The Roundup - Edition 37

The Roundup

by Chris Kresser

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Here is The Roundup, Edition 37, bringing you the best from around the web from the past two weeks!

Blast from the Past

The Wall Street Journal recently reported on the longstanding, international debate over salt and sodium guidelines and whether or not our current targets are set too low for optimal health. A new study came out recently in the New England Journal of Medicine supporting the belief that cutting back on sodium too much actually poses health hazards, including premature death. This study found that those who consumed fewer than 3,000 milligrams (mg) of sodium a day had a 27% higher risk of death or a serious event such as a heart attack or stroke in that period than those whose intake was estimated at 3,000 to 6,000 mg. 

While many researchers supported the findings as further evidence corroborating with other studies done in the past few years, there are many still who adamantly support the recommendations to consume less than 2,300 mg of sodium daily; the most notable of these advocates being the American Heart Association. It amazes me that this is still a debate, with the amount of evidence that has accumulated to this point discrediting the current guidelines and demonstrating that they may do more harm than good if adhered to.

In fact, I’ve written an entire series on salt, explaining the physiological requirements for salt and theories on the “optimal” dietary salt range. In this series, I present evidence for the dangers of too little and too much salt, and give recommendations for the type and amount of salt to include in the diet. Let’s just say my conclusions don’t support those of the AHA recommending 2,300 mg per day! You’ll have to read the series to learn more and to discover the best way to include salt in your diet in a healthy way.

Research Report

  • Another study proves that modifying cholesterol is not necessarily a good thing.
  • Eating at full-service restaurants leads to overeating that is equivalent to fast food.
  • Social stress in middle-aged men and women is associated with 2 to 3 times greater risk of death.
  • Treadmill workstations improve productivity. Another great reason to walk while you work:
  • Research shows that kids who consume full-fat dairy products gain less fat over time than those who consume reduced fat dairy. 

Worth A Look

  • My presentation “Why Paleo is Taking the World by Storm,” from the Revitalize conference is featured on Mind Body Green.
  • How far will you go to avoid introspection? We need periods of solitude and reflection to stay healthy!
  • New evidence suggests antioxidant supplements are futile compared to eating plants that struggled to survive.
  • For women who exercise frequently, add carbs back into your diet to improve painful and frustrating menstrual symptoms.
  • Jack Osbourne credits Paleo diet for helping manage his #MS and driving his recent 70lb weightloss.
  • New research suggests there may be cognitive drawbacks to reading on a screen as opposed to on paper. 
  • Listen to Dr. Lipman interview me about my bestselling book Your Personal Paleo Code (published in paperback as The Paleo Cure in December 2014).

For the Foodies

  1. When I first went paleo, I cut out added salt as well as sugar entirely from my diet. After a few weeks I started feeling awful with bradycardia (<35 bpm), hypotension and dizziness. I added back some salt and almost instantly started feeling better again.

  2. Does anyone know how to close the ad box that shows up at this site when I open a page?

    I am already on the member email list to receive notifications of new articles. But when I begin reading a new article, after about 30 seconds, a box shows up that covers the screen. And I can no longer read the article and there is no way to close the box (no X). The box has a picture of Chris and this blurb:

    “Your health should enable your dreams, not stand in their way.

    Learn the most essential steps to take to:

    Look and feel better than ever
    Prevent and reverse disease
    Have the health you deserve and
    a life you love living

    Get my FREE Take Back Your Health Action Kit,
    with a 63-page eBook, personalized email tips, and more.

    I hate spam too. Your email is safe with me.”

    Wonderful – but I don’t need to read this and I want to use the website. Is this happening to anyone else?

    Please help if you know how to close that box.

  3. The problem is how does anyone really know how much salt is in their diet?

    If under normal circumstance we are supposed to sleep 6-8 hours uninterrupted. Our salt to water ratio should prevent us from needing to shed water during that period, shouldn’t it? Since it’s a ratio shouldn’t the ‘right’ amount of salt be relative? If we are not drinking water excessively(driving up the amount of salt needed to retain it) couldn’t we use this sleep period as a gauge of our salt levels by how often we urinate during it?

  4. If it’s a balancing act between salt and water and a state of constant replenishment then then the right amount of salt should be paired with the right amount of water and it should be a range to allow it to run down to the low end not start at the low end and run into a shortage. A happy medium with room to move.

    Just a thought… Probably way over simplifying things. I read that salt and lithium were linked and that lithium was essential to brain functions. If that’s true and if it’s also true that low sodium causes anxiety. Could this be because of its impact on lithium levels?

    I upped my salt intake because my diet was not providing it by circumstance. I feel better on many levels.

  5. I have strange intolerance to salt. Any salt – sea salt, Himalayan salt, etc. Even a minuscule amount gives me bad headache, raises my blood pressure, causes cerebral edema. I also have rosacea and somehow feel these two conditions are related. If anyone has any suggestions for me, I would be very thankful. When I mentioned this to a doctor, she didn’t say anything. I rarely see doctors anyway. Please help with any info. Thank you.

  6. I’m confused by the sodium discussion because sodium seems to be used interchangeably with sodium chloride (aka table salt). My hunch is that chloride is more relevant than sodium (at least in terms of its potential to wreak havoc on health), yet it goes unmentioned in the WSJ article and most others. Heading off to read your salt article Chris hoping to find a little clarity on this.

  7. Did this study screen for people on drugs?
    People who need to watch their salt intake are often those who are on medications that challenge their kidneys and cause them to retain water. Then they need to also take a diuretic. I’ve seen this in people with normal blood pressure who were not salt sensitive until the pharmaceuticals were introduced. If they ate one salty meal, no matter how healthy or the form of salt, they retained an enormous amount of water that placed a lot of stress on their bodies, sometimes requiring them to have the fluids manually drained so they could breathe properly. If this type of person were included in the study, then it would make sense that people who eat less salt die sooner. Was it the salt or the side effects of the medications?

  8. Does anyone really have a clue on the effects of salt? The NEJM published the study Chris references, showing low-salt consumption is potentially harmful at levels below 3 gm/day. That selfsame NEJM also published a study recently by Dariush Mozaffarian et al that attributed 1.65 million deaths from cardiovascular disease worldwide to consumption of salt in excess of the “guidelines” (2.0 gm/day). Different study approaches to be sure — one was observational, one was computer-modeled based on available data. Why can’t the supposed “experts” get their stuff together and figure this out? When “expert” advice is 180 degrees apart, it’s essentially worthless.

  9. Common understanding — salt bad, potassium good.

    Well gee, how does potassium enter cells? Salt opens the gate.

    Another F for public health scares. Along with the BS out there about cholesterol, saturated fats, carbs, etcetera, etcetera.

  10. I can’t help but think that the studies that come up with the correlation between sodium intake and bad health outcomes are actually finding a correlation between processed food and bad health outcomes but then blaming the sodium rather than the obvious culprit.

    Who could possibly benefit from us vilifying the wrong culprit? Hmmm, I wonder…

  11. If only the AHA recommended 2300 mg of sodium. What their website says is:
    “AHA Recommendation

    The American Heart Association recommends people consume a maximum of 1,500 milligrams a day of sodium based on scientific evidence that it is the best approach for cardiovascular health while also providing an adequate intake of other important nutrients.”

    Here is their infographic on how much salt.

      • I’m reading it, thanks. I don’t like salt, that’s the thing, never did. Was always a sweets person, not a salt. So, to dab some broccoli in salt is not so appealing to me. I may have to just chug some as a supplement. Not sure. Anyway, as you say, I’m not stressing it!

        • Since sodium is an electrolyte and there are various hidden and visible health issues which can affect its retention and use (and, say, its balance with potassium), I personally go by taste (although I’ve also researched the biochemistry of my health issues a massive amount). Others also go by taste/desire.

          This may not work in everyone, and how our bodies regulate electrolytes given subtle modern health problems everywhere may be quite complicated.

          (For example, thin, easily excitable/high-strung folk – often females – with some sort of adrenal hypofunction can also have various problems with their aldosterone or ADH hormones which cause them to pee more often and retain water and salt less well. Many such people do not know about their adrenal hypofunction until it worsens until the symptoms are severe enough to cause them to seek information. There are probably many such subtle or mild-seeming problems with peoples’ bodies which affect their biochemistry in modern society, by my reckoning.)

  12. This is another poorly designed study that makes no attempt to remove causes of mortality other than sodium intake. A properly designed study would have used only healthy individuals, difficult to do since most people on restricted sodium diets are so for a reason, many of them cardiovascular to begin with. So it shouldn’t be that surprising that people with cardiovascular and other health problems (who have been advised to reduce sodium) have higher mortality rates.

    Once again, correlation is not causation – this study proves nothing with respect to the advisability of reduced sodium diets.

    • And to report the results as being a 27% difference in risk is manipulating the statistics. Yes, technically, a 1.27% mortality/CV event rate is 27% higher than a 1% rate (the results of the study), but only because both rates are so low. If the rates were 50% and 50.27%, it would involove exactly the same difference in number of additional people who had CV events, but the percentage difference would be 0.5%. Thus the saying there are lies, then there are darned lies, and then there are statistics.

      • While I am not debating whether the study has flawed methodology, the premise behind properly done studies that take a sample size that’s representative of the population in some proportional way…

        (say, 700 in the study : 7 billion in the world. So, 1:100,000)

        …is that deaths should increase proportionally.

        So, if there are, say, 14 deaths in group A with 1400 people (1%)… and 21 deaths in group B with 1400 people (1.5%)… You could say the death rate is higher in group B by 50%. Or lower by 33%.

        If you took the numbers again and 700 of 1400 (50%) died vs. 707 of 1400 (50.5%), there would be a 1% increase from A to B, or a ~0.9% decrease.

        The change from 14 to 21 deaths out of 1400 is very different from 700 to 707 of 1400 — accurate to the degree the data is accurate, of course, which could be not very much.

        To claim that both increased by 7 deaths is a gross misunderstanding of proportions (and – not to barrage or offend, but… – seems like the attempt of an honest layperson using incorrect methods to valiantly try to demonstrate holes he thinks are probably there. I can understand this; many people see issues with things but then explain or exemplify them inadequately. Doesn’t mean there aren’t issues but does mean that their specifics may not hold water.)

        It’s also understandable that people interpreting studies may present things in ways which get misinterpreted by the general layman population… but, the actual, hard, mathematical meaning of things like a 27% increase does not present information as any more solid than it is.

        (This is because what it is _really_ saying is “27% increase given these test conditions and factors and calculation and analysis methods.” When you take that apart mathematically, all of the uncertainty is there for you to analyze.)

        Claiming the 27% as something utterly certain to be true is another issue with “popular” (meaning “of the people” or “common”) “health” writings on ANY side of an issue is that they tend to overemphasize the certainty of study results.

        Also, I want to emphasize that many people make the mistake of seeing and experiencing potentially really strong correlations… and their intuition is accurate, and this is okay… but, then they use data/studies which are less certain but support their viewpoint and present them as more certain than they are.

        It is COMPLETELY alright to have intuition that is not validated by the SMALL set of data we call “statistically significant/accurate studies” (often only the ones published in well-known “Journals”, also, which are often very biased in selecting articles for publication — this is what meta-analyses seek to attempt to remedy).

        There REALLY ARE other methods of determining information, and there is an overemphasis on use of studies in incorrect ways (such as only considering information certain if it has been published as a study one is aware of — our knowledge is flawed and constantly expanding.

        To pick “2014” as an ARBITRARY point in the development of medicine [because it happens to be right now] is silly.

        Most people intuit that our health nowadays is to the future at an unknown date… what health in the 1800’s was to our health now.

        There will be many things proven wrong which we now regard as right. Many “commonsense” and “everybody thinks and knows that” things will be shown to be backwards, simplistic, incorrect, etc.

        It’s happened CONSISTENTLY throughout history, and it will happen to the body of knowledge we use at this arbitrary point in history.

        So, by all means, use your intuition and other reasoning skills to process all the uncertainties in data we have nowadays…

        But, it’s incorrect and just confuses the issue to try and present studies as more certain than they are, rather than simply being honest about your other data (clinical experience, repeated poor reactions, etc., etc.).

        Uncertain conclusions can be drawn without an official study, just as uncertain conclusions are drawn from studies.

        They will all be uncertain to differing degrees. The key is honesty about the uncertainty and continuing to try to understand in the face of that.

        Everything is uncertain, and there are a LOT of variables not even mentioned in studies (what chemicals were in the air of lab A vs. lab B? We know modern indoor air pollutants affect health. [Yes, deodorants, “air fresheners”, “Lysol”, and other household products are indoor air pollutants. So are scented soaps, shampoos, etc.]) as potential variables.

        Real scientia (“real” meaning an accurate representation of reality) depends upon the honesty about these issues everywhere.

        (P.S. I am not remarking specifically on this study in this article – I haven’t looked at it in detail to analyze methodology, issues, etc. This was an important “meta” point to the phenomena of relying upon a small set of our available data (in currently available studies)… and even then, debating or using them incorrectly.)

        The data you currently have available should NEVER be the only, hyperfocal, point from which you derive your conclusions with no mind to the arbitrary point in time you’re in.

        We are subject to many of the issues of the 1700’s, 1400
        s, 1000’s. Peasantry class, illegitimate claims, plent of false advertising, etc. The forms have changed some, and we are a bit more advanced, but to regard all our body of current modern info as “special” and “civilised” in some magic way just does not mathematically make sense.


        Good day, all. 😉

        • The study actually found that when the populations were adjusted for pre-existing hypertension and cardiovascular conditions, there was no significant difference in the event rates. But in any event, comparative percentages are misleading. The raw difference in the mortality/event rate was 1.2%

      • “There will be many things proven wrong which we now regard as right. Many “commonsense” and “everybody thinks and knows that” things will be shown to be backwards, simplistic, incorrect, etc.”

        Do note, also, that these things will definitely include things that many people (or all people) did not see beforehand. That’s the nature of growth and proving old ways wrong.

        …so, if you use that argument to say… for example… “Of course! I know these areas. Like organic produce! And salt! And saturated fat!” …you’re missing the point about the inherent potential blindness of ANYTHING we think now. 😉

      • “It’s happened CONSISTENTLY throughout history, and it will happen to the body of knowledge we use at this arbitrary point in history.”

  13. I find it interesting that when this article came out then a counter article came out to lower salt.

    “A new study from the New England Journal of Medicine says more 1.5 million heart-related deaths worldwide can be blamed on eating too much salt.

    Dr. Tara Narula, a cardiologist at Lenox Hill Hospital in New York City, says thousands of American lives could be saved every year if people cut their sodium intake by half.”

    It looks like no one agrees on the salt issues.

  14. Having recently read even more of Dr Brownstein’s books, the glaring flaw in the above posting is that standard table salt is heat processed, all its essential nutrients have been stripped away, considered dead, and toxic to the human body in large quantities. It upsets the fluid balance in the body.
    Therefore, clarification between discussing table salt and sea salt or unprocessed salt needs to be drawn first, before continuing any discussion. Sea-salted spring water can be a great boost for stress relief and adrenal support.

    • I agree with these lasts posts…
      It is so important that clarification be made on the difference between sea salt, table salt, etc…
      Also how much actual salt vs sodium when sodium is accounted for???
      These are important clarifications given the possible dangers…

  15. Hello Chris,

    Please feel free to move/delete this if this isn’t an appropriate place to post.

    I am a Registered Dietitan and have created a Kickstarter project to fund full-time, independent research on the saturated fat/heart disease issue. I’m hoping to reach more of the Dietitian community that unfortunately tends to disregard a lot of recommendations from people that simply don’t have the “RD” behind their name. The American Heart Association doesn’t have quality evidence based guidelines on this topic, but many people that disagree with them also misrepresent the research. I’m hoping to provide an objective review of the evidence. I have many full reviews of studies on my website already, but A LOT more are needed.

  16. there are many still who adamantly support the recommendations to consume less than 2,300 mg of sodium daily; the most notable of these advocates being the American Heart Association. It amazes me that this is still a debate

    It doesn’t amaze me at all–if the debate were settled with the science info we currently have, the AHA, along with many of its acolytes (largely remoras for funding) would be out of a job. All these naysayers are just trying to stay employed and relevant.

    Marion Nestle is one who succumbed to the nay-saying for corporate reasons–her company makes all sorts of sugar-laden, soy-laden, and carb-laden foods. She too is trying to stay in business.

    Re: adding carbs back for women who exercise frequently–why not add FAT instead? It replaces glucose, and the brain and body use it just as well, once you become keto-adapted. Besides, that would mean no more need to exercise frequently. Exercise/glucose are two sides of the same coin: we eat glucose to gain energy to exercise, yet we exercise to burn up the glucose. Why not stop the insanity and EAT MORE FAT?

      • Yes indeed!! Marion Nestle is a well-known author of several books with a focus on food politics, and she is a professor of food sciences or some similar department at NYU in New York City. She is often quoted and interviewed as an independent authority on food and nutrition.

        Geeze, it helps to get your facts straight before mouthing off like that…

  17. Meanwhile, two days ago Marion Nestle had this to say about salt:

    Here are the burning questions about sodium (which is 40% of salt) intake:

    (a) Does too much dietary sodium cause high blood pressure? Answer: an unambiguous yes (although not necessarily in everyone).

    (b) Are public health recommendations to reduce salt intake warranted? I think so, but others disagree.

    (c) If so, to what level? Although virtually all committees reviewing the evidence on salt and hypertension view public health recommendations as warranted, and advise an upper limit of about 2 grams of sodium (5 grams of salt, a bit more than a teaspoon (see table from the Wall Street Journal), these too are under debate.


    “Will no one rid me of this troublesome priest?” (Sorry, only history buffs are likely to get that one.) I wish someone would get a message to her but I do not believe it is possible; she will die with her attitudes unchanged, which is a shame as she has some good things to say besides the old-school Jane Brody talking points.

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