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Your Healthy Heart
Your Healthy Heart -- Posted by Gumbo on 11-04-04 17:26
Your Healthy Heart
Salt - The Taste Trap
By Sheldon H. Gottlieb, MD, FACC
"Tasteless. This food is tasteless," announced Zadie, my wife's grandfather,
after sampling his carefully prepared no-salt meal.
Back when he was 72, Zadie had had a heart attack. Afterwards, his doctor
issued the order: "No salt." My mother-in-law became his cook and no-salt
enforcer. For the next 20 years, until his death at age 92, his meals were
free of salt. And, to him, tasteless.
Taste, one of our five senses, is an important survival tool. The senses of
sight and hearing help us to escape from enemies and to find food and
shelter. Our senses of touch and smell help us to avoid danger and to locate
everything from food to a mate. But to survive, we have to eat and drink.
It's the sense of taste that helps us to avoid harm and to recognize
nutritious food and drink. As an added attraction, taste allows us to savor
the simple pleasure of eating.
In the magazine you are holding, just four colors are needed to faithfully
reproduce all the colors of nature. In a similar manner, we rely on five
primary tastes-salty, sour, bitter, sweet, and umami-to produce the
"taste-picture" of the foods we enjoy. (Japanese cooks have traditionally
used monosodium glutamate to give their food an over-all sense of
"tastiness" that they call umami. Umami is now recognized as a fifth
distinct taste.)
Each taste has a common food that produces its signature sensation: table
salt (sodium chloride) is salty; sour-salt (citric acid) is sour; bitters
(quinine) is bitter; table sugar (sucrose) is sweet; and, as noted above,
MSG (monosodium glutamate) is umami.
Umami is also a major target for the processed-food industry. Since
"low-sodium" has become a marketing hook, companies hope to alter MSG's
formula a bit to create sodium-free umami-calcium glutamate-to produce tasty
low-sodium food. Tasty and low-sodium-that was Zadie's dream!
Each taste has a specific set of chemical receptors located on taste buds
that are found mainly on the tongue. As reported in the Feb. 7, 2003, issue
of the journal Cell, sweet-, umami-, and bitter-tasting foods are sensed by
individual taste bud cells using similar receptor molecules. Sour and salty
tastes are sensed by a different set of special receptors called ion
channels.
Bitter or sour foods are often dangerous or poisonous, and animals will
avoid them. Sweet substances usually contain carbohydrates and are
attractive for their food value.
Salt
But salt is in a class of its own.
We require only a small amount of salt in our diet to maintain health. But
many people crave salt. Salt helps to preserve food, and to cover the "off
taste" of food that is past its prime. Salt sells, and there is a Salt
Institute to help sell it. Salty is where science, politics, public policy,
diabetes, and cardiovascular disease meet.
It's widely accepted that humans adapted to a diet that was relatively high
in potassium and low in sodium. But thousands of years ago, two important
discoveries were made. The first: salt, which dried seawater would yield,
preserved food. Second, the local ruler could make a nice living by charging
a tax on salt.
Before refrigeration was widely available, salt consumption of more than 30
grams per day was common. This is equal to about 11 teaspoonfuls of table
salt! Today, people in developed countries consume about 10 grams of salt
each day. Almost all of this sodium comes from processed foods.
In the early 19th century doctors first observed an association between salt
intake and high blood pressure (hypertension). Other research showed that
some people were more sensitive to the blood-pressure-raising effects of
salt than others. These people were said to be "salt sensitive." But it was
not until 1999, with the publication of the results of a clinical trial
called the Dietary Approaches to Stop Hypertension (DASH) trial, that a
strong evidence-based case could be made for lowering salt to control high
blood pressure. The DASH diet is high in potassium, calcium, magnesium, and
fiber, and relatively low in sodium.
The Diabetes Link
High blood pressure is the "evil twin" of diabetes, whether it be type 1 or
type 2.
Both salt sensitivity and high blood pressure are frequently found in people
with insulin resistance and type 2 diabetes. People with type 1 diabetes who
have kidney damage are also at high risk for high blood pressure. But the
risk isn't restricted to those with diabetes-high blood pressure is a major
risk factor for heart disease and stroke in all people.
The most recent American Diabetes Association statement regarding
"evidence-based nutrition principles and recommendations for the treatment
and prevention of diabetes and related complications" was published in the
journal Diabetes Care in January 2003. The expert consensus is that the
"goal should be to reduce sodium intake to 2,400 mg or sodium chloride
(salt) to 6,000 mg/day." (The Association gives two values here because the
element sodium makes up only about 40 percent of table salt [sodium
chloride] by weight. So all recommended daily allowances of sodium may be
expressed as grams of table salt or as grams of sodium. One teaspoonful of
table salt contains about two grams of sodium, and about five grams of
salt.)
But the stated goals also include eating a diet containing fruits,
vegetables, and low-fat dairy products in order to obtain potassium,
magnesium, calcium, and other nutritional requirements. These, along with
lowering sodium, help to promote a healthy blood pressure.
So for better cardiovascular health and better diabetes control, stick to a
diet that's high in tastefulness, or umami (the MSG-free sort, of course).
But hold the salt.
----------------------------------------------------------------------------
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Sheldon H. Gottlieb, MD, FACC, is a cardiologist at Johns Hopkins Bayview
Medical Center, Department of Cardiology, in Baltimore, Md. He also directs
the Diabetes-Heart Failure Program at Johns Hopkins HealthCare, LLC.
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