Tag: sodium

Reducing Sodium in Everyday Foods may Yield Heart-health Benefits Across Populations

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Lowering sodium in packaged and prepared foods could significantly improve cardiovascular health and prevent many cases of heart disease, stroke and deaths in the general population in France and the U.K., according to two new research studies published in Hypertension, an American Heart Association journal.

Consuming too much sodium is a major risk factor for hypertension, also known as high blood pressure, which can lead to health complications such as heart attack, stroke, chronic kidney disease, dementia and other forms of cardiovascular disease, according to the American Heart Association.

To address the global concern about excessive sodium consumption many countries have implemented salt-reduction strategies to improve public health and reduce health costs.

Two studies – one in France involving salt-reduction targets for baguettes and other bread products in 2025, and the other in the United Kingdom focusing on 2024 goals for takeaway and packaged foods – estimated the potential impact on the general population if those salt-reduction targets were met. The projections calculated in these two studies indicate that minor adjustments in sodium content to some of the most common prepared foods in each country would require no effort from people to change their eating habits, yet may produce significant public health benefits.

“This approach is particularly powerful because it does not rely on individual behaviour change, which is often difficult to achieve and sustain. Instead, it creates a healthier food environment by default,” said Clémence Grave, M.D., lead author of the study from France and epidemiologist and public health physician at the French National Public Health Agency, headquartered in Saint-Maurice near Paris.

The World Health Organization recommends adults should consume less than 2,000 milligrams (mg) of sodium per day, however, global intake is much higher. The American Heart Association recommends daily intake of no more than 2300mg of sodium a day – equal to about 1 teaspoon of table salt; but also says the ideal limit is no higher than 1500 mg per day for most adults, especially for those with high blood pressure.

Sodium reduction in bread (France)

In 2019, France set a national public health goal to reduce salt consumption by 30%. In 2022, a voluntary agreement was signed between the government and bread producers to lower salt content by 2025. Bread, especially the baguette, is a culturally and nutritionally central food in France, yet it can be high in salt– traditionally contain about 25% of total daily recommended intake of salt. By 2023, most breads made in France already met the new sodium standards.

To understand the potential impact of the agreement on public health, researchers used national data and a mathematical model to estimate how many cases of cardio-cerebrovascular disease (conditions and diseases that affect both the heart and the brain’s blood vessels), kidney disease and dementia could be prevented if the salt-reduction targets met full compliance.

The analysis found that with bread consumption remaining the same and sodium-reduction targets fully met, less salt in baguettes and bread would decrease daily intake by 0.35 g per person, leading to slightly lower blood pressure across the population.

“This salt-reduction measure went completely unnoticed by the French population – no one realised that bread contained less salt,” Grave said. “Our findings show that reformulating food products, even with small, invisible changes, can have a significant impact on public health.”

Sodium reduction in packaged foods and take-out meals (United Kingdom)

For the study in the U.K., researchers used national survey data to estimate the amount of salt people consumed from pre-prepared packaged and take-out meals. They then estimated daily sodium intake if all relevant food categories met the 2024 sodium-reduction targets.

Sales-weighted average and maximum salt content targets were set for 84 grocery food categories – including bread, cheeses, meats, and snacks – and, for the first time, 24 out-of-home categories such as burgers, curries, and pizza. The modelling also covered how these changes could affect heart disease, stroke, quality of life and health care costs.

The research found that fully meeting the sodium reduction goals could have reduced average salt intake from about 6.1 g to 4.9g per day – translating to an estimated average of 17.5% less salt consumed per person per day. Men would experience slightly larger reductions than women because they tend to consume more salt in general.

Even this small, daily reduction in salt would lower blood pressure modestly across the population, and the improvements could add up.

Source: American Heart Association

Potassium is Also Important for Lowering Blood Pressure

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A newly published study from the University of Waterloo suggests that increasing the ratio of dietary potassium to sodium intake may be more effective for lowering blood pressure than simply reducing sodium intake.

“Usually, when we have high blood pressure, we are advised to eat less salt,” said Dr Anita Layton, professor at the University of Waterloo. “Our research suggests that adding more potassium-rich foods to your diet, such as bananas or broccoli, might have a greater positive impact on your blood pressure than just cutting sodium.”

Potassium and sodium are both electrolytes – substances that help the body send electrical signals to contract muscles, affect the amount of water in your body and perform other essential functions.

“Early humans ate lots of fruits and vegetables, and as a result, our body’s regulatory systems may have evolved to work best with a high potassium, low sodium diet,” said Melissa Stadt, a PhD candidate in Waterloo’s Department of Applied Mathematics and the lead author of the study.

“Today, western diets tend to be much higher in sodium and lower in potassium. That may explain why high blood pressure is found mainly in industrialised societies, not in isolated societies.”

While previous research found that increasing potassium intake can help control blood pressure, the researchers developed a mathematical model that successfully identifies how the ratio of potassium to sodium impacts the body.

The model also identifies how sex differences affect the relationship between potassium and blood pressure. The study found that men develop high blood pressure more easily than pre-menopausal women, but men are also more likely to respond positively to an increased ratio of potassium to sodium.

The researchers emphasise that mathematical models like the one used in this study allow these kinds of experiments to identify how different factors impact the body quickly, cheaply, and ethically.

The study was recently published in the American Journal of Physiology-Renal Physiology.

Source: University of Waterloo

CVD Risk Warning for Paracetamol That Contains Sodium

Graphical abstract from European Heart Journal editorial: sodium hidden in medication warrants warning labels by drug companies

Clinicians have recommended avoiding effervescent, soluble paracetamol that contains sodium, following findings from a large study that shows a link with a significantly increased risk of cardiovascular disease (CVD) and mortality in people who have hypertension and even in people with normal blood pressure.

The study of nearly 300 000 patients registered with UK GPs was published in the European Heart Journal.

Sodium is often used to help drugs such as paracetamol dissolve and disintegrate in water. However, effervescent and soluble formulations of 0.5g tablets of paracetamol can contain 0.44 and 0.39g of sodium respectively. If a person took the maximum daily dose of two 0.5g tablets every six hours, they would consume 3.5 and 3.1g of sodium respectively – a dose that exceeds the WHO-recommended total daily intake of 2g a day. In 2018, 170 people per 10 000 of the population in the UK were using sodium-containing medications, with a higher proportion among women. There are alternative formulations that contain little or no sodium.

Excessive salt in the diet remains a major public health problem and is associated with an increased risk of cardiovascular disease (CVD) and death among patients with hypertension. However, there is inconsistent evidence showing an increased risk in normotensive individuals.

Professor Chao Zeng led a team which analysed data from a medical database of UK GPs’ records. They looked at 4532 hypertensive patients who had been prescribed sodium-containing paracetamol and compared them with 146 866 hypertensive patients who had been prescribed sodium-free paracetamol. They also compared 5351 normotensive patients who were prescribed sodium-containing paracetamol with 141 948 normotensive patients prescribed sodium-free paracetamol. The patients were aged 60-90 years and followed up for one year.

The researchers found the risk of heart attack, stroke or heart failure after one year for patients with high blood pressure taking sodium-containing paracetamol was 5.6% (122 cases of CVD), while it was 4.6% (3051 CVD cases) among those taking sodium-free paracetamol. Mortality risk was also higher; the one-year risk was 7.6% (404 deaths) and 6.1% (5510 deaths), respectively.

A similar increased risk was seen among normotensive patients. Among those taking sodium-containing paracetamol, the one-year CVD risk was 4.4% (105 cases of CVD) and 3.7% (2079 cases of CVD) among those taking sodium-free containing paracetamol. The risk of dying was 7.3% (517 deaths) and 5.9% (5190 deaths), respectively.

Prof Zeng said: “We also found that the risk of cardiovascular disease and death increased as the duration of sodium-containing paracetamol intake increased. The risk of cardiovascular disease increased by a quarter for patients with high blood pressure who had one prescription of sodium-containing paracetamol, and it increased by nearly a half for patients who had five or more prescriptions of sodium-containing paracetamol. We saw similar increases in people without high blood pressure. The risk of death also increased with increasing doses of sodium-containing paracetamol in both patients with and without high blood pressure.”

Prof. Zeng said that clinicians and patients should be aware of the risks associated with sodium-containing paracetamol and avoid unnecessary consumption, especially when the medication is taken for a long period of time.

“Given that the pain relief effect of non-sodium-containing paracetamol is similar to that of sodium-containing paracetamol, clinicians may prescribe non-sodium-containing paracetamol to their patients to minimise the risk of cardiovascular disease and death. People should pay attention not only to salt intake in their food but also not overlook hidden salt intake from the medication in their cabinet,” he said.

“Although the US Food and Drug Administration requires that all over-the-counter medications should label the sodium content, no warning has been issued about the potentially detrimental effect of sodium-containing paracetamol on the risks of hypertension, cardiovascular disease and death. Our results suggest re-visiting the safety profile of effervescent and soluble paracetamol.”

Being an observational study it can only show only that there is an association between salt in paracetamol and CVD and deaths, rather than that salt causes these events. Other limitations include a lack of data on dietary intake of salt and excretion of salt from urinary samples. The use of over-the-counter paracetamol was not also recorded, however by restricting the study to those over 60 who qualify for free prescriptions in the UK, the risk of this is minimised.

Source: EurekAlert!