Sodium Restriction in Heart Failure?

[00:05:03]   Sodium is an important electrolyte and sodium homeostasis is critical.

[00:06:29]   Literature from the late 1800s up to the 1970s suggest lowering intake of dietary sodium for various illnesses, including hypertension and heart disease.

[00:06:59]   Kidneys help regulate all the electrolytes in our body. Could we be pushing people into kidney problems by restricting their sodium?

• The kidneys and heart are intimately linked.
• There is a difference between prevention of a disease versus active management of the disease.
• There is a recognition that sodium intake strategies differ when we are talking about prevention vs management.

[00:10:16]   The design of the study:

• Designed a large clinical trial which included recruiting people with established heart failure (heart not functioning well) for 1 or more years.
• Over 800 people participate in the randomized trial.
• Participants were allocated to usual care including reducing dietary sodium intake vs a group that took a strict less than 1500mg of sodium per day.
• Wanted to see if that changed the rate of clinical events and also measure the quality of life and functionality.
• The main focus was on the first year followed by follow-ups.
• Dieticians from six countries created set menus, changing the sodium content only.
• The menus were country and culture specific.
• Participants were required to keep real-time 3-day food diaries.
• Results took 20% under and over reporting into consideration.

[00:17:27]   Expectations were for a 500 m of sodium per day reduction. To get people below 1500 mg per day was the actual target.

[00:18:44]   Carl explains “salt” in everyday terms – worth the listen!

[00:19:39]   Findings:

• Main outcome of the trial was to reduce the risk of all-cause death, or cardiovascular hospitalizations and cardiovascular ER visits.
• Statistically it did not reduce those the way we formally assessed, and we make sure that it is well understood.
• But numerically there were fewer events in the lower sodium arm than in the usual care arm.
• There was thus some effect, just not the effect that was anticipated.

[00:21:36]   Other interesting outcomes  - tune in!!

[00:23:27]   Why are we looking at just sodium when magnesium could be the reason some people do well, and some people do not?

• The process is very much driven by the fuel that people are eating, and the different switches made inside the heart muscle cells and the mitochondria.
• It is driven by a lot of different processes and various micronutrients, of which magnesium is just 1.

[00:33:30]   3 Clear messages from the trial.

• Clinicians need to consider sodium reduction for patients with heart failure to improve quality of life.
• For patients, it should be part of their overall health strategy to consider a healthier diet overall
• Guidelines for those who make policies.

[00:34:15]   A remarkably interesting discussion on differentiating athlete hearts (and those of active individuals) from the general public, ensues.

[00:40:22]   The best advice you can give to a patient is to avoid things in a box, a bag, or a can and refined processed foods.

[00:41:47]   Carl shares a few fascinating facts about the military.

[00:42:32]   The idea that consuming more sodium to lessen blood viscosity, is flawed. Dr Justin explains.

[00:45:38]   A detailed discussion on blood pressure, hormones and hypertension follows.

[00:53:17]   In conclusion, Dr Justin reiterates that it is really important for people to know that they can do a lot of simple uncomplicated things to promote health and self-care.