Still Another A-Salt On Science

      122 Comments on Still Another A-Salt On Science

When I returned from the Ancestral Health Symposium, I mentioned that one of the other speakers pooh-poohed a point I made in my speech about how sodium intake has little effect on blood pressure, then argued his point using bad science – which I found amusing, since my speech was about how to tell good science from bad science.

Here’s his speech. If you skip ahead to about the 9:00 mark, you’ll hear how Dr. O’Keefe “proves” that sodium does indeed cause hypertension.

Well, there you have it. The Yanomami Indians in South America have a low sodium intake compared to ours, and by gosh, you can’t find a single case of hypertension among ‘em. We’ve clearly established a link between A and B, so A must cause B. Case closed. See you next post.

No, wait … hang on a second … I hear some critical-thinking questions banging around in my head. Such as:

Q. Did the researchers control their variables?

You can’t see his slides in the video, but while Dr. O’Keefe was explaining how little sodium the Yanomami Indians consume, he was showing the audience pictures similar to these:

Hmmm … I wonder if sodium intake is the only difference between the lifestyle of the average American and lifestyle of the average Yanomami Indian? Based on these pictures, I’m guessing probably not. In fact, based on these pictures, I’m proposing a new hypothesis about hypertension:

Hypertension is caused by wearing pants.

If makes sense if you think about it. Your body is a bit like a big water balloon, and everyone knows if you squeeze a balloon, you increase the pressure inside. Now add in the fact that many Americans insist on wearing the same size clothes even as they get older and fatter, and you have a good explanation for why blood pressure tends to increase after middle age. I hereby propose we start prescribing nakedness as a cure for hypertension. (This will have the added benefit of speeding up security checks at airports.)

Pictures of the Yanomami have also inspired me to propose a second hypothesis:

You can prevent hypertension by poking holes in your skin and inserting bones.

I think this one is self-explanatory. If you think about that water-balloon example again, you’d have to agree that even if you increase the internal pressure by squeezing the balloon, you could offset the entire effect by poking a hole in the balloon’s skin.

The fact that these people consume less salt than we do and also have lower blood pressure than we do proves absolutely nothing. The lower blood pressure could be due to any number of factors.

Dr. Richard Johnson has presented some compelling evidence that hypertension is largely the result of consuming too much fructose, as I recounted in a previous post. Now, I must admit I’ve never visited the Yanomami tribes in person, but I’m willing to bet Dr. O’Keefe a thousand dollars that in addition to consuming far less sodium than we do, hunter-gatherers living in the Amazon jungle also consume far less fructose … unless they somehow manage to venture into the jungle and gather Krispy Kreme donuts, Frosted Mini-Wheats, Little Debbie Snack Cakes, Chunky Monkey ice cream, Heinz ketchup, fruit rollups, half-gallon jugs of Mott’s apple juice, and 44-ounce Coca-Cola Big Gulps.

Q. If we’re told A is linked to B, do we see that correlation consistently, or are there glaring exceptions in other populations?

A recent article published in Scientific American titled It’s Time to End the War on Salt reported on a meta-analysis of salt-restriction studies by the Cochrane Collaboration. Here’s what they found:

Intersalt, a large study published in 1988, compared sodium intake with blood pressure in subjects from 52 international research centers and found no relationship between sodium intake and the prevalence of hypertension. In fact, the population that ate the most salt, about 14 grams a day, had a lower median blood pressure than the population that ate the least, about 7.2 grams a day.

Well, but, uh, you see … there’s this one tribe in South America that consumes very little salt, and they have low blood pressure, so that must prove salt causes hypertension. We’ll just forget about all those contradictions we find in other populations ….

Q. Is this an observational study or a clinical study?

Dr. O’Keefe’s observation is just that – an observation. So what do the clinical trials tell us about salt intake and blood pressure?

Hypertension is defined as blood pressure that’s more than 20 points above normal. If salt causes hypertension, then drastically restricting salt intake – all by itself – should produce a drop in blood pressure of 20 points or so. But that simply isn’t the case. In the section of my speech that Dr. O’Keefe didn’t like, I recounted the results of a large clinical study in which researchers had the study subjects reduce their salt intake by 75%. That led to a whopping three-point drop in blood pressure on average.

Other clinical studies have produced similar (or even less-impressive) results. Here’s more from the Scientific American article:

Over the long-term, low-salt diets, compared to normal diets, decreased systolic blood pressure (the top number in the blood pressure ratio) in healthy people by 1.1 millimeters of mercury (mmHg) and diastolic blood pressure (the bottom number) by 0.6 mmHg. That is like going from 120/80 to 119/79. The review concluded that “intensive interventions, unsuited to primary care or population prevention programs, provide only minimal reductions in blood pressure during long-term trials.” A 2003 Cochrane review of 57 shorter-term trials similarly concluded that “there is little evidence for long-term benefit from reducing salt intake.”

Since my blood pressure has always been normal or a little on the low side, I believe I’ll keep putting salt on my food, Dr. O’Keefe. But if it makes you feel any better, I’ll spend more time not wearing any pants.


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122 thoughts on “Still Another A-Salt On Science

  1. Becky

    Hey, I have another theory (although I like where your pantsless theory is going. Can we ask Zac Efron to start us off?? 🙂 ). My theory is that their reduced sodium intake may be related to their lower hypertension. Think about the SAD– most people probably intake sodium in the form of processed foods: fast food, chips, processed, frozen meals, restaurants, etc. Even the so-called healthy choices like frozen diet meals are loaded with sodium. Where do you and I get our sodium? I get mine from bacon, ham, butter, and from salting my eggs, steak and broccoli. So their sodium intake is directly related to their hypertension in the fact that it comes wrapped with low- protein, high carb junk. Take out the crap, use the salt on steak or eggs and you’ve got a very different story. So there is a correlation, but once again, the idiots in science are looking at a symptom (high sodium intake) as a cause.

    Bingo.

    Reply
  2. Marilyn

    LCNana – You’re right. I’m an oldster. The skin on my hands is very nice, though I never use any lotions or creams. Just lots of butter and coconut oil, and lots of good meat, in my diet. 🙂

    Reply
  3. Blazersftw

    @LCNana I’m actually more surprised by the people who easily accept what I’m telling them. I always do kind of a double take… “I know it’s hard to, wait huh? You know I just said you shouldn’t eat grains and saturated fat is good for you right?”

    Reply
  4. marilynb

    Well, yeah, you did leave out all the white people who are natives of the Amazon rain forest.

    Oh, no … I’m an exclusionist!

    Reply
  5. John

    @Hallergon – Sodium is absolutely essential for human life. If you were to remove all the sodium from your body, you would die. You can find this fact in any Biology textbook.

    So, if you like being alive, then yeah, Salt is good for you.

    Reply
  6. Justin B

    Thanks for this, Tom. People are all too ready to believe EVERYTHING that came out of the AHS, as if some science god created the convention to tell us that “This is the truth, and the only truth. All of it.” From what I’ve heard, there wasn’t much fact checking or regulations on the speeches given. Every public figure who was tangentially related to paleo was able to speak their minds freely. This is fine, but the people listening to these speakers need to use some common sense and check out the “facts” that they were given, before hailing the “leaders of the new age in paleo science”. I’ve seen “nail in the coffin” and “Taubes” in the same sentence far too often for comfort.

    We should view symposiums as a place where people can propose and exchange ideas. I think it’s good that some of the speakers disagreed with each other; that means we have to think instead of just accepting what we’re told.

    Reply
  7. Sid Mannluv

    I love salt and for many years deprived myself from enjoying it because I thought it caused high blood pressure. Since changing my diet according to the science Taubes and yourself have discussed I am off bp meds and I eat a lot of salt in my diet. The last time I got my bp checked, about 2 weeks ago I was 124/80. Four months ago when I was avoiding salt I was on bp meds and times in the past when I couldn’t afford bp meds I had bp readings of 160/110. You know maybe it wasn’t the change in my diet that caused my bp to drop..it was because I joined a nudist colony and stopped wearing tight fitting jeans and shirts.

    A lot of people experience a drop in blood pressure after cutting back on carbs. I don’t have any data on those who join nudist colonies.

    Reply
  8. LCNana

    Wow, to be called a racist when you post great pictures of obviously engaged people doing their ‘natural’ thing, and encouraging us to see it as a good thing….I don’t get it. But then people see through their own filters eh? You could be more correctly called a carbist, no?

    Thanks for this interesting post, Tom.

    I’m a bit down today as I’ve just had long conversations with two women about their way of eating – both with fat/salt phobias – can I change their minds on what they eat? Not on your life. They sit there quietly and listen – then comes the ‘yeah, buts’ So depressing to see one lady with severely dry skin, cracked heels, dry hair, suffering from eating even salad with NO oil on it because she’s fat phobic….and she will NOT believe me – won’t even rub coconut oil on her poor heels because it’s FAT!!! I give up. But I guess I should calm down – one thing to tell people about what you are convinced is right, another for them to internalize the message. Heavy sigh.

    All you can do is put the information out there. If they aren’t open-minded, bless them and walk away.

    Reply
  9. Barry

    “I’ve seen “nail in the coffin” and “Taubes” in the same sentence far too often for comfort.”

    This is the third time I’ve seen an allusion to Taubes and the Ancestor symposium thing. What happened? I have no clue and can’t find any information on it. What happened between Taubes and _________ at the Ancestor thing? Any help?

    Check these links:
    http://www.dietdoctor.com/ahs-showdown-gary-taubes-vs-stephan-guyenet
    http://www.dietdoctor.com/guyenet-taubes-and-why-low-carb-works

    Reply
  10. Karstyl

    What I don’t get (or wish I could be surprised at) is that Dr.s know that there is a not tiny subset of the population who’s blood pressure is very sensitive to the amount of salt in their diet, some people who are a little sensitive, and most people who don’t have much of a bp rise to high salt. And this is really easy to test for. Measure bp, eat salt, measure bp. Yet they recommend all people should eat a low salt diet to control bp. There are enough people in the population that any average will show a small increase in bp for high vs low salt, but the individuals have a very wide range that differs based on their genotype.
    There is all this hype about personalized medicine and how it will transform healthcare in the future, yet even something as simple as this is not being utilized, we are still being treated as if our bodies are all the same.

    They like simple solutions. If some people are sensitive to salt, tell everyone to cut back.

    Reply
  11. Dave, RN

    I don’t know about that pants theory…
    Looks to me like everyone carrying weapons reduces blood pressure. I know it works for me!

    Reply
  12. Allison

    When I, like many, tried to avoid salt intake, had too much salt, I would balloon up like crazy whenever I did have some salt. My body’s natural mechanism to help preserve what little salt I was getting. However, I do not know what my blood pressure was during the swellings, but am curious if it made any difference(I am of normal blood pressure anyways, but wonder if those with high blood pressure would experience worse).
    Therefore, and probably like many others, I assumed that salt was indeed bad for me. Now that I don’t care what my salt intake is and let my tastebuds do the limiting for me, I do not swell up with salt intake.
    Do you know of any studies linking water retention with hypertension and blood pressure? Maybe the solution to all these is to have more salt. (and less sugars too of course)

    I assume you never tried poking a hole in your skin when you ballooned up.

    Reply
  13. Lizzy

    I find this post double hilarious beacuse pants means underwear over here (UK) tee hee hee.

    The Indians in South American don’t seem partial to either.

    Reply
  14. bec

    I consume bucketloads of salt; salt on everything! Blood pressure, last I checked, was 90/56. Hmm. More salt?

    Either that or you need to wear pants more often.

    Reply
  15. Nowhereman

    The Pants Hypothesis! You need to get that published in the scientific literature since it’s just as valid as say… the Lipid Hypothesis.

    But seriously, this is just proof that even in the Paleo community, there are going to be quacks, charlatans, and kooks. We’re not immune to it, and we need to keep ourselves honest, and rigorously review everything top to bottom. That way we don’t fall into the elitist arrogance and groupthink traps that other types of diets’ proponents fall into.

    Indeed, we should always be questioning and examining the evidence.

    Reply
  16. Auntie M

    @LC Nana, I sympathize. I’ve been trying to get my dad off his statins. They just switched him to Lipitor. I told him not to take them, and he said his doctor would kill him if his cholesterol went up. My, “What, so you’re scared of your doctor?” was met with uncomfortable laughter and continued protests that he takes the drugs so he can eat what he wants, and he’s “not giving up sandwiches”. I met with similar resistance from my sister, whose Asperger-stricken daughter was advised-by a medical professional-to try a gluten-free, dairy-free, sugar-free diet to see if it would improve her condition. My sister won’t do it because it’s “too hard”. When I commented on the gluten/dairy content of something recently, my sister’s boyfriend jumped down my throat because I’m not a registered dietician. Ahh! I keep sending periodic links and biting my tongue as much as I can, but it breaks my heart to see my family hurting themselves this way.

    As for the salt thing, it’s amazing how people just blindly follow the “salt is bad” CW. A co-worker’s boyfriend has high blood pressure, and when I asked if he was really, truly, salt-sensitive, she said, “of course” he was. I doubt they really know, but the automatic assumption is there. I have high blood pressure myself, and haven’t noticed any difference in the numbers whether I eat salt or not. I have three different BP cuffs and check regularly at the moment, so my n = 1 is that salt doesn’t bother me. Heaven forbid you ask people to try that for themselves! I’ve even offered to lend them cuffs. 🙁

    Reply
  17. Chris

    @Hallergon WOW, cannot understand why if you don’t agree with someone’s blog you don’t just go away. There are a ton of blogs where you can go and find like minded people-I promise not to follow you and harass you there…

    Great post Tom. Truly appreciate your reminders on how to spot a well done science experiment. Added bonus that it also makes me smile.

    The Older Brother and I both get these trolls showing up regularly on our blogs to tell us how much they hate us. You can’t help but wonder about the mindset.

    Reply
  18. ChrisNpiggies

    Here in the Deep South, it stays in the 90’s for about 6 months. One of my driver’s at my company told me the new safety manager at a trash company we serve cancelled all future Gatorade orders, told the employees to stay away from it, and ordered the “pickles in a bag” instead, for the salt.

    Beats the Gatorade any day.

    Reply
  19. Ricardo

    Based on the research i have done it seems its Insulin or i think insulin resistence that causes hypertension. Not sure if its also in metobolic syndrome.

    Could be, or it could be that both insulin resistance and hypertension are caused by excess fructose.

    Reply
  20. Patricia

    FDLMOA! Well done, Tom!

    It never ceases to amaze me that “scientists” can look at a group of people such as this tribe and not see the whole picture. Makes me shake my head in disbelief, or bang it on the nearest hard surface.

    @ Hallergon
    Awww, Hallergon, did someone wake up on the wrong side of his tofu and veggies this morning?

    Some people aren’t happy unless they’re in a state of righteous indignation.

    Reply
  21. Marilyn

    LCNana – You’re right. I’m an oldster. The skin on my hands is very nice, though I never use any lotions or creams. Just lots of butter and coconut oil, and lots of good meat, in my diet. 🙂

    Reply
  22. Milton

    I suspect that if nudity was prescribed for people with hypertension, you’d see a lot more legitimate research done into improving our health and appearance!

    There might be a little illegitimate research as well.

    Reply
  23. Blazersftw

    @LCNana I’m actually more surprised by the people who easily accept what I’m telling them. I always do kind of a double take… “I know it’s hard to, wait huh? You know I just said you shouldn’t eat grains and saturated fat is good for you right?”

    Reply
  24. Timothy H

    Hey Tom, long time follower, first time poster. I was unaware that you were a former alcoholic. I noticed this after reading your Wikipedia entry. That’s really too bad, I’ve seen alcoholism in many people before and I can tell you that it isn’t pleasant.

    Anyways, keep up the good work and fighting the good fight.

    I experienced a powerful urge to follow one drink with another when I was eating a lot of carbohydrates. I’m now perfectly capable of drinking a couple of glasses of wine or beer and then stopping. Some would say that means I was never an alcoholic, but I sure acted like one back in the day.

    Reply
  25. Sid Mannluv

    I love salt and for many years deprived myself from enjoying it because I thought it caused high blood pressure. Since changing my diet according to the science Taubes and yourself have discussed I am off bp meds and I eat a lot of salt in my diet. The last time I got my bp checked, about 2 weeks ago I was 124/80. Four months ago when I was avoiding salt I was on bp meds and times in the past when I couldn’t afford bp meds I had bp readings of 160/110. You know maybe it wasn’t the change in my diet that caused my bp to drop..it was because I joined a nudist colony and stopped wearing tight fitting jeans and shirts.

    A lot of people experience a drop in blood pressure after cutting back on carbs. I don’t have any data on those who join nudist colonies.

    Reply
  26. Barry

    “I’ve seen “nail in the coffin” and “Taubes” in the same sentence far too often for comfort.”

    This is the third time I’ve seen an allusion to Taubes and the Ancestor symposium thing. What happened? I have no clue and can’t find any information on it. What happened between Taubes and _________ at the Ancestor thing? Any help?

    Check these links:
    http://www.dietdoctor.com/ahs-showdown-gary-taubes-vs-stephan-guyenet
    http://www.dietdoctor.com/guyenet-taubes-and-why-low-carb-works

    Reply
  27. Karstyl

    What I don’t get (or wish I could be surprised at) is that Dr.s know that there is a not tiny subset of the population who’s blood pressure is very sensitive to the amount of salt in their diet, some people who are a little sensitive, and most people who don’t have much of a bp rise to high salt. And this is really easy to test for. Measure bp, eat salt, measure bp. Yet they recommend all people should eat a low salt diet to control bp. There are enough people in the population that any average will show a small increase in bp for high vs low salt, but the individuals have a very wide range that differs based on their genotype.
    There is all this hype about personalized medicine and how it will transform healthcare in the future, yet even something as simple as this is not being utilized, we are still being treated as if our bodies are all the same.

    They like simple solutions. If some people are sensitive to salt, tell everyone to cut back.

    Reply
  28. Dave, RN

    I don’t know about that pants theory…
    Looks to me like everyone carrying weapons reduces blood pressure. I know it works for me!

    Reply
  29. Lizzy

    I find this post double hilarious beacuse pants means underwear over here (UK) tee hee hee.

    The Indians in South American don’t seem partial to either.

    Reply
  30. bec

    I consume bucketloads of salt; salt on everything! Blood pressure, last I checked, was 90/56. Hmm. More salt?

    Either that or you need to wear pants more often.

    Reply
  31. Keenie Johnston

    Wow, I read Timothy’s comment and had to see for myself. Yep, Tom Naughton’s wikipedia article lists him as a former alcoholic. So now we have a former alcoholic, bald, middle aged, pudgy, wierd stanced, snarky 3rd rate comedian telling Americans that salt and saturated fat is good for you.

    What could go wrong!?

    All kind of things could go wrong. For example, vegetrollians who can’t spell “weird” could show up on my blog.

    Still trying to figure out where the rumor about my “wierd” stance came from …

    Reply
  32. Ricardo

    Based on the research i have done it seems its Insulin or i think insulin resistence that causes hypertension. Not sure if its also in metobolic syndrome.

    Could be, or it could be that both insulin resistance and hypertension are caused by excess fructose.

    Reply
  33. Milton

    I suspect that if nudity was prescribed for people with hypertension, you’d see a lot more legitimate research done into improving our health and appearance!

    There might be a little illegitimate research as well.

    Reply
  34. Emily

    Yes, you have to wonder about the vegetrollians’ mindset. What I wonder about is their obsession with body odors and butts. I guess their brains must be stunted to a juvenile level ’cause they don’t eat good fats.

    One can only guess.

    Reply
  35. Timothy H

    Hey Tom, long time follower, first time poster. I was unaware that you were a former alcoholic. I noticed this after reading your Wikipedia entry. That’s really too bad, I’ve seen alcoholism in many people before and I can tell you that it isn’t pleasant.

    Anyways, keep up the good work and fighting the good fight.

    I experienced a powerful urge to follow one drink with another when I was eating a lot of carbohydrates. I’m now perfectly capable of drinking a couple of glasses of wine or beer and then stopping. Some would say that means I was never an alcoholic, but I sure acted like one back in the day.

    Reply
  36. Christopher

    Been reading the comments since my post, and gotta say, i hate the trolls. I get them all the time on my case. Look Keenie, why don’t you, instead of scoffing and trolling, go out and do some research like I did. When I saw Fat Head, the first thing I did was go online and look this stuff up for myself. Not to say I didn’t believe what you were sayig from the start Tom, but I always like to check. Anyway Keenie, think about this next time you’re making yourself a small salad for your dinner. While there are a few people who seem healthy on a vegetarian, most are not, and that includes mentally as well as physically. A vegetarian friend of mine doesn’t believe Tom. She’s really thin, but you shouldn’t base health off weight. She’s been taking Tae Kwon Do classes for years and she still has trouble doing a few push ups. She also has the worst attention span I’ve ever seen, which I now attribute to not enough proper nutrients in her diet, like, I don’t know, say…fat and salt. I on the otherhand am also in Tae Kwon Do, and I am overweight by normal standards. I have my Black Belt and can do more push ups and pull ups than anyone in the class aside from the instructors. What say you to that?

    Reply
  37. Joe Lindley

    Really enjoyed this Tom. Reminds me a little of an argument from Gary Taubes. Not sure if I got it right but it was something like this: that if you restrict your salt intake FOR THE REST OF YOUR LIFE, and live till you are are 90, you may live an extra month or two. NO THANKS – PASS THE SALT.

    But you could enjoy an extra month of bland food!

    Reply
  38. Keenie Johnston

    Wow, I read Timothy’s comment and had to see for myself. Yep, Tom Naughton’s wikipedia article lists him as a former alcoholic. So now we have a former alcoholic, bald, middle aged, pudgy, wierd stanced, snarky 3rd rate comedian telling Americans that salt and saturated fat is good for you.

    What could go wrong!?

    All kind of things could go wrong. For example, vegetrollians who can’t spell “weird” could show up on my blog.

    Still trying to figure out where the rumor about my “wierd” stance came from …

    Reply
  39. Emily

    Yes, you have to wonder about the vegetrollians’ mindset. What I wonder about is their obsession with body odors and butts. I guess their brains must be stunted to a juvenile level ’cause they don’t eat good fats.

    One can only guess.

    Reply
  40. Christopher

    Been reading the comments since my post, and gotta say, i hate the trolls. I get them all the time on my case. Look Keenie, why don’t you, instead of scoffing and trolling, go out and do some research like I did. When I saw Fat Head, the first thing I did was go online and look this stuff up for myself. Not to say I didn’t believe what you were sayig from the start Tom, but I always like to check. Anyway Keenie, think about this next time you’re making yourself a small salad for your dinner. While there are a few people who seem healthy on a vegetarian, most are not, and that includes mentally as well as physically. A vegetarian friend of mine doesn’t believe Tom. She’s really thin, but you shouldn’t base health off weight. She’s been taking Tae Kwon Do classes for years and she still has trouble doing a few push ups. She also has the worst attention span I’ve ever seen, which I now attribute to not enough proper nutrients in her diet, like, I don’t know, say…fat and salt. I on the otherhand am also in Tae Kwon Do, and I am overweight by normal standards. I have my Black Belt and can do more push ups and pull ups than anyone in the class aside from the instructors. What say you to that?

    Reply
  41. Joe Lindley

    Really enjoyed this Tom. Reminds me a little of an argument from Gary Taubes. Not sure if I got it right but it was something like this: that if you restrict your salt intake FOR THE REST OF YOUR LIFE, and live till you are are 90, you may live an extra month or two. NO THANKS – PASS THE SALT.

    But you could enjoy an extra month of bland food!

    Reply
  42. Robinowitz

    I put salt on just about everything and have always maintained a BP around 120/60…even throughout my pregnancy. My doc was always so pleased about that and probably thought I ate a low-salt diet. Whenever someone says that some meal is better because it’s low in salt I always tell them about how much salt I use and my BP and they never know what to say. I’m sure they just think I’m genetically gifted in the BP department but I seriously doubt that’s the case. I love salt and love buying all the different varieties–Himilayan rose salt is one of my favorites, though I usually use celtic sea salt.

    P.S. Remember not to feed the trolls or they’ll keep showing up like a bunch of lonely (and hungry) stray cats:)

    Unfortunately, I think they enjoy showing up here and getting smacked around. Either that or they lack the intelligence to recognize when they’re getting smacked around.

    Reply
  43. Bernardo

    Everybody knows that all modern diseases are caused by speaking English. USA, Canada, Australia, UK, all on top of the list. The rate of incidence of these same diseases have grown in Brazil as people start going to English courses more often. Lately I’ve been trying to stay on a French/Portuguese speaking regime but this post will surely make my pressure skyrocket.

    Si, si, correcto!

    Reply

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