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Too Little Salt Can Cause High Blood Pressure

Both too much salt and too little salt can cause high blood pressure. A recent study analyzing 23 different studies of 274,683 participants shows that taking in too little salt may be even more likely than too much salt to cause high blood pressure and premature death (American Journal of Hypertension, published online April 1, 2014).

Last year, the Institute of Medicine issued a report concluding that there was insufficient evidence to conclude that severe salt restriction (reducing daily sodium intake to less than 2,300 mg) reduces risk for heart attacks or death. In response, the American Heart Association maintained its recommendation to reduce salt intake to less than 1,500 mg of sodium each day. This is the range of low salt intake that these recent studies show is associated with increased heart attack and death risk.

How Can Too Little Salt Cause High Blood Pressure?
When your body is low on salt, your adrenal glands produce large amounts of aldosterone and your kidneys produce large amounts of renin to help you retain the salt that you have left in your body. Both of these hormones also constrict your blood vessels to raise your blood pressure significantly.

Who Is Most Likely to Be Harmed by Salt Restriction?
Regular exercisers should think twice before they try to restrict salt. The more often and more intensely you exercise, the more likely you are to get into serious trouble from salt restriction. Exercisers lose a tremendous amount of salt through sweating. Your kidneys can retain a lot of salt when you are low on salt, but your sweat glands cannot. Vigorous swimming can cause you to lose two pounds of sweat in an hour, even though you won't see any sweat. Regular exercisers are also far less likely than non-exercisers to develop high blood pressure from excessive salt intake.

Signs of Not Getting Enough Salt
Your blood sodium (salt) level is too low when it is below 130 mEq/L. Salt restriction may result in delayed recovery from previous exercise, muscle weakness, pain and cramps, fatigue, nausea and vomiting, headache, confusion, loss of appetite, restlessness, irritability, seizures, falling, difficulty walking, and inability to concentrate.

Who Will Develop High Blood Pressure from Taking in Too Much Salt?
Not everyone who takes in large amounts of salt will develop high blood pressure. People who develop high blood pressure from excessive salt intake are called salt sensitive. Those who do not develop high blood pressure from excessive salt intake are called salt insensitive. The people most likely to suffer high blood pressure from excess salt intake are those who are insulin insensitive. They are the people who suffer from diabetes or from metabolic syndrome (pre-diabetes). They develop high blood sugar levels after they eat.

More than 90 percent of North Americans will eventually develop high blood pressure. The people most likely to develop high blood pressure from excess salt are those who already have high blood pressure. People who already have diabetes and those who are headed for diabetes should be advised to restrict salt and change their lifestyles to lower their high blood sugar levels. Also restrict salt if you do not exercise and therefore lose very little salt though sweat.

How to Tell If You Have High Blood Pressure
Check your blood pressure twice each day: during the day and before you go to bed each night. Take only a single reading each time and then average the blood pressures over the week for both daytime and bedtime readings. Normal blood pressure is significantly higher during the day than it is at night before you go to bed and in the morning when you first wake up. You have high blood pressure if the systolic pressure is above 120 mm Hg before you go to bed or when you first wake up in the morning, or if it is above 139 during the day.

How to Tell If You Are Likely to be Salt Sensitive
Salt-sensitive people are those who are likely to develop high blood pressure from taking in too much salt. If you are diabetic or pre-diabetic, you may be salt sensitive and probably should restrict salt. All of the following signs, symptoms and lab values increase your risk for diabetes:
• High triglycerides (greater than 150)
• Low good HDL cholesterol (less than 45)
• Fatty liver (on a sonogram)
• Fasting blood sugar above 100
• High fasting insulin levels
• Blood sugar above 140 two hours after a meal
• Storing fat primarily in the belly
• Narrow hips. small buttocks
• Increased small particle lipoproteins
• Blood levels of vitamin D below 75 nmol/L
• Being overweight
• Not exercising

Summing Up
I recommend that you buy and use your own blood pressure cuff to monitor your blood pressure. If you have day-time or bed-time high blood pressure, check with your doctor who may prescribe medication until you are able to bring your blood pressure under control with lifestyle changes:
• Limit restaurant foods, commercial frozen foods, bakery products, cold cuts, pizza, fried foods and so forth. About 80 percent of dietary salt for North Americans comes from processed and commercially prepared foods.
• Limit or avoid red meat, sugar-added foods and sugared drinks
• Increase fruits and vegetables
• Lose excess weight
• Exercise
• Check hydroxy vitamin D level

April 27th, 2014
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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