantages of keeping records is you can figure this out so your routine is not a BALL AND CHAIN. Breaking the routine for more than1-2 days quickly casues BP to rise. After 3 days (typically on a trip) of eating restaurant food I end up at a BP of about 142/85. Last year I took 2 trips in a month. 1 to Brazil and 1 to Africa. I got no exercise, ate everything they put in front of me, enjoyed life and my BP ended up at about 150/95 with a resting pulse of 55. It took 3 weeks of exercise and proper food to get it back down to my target 127/77 and resting pulse of 45.

If you want to control BP with the mimimum amount of drugs, get a Blood Pressure cuff, keep a diary and figure it out. You should east the DASH low sodium diet and have at least 35 minutes of aerobic exercise every second day 7 days a week. That should do it. You may still need drugs but you will need less drugs.

I have read most of the scientific literature as well as Gary Taubes comments on the subject. There is some controvery about sodium and whether or not some people are more sodium sensitive than others. This point is always used to defeat attempts to force the food processing industry to reduce the amount of sodium in processed food. This is a complete red herring. The point is that unless people are willing to prepare low sodium high potassium meals from scratch, they must eat processed food and restaurant food. These people are simply unable to obtain the food that might help them control BP. Cook your own food.

The Natural Health Guy

But sodium and salt aren’t necessarly the same thing, as more than 50% of salt is chloride, and this has a big impact in the Acid-Base balance, as a recent study has shown(Frassetto LA, Morris RC Jr, Sebastian A. Dietary sodium chloride intake independently predicts the degree of hyperchloremic metabolic acidosis in healthy humans consuming a net acid-producing diet.Am J Physiol Renal Physiol. 2007 Aug;293(2):F521-5.).

Why this is important? Because many studies done with kidney patients have shown that a chronic metabolic acidosis leads to:

- Bone Loss:
1. Barzel US (1995) The skeleton as an ion exchange system: implications for the role of acid-base imbalance in the genesis of osteoporosis. J Bone Miner Res 10:1431–1436

2. Kraut JA,Mishler DR, Singer FR,Goodman WG. The effects of metabolic acidosis on bone formation and bone resorption in the rat. Kidney Int 1986; 30:694–700)

- Muscle loss:

1. May RC, Kelly RA, Mitch WE . Metabolic acidosis stimulates protein degradation in rat muscle by a glucocorticoid-dependent mechanism. J Clin Invest 1986; 77:614–621

2. Williams B, Layward E, Walls J. Skeletal muscle degradation and nitrogen wasting in rats with chronic metabolic acidosis. Clin Sci 1991; 80:457–462

3. Garibotto G, Russo R, Sofia A, Sala MR, Sabatino C, Moscatelli P, Deferrari G, Tizianello A. Muscle protein turnover in chronic renal failure patients with metabolic acidosis or normal acid-base balance. Miner Electrolyte Metab 1996; 22:58–61

4. Bell JD, Margen S, Calloway DH. Ketosis, weight loss, uric acid, and nitrogen balance in obese women fed single nutrients at low caloric levels. Metabolism 1969; 18:193–208

5. May RC, Kelly RA, Mitch WE. Mechanisms for defects in muscle protein metabolism in rats with chronic uremia. Influence of metabolic acidosis. J Clin Invest 1987; 79:1099–1103

6. Papadoyannakis NJ, Stefanidis CJ, Mc-Geown M. The effect of the correction of metabolic acidosis on nitrogen and potassium balance of patients with chronic renal failure. Am J Clin Nutr 1984¸40:423–627

7. Hannaford MC, Leiter LA, Josse RG, Goldstein MB,Marliss EB,Halperin ML. Protein wasting due to acidosis of prolonged fasting. Am J Physiol 1982; 243:E251–E256

8. Gougeon-Reyburn R, Lariviere F, Marliss EB. Effects of bicarbonate supplementation on urinary mineral excretion during very low energy diets. Am J Med Sci 1991; 302:67–74

9. Mitch WE, Medina R, Grieber S, et al. Metabolic acidosis stimulates muscle protein degradation by activating the adenosine triphosphate-dependent pathway involving ubiquitin and proteasomes. J Clin Invest. 1994; 93:2127–2133.

10. May RC, Masud T, Logue B, Bailey J, England BK. Metabolic acidosis accelerates whole body protein degradation and leucine oxidation by a glucocorticoid-dependent mechanism. Miner Electrolyte Metab. 1992; 18:245–249.

11. May RC, Masud T, Logue B, Bailey J, England B. Chronic metabolic acidosis accelerates whole body proteolysis and oxidation in awake rats. Kidney Int. 1992; 41:1535–1542.

12. May RC, Hara Y, Kelly RA, Block KP, Buse MG, Mitch WE. Branched chain amino acid metabolism in rat muscle: abnormal regulation in acidosis. Am J Physiol. 1987; 252:E712–E718.

- Decreases Growth Hormone Release:

1. Caldas A, Fontoura M. Effects of chronic metabolic acidosis (CMA) in 24-hour growth hormone secretion. J Am Soc Nephrol 1993; 4:828–828

2. McSherry E, Morris RC, Jr. Attainment and maintenance of normal stature with alkali therapy in infants and children with classic renal tubular acidosis. J Clin Invest 1978; 61:509–527

And studies also done by Sebastian’s team have shown that by giving healthy people (who had a low grade, chronic, metabolic acidosis, as everybody who eats the typical american crap food has) potassium bicabonate it improved biomarkers of:

- bone health (Frassetto L, Morris RC Jr, Sebastian A. Long-Term Persistence of the Urine Calcium-Lowering Effect of Potassium Bicarbonate in Postmenopausal Women. J Clin Endocrinol Metab 90: 831–834, 2005)

- and reduced muscle loss (Frassetto L, Morris RC Jr, Sebastian A. Potassium bicarbonate reduces urinary nitrogen excretion in postmenopausal women. J Clin Endocrinol Metab. 1997 Jan;82(1):254-9)

Finally, in 2006 and 2008, two intervention studies have shown that fruits and vegetables (as opposed to grains) improved bone health (Jajoo R, Song L, Rasmussen H, Harris SS, Dawson-Hughes B.
Dietary acid-base balance, bone resorption, and calcium excretion. J Am Coll Nutr. 2006 Jun;25(3):224-30.) and reduced muscle loss (Bess Dawson-Hughes, Susan S Harris, and Lisa Ceglia. Alkaline diets favor lean tissue mass in older adults. Am J Clin Nutr 2008 87: 662-665.)

It’s also important to mention that previous studies had shown that Hypertension could also result from a disturbance in the acid-base balance.

And there are old studies showing that chloride raised blood pressure to a significantly higher level than sodium:

1. Kurtz TW,Morris RC, Jr. (1983) Dietary chloride as a determinant of sodiumdependent
hypertension. Science 22:1139–1141

2. Luft FC, Steinberg H, Ganten U, Meyer D, Gless KH, Lang RE, Fineberg NS, Rascher W, Unger T, Ganten D (1988) Effect of sodium chloride and sodium bicarbonate on blood pressure in stroke-prone spontaneously hypertensive rats. Clin Sci 74:577–585

3. Luft FC,Zemel MB, Sowers JA,Fineberg NS,Weinberger MH (1990) Sodium bicarbonate and sodium chloride: effects on blood pressure and electroyte homeostasis in normal and hypertensive man. J Hypertens 8:663–670

4. Tanaka M, Schmidlin O, Olson JL,Yi SL, Morris RC (2001) Chloride-sensitive renal microangiopathy in the strokeprone spontaneously hypertensive rat. Kidney Int 59:1066–1076

The bottom line is: we never evolved to eat a high salt diet, but if one consumes high amounts of salt, I suggest that the intake of fruits and vegetables also increases (to balance both the POtassium/Sodium Ratio, and the Bicarbonate/Chloride ratio).

This is one reason I do not advocate a diet based exclusivly on animal products, like the Eskimo do. For me a healthy paleo type diet includes a high amount of low glycemic load fruits and vegetables, along with the meat, fish, eggs, nuts and olive oil (our ancestors ate the animal’s fat; yet most of it was monoinsaturated, and since It is hard to find grass fed animal fat, I use olive oil to emulate that).

Congratulations on your work.

Miguel

I do not cook with salt for most of my cooking. When other people cook or when I eat out, the food is usually to “salty” for my tatste.
However, when I make certain recipes were salt is part of the “flavoring of the recipe” (like roasted kale with generous sprinklng of sea salt)
I never feel like it’s too salty, on the contrary, I could put on more. I never feel my bp spike when I eat it. Nor any other effects. I don’t use “commercial” salt. I agree with the majority of comments to stay away from the processed foods and don’t worry to much about the salt.

Marc

like the lipid idea, the obsession with salt masks a desparate desire to squeeze a lot of significance from a little stone of evidence

his points still generally stand, despite more recent “evidence”

the issue is really a red herring

hypertension is part of the constellation of associative symptoms of civilisation diseases

if salt - of itself - has an effect it is too minor to bother about

one “real” issue is salt retention - leading to water retention - resulting from high blood sugar (which is why you loose water and lower blood pressure at first on low carb)

go low carb and you won’t need to worry about salt - you won’t be eating processed junk food anyway

in the context of a balanced traditional low carb diet, SEA salt should be vaunted not taunted

salt is vital to health

markus