Diabetes and Salt Restriction







If you look at just about any dietary recommendation for diabetics, you will see that sodium restriction plays a prominent role, and a more prominent role I might add than carbohydrate restriction.  That's pretty bizarre actually given that we are definitely carb intolerant, and we may or may not have hypertension, high blood pressure in other words.

Ironically, it's too many carbs that are a big culprit in hypertension, because carbs cause the body to retain too much sodium, and a lot of carbs, and we as a species tend to eat a whole lot of them these days, causes a lot of sodium retention.

I found this out first hand actually, as even though I never had high blood pressure like my  father did, my systolic was in the 130's for several decades, although this is only higher normal.  So once I started restricting carbs after I found out I had diabetes, this sent my blood pressure down considerably, low enough to have clear symptoms.  

I'm fine now and the hypotension is long gone but I get a lot of salt in my diet, and that along with tweaking the carbs up some tool care of it.  I use all the salt I want now though, everything I eat is very salty in fact, and I average around 120/70, which is considered to perfect actually.  So when I read things like since I am a diabetic I have high blood pressure and need to be restricting sodium, this just causes me to shake my head.

As diabetics we tend to be cast into the same boat, I'm also told that I need to watch calories because I need to lose weight, I actually went from normal weight when I started treating my diabetes to significantly underweight, as restricting carbs and lowering insulin does cause you to lose weight, and now I've adjusted things and my weight is normal again, but I don't need to lose any and object as well to be given diets designed to do that, just assuming we all need to, this is all stupid.

So back to the sodium thing.  Depending on your carb consumption, you may actually need a lot of sodium not to have low blood pressure, and this isn't just me, others who are restricting carbs can see this happen as well.  Now the authorities who tell you to restrict sodium don't tell you to restrict carbs all that much either, but still, you would think they would be intelligent enough to at least say if you have high blood pressure you should reduce sodium, not since you are a diabetic you do.

Of course some of these authorities want all of us to restrict sodium, the blood pressure meter at the supermarket where I shop has a sign that tells everyone to restrict sodium, and I used to see that back when I had readings of 100/55 and such.  

It says ask your pharmacist about reducing sodium, so one time, back then when I was low, I said to one of the pharmacists here, if high sodium causes high blood pressure, and mine is low, does this mean I should be increasing it?  I got a lot of stammering and double talk and a talk to your doctor thrown in there and the whole thing was hilarious.

A lot of diabetics do suffer from high blood pressure though, especially ones that aren't restricting their carb intake too much.  A bigger question here though is, should people with high blood pressure be restricting their sodium?

Your answer might be, and actually almost certainly would be, well of course.  If you believe the medical authorities, well restricting sodium does lower high blood pressure, and lowering high blood pressure by restricting sodium is good, right?  Well people wouldn't even ask whether this is right, they would assume with certainty it is, but is this an assumption correct though?

For those who are interested in this, Dr. Jason Fung has a video out entitled Salt Scare which is very well worth watching for anyone who is either restricting sodium or is just interested in the topic.  

The bottom line here is that, yes, sodium restriction does lower blood pressure, but not anywhere near as much as we may think, about 5 mmHG for people with hypertension and about 2 mmHG for people without hypertension.

That's the good news.  The bad news is that sodium restriction might give you a little lower blood pressure, but it can also kill you, in other words it will shorten your expected lifespan.  

The lower blood pressure is a positive thing though, so this isn't how it increases morbidity, and the negative outcome overall is likely do to the way it messes with your adrenal hormones.  Sodium restriction increases all of them in fact.  While these increases are fairly small, they are significant.

So these things aren't particularly healthy for the cardiovascular system, and higher elevations are associated with increased risk here.  We can't just look at the at the alleged benefits of lower blood pressure without looking at the other side of the coin though, the negative effects of salt restriction.

So why do we think that sodium restriction improves cardiovascular outcomes anyway?  Dr. Fung cites the Intersalt Study, and points out the flaw in it, the inclusion of 4 primitive societies who at the time ate a low amount of salt but also are so distinct from the rest of the world in terms of their diet and lifestyle that they cannot be included.

So once you correct this flaw, it turns out that the association goes the other way, and higher salt intake is actually associated with lower risk of cardiovascular disease.  Even with the flaw included, the study shows that life expectancy is increased with higher salt intake, although that part was ignored as it doesn't grind their axes.

Dr. Fung cites further evidence showing the opposite of the official viewpoint, that more salt intake actually reduces not increases mortality, both cardiovascular mortality and overall mortality.

What if people already have high blood pressure though?  Surely they should eat less salt?  Well mortality goes up for them as well when they reduce sodium, and we have good evidence to show this.

So the evidence is actually pretty clear that we should be telling people not to restrict sodium, but instead to make sure that people are getting enough, which salt restricted diets do not provide.  As usual, conventional medicine focuses on one single component of something to the exclusion of other considerations, even when these other outcomes include a higher risk of death.  

The beat goes on though, sodium restriction still carries the day, and by sodium restriction raising adrenal hormones, well they have meds for that, such as beta blockers, and increasing cardiovascular disease also is pretty profitable, so they do have it pretty well figured out if profit is the goal, but we need to be a lot more wiser to not only this but everything else that conventional medicine has duped us with.

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