Salt intake in hypertension  and heart failure. Reduce salt? Increase potassium? 16

Salt intake in hypertension and heart failure. Reduce salt? Increase potassium? 16

Can we help?

Professor Ellison. What are the top two, three questions patients ask you? And what are the questions that patients should ask, but perhaps they don't ask as often? Well, patients have asked a lot of great questions. Certainly, the most common question is about reducing dietary salt. And I think, as I mentioned at the beginning, I think that there's been so much study and so much interest in salt. But the part that's often omitted from those discussions, if the discussions are had in the medical literature, is that salt is a component of food that does increase its palatability and its taste. I live in Portland, Oregon, where there are many, many great restaurants. But if I go to any of these restaurants, the amount of salt in the restaurant food is very high. And we were recently rated as the best restaurant city in the country. And it's probably partly because they're putting all that salt in the food. So, it's very easy to say that you should just stop eating salt and trying to adhere to the APA guidelines. But it's not so easy to do it. So, I guess my responses are twofold to that. The first is that, as I mentioned at the beginning, I think avoiding excess salt is a good thing, and you should try and do that. But just as important as trying to really increase the amount of potassium in your diet or increasing the ratio of potassium to sodium. I think it's easier to tell people to eat more of something than eat less of something. Dr. David Ellison, MD.: And so, eating more fruits and vegetables, eating more high potassium foods, I think is something I always recommend to patients. Dr. David Ellison, MD.: And so that may mitigate some of the adverse effects of salt. The other comment I have to patients is that most of this is not that much in the control of the patient, I think it's hard to to live in today's world without encountering salt when you go out when you eat in restaurants. But I do think we should encourage the industry to reduce the amount of salt because in this country, unlike in China, most of the salt we get in our foods is as in processed food, there's a ton of salt in bread, for example. And all processed foods are very high in salt. And I do believe that the industry could reduce the ratio, the amount of salt or increase the ratio of potassium to salt. And that would be beneficial for all of us. And that wouldn't force people to make these hard choices when you sit down to eat a meal in a restaurant or sit down to eat something you've taken out of the refrigerator. Obviously, if you can do it, eating fresh, fresh food is better. But I think that it would be great if we could somewhat reduce the amount of salt in food and I think that would be palatable, perhaps replacing it with a little bit of potassium, because that is a salt substitute and most people think salt substitute tastes pretty good. So, I think that's the number one question. The number two question is really related to it. So that's for general health. The number two question is, Doctor, I have heart failure, do I need to reduce the amount of salt I take in and again, that's a controversial subject. We always caution that diuretics are most effective if you reduce your dietary salt intake. And I think that's pretty clear in patients who are in a steady state. But there's been some very provocative data recently suggesting that in acute decompensated heart in acute decompensated heart failure patients, aggressively restricting salt intake when those patients come into the hospital doesn't appear to be beneficial, and it may actually be harmful. Dr. David Ellison, MD.: And so, the potential problem with restricting dietary salt intake severely is that it activates the renin-angiotensin-aldosterone system. And we know the renin system is very important as an important contributor to the pathogenesis of heart failure, and probably also due to hypertension. Dr. David Ellison, MD.: And so, if you restrict your dietary salt intake too much, that probably has more of an effect to activate the rest, and may not be beneficial in those patients. So, I tell all of my patients, in most situations that I am a believer in the Goldilocks effect. I think that reducing excess salt intake is important. But I also think it may be possible to reduce salt intake too much. And especially considering the fact that those very low salt foods are often not the most appealing to the average American. It's more important to reduce it somewhat than to try and reduce it to zero, and then replace it with potassium, if you can.