Doctors denounce study endorsing high salt intake Blacks, diabetics, the obese and elderly at greatest risk

March 14, 1998|By Jonathan Bor | Jonathan Bor,SUN STAFF

Doctors were quick yesterday to criticize a new study that found the highest death rates among people who consumed the least salt -- warning that millions of Americans could jeopardize their health if they increase their sodium consumption.

The risk could be greatest for African-Americans, who suffer the nation's highest rates of hypertension and its consequences, which include heart disease, stroke and kidney failure, doctors said.

"This sends out the wrong message and magnifies what is already a very serious problem in the real world," said Dr. Matthew R. Weir, a kidney specialist at the University of Maryland Medical Center.

Salt-sensitive population

Dr. Elijah Saunders, a UM Medical Center cardiologist, said that about 70 percent of African-Americans are salt-sensitive -- meaning they are genetically predisposed to develop high blood pressure in the face of too much dietary salt.

Other populations are at risk, too, Saunders said. These include the elderly, obese and the 20 million Americans who suffer from diabetes.

"To say that it's ill advised to reduce salt in the diet, or worse, to say that people who restrict salt in the diet are going to have more heart attacks, strokes or cardiovascular events -- that's the wrong interpretation," Saunders said.

Researchers at the Albert Einstein College of Medicine in New York examined sodium intake and death among 11,346 Americans who were originally questioned in the 1970s by the U.S. government's National Health and Nutrition Examination Survey.

Study flawed, critics say

After tracing what happened to the people in the years that followed, researchers found that people who ate the least salt died the most from any cause. Critics said the study was flawed because it relied on people's memories of what foods they ate and how much salt they added over a 24-hour period.

"A single day in one's life doesn't reflect how they live normally," Saunders said. People are likely to play down their salt consumption because they have heard the warnings.

Dr. Michael Alderman, who led the study, said nobody should alter dietary habits on the basis of this one study. But, in a challenge to conventional wisdom, Alderman said he found no evidence to support low-salt recommendations issued by such groups as the American Heart Association.

The findings "do not support current recommendations for routine reduction of sodium consumption, nor do they justify advice to increase salt intake or to decrease its concentration in the diet," the researchers said in a statement.

Alderman is chairman of Einstein's epidemiology department and president of the American Society of Hypertension.

Avoid processed foods

Current recommendations call upon Americans to reduce their salt intake to less than 2,400 milligrams of salt per day. Experts say people should greatly limit their use of the salt shaker, but they agree that this is not enough. Processed foods are the real villain because they are loaded with salt, they say.

Dr. David Meyerson, a cardiologist at the Johns Hopkins Bayview Medical Center, said a serving of tomato juice can carry 800 to 1,000 milligrams of salt, while many canned soups contain 1,000 milligrams. "It's very easy to eat enormous amounts of salt," he said.

Meyerson said the widespread publicity given to the study could cause people to exaggerate its importance.

Incidence among blacks

"People with heart disease, people being treated by physicians and cardiologists should not go against doctors' recommendations," said Meyerson, a spokesman for the Heart Association. "This study does not speak to them."

The Heart Association still holds "that a moderate- to low-sodium diet is better for most people in the population than low-sodium diets. This might be especially true for our African-American population who as a group appear to have a higher incidence of severe high blood pressure and stroke earlier in life."

Pub Date: 3/14/98

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