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Salty Situations: The Link Between Sodium and Hypertension

A high-sodium diet can have a seriously detrimental effect on your blood pressure. 

According to findings published November 11, 2023 in JAMA and presented at the American Heart Association Scientific Sessions 2023, people can significantly lower their blood pressure, even if they are already on blood pressure medication, if they cut down on salt by about a teaspoon a day.

Considered one of the largest studies on sodium and hypertension, Norrina Allen, PhD , a coauthor of the study, a professor of preventive medicine, and the director of the Institute for Public Health and Medicine at Northwestern Medicine in Chicago, it was found that nearly 3 in 4 people saw a decline in their blood pressure in as little as one week when they went from a high salt to low salt diet.

Lead author of the study Deepak K. Gupta, MD, an associate professor of medicine and the director of the Vanderbilt Translational and Clinical Cardiovascular Research Center at Vanderbilt University Medical Center in Nashville, Tennessee also showed that lowering blood pressure through dietary sodium reduction can be achieved safely and rapidly within one week, “The average amount of blood pressure lowering was about 8 millimeters of mercury (mmHg) for systolic blood pressure, which is similar to the effect produced by medications for high blood pressure,” says Dr. Allen.

Dr. Allen found that 70-75 percent of all people, regardless of whether they are already on blood pressure medications or not, are likely to see a reduction in their blood pressure if they lower the sodium in their diet.

Most guidelines recommend a daily dose of sodium <2 g, yet it was found that most individuals consume about 3,400 mg per day almost double this recommended daily dose. Salt restriction is believed to be a cost-effective measure to reduce population morbidity and mortality. World Health Organization (WHO) is raising awareness about salt restriction, aiming to reduce the global sodium intake by a relative 30% by the year 2025.

The risk of cardiovascular disease increased up to 6% for every 1 g increase in dietary sodium intake.

High sodium intake and the increase in blood pressure levels are related to water retention, increase in systemic peripheral resistance, alterations in the endothelial function, changes in the structure and function of large elastic arteries, modification in sympathetic activity, and in the autonomic neuronal modulation of the cardiovascular system.

This is one of the largest studies to investigate the effect of reducing sodium in the diet on blood pressure that includes people with hypertension and already on medications.

How Much Sodium Per Day?

If you have high blood pressure reducing sodium with a low sodium diet is a priority. Some sodium is necessary for health, but not much: about 1,500 milligrams a day is the minimum daily requirement. The upper limit, 2,300 mg, is equal to only about 1 teaspoon of salt.

How to Reduce Sodium Intake

The best way to combat high sodium in your daily diet is to watch your intake of highly processed foods. Read the Nutrition Facts label and look for the Daily Value of sodium in the foods you eat. And consider these satisfying options to keep sodium under control: fruits and vegetables, unsalted nuts, legumes and whole grains (including brown rice, oats and barley).

Additional ways to lower sodium intake:

  • Get more natural sources of potassium in your diet by including additional servings of fruits and vegetables.

  • Watch portion sizes, especially when it comes to already prepared foods.

  • Limit cured foods, including cold cuts and sausages.

  • Rinse canned foods or look for no-salt added varieties.

  • Choose lower sodium packaged foods.

  • Remove the salt shaker from the table.

  • Increase your intake of whole grains such as brown rice, quinoa, oats, bulgur, buckwheat and wild rice.

  • Include beans, peas and more plant-based sources of protein.

  • Substitute crackers and chips with a small amount of unsalted nuts.

Cooking with Less Salt

There are lots of flavors you can add to your meals to delight your taste buds, without raising your blood pressure.

Ingredients you can use to add flavor include:

  • fresh, frozen or dried herbs

  • onion powder

  • garlic powder

  • black pepper

  • dried oregano

  • dried basil

  • coriander

  • shallots

  • chili powder

  • curry powder

  • paprika

  • thyme

  • rosemary

  • turmeric

  • ginger

  • cinnamon

  • cumin

  • lemon juice

  • vinegar

In most people, the kidneys have trouble keeping up with excess sodium in the blood. As sodium accumulates, the body holds onto water to dilute the sodium. This increases both the amount of fluid surrounding cells and the volume of blood in the bloodstream. Increased blood volume means more work for the heart and more pressure on blood vessels. Over time, the extra work and pressure can stiffen blood vessels, leading to high blood pressure, heart attack, and stroke. It can also lead to heart failure. There is some evidence that too much salt can damage the heart, aorta, and kidneys without increasing blood pressure, and that it may be bad for bones, too. 

Are “natural” salts healthier than table salt?

Salt is harvested from salt mines or by evaporating ocean water. All types of salt including Kosher salt, Sea salt and Himalayan pink salt  are made of sodium chloride, and the nutrient content varies minimally. Although less processed salts contain small amounts of minerals, the amount is not enough to offer substantial nutritional benefit.

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