As of 2023, it is estimated that 49.1% of adults aged 20 and older in the United States are diagnosed with hypertension and are at risk for Coronary heart disease. This is a national serious health concern. The cause of hypertension and heart disease is multifaceted and the removal of one or two nutrients from the diet will not solve the problem.
Every hypertensive client who enters my office had been making drastic efforts to remove sodium from their diet. They don’t add salt to home-made meals and season with salt substitutes; everything they buy is either low-sodium or sodium-free; they avoid soy sauce, potato chips, and eat their popcorn unsalted. They always read food labels before every purchase. Yet, their blood pressure keeps creeping up, and many of them have had to increase the dose or change medication altogether. Despite this failure to manage hypertension with sodium control, doctors are still recommending a low-sodium diet as the ultimate solution for lowering blood pressure.
Why Is Sodium Ostracized
How did sodium get into so much trouble with the medical community? It began with two French scientists, Ambard and Beaujard, over a century ago. They observed that salt (sodium chloride) restriction improved blood pressure levels in a few hypertensive patients. At the time, the hypothesis was that chloride retention increased blood pressure, not sodium. The study sample these scientists used was very small, about 6 people, and it was revealed later that it was not properly controlled. Even then, the results showed only a minor decrease in a few hypertensive patients in the study. But that sparked the interest of other scientists to look into the question.
In the years and decades following this discovery, other scientists tried to study the effect of sodium and chloride on hypertension, potassium and sodium, or just sodium alone. Studies remained conflicting and failed to show significant results. Moreover, these early clinical studies that showed some results with low salt diets “lacked pretreatment control observations. None were randomized controlled trials but rather case reports, mainly in hospitalized patients, and the simple act of being hospitalized was thought to provide much of the blood pressure–lowering “benefit” with salt restriction in these studies.
So, although many of these studies were reporting significant falls in blood pressure with salt restriction, genetic or environmental factors may influence a person’s sensitivity to sodium. “In sodium-sensitive hypertensives, modest dietary sodium restriction is beneficial in both reducing blood pressure and in controlling the elevated pressure with medication.” (1)
Even with better-controlled studies conducted by other scientists of the same era, salt reduction lowered blood pressure in less than half of the patients tested, and no effect was noted when high salt intake was resumed. Another significant factor to point out is that most of the hypertensive patients tested had kidney disease.
Scientists further advised that sodium restriction had negative health implications and was not a solution for hypertension. Lack of sodium impairs blood flow to the kidneys, reduces glomerular filtration rate, and puts patients at risk of renal disease. The study also showed that a few patients who were placed on sodium restriction had their kidney function return to normal after the administration of 30 grams (6 teaspoons) of salt a day.
In summary, here is what we knew in the first half of the 20th century about the relationship between salt and hypertension:
- Early findings attributing benefits of salt restriction on hypertensive patients were drawn from poorly controlled case reports
- Later, randomized and better-controlled studies failed to establish a strong link between low-salt diets and hypertension. Only 25% of the patients responded positively
- Further studies confirmed that low-salt diets were not the best treatment for hypertension. The food didn’t taste good; the diet had a small to no effect on hypertension, and the patient’s experience was overall negative
- Evidence showed that prolonged salt restriction leads to severe health consequences
- The results of all previous studies were inconclusive, misleading, and confusing at best
Root Cause of Hypertension
So, where does that lead us? Hypertension is a complex disorder based on genetics and lifestyle choices that put individuals at high risk for cardiovascular disease. Its prevalence continues to increase and affects over 30% of the global population, to count only diagnosed cases. Numerous studies conducted in more recent years still haven’t found strong evidence that sodium restriction reduces blood pressure. But they have confirmed one thing: some people can tolerate high levels of sodium while others cannot. So, the new label is salt sensitivity. For the longest time, it was believed that only kidney function impairment played a role in sodium accumulation and elevation of blood pressure. But recent data has proved otherwise.
“Recent studies suggest that nonosmotic salt accumulation in the skin interstitium and the endothelial dysfunction which might be caused by the deterioration of vascular endothelial glycocalyx layer (EGL) and the epithelial sodium channel on the endothelial luminal surface (EnNaC), also play an important role in nonosmotic storage of salt. These new concepts emphasize that sodium homeostasis and salt sensitivity seem to be related not only to the kidney malfunction but also to the endothelial dysfunction”(2).
It’s now clear that the pathophysiology of hypertension is still a mystery and further research is needed to understand this disorder.
As of now, sodium restriction should focus more on the reduction or elimination of processed food, cheese (one of the highest foods in sodium), and low-end restaurant foods, which are always high in saturated fat, food additives, high sodium/low in potassium, poor in fiber and most micronutrients.
In the 18 years I have been changing people’s diets, I have never modified my recipes to be low in sodium. I always used salt in everything I made, including desserts. I use soy sauce, miso to season different dishes and never use any salt substitutes. My clients are always pleasantly surprised when I tell them that they can season their food with real salt. Yet, after a few weeks on the MicroRiche diet (less than three months), everyone without exception had their blood pressure drop significantly. Many clients reduced the drug dose while others were able to do away with the medication completely.
It’s worth noting that some people’s hypertension will always necessitate pharmaceutical therapy. Age, menopause, and genetics play an important role in all aspects of health. But if they follow a healthy diet daily, they will only need a small dose to stabilize it.
How to Prevent Hypertension and Heart Disease
It goes without saying that high blood pressure can lead to coronary heart disease (CHD). Reducing the risk takes more than sodium control. The following list is a starting point, but each person needs an evaluation, a personalized nutrition plan that addresses all aspects of health to improve the outcome.
- Eliminate processed foods. They contain more than sodium. They are loaded with simple sugars, saturated fat, food coloring, and so many toxic chemicals that will increase the chances of inflammation, type 2 diabetes and weight gain.
- Reduce stress. This is one of the major causes of hypertension and heart disease. There are many ways to reduce stress, but the first step is to get enough sleep and rest.
- Reduce consumption of animal foods. Eggs and meat are high in saturated fat and lead to clogged arteries
- Eliminate dairy. This is the number one allergen in the Western diet, closely followed by gluten. Avoiding cow products will reduce inflammation, weight gain, gut dysfunction, fatigue, sinus infections, and so many health problems
- Reduce alcohol consumption
- Increase intake of green leafy vegetables, fruits, nuts, and seeds. They are high in phytonutrients that fight inflammation and disease
- Replace meat with plant-based protein sources (beans, lentils, chickpeas, nuts, seeds, tofu) at least 3 times a week
- Drink at least 2 liters of water a day
Find heart-healthy tips in this article “Heart Healthy Foods Can Beat Cardiovascular Disease” (3)