That Low Salt Diet Probably Won't Prevent Heart Failure

There have been lots of recommendations over the years to eat a low-sodium diet. We've talked about the evidence on this before. Well, get ready to taste salt again. Research points to the conclusion that low sodium diets don't do much to help with heart failure.
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[@derektober8736]

"...the assurance with which we speak should match the quality of evidence behind our recommendations." Words to live by.

[@Elspm]

This quote should definitely be on a t-shirt

[@kthfox]

Lazy science hurts us all. Keep fighting the good fight against over-hype, my man. Love your content.

[@arthas640]

I've always thought that "salt causes heart disease" seemed flawed, even when i was a kid and didn't know anything about medical science. Some of the healthiest people on the planet like the Koreans and Scandinavians eat very salty foods and they're living long lives. Until very recently people ate alot of pickled and salted foods (a serving of kimchi or sauerkraut each have 1/3 to 1/2 of your daily salt intake), and if they were eating a ton of salt (i've heard their average intake was 4 or 5 times ours) you'd expect them to suffer heart failure, heart attacks, or other fatal cardiovascular problems at a higher rate then modern people but that isn't true. The low salt diet was just a "quick fix" that doesn't seem to effect our health that much.

[@alexshih3747]

@@arthas640 Also, dietary fat and cholesterol aren't actually harmful for the most part. Added sugar and vegetable oils are the real poisons.

[@MindlessTube]

Hate when people say eat more healthy, when no one can agree on what is or not is healthy.

[@mexicanjesus3055]

Eat more fruit. Eat more vegetables. Avoid processed foods. Simple

[@donkeykong315]

Not easy, but simple.

[@user-vn7ce5ig1z]

My mother ate healthy her whole life but suddenly got CHF. They put her on a low-sodium, low-liquid diet but it did absolutely nothing and she still ended up dying. ☹ It pisses me off when they come up with new information and such after it's too late. 😒

[@ooooneeee]

I'm sorry.

[@patienceachope7958]

So sorry for that

[@DrDeFord]

As I understand it (as an emergency physician), the low salt diet isn’t supposed to prevent or improve heart disease, but reduce circulating volume in CHF, thereby preventing exacerbations and cardiogenic pulmonary edema. This is just the flip side of the use of diuretics in heart failure. The studies you cite don’t seem to address that.

[@danieljensen2626]

If they don't address that then it means there are no studies supporting the use of salt restriction for that purpose though... Seems pretty likely that would have been mentioned in the meta analysis if there were any.

[@ooooneeee]

@@danieljensen2626 meta analyses are not immune to bias in which studies they choose to not include.

[@thatjillgirl]

Yeah, I was also reminded of loop diuretics. We know they don't improve mortality in heart failure. We give them to help with symptom control.

[@gardenhead92]

I love salt but I want to stick to a low-sodium diet, so now I just eat chloride

[@TMM6900]

NaCl

[@peter_smyth]

You must be very negatively charged by now.

[@hoy8039]

Thank you for shining light on this. For reference I was also under the impression that salt was terrible for u and avoided it like the plague. But was always tires and sluggish especially after working out. Joined the and was actually told to salt my food at every meal. Reason is to encourage replenishing the salts your body sweats out as well as helping your body absorb nutrients from your food to aid in recovery.

[@bdf2718]

Going by what my doctor told me, aren't there other consequences to hypertension than heart failure? Like strokes? Dropping dead of a heart attack doesn't worry too much (as long as it's fairly quick). Spending years incapacitated by a stroke does.

[@thatjillgirl]

Yep. Keeping blood pressure within a healthy range can help decrease risks for several things, including stroke.

[@jorellaf]

Can we get the citation links (at least the DOI or the title and author) on the description? Would be really useful. Thanks for your work!

[@ooooneeee]

Seconded

[@eugenetswong]

Isn't that text at the bottom left of the screen an unofficial citation? Isn't it good enough?

[@jorellaf]

@@eugenetswong Sure, but then we need to find the timestamp, pause the video, type it ourselves from the video and then search for it instead of just clicking the DOI link or copy pasting it.

[@TinyMedicine]

Just 2 weeks ago, on my Final examination of Medical school, I wrote a full page on instructing a patient with hypertension. Of course, I emphasized that I will advice the patient to cut daily salt intake. But in my defense, all most all medical textbooks ( even Kumar & Clerk) recommends cutting down Salt.

[@zupnikal]

Cut junk food, eat meat, salt to taste, drink water. #NSNG

[@Chamelionroses]

@@zupnikal true but most westerners do not do this. Either to much ir to little of whatever is done. Then the consequences happen.

[@kgal1298]

I think because if you look at foods with high salt they're normally processed. If you cook at home you won't be hitting as high of levels of sodium in your food thus lowering it. Notice a lot of people with hypertension usually aren't in the best of shape and rarely work out, this isn't constant of course, but it is something you notice when you meet these people. Same with diabetes really.

[@zupnikal]

@@Chamelionroses I was forced, a decision was made. The End. I cannot go back to my old ways.

[@xblur17]

My 2µF meat increases heart disease rates. Eat more veggies and fiber.

[@thatjillgirl]

You know, it occurred to me that this kind of relates to medications for heart failure. The whole idea behind recommending low salt for heart failure patients is, I think, that it will decrease water retention, which will in turn help relieve *symptoms* of heart failure. Similarly, loop diuretics are often used in heart failure for the same reason--they help with symptoms by decreasing blood volume. But it's already known that loop diuretics are *not* one of the medication classes that actually improve mortality in heart failure, even though they can make patients feel better. So I suppose it's not that surprising that low salt diets could be the same. (Although perhaps low salt diets can also make patients feel better? Which is not nothing. Improving mortality is the primary goal, but improving quality of life definitely counts for something.)

[@shamanthbv]

Some doctors say low sodium and potassium will lead to heart failure as these elements are required by muscles to fire and to produce heart beat, but what I have seen is people with high blood pressure completely stop taking the salts which is also not advisable. Only wise thing is to reduce the intake and not completely elemenate the salt from your diet. What is your take on this?

[@christhecurler]

If you want to become a better cook and make really delicious food, the best thing you can do is properly season your food with salt.

[@aarons8711]

+

[@lohphat]

Cardinal rule for shooting video: Don't wear clothes with regular orthogonal patterns like tightly-spaced stripes as it causes moiree patterns.

[@bdf2718]

Could be worse. On old-style analogue TV it could also cause irritating colour fringes when the spatial frequency of the stripes happened to match the chroma sub-channel frequency.

[@paulfoss5385]

Is that bad? I think they look cool.

[@aethylwulfeiii6502]

It’s called aliasing, very mesmerizing. Triggering to the photosensitive.

[@jordanmjk0]

Could you link your sources? I want to check this out myself.

[@raniasham3176]

Don’t agree my dad with diastolic failure when the dr increased his sodium intake he developed edema in legs then in lungs

[@caseyweimar6333]

You figure salt aka sodium, since it's an ESSENTIAL MINERAL TO RUN THE HEART, wouldnt be so restricted in cardiac pt's.. but that's just me.

[@hiccuphufflepuff176]

Here's a random fact that surprised me: whole wheat pasta has a lot of potassium in it, about as much as potatoes by dry weight. Not sure if white pasta is the same. That's according to the brands in Canada that choose to list potassium on the nutrition guide. Single ingredient: "durum whole grain whole wheat semolina." So if you're like me and eat a lot of pasta and bananas, too much potassium might be something to watch for.

[@ExPwner]

Besides potassium, why don't they also point out increasing intake of WATER? Does water not also have an inverse relationship with sodium? I don't think that you mentioned it anywhere in this video, yet bodybuilders constantly talk about the interaction of sodium and water when competing.

[@joshuacook2]

Where are the results from these studies? They should be complete by now, right?

[@timwcronin]

Do you ever feel you're yelling into the abyss about evidence based medicine? I have a few doctor friends and whenever I talk about procedures that shouldn't be done because they have no basis on evidence, and that medicine is slow to change, they're incredulous.

[@pida9669]

The 2020 PROHIBIT trial showed showed that patients with heart failure randomly assigned to a lower-sodium diet (1500mg/day) for 12 weeks did not have any increased adverse effects, but did have an increased quality of life when compared to the higher-sodium diet (3000mg/day). Study details: pubmed.ncbi.nlm.nih.gov/31959014/ I also did a thorough fact-checking of the potential risks of higher- versus lower-sodium diets here: rebelthoughts.org/fact-checking-the-salt-fix/ Take care and be well!

[@aethylwulfeiii6502]

Hospital patients aren’t really typically sweating and doing hard marathon workouts.

[@jessicaonymous4352]

I enjoy the use of the pill to switch between scenes

[@abqmalenurse]

I'm a nurse with years of cardiac experience. Only time I advise patients to adhere to a low sodium diet is if they have some form of renal (kidney) impairment.

[@pida9669]

You may want to check out the in-depth fact-checking I did on higher- versus lower-sodium diets here: rebelthoughts.org/fact-checking-the-salt-fix/ Take care and be well!

[@elenora67]

Hi. What do you reccomend for salt intake for someone with CHF and edema

[@ghostfoxsarah]

I've known too many kids, teen girls in particular, get seriously sick from their parents forcing them on a low salt diet. These girls were all healthy to almost underweight to begin with.

[@MsCellobass]

A lot of the medical profession don’t know what the heck they’re doing!! My mother nearly died at the hospital because of low sodium.

[@iKhanKing]

I have to say, as a medical student, I love your show. It really helps me engage with some of the new research, and to think critically about evidence based medicine. The video about stenting for stable angina, actually put me in an interesting conversation with my Cardiology professor.

[@OmegaGrape]

People on keto talk about how you need more than it's recommended! Cool stuff

[@allyourpcarebelongtous8744]

Erm that's because when we do keto, we're removing carbs from our diet and so need extra help retaining the water carbs normally assist in retaining. I wouldn't necessarily tell a person on a non-keto diet to eat lots of salt - especially at the levels of keto dieters. I mean, I get something like 3T a day. I don't know that someone eating carbs needs to consume that much. With that said, I don't think salt is the devil, either. If you're feeling bloated or having an off heart beat, your sodium is too high. You should be looking for signs like that instead of going off any arbitrary number recommendations.

[@Odin0292]

@@allyourpcarebelongtous8744 Another reason to increase salt on keto is becaus you eat less carbs, thus you have lower insulin levels. Higher insulin levels increase reabsorbtion of sodium in the kidneys and with lower levels you excrete more.

[@Chamelionroses]

@@allyourpcarebelongtous8744 when you take away from nutrition in diets other ways need replaced. This from carnivore diet to vegan diets still a person needs balanced nutrition to stay healthy.

[@piteoswaldo]

@@allyourpcarebelongtous8744 "I get something like 3T a day" 3 teslas every day? That's a strong magnetic field you're being exposed!

[@allyourpcarebelongtous8744]

@@Chamelionroses I don't get your comment. You restated what I already stated. Not certain what the point was you were getting at

[@chelseascreatures]

Has their been an update on these studies?

[@constexprDuck]

Very interesting video. Also interesting moire patterns on your shirt!

[@itbakkawi]

I'm a big fan of your channel, but could you include the article sources at the bottom of the description?

[@SabbathSOG]

Great info. Thx. 😊

[@Trendle222]

all i know is when i cut out the salt to a great degree and stopped averageing 6-7000 mg of sodium a day and now take in about 1000mg a day, my heart stopped skipping beats and is now super 'calm' , unlike before after a high 3000mg sodium meal beating out of my freaking chest. i think lowering sodium to a lower level HAS to be healthier from my personal experience. Sure u need some, but a lot of sodium is in most foods (chicken, veggies, fruit....) we dont need to add that much more! this is ridiculous

[@user-nu8in3ey8c]

Sodium in congestive heart failure can cause an increase in edema, and that edema can back up into the lungs and cause problems with breathing. It is easily observable that consuming sodium(and other electrolytes) by a sufferer of heart failure will result in an increase in edema. Edema can be life threatening if it backs up into the lungs.

[@95GuitarMan13]

I would like to see a video on the AHA's "Life's Simple 7"

[@Chamelionroses]

That thing about moderation per person needs in health. The thing about consistant to much salt as like in Jilly Juice of course is a bad thing.

[@kd1s]

Consider we've been lied to about salt and fat for decades. Salt or sodium as I know it is necessary to nerve signaling and cellular metabolism. And without fats and cholesterol we wouldn't have cell membranes, or the myelin sheath over the nerves in our spin.

[@spencerlemon2679]

What I've Learned did a few good videos on myths about salt

[@bruceliu1657]

Might be the sodium and potassium pump. Need both for the micro machine to work.

[@aethylwulfeiii6502]

Definitely don’t need 3000 milligrams of sodium chloride.

[@bekkayya]

Covering why bad medical sciece is good and I'm glad you do it but its depressing after a while. Any chance for a video on what we -should- be doing? Or would that be like 2m of saying "diet and exersize"?

[@bekkayya]

we need like an general MPAA-like rating while talking about sciece so people can get an idea how solid it is.

[@scotthendricks5665]

So you are saying take my Metamucil?

[@jabberwockydraco4913]

episode on keto?

[@Luchoedge]

Solution: Salty bananas.

[@alexascencio2553]

Lucho-Core facts.

[@Nhoj31neirbo47]

I wonder if consuming less refined products than ‘table’ salt is a healthier option. There are salts that are complexes of minerals and are usually grey, brown, pink or flecked with color. Personally, just as I avoid refined sugar, I try to limit my consumption of refined salt.

[@mathieulemoine1294]

Isn't an excess of salt/sodium also associated with other negative outcomes such as water retention? Or is that a myth as well? #WhatsTheEvidence?

[@asn9337]

if there is one thing that gets hammered into medical students' is that patient with heart issues should restrict sodium intake. it's like gospel. do say smth else during grand rounds would be unthinkable :))

[@peanut12345]

Do not mention Sea Salt to maintain the blood and heart system or real health{not DR. Health}. Low salt causes heart problems.

[@stevendv8487]

No harm to low salt intake? Who with a shred of knowledge believes that!

[@heeseungswifereal3453]

Might not but sure ass hell it's going to sent fluid rich blood to your lungs

[@jeanku]

The problem is not salt... The problem is all the crap that people buy at stores or restaurants that have sodium and others, thats the problem for americans. They restrain salt from thr diet which is actually good but keep on consuming the other stuff that is bad.

[@xblur17]

This channel has become all about promoting bad habits. Drink some alcohol, add some salt to your diet, don’t worry you’re good! P.S. if you’re reading this, look up the WFPB diet if you actually want to do something good for your body.

[@reinux]

I get that EBM is conservative by design, but this channel seems to get a hard-on from citing null-result articles over all else. You're not going to get a double-blind placebo-controlled trial for everything. Rejecting everything that isn't, even when the evidence is of reasonable quality in other ways, is kind of absurd.

[@JSBPisgah]

Wait a second...even if lowering sodium is just a best guess at this point, MD's don't have the luxury of recommending only those treatments with very strong support if there aren't superior alternatives. Other dietary changes and exercise have poor compliance, right?

[@SaucerJess]

💙

[@kgal1298]

But every Instagram influencers for diets says you should have less than 1500mg a day. LMAO I wish I were kidding. Here's the thing if I could my food at home and track I might be taking in 600-800 a day with a few days per week with higher levels if I eat out. People need to stop quoting studies that lack research though. Most studies are out to find a link anyway so if the studies intent isn't an answer to your question then it's probably not totally correct. You also have a lack of long terms studies in nutrition leading to a lot of people assuming things about eating a certain way. Though to be fair I prefer eating Meditteranean style because it's less meat-heavy, but that's a personal preference.

[@Bastispark]

So in a nutshell... Eat more Bananas to increase Potassium and fibre intake

[@mvsawyer]

no, they are not giving you dietary advice. The point is to evaluate the data and make assurances in accordance with it.

[@mvsawyer]

Brought to you by Big Sodium.

[@DavidRichardson28]

Salt does not cause high blood pressure or heart disease. High fat, high cholesterol diets do.

[@danieljensen2626]

Dietary cholesterol actually doesn't affect either of those things, and fat probably doesn't really either... Most overweight people are eating too many carbs. But also, diet is complicated and it's not that strong of a research field.

[@DavidRichardson28]

@@danieljensen2626 Lololol I eat over 500 grams of carbs a day.. Every single fruitarian, vegan, whole foods diet is high in carbs. Lolol heart disease is way down, cancer, high blood pressure, diabetes.. All down in HIGH CARBS GROUPS.. Take a person eating what you think is a clean diet and feed them a whole foods diet and their risk factors drop by far. Stop it. All of the science supports cholesterol as being the top contributor to heart disease

[@danieljensen2626]

High blood cholesterol is related, but that actually has nothing to do with dietary cholesterol. Simple carbs (sugars) are more the problem, fruits and veggies have a lot more complex carbs. Plus a lot of those diets are just really high in fiber so you don't actually digest everything you're eating.

[@DavidRichardson28]

@@danieljensen2626 so you'll go against thousands of studies and all of the leading figures in science because you say so. Lololol.

[@danieljensen2626]

@@DavidRichardson28 There aren't thousands of studies on any dietary issue, dietary science is kinda trash tbh, but what studies there are are more contradictory than you think. Cholesterol: kzbin.info/www/bejne/p6XUeXmCmKiJidU Fat: kzbin.info/www/bejne/pXqznWiuhb59gLc