Document Detail

Should we restrict chloride rather than sodium?
MedLine Citation:
PMID:  15193367     Owner:  NLM     Status:  MEDLINE    
Low-salt diets have potential for prevention and treatment of hypertension, and may also reduce risk for stroke, left ventricular hypertrophy, osteoporosis, renal stones, asthma, cataract, gastric pathology, and possibly even senile dementia. Nonetheless, the fact that salt restriction evokes certain counter-regulatory metabolic responses-- increased production of renin and angiotensin II, as well as increased sympathetic activity--that are potentially inimical to vascular health, has suggested to some observers that salt restriction might not be of unalloyed benefit, and might in fact be contraindicated in some "salt-resistant" subjects. Current epidemiology indicates that lower-salt diets tend to reduce coronary risk quite markedly in obese subjects, whereas the impact of such diets on leaner subjects (who are less likely to be salt sensitive) is equivocal--seemingly consistent with the possibility that salt restriction can exert countervailing effects on vascular health. There is considerable evidence that sodium chloride, rather than sodium per se, is responsible for the known adverse effects of dietary salt. Other non-halide sodium salts, such as sodium citrate or bicarbonate, do not raise plasma volume, increase blood pressure, boost urinary calcium loss, or promote stroke in stroke-prone rats. Nonetheless, these compounds have been shown to blunt the impact of salt restriction on renin, angiotensin II, and sympathetic activity in humans. This may rationalize limited clinical evidence that organic sodium salts can decrease blood pressure in salt-restricted hypertensives. Furthermore, organic sodium salts have an alkalinizing metabolic impact favorable to bone health. These considerations suggest that restricting dietary salt to the extent feasible, while encouraging consumption of organic sodium salts in mineral waters, soft drinks, or other nutraceuticals--preferably in conjunction with organic potassium salts and taurine--may represent a superior strategy for controlling blood pressure, promoting vascular health, and preserving bone density. Further clinical studies should determine whether a moderately salt-restricted diet supplemented with organic sodium salts has a better and more uniform impact on hypertension than salt restriction alone, while rodent studies should examine the comparative impact of these regimens on rodents prone to vascular disease.
Mark F McCarty
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Medical hypotheses     Volume:  63     ISSN:  0306-9877     ISO Abbreviation:  Med. Hypotheses     Publication Date:  2004  
Date Detail:
Created Date:  2004-06-14     Completed Date:  2005-01-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7505668     Medline TA:  Med Hypotheses     Country:  Scotland    
Other Details:
Languages:  eng     Pagination:  138-48     Citation Subset:  IM    
Pantox Laboratories, 4622 Santa Fe St., San Diego, CA 92109, USA.
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MeSH Terms
Clinical Trials as Topic
Diet Therapy / methods,  statistics & numerical data
Diet, Sodium-Restricted / methods*,  statistics & numerical data*
Evidence-Based Medicine / methods
Hypertension / diet therapy*,  epidemiology*
Risk Assessment / methods*
Risk Factors
Sodium Chloride, Dietary*
Sodium, Dietary
Treatment Outcome
Reg. No./Substance:
0/Sodium Chloride, Dietary; 0/Sodium, Dietary

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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