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Sodium, Calcium and You

PostPosted: Wed Apr 16, 2008 1:25 pm
by JeffN
Greetings All,

This article came out today and is another one that supports the sodium guidelines I recommend.

The calcium recommendations in the USA are high not just because of the high animal protein we consume but also because of the high salt levels in our diets.

Notice that there was a negative calcium balance on the high sodium diet, even with a high calcium intake.

The level of sodium on the high salt diet is similar to the level we consume in this country and the level of sodium on the low sodium diet is similar to where you would be if you followed my guidelines and those of Dr Mcd


- Ensure adequate calcium from plant foods
- Minimize/Eliminate animal protein
- Limit Added Sodium

In Health
Jeff

Sodium and Bone Health: The Impact of Moderately High and Low Salt Intakes on Calcium Metabolism in Postmenopausal Women.J Bone Miner Res. 2008 Apr 14;PMID: 18410231

Abstract

High salt intake is a well-recognised risk factor for osteoporosis because it induces calciuria, but the effects of salt on calcium metabolism and the potential impact on bone health in postmenopausal women have not been fully characterised.

The present study investigated adaptive mechanisms in response to changes in salt and calcium intake in postmenopausal women.

Eleven women completed a randomised cross-over trial consisting of four successive five week periods of controlled dietary intervention, each separated by a minimum 4 week washout. Moderately low and high calcium (518 mg versus 1284 mg) and salt (3.9 g versus 11.2 g) diets, reflecting lower and upper intakes in postmenopausal women consuming a Western-style diet, were provided. Stable isotope labelling techniques were used to measure calcium absorption and excretion, compartmental
modelling was undertaken to estimate bone calcium balance, and biomarkers of bone formation and resorption were measured in blood and urine.

Moderately high salt intake (11.2 g/d) elicited a significant increase in urinary calcium excretion (p = 0.0008) and significantly affected bone calcium balance with the high calcium diet (p = 0.024). Efficiency of calcium absorption was higher following a period of moderately low calcium intake (p < 0.05) but was unaffected by salt intake. Salt was responsible for a significant change in bone calcium balance, from positive to negative, when consumed as part of a high calcium diet, but with a low calcium intake the bone calcium balance was negative on both high and low salt diets.

PostPosted: Wed Apr 16, 2008 1:56 pm
by Jaggu
Jeff,

Do you recommend any sodium substitute?

PostPosted: Wed Apr 16, 2008 1:59 pm
by JeffN
Jaggu wrote:Jeff,

Do you recommend any sodium substitute?


Yes, fresh herbs and spices. :)

And, the natural taste of food.

If you give up sodium you will quickly lose the taste for it.

In Health
Jeff

PostPosted: Thu Apr 17, 2008 7:09 am
by DianeR
What level of sodium do you recommend? And is this figure an average consumption level or the level one should not exceed on any given day?

PostPosted: Thu Apr 17, 2008 7:25 am
by JeffN
DianeR wrote:What level of sodium do you recommend? And is this figure an average consumption level or the level one should not exceed on any given day?


Hi Diane

You can read all about this here

http://www.drmcdougall.com/forums/viewtopic.php?t=5916

The Upper Limit set by the Institute Of Medicine is 2300 mgs a day, total, from all sources.

77% of our intake is hidden in packaged foods and restaurant foods. About 10% occurs naturally and about is what we add at the table, or in cooking

A tsp of salt is 2200 mgs, and a tsp of sea salt is 2000 mgs.

In Health
Jeff

PostPosted: Thu Apr 17, 2008 8:57 am
by Melinda
Jeff, could you translate the figures from the low/high salt study into milligrams? Am I correct in thinking that the 3.2g/dl translates into 3200 mgs? Thanks.

PostPosted: Thu Apr 17, 2008 9:00 am
by Melinda
sorry, I read that wrong - I take it that the 3.9g of salt translates into 3900 mgs? That seems a little high, let alons the 11+figure!

PostPosted: Thu Apr 17, 2008 9:25 am
by JeffN
Melinda wrote:sorry, I read that wrong - I take it that the 3.9g of salt translates into 3900 mgs? That seems a little high, let alons the 11+figure!


Sure.

Salt, is a combo of sodium and chloride. Salt is about 60% chloride and 40% sodium.

To make the example easy, if we ate 10 grams of salt, we take in 4 grams of sodium, which is 4000 mgs and 6 grams of chloride (6000 mgs).

So, the 3.9 grams of salt, in the low salt group equals 1560 mgs of sodium, which is right in line with the 1200-1500 recommended by the IOM.

And, the 11.2 grams of salt, in the high salt group, equals 4480, which is right inline with the estimated average intake in USA of 4000 to 5000.

Hope that clarifies it.

In Health
Jeff

PostPosted: Mon Apr 28, 2008 9:23 am
by zeuxia
Jeff,

What is your calcium recommendation? I know in nursing school we are taught that all of our premenopausal women should be consuming 1000mg/day and postmenopausal women should be consuming 1500mg/day. Definitely a lot higher than what I consume on a daily basis! It's amazing that how our calcium intake goes UP our Osteoporosis goes UP as well! This link with salt is also very interesting as well.

Thanks,
zeuxia

PostPosted: Mon Apr 28, 2008 10:20 am
by JeffN
zeuxia wrote:Jeff,

What is your calcium recommendation? I know in nursing school we are taught that all of our premenopausal women should be consuming 1000mg/day and postmenopausal women should be consuming 1500mg/day. Definitely a lot higher than what I consume on a daily basis! It's amazing that how our calcium intake goes UP our Osteoporosis goes UP as well! This link with salt is also very interesting as well.

Thanks,
zeuxia


Hi

There is no simple answer as there are so many factors that influence all these recommendations. While they usually put out a single number for certain ages and genders, the reality is, there are many factors that influence actual needs.

There are populations around the world that do no have osteoporisis yet have calcium intakes in the 300-500 range. Most of them also have total protein intakes about half of the USA and animal protein intakes of 1/4 to 1/7 of the USA.

While we often hear about the impact of animal protein, there are many other factors that may play as big if not a bigger role. These inlude Vit D, Vit K, Sodium, magnesium, boron, weight bearing exercise, etc.

There is evidence that if Vit D intake is adequate, calcium needs go down and getting adequate Vit D may the more important issue. Same with sodium (as mentioned above). Studies on Vit K have shown that adequate Vit K (leafy greens) may reduce fracture risk by about 30%. Smoking, caffeine, are other factors that also play a role.

The problem is that some people want to beleive their "real" need is in the lower range cause they are vegan, but they do not do the rest of the related issues and they may run into a problem later on.

If someone really kept their animal protein to a minimum (or eliminated it) and got adequate Vit D, Vit K, magnesium, boron, calcium, etc (from a whole food plant based diet), limited total sodium and got lots of weight bearing exercise, and adequate sunshine, could they get away with a lower intake in the 300-750 range? More than likely. And that range is easily achieved on a whole food plant based diet.

But, if they are vegan, but still eat lots of refined processed foods that are low in nutrients (magnesium, calcium, boron) and high in sodium, and few greens (Vit K) , sunshine, and are sedentary, will that lower range of 300-750 be enough? Probably not.

That is why I keep the bar, as far as compliance to the whole program of a healthy lifestyle, high, and am always "gently" pushing for everyone to do as much as they can because it is the "total" picture that matters and not anyone isolated issue (i.e, vegan, animal protein, etc).

You may want to review this document by the WHO/FAO that reviews all of this.

http://www.fao.org/docrep/004/Y2809E/y2809e0h.htm#bm17

If you look at figure 18, you will see the impact of sodium and animal protein on calcium balance.

Quoting from the chart (Intercept value means where "balance" is reached)

Note: In a western-style diet, absorbed calcium matches urinary and skin calcium at an intake of 840 mg as in Figure 14. Reducing animal protein intakes by 40 g reduces the intercept value and requirement to 600 mg. Reducing both sodium and protein reduces the intercept value to 450 mg.


In Health
Jeff

PostPosted: Tue Aug 05, 2008 7:53 am
by JeffN
This topic came up in the current 10 day program, so I bumped this thread up so it easy for them to find and am adding in a few more comments.

From the following CPE course, written by my colleague, Jay Kenney, PhD, RD

http://www.foodandhealth.com/cpecourses ... orosis.php

Dietary Salt Increases Bone Loss

One of the most important factors contributing to an increased loss of calcium in the urine and the development of osteoporosis has been widely ignored by most clinicians and the mass media. The scientific evidence is very consistent that excessive intake of dietary salt greatly increases the loss of calcium in the urine. Increased salt intake has also been associated with reduced peak bone mass and a more rapid loss of BMD in older people. It is hard to escape the conclusion that the amount of salt added to commercial foods and at home in all modern societies must play a major role in the development of ostepenia and eventually osteoporosis. It seems likely that dramatically reducing dietary salt would help prevent many broken bones in America every year. One must increase the intake of dietary calcium by approximately 1000 mg daily to prevent bone loss in postmenopausal women who are ingesting an extra 2000 mg of sodium as salt daily. Results of a longitudinal study suggested that reducing dietary sodium excretion by 50% (from 3450 to 1725 mg/d) would be as effective in slowing the loss of bone as increasing dietary calcium by 891 mg/d.

A study in New Zealand showed that there was a progressive increase in urinary calcium excretion as dietary salt intake increased from 70 to 220 mmol/d (or about 1600 to 5000 mg of sodium). Data from this study suggested that reducing dietary sodium from 5000 to 1600 mg daily would reduce the loss of calcium in the urine by 32% in men and 27% in women. Simply put, the more salt you eat, the more calcium you'll excrete.

However, it should be noted that the problem with increased urinary excretion of calcium with increased dietary salt is not caused by the sodium ion alone. Even 5500 mg of sodium when given as either sodium citrate or sodium bicarbonate did not increase urinary calcium excretion as sodium chloride does. Using low-sodium baking powder (which contains potassium bicarbonate) in place of regular baking powder (which contain sodium bicarbonate) will also help to reduce urinary calcium excretion and presumably also the loss of BMD.

It has been shown that both a lack of calcium and/or an excess of salt in the diet leads to a reduction in bone density in young females. In postmenopausal women, an increase in dietary salt has been shown to increase urinary calcium excretion and lead to an increased loss of bone minerals. While increased dietary phosphate can blunt the increased calcium excretion caused by a high protein intake, increased dietary phosphate has no impact on the increased excretion of calcium caused by adding more salt to the diet.

An excessive intake of dietary salt is the primary causal factor in the development of essential hypertension. High blood pressure is also associated with increased bone loss in elderly white women. While there is no prospective human data on the long-term impact of reducing dietary salt on BMD, the data showing a strong correlation between urinary sodium and both urinary calcium and urinary hydroxyproline (a marker for bone loss) certainly suggests that the unnaturally high intake of salt in all modern human populations plays a major role in the development of osteoporosis. Because older Americans will develop either high blood pressure, osteoporosis or both it is perplexing that the media and most health professionals do not more strongly encourage people to reduce their salt intake. A low salt intake combined with a diet higher in fruits, vegetables, whole grains and nonfat dairy products (DASH-style diet) should slow the loss of bone mineral density as people age by improving bone metabolism.

Low-Sodium DASH Diet Improves Bone Metabolism

Epidemiological studies have found that people who consume more fruits and vegetables tend to have stronger bones. [New SA, Robins SP, Campbell MK, et al. Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? Am J Clin Nutr 2000; 71:142-51]. In addition numerous studies have shown that increasing dietary salt intake leads to an increased loss of calcium in the urine and an increased serum parathyroid hormone level. [Massey L, Whiting S. Dietary salt, urinary calcium and bone loss. J Bone Miner Res 1996;11:731-6 ]. In theory, it seems likely that combining a DASH-style diet with a low sodium intake should improve bone metabolism and may help prevent the development of osteoporosis.

A recent studied examined the combined impact of either the DASH diet versus a more conventional American diet each fed with 3 different levels of dietary sodium intake. The DASH- Sodium trial enabled researchers to examine the impact of 3 different levels dietary salt (50, 100 & 150mmol of Sodium/day) with either a typical American diet or with the DASH diet. Compared to a typical Americican diet the DASH diet contains more whole grains, fruits, vegetables and low-fat dairy products and less meat and other foods high in saturated fat as well as less sugar and refined carbohydrates. This new study specifically examined the individual and combined impact of different levels sodium intake and consuming the DASH diet on bone metabolism. Switching from a typical American diet to the DASH diet resulted in about a 10% reduction in osteocalcin, a hormone associated with more rapid breakdown of bone. Another marker of bone breakdown called C-terminal telopeptide of type 1 collagen (CTX) was also about 16-18% lower on the DASH diet than the more typical American diet. However, urinary calcium loss was not significantly increased on the American diet compared to the DASH diet. Increasing dietary sodium (as salt) was associated with a greater loss of calcium in the urine on both the DASH diet and the more typical American diet. Urinary calcium excretion was increased somewhat more on the typical American diet than on the DASH diet. Calcium excretion was also increased significantly more with increasing dietary salt in subjects with high blood pressure compared to those who were normotensive. The authors of this study conclude, “…the DASH diet significantly reduced bone turnover, which if sustained may improve bone mineral status. A reduced sodium intake reduced calcium excretion in both diet groups and serum osteocalcin in the DASH group. The DASH diet and reduced sodium intake may have complementary, beneficial effects on bone health.” [Pao-HWA L, Ginty F, Appel LJ, et al. The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. J Nutr 2003;133:3130-6]. Given the fact that most older Americans have or will soon develop hypertension and that most are also at risk of developing osteoporosis it seems prudent to encourage all older Americans to adopt a low-sodium DASH-style diet.

Massey LK, Whiting SJ. Dietary salt, urinary calcium, and bone loss. J Bone Miner Res 1996;11:731-6

Devine A, Criddle RA, Dick IM, et al. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am J Clin Nutr 1995;62:740-5

Goulding A. Fasting urinary sodium/creatinine in relation to calcium/creatinine and hydroxyproline/creatinine in a general population of women NZ Med J 1981;93:294-7 and Goulding A. Osteoporosis: why consuming less sodium chloride helps conserve bone. NZ Med J 1990;103:120-2

Lemann J, Gray RW, Pleuss JA. Potassium bicarbonate, but not sodium bicarbonate, reduces urinary calcium excretion and improves calcium balance in healthy men. Kidney Int 1989;35:688-95

Kurtz TW, Al-Bander HA, Morris RC. Salt sensitive essential hypertension in men. Is the sodium ion alone important? N Engl J Med 1987;317:1043-8

Matkovic V, Illich JZ, Andon MB, et al. Urinary calcium, sodium, and bone mass in young females. Am J Clin Nutr 1995;62:417-25

Zarkadas M et al. Sodium Chloride supplementation and urinary calcium excretion in postmenopausal women. Am J Clin Nutr 1989;50:1088-94

Devine A, Criddle RA, Dick IM, et al. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am J Clin Nutr 1995;62::740-5

Whiting SJ, Anderson DJ, Weeks SJ. Calciuric effects of protein and potassium bicarbonate but not sodium chloride or phosphate can be detected acutely in adult women and men. Am J Clin Nutr 1997;65:1465-72

Kenney JJ. Salt: Has it been given a fair shake? Or is it a serial killer? http://www.foodandhealth.com/cpecourses/salt.htm

Cappacino FP, Meilahn E, Zmuda JM, et al. High blood pressure and bone-mineral loss in elderly white women: A prospective study. Lancet 1999;354:971-5

Jones G, Beard T, Parameswaren V, et al. A population-based study of the relationship between salt intake, bone resorption and bone mass. Eur J Clin Nutr 1997;51:561-65


In addition, excess salt is about more then just blood pressure and bone health, it has been linked with;

- Stroke and cardiovascular disease.
- Left ventricular hypertrophy
- Duodenal ulcers and gastric ulcers
- GERD
- Heartburn
- Headaches
- Osteoporosis
- Gastric cancer
- Arteriosclerosis
- Angina
- immune dysfunction
- endothelial dysfunction


In Health
Jeff

Re: Sodium, Calcium and You

PostPosted: Thu Aug 24, 2017 1:33 pm
by JeffN
In the above original post, I posted a study showing how dietary salt increases calcium excretion in the urine, which, with the current excessive intake of salt in the US, could theoretically be a significant risk factor leading to osteoporosis.

This study links high salt intake to weaker bones over the long term.

In Health
Jeff

High dietary sodium intake is associated with low bone mass in postmenopausal women: Korea National Health and Nutrition Examination Survey, 2008–2011
Osteoporosis International
April 2017, Volume 28, Issue 4, pp 1445–1452

https://link.springer.com/article/10.10 ... 017-3904-8

Abstract
Summary

The present cross-sectional study performed using data from the Korea National Health and Nutrition Examination Survey in 9526 women older than 18 years of age demonstrates that high sodium intake is associated with lower bone mineral density and sodium intake ≥2000 mg/day is a risk factor for osteoporosis in postmenopausal women.

Introduction

Several studies have reported that large amount of dietary sodium intake is highly associated with elevated urinary calcium. However, the direct effect of excessive dietary sodium intake on bone mass, as a risk factor for osteoporosis, is still a controversial issue. The aim of the present study was to assess the relationship between high intake of sodium and lower bone mass and risk of osteoporosis in adult women.

Methods

This cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2008–2011. Participants (n = 9526 women older than 18 years) were divided into a premenopausal (n = 4793) and postmenopausal (n = 4733) group. Both groups were subdivided into five groups according to quintiles of energy-adjusted sodium intake. Multiple regression analysis was performed to assess relationships between sodium intake and lower bone mass.

Results

Multivariate linear regression analysis showed that high sodium intake was negatively associated with bone mineral content (BMC) and bone mineral density (BMD) in postmenopausal women. After adjusting confounding factors, high sodium intake was negatively associated with BMC and BMD of the lumbar spine in postmenopausal women. Postmenopausal women, whose sodium intake was ≥2000 mg/day (odds ratio 1.284, 95% CI 1.029–1.603, P = 0.027), were at risk of developing osteoporosis after adjustment of confounding variables.

Conclusions

The present study suggested that high sodium intake could be a potential risk factor for low bone mass after adjusting for confounding factors in postmenopausal women.



And this one links a taste for saltier foods to osteoporosis.

Salty food preference is associated with osteoporosis among Chinese men.
Asia Pac J Clin Nutr. 2016 Dec;25(4):871-878. doi: 10.6133/apjcn.102015.06.

http://apjcn.nhri.org.tw/server/APJCN/25/4/871.pdf

Abstract

BACKGROUND AND OBJECTIVES:
The main purpose of this study was to evaluate the associations between salty food preference and osteoporosis (OP) in general Chinese men.

METHODS AND STUDY DESIGN:
We conducted a largescale, community-based, cross-sectional study to estimate the associations by using self-report questionnaire to evaluate the salty food preference. The total of 1,092 men was available to data analysis in this study. Multiple regression models controlling for confounding factors to include salty food preference variables were employed to explore the relationships for OP.

RESULTS:
We found negative correlations between preference for salty food and T-score (p=0.006). Multiple regression analysis showed that the preference for salty food was significantly positively associated with OP (p<0.05 for all). The men with preference for salty food habits had a higher prevalence of OP.

CONCLUSION:
The findings indicated that salty food preference was independently and significantly associated with OP. The prevalence of OP was more frequent in Chinese men preferring salty food habits.