#375: Salt, Sodium & Health

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Today's Topic in Focus: Sodium & Health [03:42]

In this episode Danny and Alan discuss the current evidence base related to sodium intake and health, most notably cardiovascular disease. The episode walks through understanding diet-disease relationships, the epidemiology of sodium and health outcomes, the reasons for conflicting conlusions, sodium measurements in research, intervention trials, and more. Importantly, the claim that the sodium-CVD risk relationship exhibits a "J-shaped curve" (i.e. risk is low at moderate intakes and higher at both low and high intakes) is dissected, with recommendations given on how to reconcile all the available evidence.

Studies Referenced:

  1. Engberink  et al., 2017 - Use of a Single Baseline Versus Multiyear 24-Hour Urine Collection for Estimation of Long-Term Sodium Intake and Associated Cardiovascular and Renal Risk
  2. Intersalt, 1988 - an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion
  3. Cook et al., 2014 - Lower levels of sodium intake and reduced cardiovascular risk
  4. Graudal et al., 2014 - Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis
  5. Mente et al., 2016 - Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies
"I Have a Question!"  [83:33]

This episode's questions from listeners:

  1. David asks: "How much sodium does it take to incease blood pressure? Does "natural salt", like Redmond brand salt, make a difference?
  2. Nick asks: "In the low carb/ketogenic diet community there is this notion (I believe it originates from Steven Phinney) that the kidneys excrete more sodium while in ketosis, thus increasing sodium requirements while on a ketogenic diet. This has led to some prominent members of that community suggesting that supplementing up to 10g of salt per day can be beneficial. Any comments?"
Quack Asylum [90:51]

Claims about the health-promoting effects of sodium from author of "The Salt Fix", James DiNicolantonio.

    Random Recommendations [99:09]

    Alan's Recommendation: The Cicero Trilogy - Robert Harris

    Danny's Recommendation:
    Zen and the Art of Motorcycle Maintenance - Robert M Pirsig

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