Live Heart Healthy. Live Well & Live Long

Low Sodium low Blood sugar; reverse causation

by | Jul 6, 2020

Don’t salt your own food because you hear someone has low sodium. That could be a catastrophic mistake. You wouldn’t start eating plain sugar because you hear someone suffered hypoglycemia, would you?
Hypoglycemia (low blood sugar) usually occurs in someone who is already diabetic. You should treat that with sugar immediately, otherwise it could be fatal. That, however, is not a good reason for everybody else to consume plain sugar to prevent hypoglycemia. Hypoglycemia is a problem usually in people who already have diabetes.
In the same way, average healthy individuals hardly ever have low sodium. Low sodium, with rare exceptions, is a problem in people who already are on multiple medications, are in renal failure, heart failure, taking chemotherapy or otherwise not in good general health and not able to consume a regular variety of food for any reason. Eating plain sugar and salt will drive you into getting these very problems which in turn can lead to low sodium or low sugar. This phenomenon has been described by multiple authors as “reverse causation”. We should be stepping up efforts to cut salt in our food. You don’t want to risk far too many health problems linked to salt to yourself or your loved ones in the name of “taste”. In case you missed it, high blood pressure, which is only one of the many problems linked to salt, is a bigger health problem when compared to tobacco; declared WHO almost a decade ago. On top of all the health problems we already know that are linked to table salt, we are learning in the last few years, that we are also reducing our defense against infections and increasing self-destructing auto-immune responses
Even medical professionals need to be more aggressively engaged in prevention of salt related health problems. Based on thousands of scientific papers, every medical organization in the world is recommending salt reduction. Yet medical professionals are largely on the sidelines especially when it comes to self-compliance and leading by example. Please see the attached, which is one of many review articles, titled “Understanding the science that supports population‐wide salt reduction programs”.
Despite the abundance of studies and data showing the deleterious impact of sodium, a few misunderstood articles about low sodium have hindered engagement. I urge my colleagues to look deeper into these articles and review the extensive criticism of these papers focused on the issue of low sodium. Please see the attached references that include these critiques from prestigious institutions across the globe written by prominent scientists who have dedicated most of their lifetime on this subject. These references come not just from one country, but from America, Canada, England, and EU.
For Example: Prof Francesco Cappuccio (President and Trustee of the British and Irish Hypertension Society, Head of the WHO Collaborating Centre for Nutrition, member of CASH, WASH, True Consortium – all unpaid) summarized one of major sources of this confusion as follows:
The PURE study, due to the numerous flaws highlighted in the last few years in international journals, is not fit to address any of the issues regarding salt consumption and cardiovascular outcomes.
Additional quotes from some of these papers are attached below.
Hypoglycemia and symptomatic low sodium have to be treated immediately. But to keep on simply eating salt and sugar may not be the best solution. There are better things you can do about low sodium.
First, rule out medication induced low sodium. Try to aggressively wean off all the non-essential pills. Then reduce the doses of the essential ones to the lowest level or stop entirely for a duration of time under the guidance of a medical professional. Add medications one at a time at the lowest doses as needed.
Low sodium could be an indication of renal, gastrointestinal or endocrine problems. Salt-wasting enteropathies and nephropathies have been described. To look into it will require a diligent physician who may order tests that are not the usual run-of-the-mill type, such as urine electrolytes.
High Potassium needs immediate attention just like hypoglycemia, however low sodium can be watched to a certain level if there are no symptoms. High potassium in combination with low sodium could be a sign of a deep-rooted kidney problem. A kidney specialist (Nephrologist) should be consulted at this stage.
Some of the most commonly used diuretics (water pills) by design will make the kidney lose potassium as well as sodium. Individualized selection of the right combination of medications may address this problem.
In summary, persistent low sodium needs a deeper look. Given the long list of health problems associated with salt, simply eating salt should be reserved for symptomatic low sodium situations, the same way as hypoglycemia.

Recommended for Further Reading:
Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network

Is Reducing Dietary Sodium Controversial? Is It the Conduct of Studies With Flawed Research Methods That Is Controversial? A Perspective From the World Hypertension League Executive Committee. Norm R.C. Campbell, MD;1 Daniel T. Lackland, DrPH;2 Mark L. Niebylski, PhD, MBA, MS;3 Peter M. Nilsson, MD, PhD4 The Journal of Clinical Hypertension Vol 17 | No 2 | February 2015

Understanding the science that supports population‐wide salt reduction programs Jacqui Webster PhD Temo Waqanivalu MBBS, MPH JoAnne Arcand PhD, RD Kathy Trieu MPH Francesco P. Cappuccio MD, DSc Lawrence J. Appel MD, MPH … See all authors

Lower Levels of Sodium Intake and Reduced Cardiovascular Risk No evidence for an increased CVD risk with very low sodium intake Cook NR, Appel LJ, Whelton PK Circulation. January 10, 2014 doi: 10.1161/CIRCULATIONAHA.113.006032
WASH response to Lancet publication

Selected Quotations:

“The PURE study, due to the numerous flaws highlighted in the last few years in international journals, is not fit to address any of the issues regarding salt consumption and cardiovascular outcomes.”
…Prof Francesco Cappuccio, President and Trustee of the President of the British and Irish Hypertension Society, Head of the WHO Collaborating Centre for Nutrition, member of CASH, WASH, TRUE Consortium – all unpaid.

“In our view, papers of poor scientific quality should not be considered as part of the evidence base.”
…Prof Graham MacGregor, Chair of Blood Pressure UK (BPUK), Action on Salt and World Action on Salt and Health. BPUK, Action on Salt and WASH are non-profit charitable organizations and Graham does not receive any financial support from any of these organizations.

“Salt consumption to prevent cardiovascular disease is strong and such new controversial studies – in particular the PURE Study – are inappropriate to address the complex associations between salt intake and CVD outcomes and should not overturn the concerted public health action to reduce salt intake globally…”
…A scientific statement from the European Salt Action Network


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