>Dr. Alderman said a low salt diet
>doesn't look like a good idea and before you go mucking about in the lives
>of 250 million Americans, you have to have evidencae that it improves
>lives.  His researach showed that those who ate the least salt, had the
>most heart attacks. (Don Wiss read and forwarded this message.)

Yes, Michael Alderman and colleagues found that among 1,900 men with
hypertension who were all on medication, urinary sodium excretion was
gradually inversely related to the risk of myocardial infarction (heart
attack) during an average follow-up of 3.8 years [Alderman M et al. Urinary
sodium excretion and myocardial infarction in hypertensive: a prospective
cohort study. Am J Clin Nutr 1997; 65(suppl): 682S-6S]. In the four equally
large groups excreting less than 89, 89-126, 127-174 and more than 174
mmol/day there were, respectively, 22, 10, 10 and 4 cases of myocardial
infarction. It is therefore concievable, but far from certain, that salt
restriction is dangerous in such patients, and if so I would start looking
at whether the danger is to combine antihypertensive medication and salt
restriction. I would also suggest such patients to discuss their lifestyle
changes with their doctor, although he may unfortunately not know enough
about these things (but who does?). In the future it may furthermore be
possible to find subgroups of patients who can lower their salt intake
safely (remember there are other potential health risks with too much
salt).

Obviously a very low salt intake was without risks during human evolution,
and the Yanomamo indians of the Amazone safely eat only 1 (one) mmol/day.
However, this does not necessarily apply to all contemporary humans,
depending on medication and other lifestyle factors. We must keep in mind
that none of our medicines have been tested in humans eating a paleolithic
diet. Accordingly, much more research is needed, and this was the official
conclusion drawn by Alderman in his article although he may act differently
in other circumstances.

The information I (presently) give to my own hypertensive patients is that
if they cannot change their lifestyle (less empty calories, more exercise,
weight reduction and so on) radically enough to get rid of their
antihypertensive medication (which many of them theoretically can), it may
not be without risk to restrict their sodium intake below, say 100
mmol/day.

Anyone who is interested in the possible adverse effects of salt
restriction should read parts of the February issue of Am J Clin Nutr or,
if the language is to technical, suggest it to be read by someone else.

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Staffan Lindeberg M.D. Ph.D. Dept of Community Health Sciences, Lund
University, Mailing address: Dr Staffan Lindeberg, Primary Health Care
Centre, Sjobo, S-22738 Sweden, +46 416 28140, Fax +46 416 18395
<[log in to unmask]> http://www.panix.com/~paleodiet/lindeberg/
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