Does a low-salt diet really improve your health?

Q. My doctor has been on my case to cut down the salt in my diet. But I like salt, and I hear that not all medical studies show that a low-salt diet really improves your health. Can you unconfuse me?

A. You’re right — the value of a low-salt diet for the average person has been controversial. Many studies have shown that a low-salt diet improves cardio­vascular health. However, the studies have had limitations: some involved relatively few people, and some measured how much salt people say they eat but not how much salt they actually eat.

A study from Harvard published online Nov. 13, 2021, by The New England Journal of Medicine overcame both of these problems. The study involved nearly 11,000 people who were followed carefully for almost nine years. Researchers measured the amounts of two types of salt the people actually ate: common table salt (sodium chloride) and another mineral often used as a salt substitute (potassium chloride). People who consumed the most sodium chloride had a 60% higher risk of a major cardiovascular event (a heart attack, a stroke, cardiac stent placement, or bypass surgery) compared with those who consumed the least. In contrast, people who consumed the most potassium chloride had a 31% lower risk of a major cardiovascular event compared with the people who consumed the least. In short, this study seems to say that it would be healthy to substitute potassium chloride for common table salt. However, because this is an observational study and not a randomized trial, that conclusion can’t be made for sure.

Fortunately, a randomized trial published online by the same journal Aug. 21, 2021, came to a clear conclusion. Nearly 21,000 people in China were randomly assigned, over the next five years, to use a salt substitute that mixed potassium chloride and sodium chloride, or to use regular table salt (all sodium chloride). The study participants all were ages 60 or older, had experienced a stroke in the past, and had high blood pressure (hypertension). In the group that used the salt substitute, the risks of another stroke, a major cardiovascular event, and death were 12% to 14% lower, compared with the group that used regular table salt. We can’t know if the same would have been true in younger people, people who are not Chinese, or people who had no history of a stroke or other cardiovascular disease.

Controversial medical issues are rarely completely settled by new studies, because all studies have limitations. Nevertheless, I regard these two studies as providing strong evidence that a diet with a high content of sodium chloride should be avoided, and that we should probably be using salt substitutes containing potassium chloride more often. I will be.

— Anthony L. Komaroff, M.D.
Editor in Chief, Harvard Health Letter

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

O Lord, forgive your people Israel whom you have redeemed. Do not charge your people with the guilt of murdering an innocent person.’ Then they will be absolved of the guilt of this person’s blood. (Deuteronomy 21:8)

The Lord will never pardon such people. Instead his anger and jealousy will burn against them. All the curses written in this book will come down on them, and the Lord will erase their names from under heaven. (Deuteronomy 29:20)

Then Joshua warned the people, “You are not able to serve the Lord, for he is a holy and jealous God. He will not forgive your rebellion and your sins. (Joshua 24:19)

But now, please forgive my sin and come back with me so that I may worship the Lord.” (1 Samuel 15:25)

Please forgive me if I have offended you in any way. The Lord will surely reward you with a lasting dynasty, for you are fighting the Lord’s battles. And you have not done wrong throughout your entire life. (1 Samuel 25:28

l of us must die eventually. Our lives are like water spilled out on the ground, which cannot be gathered up again. But God does not just sweep life away; instead, he devises ways to bring us back when we have been separated from him. (2 Samuel 14:14)“

My lord the king, please forgive me,” he pleaded. “Forget the terrible thing your servant did when you left Jerusalem. May the king put it out of his mind. (2 Samuel 19:19)

Judgment for David’s Sin But after he had taken the census, David’s conscience began to bother him. And he said to the Lord, “I have sinned greatly by taking this census. Please forgive my guilt, Lord, for doing this foolish thing.” (2 Samuel 24:10)

May you hear the humble and earnest requests from me and your people Israel when we pray toward this place. Yes, hear us from heaven where you live, and when you hear, forgive. (1 Kings 8:30) “

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