Speaker 1: Intake of salt is a biological imperative inextricably woven into
Speaker 1: physiological systems, human societies, and global culture. However, excessive salt
Speaker 1: intake is associated with high blood pressure. The crucial question
Speaker 1: is whether salt exerts a causal influence on patient centered
Speaker 1: health outcomes such as myocardial infection, stroke, and death. However,
Speaker 1: this issue is controversial and fiercely debated. Despite the controversy,
Speaker 1: two broad points of consensus exist. The first is that
Speaker 1: the uncertainty could be resolved by better quality data, that is, large,
Speaker 1: randomized clinical trials with sufficient follow up to assess robust
Speaker 1: cardiovascular outcomes. The second is that the barriers to performing
Speaker 1: such trials are so substantial that they will be rarely,
Speaker 1: if ever surmounted.
Speaker 2: Okay, so many questions.
Speaker 1: What was that? From?
Speaker 2: When was that? From? Who wrote that?
Speaker 1: I can't wait to tell you? Okay? So that was
Speaker 1: I pulled clips like little bits from the intro and
Speaker 1: from later in a paper, from a very very recent paper.
Speaker 1: I have just scrolled. Why didn't I put this up?
Speaker 1: I'm scrolling all the way to the bottom of my
Speaker 1: notes from Nature Reviews Nephrology from twenty twenty two by
Speaker 1: hunter at All titled the Impact of Excessive Salt Intake
Speaker 1: on Human Health, and this paper that little intro, that's
Speaker 1: the end of my.
Speaker 2: I mean, that's what like, That's what kills me, is
Speaker 2: that I feel like since that could The reason I
Speaker 2: asked where when is it from? Is because that could
Speaker 2: have been from so many different points in history over
Speaker 2: the salt debate. We need better data, we need randomized
Speaker 2: control trials, we need long term data sets and follow up.
Speaker 1: And it is from twenty twenty two. So that's what
Speaker 1: we're going to talk about today in this episode.
Speaker 2: Hi, I'm Aaron Welsh.
Speaker 1: And I'm Aaron Allman updight.
Speaker 2: And this is this podcast will kill you. Welcome back
Speaker 2: to Salt Salt. Here we go again, Yeah.
Speaker 1: We go again. I'm really excited about today's episode. I
Speaker 1: don't know how many answer any of your questions, but
Speaker 1: I think I think we'll come to some clarity. I
Speaker 1: honestly really actually do at the end of this.
Speaker 2: I am hopeful. I know that if there is a
Speaker 2: thread to be pulled, you will find it and yank
Speaker 2: it out from the yank Yeah, yeah, I do. I'm
Speaker 2: thrilled for this. Yeah, I already want to start asking questions,
Speaker 2: and that is a first like that is early for me,
Speaker 2: so good.
Speaker 1: I can't wait. I can't wait for you to ask
Speaker 1: me questions and then I'll be like that's the one
Speaker 1: I don't have an answer for, or like, oh my god,
Speaker 1: now I have to scroll one hundred years in my notes.
Speaker 1: I can't wait. I have fifteen pages of notes here
Speaker 1: erin so like, I've got to have answers to something.
Speaker 1: But firstarantiny time it is?
Speaker 2: It is we're again drinking the grains of salts, which
Speaker 2: is based on a salty dog. I mean it is
Speaker 2: a salty dog, which is great fruit juice and vodka
Speaker 2: or gin, whichever you prefer. Make sure your rim is
Speaker 2: salted unless you're dealing with high blood pressure. No, just kidding,
Speaker 2: I don't know, but that is the technical recipe. Also,
Speaker 2: this reminds me that if you are just now tuning in,
Speaker 2: then you didn't see at the top that it says
Speaker 2: Salt Part two. You really don't have to listen to
Speaker 2: the first episode, but you should. It's not like there's
Speaker 2: a narrative that you'll miss, but you'll miss a lot.
Speaker 2: You'll miss some. It'll help you with trivia. It's got
Speaker 2: some cool It's a great episode. Do you want to
Speaker 2: learn where the term grain of salt comes from? Check
Speaker 2: it out.
Speaker 1: You've got to listen to that episode. We're not going
Speaker 1: to tell you now.
Speaker 2: Yeah.
Speaker 1: Anyways, we'll post the recipe for the drink on our website.
Speaker 1: This podcast with you dot com and our social media
Speaker 1: is so make sure you're following us there. You find
Speaker 1: lots of other cool stuff on our website too, like
Speaker 1: trans scripts and a bookshop dot orgiphiliated account, and a
Speaker 1: good Reads list and merch and all the sources from
Speaker 1: all of these episodes. Boy do I have a long
Speaker 1: list for this one bloodmobile? Who does our music? You know?
Speaker 1: Contact us form.
Speaker 2: Lots of things.
Speaker 1: I'll check it out.
Speaker 2: Is there any other business or can we like get
Speaker 2: straight to things? Let's do this?
Speaker 1: Oh yes, very short break life evolved in the oceans,
Speaker 1: which are salty.
Speaker 2: I loved this. I'm like, wait a second, have I
Speaker 2: said this before?
Speaker 1: No, you haven't, but it is the most Aaron Welsh
Speaker 1: way to start the thing. Ever that I was like
Speaker 1: thrilled that you didn't start that way and that I
Speaker 1: could do it.
Speaker 2: I did think about going into the evolutionary origins and
Speaker 2: then I was like stop.
Speaker 1: Yeah, no, no, I'm not going any further than that. Life
Speaker 1: evolved in the oceans. Yeah, the oceans are salty, and
Speaker 1: with the evolution from single celled organisms to multicellular organisms,
Speaker 1: salt became a major component of our extracellular fluid, that is,
Speaker 1: the fluid that is on the outside rather than the
Speaker 1: inside of our cells. Our bodies are basically just made
Speaker 1: up of tiny little water balloons bathing in more water. Yeah, okay,
Speaker 1: and all of the water inside and outside of our
Speaker 1: cells is salty water. Yeah, but the salt on the
Speaker 1: inside of our cells is mostly potassium. So the ions
Speaker 1: that make up the salt mostly are potassium, and the
Speaker 1: salts outside of our cells most are made up of sodium. So,
Speaker 1: as we moved from our ocean homes to land, and
Speaker 1: by we I mean like, you know, creatures and not
Speaker 1: like humans.
Speaker 2: Global evolutionary we yeah.
Speaker 1: Exactly, we were no longer bathing in sodium all the time, right,
Speaker 1: and thus we had to find ways to ingest it. Yeah.
Speaker 1: So animals evolved taste receptors to be able to detect salt,
Speaker 1: and in general, like you kind of mentioned, Aaron, most
Speaker 1: animals have actually a pretty consistent like upside down U
Speaker 1: shaped preference curve for saltiness, right, but I think it's yeah,
Speaker 1: upside down you so like it's delicious right in the middle.
Speaker 1: If it's not salty enough, it doesn't taste good. If
Speaker 1: there's too much salt also doesn't taste good. Right. So
Speaker 1: when we talk about salt in this episode, like you
Speaker 1: said last week as well too, I'm talking about sodium
Speaker 1: chloride NaCl uh huh. I mean when I set it
Speaker 1: in the bodies where there's other salts in your bodies,
Speaker 1: and there's other ions that are important, But from now
Speaker 1: on out, I'm just talking about sodium chloride.
Speaker 2: Okay, Can I already ask a question? Yeah, Garby, you
Speaker 2: mentioned potassium is on the inside and sodium is on
Speaker 2: the outside.
Speaker 1: Huh.
Speaker 2: And what happens then?
Speaker 1: Like okay, yeah, let me let's sorry.
Speaker 2: Yeah, well it's not a question. It was more just
Speaker 2: like tell me more.
Speaker 1: Yes, let me continue setting the scene and then I
Speaker 1: will I will get into that, okay, very shortly. Well,
Speaker 1: we're talking mostly about sodium chloride today. Lots of other
Speaker 1: salts exist in chemistry, salt like table salt, Sodium chloride
Speaker 1: is about forty percent sodium. Yeah, like by weight, so
Speaker 1: ten grams of salt. This is important for one work
Speaker 1: because like all of the dietary guidelines and things talk
Speaker 1: about sodium, right, But then a lot of studies just
Speaker 1: talk about salt. So we can use these interchange ten
Speaker 1: grams of salt four grams of sodium. That's the equivalence there.
Speaker 2: Okay, guess what there are like online calculators that I
Speaker 2: had to use to be like how much sodium are wet?
Speaker 2: I would be like how much salt does the average
Speaker 2: American eat? Oh? You know, however thirty two hundred milligrams
Speaker 2: of salt or sodium, So like right, no, but how
Speaker 2: much salt are we eating?
Speaker 1: How much salt does that? Yeah? Exactly. Also, then some
Speaker 1: studies like to use millimals just to make them sound
Speaker 1: more smart, and you're just like, now I have to
Speaker 1: take it from mills to milligrams, Like stop it, it's unnecessary.
Speaker 1: But so the questions that I want to answer today
Speaker 1: in this episode are number one, why do we give
Speaker 1: a crap about sodium? And that's going to get it
Speaker 1: your question of like sodium potassium, what does that mean?
Speaker 1: What does it do in our bodies? Why do we
Speaker 1: actually need it. What is the problem or is there
Speaker 1: a problem with excess sodium and how much? What does
Speaker 1: excess actually mean? And why is there so much debate
Speaker 1: about this? Yeah, that's going to be a big part
Speaker 1: of the episode. What I am not going to talk
Speaker 1: about is hypo and hyper natremia. That is when your
Speaker 1: blood sodium is too low or too high. I'm not
Speaker 1: going to talk about it in any great detail. If
Speaker 1: you are a medical student or a resident, you're welcome
Speaker 1: for not making you listen to that. If you don't
Speaker 1: know what that means, you can watch some doctor Glalcum
Speaker 1: Flecken videos because they sum up both my knowledge and
Speaker 1: also why I have no interest in talking about those things, because.
Speaker 2: Are those acute stages.
Speaker 1: They can be acute or chronic. Okay, okay, yeah, and
Speaker 1: it's all just a mess. But you will understand why
Speaker 1: it's important when I tell you why do we have
Speaker 1: to give a crap about sodium? Right at its core,
Speaker 1: at its most important, sodium is what determines our total
Speaker 1: body fluid balance. So because it is the most abundant
Speaker 1: cat ion, positively charged ion in our extracellular fluid, it
Speaker 1: is what determines how much fluid volume we actually have
Speaker 1: in our bodies. Right, Because the salt on the inside
Speaker 1: of our cell bags is mostly potassium and the salt
Speaker 1: on the outside is mostly sodium, it doesn't matter which
Speaker 1: is which as long as their concentrations are the same.
Speaker 1: Our bodies have to keep a balance of these fluids.
Speaker 1: So the concentration of particles on the inside of our
Speaker 1: cell has to match the concentration on the outside if
Speaker 1: they don't, Like if you were to dump a bunch
Speaker 1: of sodium into your bloodstream into your extracellular fluid, then
Speaker 1: your body would have to compensate by extracting fluid from
Speaker 1: cells in order to make up for that.
Speaker 2: Right, Okay, And the identity of sodium versus potassium doesn't
Speaker 2: necessarily matter, I imagine it does at a point.
Speaker 1: It does, absolutely, but it doesn't for the purposes of
Speaker 1: just understanding that, like at its core, you just have
Speaker 1: to have balance. It so happens that potassium is what
Speaker 1: exists inside of our cells, and sodium primarily exists outside
Speaker 1: of our cells, And our cells do a lot of
Speaker 1: transmitting sodium and potassium back and forth through these atp
Speaker 1: ion channels, and that is all very important. But to
Speaker 1: understand fluid balance. You need to know that potassiums on
Speaker 1: the inside and sodiums on the outside, and they got
Speaker 1: to be concentration wise balanced.
Speaker 2: Right.
Speaker 1: Sodium is also an incredibly important cad on outside of
Speaker 1: fluid balance. It's a neurotransmitter. It is essential for our
Speaker 1: muscles to be able to contract, and so it's something
Speaker 1: that our cells also use in communication with other cells. So,
Speaker 1: make no mistake, we cannot exist without sodium.
Speaker 2: It's necessary for life.
Speaker 1: It is necessary for life, and the volume of our
Speaker 1: fluid in our bodies is proportional to our total body
Speaker 1: content of sodium. Right, So, in order to if you
Speaker 1: lose a bunch of volume, for example, if you're bleeding,
Speaker 1: or if you're even just peeing out way too much,
Speaker 1: or you're sweating or you're having diarrhea, in order to
Speaker 1: replace the volume that you've lost of fluid, you have
Speaker 1: to also replace sodium. You cannot replace it with just water,
Speaker 1: it will not work. Right. We lose sodium predominantly through
Speaker 1: our kidneys. In fact, shout out to our kidneys. They
Speaker 1: are so stellar at this that they excrete about ninety
Speaker 1: to ninety five percent of what we ingest regardless of
Speaker 1: how much we ingest. Isn't that interesting?
Speaker 2: Wait? So okay, but you said it's a proportion that
Speaker 2: they excrete out or.
Speaker 1: Is it ninety to ninety five percent of what you
Speaker 1: ingest you're going to pee out in your kidneys.
Speaker 2: So let's say we're talking about sodium sodium. Yeah, so
Speaker 2: let's say that you, you know, going back to last
Speaker 2: week's episode when the ridiculous estimate, shocking estimate of one
Speaker 2: hundred grams of salt a day a day, let's say, so,
Speaker 2: that's forty grams of sodium oday. Yeah, that ninety percent
Speaker 2: that's excreted out. You've got a lot more salt remaining
Speaker 2: in your body than if you're.
Speaker 1: Oh, Aaron, you're so right.
Speaker 2: Thank you for leading me perfectly to that.
Speaker 1: You did it all on your own. Oh my god, Yes, exactly,
Speaker 1: exactly right. Proportionally percent of what we ingest, regardless of
Speaker 1: what we're ingesting. Right, we're gonna lose some through our
Speaker 1: gi tract, via your poop. You're gonna lose some via sweat,
Speaker 1: et cetera. Okay, most of its kidneys, Most of it's kidneys,
Speaker 1: and our kidneys. They do a really good job of
Speaker 1: deciding how much to kick out and how much to
Speaker 1: keep depending on how much we eat, because it is
Speaker 1: going to be variable. Right, if you're not getting enough,
Speaker 1: if you are deficient in your sodium intake, or if
Speaker 1: you've got other reasons that your body decides, hey, we
Speaker 1: need to hold onto this. Your kidneys can actually keep
Speaker 1: almost all of it. They can They can keep almost
Speaker 1: one hundred percent of your sodium if they need to.
Speaker 2: Two questions, Okay, what are some of the conditions that
Speaker 2: your kidneys might keep more sodium than is necessary? And
Speaker 2: how often does someone actually not consume enough sodium in
Speaker 2: like the your like a normal day to.
Speaker 1: Day you know, such great questions. How often in the
Speaker 1: year twenty twenty five is someone not getting enough sodium?
Speaker 1: Very rare? Okay, it's very hard to not get enough
Speaker 1: sodium for most people. You If you, for example, were
Speaker 1: to lose a lot of blood or lose a lot
Speaker 1: of volume for any reason, then your blood pressure would
Speaker 1: probably drop. Then your kidneys would say, hey, we need
Speaker 1: to hold onto blood pressure. We're going to do that
Speaker 1: by holding on all of our sodium. We're not going
Speaker 1: to let any sodium go, and that's going to help.
Speaker 1: You're going to need to ingest sodium, either via like
Speaker 1: ivy fluids or just eating salt in order to make
Speaker 1: up for those losses. But your kidneys are also going
Speaker 1: to react very quickly to hold on to as much
Speaker 1: as possible. There's other like disease states. For example, if
Speaker 1: you have issues with your adrenals where you're not producing
Speaker 1: certain hormones. Because it's a lot of very complicated it's
Speaker 1: your kidneys, it's your brain, it's your blood vessels and
Speaker 1: sensors that are in your blood vessels. It's hormones that
Speaker 1: are controlling all of this. So if you have deficiencies
Speaker 1: in certain hormones, then your kidneys might flip on and say, hey,
Speaker 1: we need to hold on to all the sodium that's
Speaker 1: possible because we are you know, at risk of losing
Speaker 1: it or whatever. Or maybe you have deficiencies and hormones
Speaker 1: and you can't do that and so you're losing a
Speaker 1: lot of sodiums. So then you might have what so
Speaker 1: many animals have big bone lick stake park and that
Speaker 1: is what's called sodium appetite. Yes, and sodium appetite is
Speaker 1: this idea that we know exists in animals that in
Speaker 1: a state of sodium deficiency. Animals will exhibit these pretty
Speaker 1: extreme sodium seeking behaviors and they will do extra work
Speaker 1: to seek out and consume salt. And we see this
Speaker 1: in a lot of different animals, mice, rats, rabbits, pigeons, goats,
Speaker 1: we learned, kangaroos, sheep, cattle, monkeys, horses. So the question
Speaker 1: is does this sodium appetite exist in humans, And we
Speaker 1: think probably yes, though the data is based on a
Speaker 1: few cases of like, for example, kids who had no
Speaker 1: functional adrenals, so they were salt wasting. Their kidneys could
Speaker 1: not hold on to salt, and so they had an
Speaker 1: increased need for salt and exhibited these kinds of salt
Speaker 1: seeking behaviors. In the literature, these are like really old
Speaker 1: single case type studies. Yea, but then yeah, so those
Speaker 1: individuals in those studies did exhibit that kind of sodium
Speaker 1: seeking what we would call sodium appetite. That's not the
Speaker 1: same thing as what we experience now, which is sodium
Speaker 1: preference where we like it so we eat it because
Speaker 1: it tastes good. That does not mean that we are
Speaker 1: sodium deficient.
Speaker 2: Right, even though it feels sometimes like the same thing.
Speaker 1: Right, hard to distinguish perhaps.
Speaker 2: Okay, I have a question about you said like salt appetite,
Speaker 2: this instinctual drive to find salt, and you said that
Speaker 2: they tested out in kids that lacked adrenals. Tell me
Speaker 2: why that would. What's happening there is their kidneys aren't
Speaker 2: holding on like yeah.
Speaker 1: Yes, exactly that. So your adrenals they do a lot,
Speaker 1: but one of the hormones that they make is called aldosterone,
Speaker 1: which is a very important part of mediating the resorption
Speaker 1: of sodium in your kidneys. And so without being able
Speaker 1: to make that particular hormone, then you can't have a
Speaker 1: signal to tell your kidneys to hold on to sodium,
Speaker 1: and so you're basically sodium wasting. And there's other conditions
Speaker 1: as well too. There's like genetic conditions, or there's maybe
Speaker 1: damage to the kidney. There's medications that can make you
Speaker 1: lose more sodium in your urine through your kidneys. Okay, yeah,
Speaker 1: but a lot of it is under that hormonal control.
Speaker 1: So that's why it was in kids who had like
Speaker 1: not either they didn't have adrenals or they had non
Speaker 1: functional adrenals. I can't remember which one. Okay, And your
Speaker 1: drenals do a lot more than just teldosterone, but that's
Speaker 1: important for salt.
Speaker 2: And your kidneys do a lot more than just sodium too, yes, Vato.
Speaker 1: But so this all begs the question how much sodium
Speaker 1: do we actually need?
Speaker 2: How much?
Speaker 1: Aaron? This is my favorite question that I've asked myself, yeah,
Speaker 1: in a while, and it is very hard to come
Speaker 1: to an actual answer on this. So you mentioned, and
Speaker 1: I'm so glad that you did in last episode, that
Speaker 1: our early hominid ancestors, their estimated amount of salt intake
Speaker 1: was about one gram of salt per day or less.
Speaker 1: That's four hundred milligrams of sodium. Now, there also was
Speaker 1: a study that came out in the late eighties called
Speaker 1: inter Salt, and this was this one of these big,
Speaker 1: big observational studies that first showed a relationship. Not first
Speaker 1: because you said it was like you know, in the
Speaker 1: early nineteen hundreds.
Speaker 2: Twenty six, if you're talking, you know, correct hard hard
Speaker 2: pulse that hardens.
Speaker 1: Yeah, But this was one of like a big important
Speaker 1: observational study that looked at a bunch of different populations
Speaker 1: with variation in their average salt intake and found a
Speaker 1: very strong relationship between higher salt intake and blood pressure.
Speaker 1: In this study, they also looked at several remote human
Speaker 1: populations in Brazil, Kenya, and Papula, New Guinea, and in
Speaker 1: those populations, people, yes, had very low blood pressure, but
Speaker 1: they also had substantially lower sodium intakes compared to what
Speaker 1: we see today, one to three grams of salt on average,
Speaker 1: which is four hundred milligrams to one point two grams
Speaker 1: of sodium per day.
Speaker 2: I mean, it's to be hard, I feel like, in
Speaker 2: our like in the US, to eat that, to select
Speaker 2: that diet, right.
Speaker 1: Listen, we'll get there. It's very hard, Okay, But this
Speaker 1: all becomes really important because, as I'm going to talk
Speaker 1: about later, there is a lot of weird debate about
Speaker 1: what our quote unquote physiologic need actually is. Okay, and
Speaker 1: we'll get into the people who are claiming things that
Speaker 1: they're claiming, but it is very clear from these early
Speaker 1: you know, these estimates of early hominid we can't we
Speaker 1: can't have exact data on that, right, but these estimates
Speaker 1: based on the sodium content of the types of foods
Speaker 1: that early hominids would be eating, plus the fact that
Speaker 1: there are, or at least in the eighties and seventies
Speaker 1: were societies in which people were consuming very minimal amounts
Speaker 1: of salt and they were living, surviving, maybe thriving, I
Speaker 1: don't know, but their bodies were functioning just fine. So physiologically,
Speaker 1: most estimates say we need at a minimum about five
Speaker 1: hundred milligrams of sodium a day in order to continue
Speaker 1: our bodily functionings, to keep up with losses from our kidneys,
Speaker 1: from our sweat, from our GI tract. And that's going
Speaker 1: to vary based on how much you're sweating, how much
Speaker 1: you're pooping, and how great your kidneys are at retaining sodium.
Speaker 2: What about potassium, great question.
Speaker 1: Potassium is incredibly important and actually plays a huge role
Speaker 1: in this sodium blood pressure, et cetera debate. And I
Speaker 1: didn't write down the exact like what the RDA the
Speaker 1: recommended amount of potassium that you get is, so I
Speaker 1: don't know the exact numbers of that, but potassium is
Speaker 1: absolutely essential to consume every day as well.
Speaker 2: And we're but I'm asking about the intrasalt study. Were
Speaker 2: those populations, the remote populations, were they consuming some other
Speaker 2: types of salt, you know, potassium or whatever.
Speaker 1: They were probably consuming more potassium than what we consume
Speaker 1: or what a lot of other populations consume. Because foods
Speaker 1: that tend to be low in sodium are often high
Speaker 1: in potassium. That's very interesting, because whole foods are very
Speaker 1: high like fruits, vegetables, these kinds of things tend to
Speaker 1: be very high in potassium. Harm. Okay, we'll get there, Okay, okay,
Speaker 1: So that's how much salt we need, like bare minimum
Speaker 1: to survive. We think, right, how much salt do we get?
Speaker 1: On average? Global daily salt intake is estimated. Most estimates
Speaker 1: and by the World Health Organization are about ten grams
Speaker 1: of salt per day, which is about four grams of sodium.
Speaker 1: There is a lot of variation, so the average ranges
Speaker 1: from just over two grams to just over five grams
Speaker 1: per day based on different populations, and of course there's
Speaker 1: a lot of individual and day to day variation. Now,
Speaker 1: the World Health Organization recommends a limit of no more
Speaker 1: than two grams of sodium a day two thousand milligrams,
Speaker 1: that's five grams of salt. The American Heart Association in
Speaker 1: the US recommends for all adults absolutely no more than
Speaker 1: two point three grams of sodium, and for anyone with
Speaker 1: high blood pressure or at high risk for cardiovascular disease.
Speaker 1: They recommend a limit of one point five grams of sodium.
Speaker 1: Other countries have slightly different recommendations, but they're all in
Speaker 1: this ballpark of around two grams of sodium, around five
Speaker 1: grams of salt, and yet globally, on average, we are
Speaker 1: getting more than double the amount of what most major
Speaker 1: medical societies recommend. Why is that? What impact is this having?
Speaker 1: And why is there so much controversy about this? Still?
Speaker 2: This is so fascinating because I think question being how
Speaker 2: much salt do we need? Versus how much salt is
Speaker 2: too much? I feel like is really different. Those are
Speaker 2: two entirely different questions.
Speaker 1: They are, And I.
Speaker 2: Also want to understand how we arrived at this number,
Speaker 2: these recommended numbers, which have been revised down over the
Speaker 2: past fifty years.
Speaker 1: Yes, they have been revised down. To me, most of
Speaker 1: the data that has led to the revising down of
Speaker 1: these numbers is based on blood pressure, because there is
Speaker 1: honestly very little at this point controversy left about the
Speaker 1: data that pretty clearly shows that a reduction in salt
Speaker 1: intake from that about four grams of sodium, which is
Speaker 1: our average. Reduction from that reduces blood pressure, especially on
Speaker 1: a population level, and in most studies it reduces it
Speaker 1: to what would be considered a clinically relevant to so
Speaker 1: like about the same amount that you would see if
Speaker 1: you were starting someone on an anti hypertensive medication at
Speaker 1: a low dose, right, so not quite as good as
Speaker 1: blood pressure medicine, but you know at a population level
Speaker 1: you're going to be reducing blood pressure by reducing sodium
Speaker 1: intake from that current average of about four grams. The
Speaker 1: exact amount that you're going to get is going to
Speaker 1: very study to study. There's a lot of individual variation.
Speaker 1: Not every person gets the same degree of benefit, but
Speaker 1: across the board, like studies don't argue that lower sodium diets,
Speaker 1: Both interventional studies and observational studies agree that a reduction
Speaker 1: in sodium intake and lower sodium diets reduce blood pressure. Now,
Speaker 1: blood pressure is one of the major risk factors for
Speaker 1: cardiovascular disease, including heart attack, heart failure, stroke, and death
Speaker 1: from cardiovascular disease. High blood pressure is one of the
Speaker 1: major risk factors, so the biggest risk of diets that
Speaker 1: are high in sodium is an increased risk of cardiovascular disease,
Speaker 1: and this is where so much of this controversy lies.
Speaker 2: Is now the time to ask what the mechanism is
Speaker 2: between sodium intake and blood pressure?
Speaker 1: Great question? Yes, now is a great time to ask.
Speaker 1: So there's a complicated answer, which is a lot of
Speaker 1: like we don't quite know and the mechanisms da da
Speaker 1: da da. And then there's a simple answer, which is
Speaker 1: that when you consume more salt, because you're not excreting
Speaker 1: one hundred percent of it, some additional salt is going
Speaker 1: to stay in your body and that is going to
Speaker 1: tell your kidneys to hold not even tell your kidneys,
Speaker 1: kind of force your kidneys to hold on to water
Speaker 1: because water follows sodium yep. And so as your blood
Speaker 1: volume spans and your extracellular fluid volume expands because it
Speaker 1: will because you're holding on to water. By holding on
Speaker 1: to sodium, that is going to cause an increase in
Speaker 1: your blood pressure because you're increasing the volume in your
Speaker 1: blood and.
Speaker 2: Just more is shooting through those vessels.
Speaker 1: Right, you've got more sodium or holding onto more water,
Speaker 1: So now you have more fluids, so you have more pressure. Okay, Now,
Speaker 1: most of the time, if you're kidneys, which sense this
Speaker 1: increase in volume and sense this increase in blood pressure.
Speaker 1: What they should do is excrete more sodium because they
Speaker 1: can sense this and they can say, oh, we need
Speaker 1: to get rid of some sodium in order to get
Speaker 1: rid of some water because our pressure is too high.
Speaker 1: So what exactly happens in these especially long term high
Speaker 1: sodium diets, because this is not like a today tomorrow
Speaker 1: type of situation. This is like a long term trend
Speaker 1: that we see, Okay, especially in places where there are
Speaker 1: high sodium diets for a very long time. There's in
Speaker 1: like an increasing effect of high sodium diet with age
Speaker 1: and with time, And so what exactly is going on
Speaker 1: and what other miscommunications are happening between you know, our
Speaker 1: reunnin and geotensin system and aldosterone and all of these
Speaker 1: hormones and our kidneys and the receptors in our carotids
Speaker 1: that are also telling our kidneys in our brain how
Speaker 1: much blood pressure we have. Like there's some miscommunication that's
Speaker 1: going on that leads to over time and increase in
Speaker 1: blood pressure.
Speaker 2: And so our kidneys are just is it our kidneys
Speaker 2: that aren't responding as well?
Speaker 1: Or is it that's part of what we think is
Speaker 1: that it's like, for some reason or another there's a
Speaker 1: loss of some of this feedback where they're not able
Speaker 1: to sense this increase in blood pressure, or in some
Speaker 1: cases they even maybe go, hey, let's activate this system
Speaker 1: and actually increase blood pressure more or something weird, like
Speaker 1: a like a paradoxical kind of response. So it's not
Speaker 1: like a super clear cut but and it's most basic.
Speaker 1: You can think of it as you're increasing the amount
Speaker 1: of sodium, therefore you're increasing fluid, therefore you're increasing pressure.
Speaker 2: Why does age play a role?
Speaker 1: I mean, age plays such a huge role in our
Speaker 1: cardiovascular health overall. We see like a decrease in elasticity
Speaker 1: of the vessels. So is it that they're not able
Speaker 1: to expand to that increasing volume. There's a chronic inflammation
Speaker 1: that's going on, Like there's so there's so much So
Speaker 1: that's that's a different question. But yeah, so that's how
Speaker 1: we think that blood pressure is like involved with sodium. Right,
Speaker 1: So then the question is if we know that blood
Speaker 1: pressure is such a huge risk for cardiovascular disease, and
Speaker 1: diets that are high end sodium increase your blood pressure,
Speaker 1: do they increase the risk of cardiovascular disease, and that
Speaker 1: question has been fracked with so much controversy. Yeah, it has,
Speaker 1: so let me try and break it down a little bit. Okay,
Speaker 1: nearly all of the large scale meta analyzes that have
Speaker 1: been done to look at this question, does reducing sodium
Speaker 1: intake decrease cardiovascular mortality? All of these large scale meta
Speaker 1: analyzes do show a significant reduction in risk of stroke,
Speaker 1: heart attack, cardiovascular disease, and mortality from cardiovascular disease. The quality, though,
Speaker 1: of this data is not as good as the strength
Speaker 1: of the data that we have for this direct association
Speaker 1: between sodium and blood pressure. We don't have long term
Speaker 1: randomized clinical trial because that is very hard to do.
Speaker 1: As I said, at the first hand account, the estimates
Speaker 1: that I have seen are that to get really good
Speaker 1: data on this, you would have to enroll between seventeen
Speaker 1: thousand and thirty seven thousand people. You'd have to follow
Speaker 1: them for a number of years because you need to
Speaker 1: have enough unfortunately bad cardiovascular outcomes to be able to
Speaker 1: get that data, and it would cost between four hundred
Speaker 1: and nine hundred million dollars. So I know some people
Speaker 1: who could fund that, you know what I'm saying. Not
Speaker 1: like personally.
Speaker 2: But but are they willing?
Speaker 1: Are they willing? No? But what it also seems to
Speaker 1: me is that a lot of this controversy about the
Speaker 1: strength of this data and whether it is real or
Speaker 1: not hinges on a couple of types of data and
Speaker 1: a couple of studies that have come out. One of
Speaker 1: them is not just one study but a few studies.
Speaker 1: Like one type of study has found that there might
Speaker 1: be an increased risk of cardiovascular disease or death from
Speaker 1: cardiovascular disease at very low sodium intakes, closer to that
Speaker 1: one point two grams of sodium that a lot of
Speaker 1: people actually recommend, right right right, So there are some
Speaker 1: studies that suggest who have looked at like the lowest,
Speaker 1: the intermediate, and high sodium intake levels, some studies suggest
Speaker 1: that actually the risk of cardiovascar disease is very clear
Speaker 1: above like four to five grams of sodium intake a day. Okay,
Speaker 1: so like eight to ten grams of salt that is
Speaker 1: too much, But the recommendation should be more like three
Speaker 1: to four grams of intake and not this super restrictive
Speaker 1: one point five to two point three grams of sodium intake.
Speaker 1: That's what some of these studies say, okay, now the critics,
Speaker 1: I know you have questions like why what the critics,
Speaker 1: what's the mechanism? Yeah, yeah, what's the mechanism? Great question.
Speaker 1: I don't know. Okay, I don't know. They have not
Speaker 1: offered a mechanistic explanation. And some of the critics of
Speaker 1: these studies that have looked at what they call this
Speaker 1: J shaped curve right where like lowest intake is potentially
Speaker 1: harmful and higher intake is potentially harmful, so there's a
Speaker 1: sweet spot in the middle. Some of the critics of
Speaker 1: this say, look, in those studies that have looked at
Speaker 1: low intake or that have shown low intake to be
Speaker 1: potentially dangerous, that could actually be from what's called reverse causality,
Speaker 1: because in those studies they included a lot of people
Speaker 1: who also already had known cardiovascular disease or high blood
Speaker 1: pressure or heart failure. Those people might be more likely
Speaker 1: to be on a low sodium diet because they've been
Speaker 1: advised to cut out salt from their diet, and then
Speaker 1: they die from cardiovascular disease.
Speaker 2: It's very interesting that that is not something that would
Speaker 2: have been controlled for or right, you know, in those studies.
Speaker 1: Yeah, yeah, exactly, so mays like, actually need some better
Speaker 1: studies on this stuff. It's bananas. They also criticize some
Speaker 1: of the like methodological issues with some of those studies
Speaker 1: because they relied more on like spot urine rather than
Speaker 1: twenty four hour urine, which is how we measure sodium
Speaker 1: intake more reliably. But that's just like a lot of
Speaker 1: like it all just points to the fact that like
Speaker 1: these people say this data is not strong enough to
Speaker 1: show a strong link, and these people say this data
Speaker 1: is not strong enough to show a strong link, and
Speaker 1: it's like, my goodness, Okay, oh.
Speaker 2: It's really interesting. I think, like also in the context
Speaker 2: of evolutionary history, like our hominin ancestors. But at the
Speaker 2: same time, though, like how cardio of I don't even
Speaker 2: want to like this is like such a can of worms.
Speaker 1: Okay, listen, Yeah, there's multiple kinds of worms that you're
Speaker 1: about to talk about, and I want to get at
Speaker 1: one that you're saying this evolutionary history thing, because listen,
Speaker 1: the other camp of people who seem super adamant that
Speaker 1: we should not be pushing for lower sodium, that we
Speaker 1: should not be having our medical societies have a push
Speaker 1: for sodium. It should not be a public health goal.
Speaker 1: They seem to be in this group. Get ready for this?
Speaker 1: I get I'm too excited, they claim based on their data,
Speaker 1: they have done all these studies. They've looked at like
Speaker 1: fifty thousand people using these really great, high quality twenty
Speaker 1: four hour year in studies across a number of different
Speaker 1: countries with different cultures, et cetera. And over the last
Speaker 1: fifty years they say there's been no substantial change in
Speaker 1: our salt intake over time, and it follows a normal
Speaker 1: distribution between about two point six grams and four point
Speaker 1: eight grams of sodium a day. And therefore they say
Speaker 1: that is our physiologic need of salt because for the
Speaker 1: last fifty years it hasn't changed, and because it follows
Speaker 1: a normal distribution, that is what our physiological requirements are.
Speaker 1: This is a true argument that people are making in
Speaker 1: a bunch of studies. It seems to be mostly one
Speaker 1: dude who makes this arm and then get cited over
Speaker 1: and over and over in all the studies that are saying, well,
Speaker 1: this J shaped curve and don't you know our physiologic need?
Speaker 1: And I'm like, you cannot tell a human's physiologic need
Speaker 1: from fifty years of data. That's a post industrial revolutionary
Speaker 1: You're kidding me, m I was aghast.
Speaker 2: I mean, I'm not surprised the this is one of
Speaker 2: the most heated debates. I really is. It's like it
Speaker 2: also doesn't feel like a debate too it or like
Speaker 2: it feels like the arguments for we are like that
Speaker 2: is a ridiculous claim.
Speaker 1: To me, and yet Aaron, it is so cited. Okay,
Speaker 1: this J shaped curve, it seems like we need to
Speaker 1: investigate a little bit more. What is the ideal amount
Speaker 1: of assault consumption? That is, at its core the major question.
Speaker 1: There is no doubt that diets very high in sodium,
Speaker 1: especially over that four g of sodium, which is what's average,
Speaker 1: are going to increase your risk for blood pressure, and
Speaker 1: almost all the data also agrees that that will increase
Speaker 1: your risk for cardiovascular disease between this like one point
Speaker 1: five to four grams. There's people who just want to
Speaker 1: like fine tune this debate, which makes sense at a
Speaker 1: public health level, like we need to have recommendations, right, sure,
Speaker 1: but like I just the arguments that are trying to
Speaker 1: be made, I just I'm like, I get.
Speaker 2: I mean, in the past fifty years, how many people
Speaker 2: are smoking cigarettes? Like, does that mean that that's a
Speaker 2: physiological need? Right?
Speaker 1: Do you know what? Also, the rates of hypertension have
Speaker 1: also been stable over that exact same time period in
Speaker 1: which our salt consumption has been stable. So like, that
Speaker 1: doesn't tell us anything. It literally doesn't tell us anything.
Speaker 1: Our awareness and treatment have actually improved. So that's nice,
Speaker 1: but like, come on, it's not just blood pressure. Also,
Speaker 1: there are more and more studies and more and more
Speaker 1: data coming out that dietheset a high end sodium are
Speaker 1: also linked to a number of other potential diseases or
Speaker 1: whole body system changes that might result in disease. We
Speaker 1: see increases in inflammation, we see a potential for increased
Speaker 1: risk in autoimmune diseases. We see changes in the gut microbiome,
Speaker 1: and we see associations with certain cancers, especially stomach cancer.
Speaker 1: And we don't fully understand the mechanisms of these, but
Speaker 1: we know that more and more data is coming out
Speaker 1: that these exist, and so people are looking into like
Speaker 1: what could these mechanisms be. It seems to be that
Speaker 1: there's like changes in our T cell response, there's this
Speaker 1: like pro inflammatory state there's an increased in scret muscle contraction,
Speaker 1: et cetera.
Speaker 2: That's I think that's that's interesting too, This argument about well,
Speaker 2: this is our physiological need. If we have less than this,
Speaker 2: then we'll die and this is what we whatever. Like
Speaker 2: that also, I think, doesn't it dismisses these health these
Speaker 2: potential health res as something that is not linked to salt.
Speaker 2: But it because otherwise we would be eating less salt,
Speaker 2: right because otherwise, or we would have adapted to consume
Speaker 2: more salt somehow, the human species over the past five
Speaker 2: thousand years. But the other thing too, is that these
Speaker 2: all of these chronic conditions for the most part, like
Speaker 2: you said, there's this age component to it, yes, and
Speaker 2: so in which case, like it just is, yeah, it
Speaker 2: doesn't make sense.
Speaker 1: I know. It's there's also an argument that's like, well,
Speaker 1: we can't consume a lower sodium diet in our current
Speaker 1: society and it would require such a societal shift that
Speaker 1: therefore we shouldn't recommend it. Like what, it's too hard
Speaker 1: to do, so we shouldn't do it. High sodium intake
Speaker 1: is also associated with an increased risk of osteoporosis and
Speaker 1: kidney stones, and we think that it's by a similar mechanism,
Speaker 1: because when you are consuming more sodium, then you will
Speaker 1: have increased excretion of sodium, and calcium follows sodium the
Speaker 1: same way that water does soday. Okay, and overall, the
Speaker 1: World Health Organization estimates that there are nearly two million,
Speaker 1: the most reason data I saw said one point eight
Speaker 1: nine million excess deaths every year that are due to
Speaker 1: excessive sodium consumption.
Speaker 2: Okay, So I have some questions now, uh huh, give
Speaker 2: it to me. So, like we talked about, there is
Speaker 2: variation in individual sensitivity to sodium and the impact of sodium.
Speaker 2: What are some of the reasons for that, and how
Speaker 2: does that sort of just come out in the wash
Speaker 2: when we're talking about the levels of sodium that we're
Speaker 2: talking about.
Speaker 1: This is a really important question. So there's this phenomenon
Speaker 1: that is talked about in the literature of like salt sensitivity,
Speaker 1: so called salt sensitivity, right, And the thought is that
Speaker 1: maybe it's like fifty percent or or less, or some
Speaker 1: studies say more of people whose blood pressure specifically actually
Speaker 1: responds to an increase in dietary sodium. So they call
Speaker 1: those people salt sensitive. That is not a term that
Speaker 1: can be easily measured. There is not an agreed upon
Speaker 1: degree of salt sensitivity. How much of an increase in
Speaker 1: your blood pressure do you need to have to be
Speaker 1: considered salt sensitive. That's not a there's not a metric
Speaker 1: for that. But overall, yes, it is the case that
Speaker 1: not everyone's blood pressure is going to increase necessarily as
Speaker 1: a result of an increase in salt intake. Some people
Speaker 1: might have very low blood pressure on average, and in
Speaker 1: fact need more salt in their diet in order to
Speaker 1: maintain their blood pressure, and they could be at risk
Speaker 1: of hypotension having too low of blood pressure if they're
Speaker 1: not getting enough dietary sodium.
Speaker 2: What is clinical hypotension?
Speaker 1: Oh, it depends on your age, but and it depends
Speaker 1: on your if you're symptomatic or not.
Speaker 2: But yeah, okay, symptomatic meaning you're faint or like you could.
Speaker 1: Faint, you could pass out. But it kind of depends.
Speaker 1: Usually if you're talking about like under an nineties over sixties,
Speaker 1: that's that's pretty low, ok But someone who's you know,
Speaker 1: always quite a lot higher than that and suddenly drops,
Speaker 1: then you might consider that hypertensive. It kind of just
Speaker 1: cost okay, Okay, but yeah, so it does depend. But
Speaker 1: there it is the case that not every person needs
Speaker 1: the exact amount of salt in their diet. Public health
Speaker 1: recommendations don't apply exactly to every single individual. Equally, if
Speaker 1: you have certain conditions, you might need to follow slightly
Speaker 1: different recommendations. Then what is like the World Health Organization,
Speaker 1: the CDC, the FDA, they are making recommendations for the
Speaker 1: general public, and it's estimated that over seventy to eighty
Speaker 1: percent of adults are consuming significantly more than two point
Speaker 1: three grams of sodium per day. So the advice to
Speaker 1: reduce sodium applies to most people, not to everyone, which
Speaker 1: is also why you shouldn't be taking medical advice from
Speaker 1: podcasts or Instagram content creators because it doesn't apply to everyone.
Speaker 1: There's also another huge confounder that we haven't even talked
Speaker 1: about yet, and that is that this is true of
Speaker 1: all nutritional studies. But it's very true in all of
Speaker 1: these studies that look at blood pressure and cardiovascular disease
Speaker 1: and sodium, and that is that you cannot change only
Speaker 1: your sodium intake.
Speaker 2: Yeah, how different? Like what, Yeah, the foods that you're eating.
Speaker 1: The foods that you eat will change there is a
Speaker 1: very solid amount of data that shows an inverse relationship
Speaker 1: between potassium intake, for example, and blood pressure and cardiovascular disease,
Speaker 1: meaning for most people. Not true for everyone, because if
Speaker 1: you have kidney disease, this might not apply. But for
Speaker 1: most people, increasing your potassium intake can reduce your blood
Speaker 1: pressure and in some cases offset some of the effects
Speaker 1: of sodium. A lot of our nutrient dense whole foods,
Speaker 1: like fruits, vegetables, legumes, whole grains, these are high in potassium. Also,
Speaker 1: many of our salt substitutes. If people are going to
Speaker 1: swap out their salt that they're sprinkling or cooking with
Speaker 1: for a salt substitute, they're switching their sodium for potassium.
Speaker 2: What are some of these salt substitutes.
Speaker 1: Oh, I don't know. You just buy them at the grocery. Toot.
Speaker 1: It's called like substitutional substitute. It's a potassium salt. Sometimes
Speaker 1: it's just like pure what they're Yeah, sometimes they're pure potassium.
Speaker 1: Sometimes they're like a mixture of sodium chloride and like
Speaker 1: a potassium chloride or a potassium another potassium salt. There's
Speaker 1: been some really interesting data actually on using those, and
Speaker 1: then some of the really strong data is from like
Speaker 1: a big study in China where they took entire villages
Speaker 1: and they were like, you guys are getting salt substitute
Speaker 1: and you guys are getting real salt. And they saw
Speaker 1: significant decreases in cardiovascular mortality and strokes and all of
Speaker 1: these things, and decreases in blood pressure in the salt
Speaker 1: substitute group. But you can't quite disentangle the effects of
Speaker 1: potassium and sodium in that right, because they're connected.
Speaker 2: They're connected. And also, like you do a sub salt substitute,
Speaker 2: but most people don't. Most of the dietary salt that
Speaker 2: we consume is not from salt that we sprinkle on foods.
Speaker 2: It's from the salt that's in the foods.
Speaker 1: In the US, that's absolutely true. In this part of
Speaker 1: China where they were doing it, most of their sodium
Speaker 1: actually does come from discretionary sources. So that's why it's
Speaker 1: an interesting study in that case. But yes, you're right,
Speaker 1: for us, for most people in the US, in Canada,
Speaker 1: in Europe, our sodium consumption is mostly coming from things
Speaker 1: that are not the salt shaker on our table. I
Speaker 1: think it's most estimates are like fifteen percent or something
Speaker 1: of our sodium intake comes from adding salt to our foods.
Speaker 1: Most of it comes from the fact that every single
Speaker 1: food that comes in a package has sodium added to it.
Speaker 2: Yeah.
Speaker 1: Yeah, And so there is something to be said for
Speaker 1: the fact that all of the trials that have looked
Speaker 1: at long term sodium trends do not find that people
Speaker 1: are able to reliably stick to low sodium diets. Usually
Speaker 1: less than ten percent of people in these studies can
Speaker 1: stick to these limits of less than two grams or so.
Speaker 1: I do not buy the argument that this is physiologically
Speaker 1: driven at like an evolutionary level. This is a reflection
Speaker 1: of our food systems and the fact that it is
Speaker 1: very difficult even when you're trying to avoid sodium. But
Speaker 1: that doesn't mean it's not an important conversation, right, because
Speaker 1: if you're recommending fifteen hundred milligrams of sodium and it's
Speaker 1: impossible to do that in our grocery stores, you're setting
Speaker 1: people up for failure. So that's a problem too.
Speaker 2: Yeah, And it's also like more time consuming, more expensive.
Speaker 2: Often it's like you're yeah, it's hard.
Speaker 1: Yeah, here, and like at the bottom line, to me, okay, Kenna,
Speaker 1: if I can conclude, please, the biggest problem, the unspoken
Speaker 1: piece in all of these conversations about sodium and health
Speaker 1: and blood pressure is the same story as food dies.
Speaker 2: Yeah, what about food?
Speaker 1: Does single piece of our food system arin?
Speaker 2: Yeah?
Speaker 1: Yeah, there's some really interesting data that there's these long
Speaker 1: term studies that have been done on Japanese Americans living
Speaker 1: in Hawaii and Japanese people living in Japan, and they
Speaker 1: look at cardiovascular disease and blood pressure and all of
Speaker 1: these rates. We have and die from cardiovascular disease in
Speaker 1: the US at substantially higher rates than people in Japan.
Speaker 1: Like when you compare US to japan data, Japan has
Speaker 1: some of the best health metrics out there. They also
Speaker 1: consume so much sodium, significantly more sodium on average than
Speaker 1: in America than in the US. And in these studies
Speaker 1: that have looked at Japanese men and women and Japanese
Speaker 1: American men and women living in Hawaii, we see higher
Speaker 1: blood pressure in Japanese populations living in Japan, and yet
Speaker 1: higher cardiovascular disease in Japanese Americans living in Hawaii. Because
Speaker 1: guess what, it's not just sodium that's different in their diets.
Speaker 1: There's higher intakes of omega three fatty acids, there's higher
Speaker 1: total cholesterol intakes. There's also interestingly higher rates of smoking
Speaker 1: and alcohol use, but lower intakes of total calories and
Speaker 1: protein and fat including saturated fatty acids. Nothing that we
Speaker 1: eat is in isolation. Ye right, Yeah, so, yes, it
Speaker 1: is important to have these dietary guidelines, but these exist
Speaker 1: in the context of so many other foods, and it
Speaker 1: is one single part of your overall food system.
Speaker 2: This is fascinating and I feel like there is a
Speaker 2: to me, there is like a clear answer in many ways.
Speaker 2: Your sodium, yeah, am I Yeah, Honestly, while I was reading,
Speaker 2: I was trying to use less. I use a lot
Speaker 2: of salt. But I think I think you're right, Like
Speaker 2: my Yes, I can reduce my discretionary salt, but am
Speaker 2: I still gonna want, you know, salty crackers and stuff. Yeah,
Speaker 2: so I'm going to try to less or at least
Speaker 2: try to eat more whole foods.
Speaker 1: Like I mean, we all need to be doing that,
Speaker 1: that's true.
Speaker 2: Yeah, but yeah, I think I think it's like because
Speaker 2: I feel like I have. The more salt I eat,
Speaker 2: the more I want, and then it becomes like a problem.
Speaker 2: So maybe I'll try you know what, you know what,
Speaker 2: I do kind of want to try it. To the
Speaker 2: salt alternatives, Yeah yeah.
Speaker 1: My husband Trek got really into those for a while.
Speaker 1: We had a lot of potassium salt in the house
Speaker 1: for a while.
Speaker 2: Yeah, I'm intrigued.
Speaker 1: Yeah yeah, Well, if you're also intrigued and want to
Speaker 1: learn more about this debate or whether you should reduce
Speaker 1: your salt intake or not. My favorite paper, honestly was
Speaker 1: the one that I pulled that first hand account from,
Speaker 1: and it was by Hunter at All in Nature of
Speaker 1: Views and Nephrology twenty twenty two, The Impact of Excessive
Speaker 1: Salt Intake on Human Health. I thought that they did
Speaker 1: a really good job of explaining all of the controversy
Speaker 1: of providing the data. I know, not on quote unquote
Speaker 1: both sides, but like providing all of the data. They
Speaker 1: definitely have a bent, they think that we're eating too
Speaker 1: much salt. But I really enjoyed that paper. I also
Speaker 1: read it piecemeal, and I wish I had just read
Speaker 1: it all the way through at the beginning, because it
Speaker 1: was most of my stuff ended up putting from there.
Speaker 1: But I was like reading it and then I found others. Anyways,
Speaker 1: it's a great paper. There's also some interesting ones about
Speaker 1: like our regulation of salt appetite and like the you know,
Speaker 1: the salt drive and everything. So I have a couple
Speaker 1: of papers on that. And then literally, I mean so
Speaker 1: just so many papers. I think. Another great one was
Speaker 1: from twenty eighteen by he at All the Role or
Speaker 1: He and McGregor. It was the role of salt intake
Speaker 1: in prevention of cardiovascular disease Controversies and challenges. I enjoyed
Speaker 1: that one, but there's so many, including all of the
Speaker 1: controversial ones. You can find them on our website this
Speaker 1: podcast wkay dot com under the episode's tab.
Speaker 2: Thank you to Bloodmobile for providing the music for this
Speaker 2: episode and all of our episodes.
Speaker 1: Thank you to Leon and Tom and Pete and Brent
Speaker 1: and Jessica and everyone else that is exactly right for
Speaker 1: making all of this possible.
Speaker 2: Thank you, thank you, and thank you to you listeners.
Speaker 2: I hope you liked these episodes. Let us know what
Speaker 2: you think.
Speaker 1: Yeah, I'm very curious. Yeah, how much sodium do you eat?
Speaker 1: You don't have to tell me that you don't. There's
Speaker 1: no judgment here. And a special shout out as always
Speaker 1: to our patrons, thank you so much for your support.
Speaker 1: It means the world to us.
Speaker 2: Until next time, wash your hands, you filthy animals.