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• W2314009289 abstract "Introduction Salt is the only rock we eat. And we eat a lot of it, an average of 8.5 gm a day, nearly 80% of it in our processed foods. Some Americans consume as much sodium in 1 d as some Yanomami Indians do in 1 year. Of course, the Yanomami live deep in the Amazon rainforest of Brazil, and although they have no hypertension, they have other problems. The influential yet controversial “Intersalt” study on 52 populations around the globe showed how tricky it can be to draw firm and uncontested conclusions about salt intake, blood pressure, and health (6,16). In fact, the salt controversy — how much salt is healthy and whether we all should eat less salt — has raged for 40 years and may not end soon. It is a clash between the requirements of public health policy and those of good science. It is a debate on how much evidence we need to make sweeping changes in our diet, changes that will require the cooperation of the food industry. It also may be a clash of titanic egos and of researchers who have chosen sides. The momentum seems to be with those who say we all need less salt than we get. But the paradox is that some athletes need more salt. Let me explain. Do We All Need Less Salt? The cycle seems eternal: each new study that supports universal sodium reduction is followed by another study refuting it. Call it the salt war. I will cover only the two most recent battles in the very long salt war. In recent years, the Centers for Disease Control and Prevention (CDC) and the American Heart Association (AHA), along with the World Health Organization, have agreed that reducing our dietary sodium is a vital public health aim to reduce blood pressure and improve the cardiovascular health of Americans. The CDC claims that 90% of Americans consume too much sodium (>2,300 mg·d−1) and that higher sodium intake is tied strongly to higher blood pressure, which contributes to nearly 1,000 deaths a day and is a leading risk factor for heart disease and stroke (10). In 2012, the CDC commissioned the Institute of Medicine (IOM) to review the recent studies on direct health outcomes (vs. blood pressure as a surrogate end point) and analyze all the pros and cons of aiming for an even lower population sodium intake (<1,500 mg·d−1). The IOM report agreed that reducing excessive sodium intake (to 2,300 mg·d−1) would lower the risk of heart disease and stroke and thus improve public health, but the IOM found the direct-outcomes evidence inconclusive as to whether even lower sodium intakes (down to 1,500 mg·d−1) were associated with either greater or lesser risk of cardiovascular diseases (CVD) (14). The usual controversy arose, as some in the media misread the IOM report, with headlines like “No Benefit Seen in Sharp Limits on Salt in Diet” (12). The CDC felt the need to reaffirm the aim of 1,500 mg·d−1 for certain subgroups (including persons with hypertension, blacks, and older persons); the IOM felt the need to clarify their report; and the AHA and some public health experts continued to urge all Americans to eat no more than 1,500 mg·d−1 of sodium (8,10,14). The most recent salt war began in April 2014. A new study shows a decline in CVD after health officials in England limited salt in processed foods. From 2003 to 2011 in England, as the average salt intake fell by 15%, the average blood pressure also fell and there was a decline of 40% in deaths from heart attack and 42% in deaths from stroke. The British researchers concluded that the lower CVD death rates were multifactorial, but the reduction in salt intake likely played a key role (11). They admitted to possible ecological bias because their population surveys were based on different sets of participants, they could not adjust for exercise habits, and salt intake was gauged in a British population different from the ones they studied. In response to this study from England, the salt war flared up again. “Low salt” allies wrote essays like “The Public Health Crisis Hiding in Our Food” (7). Others wrote articles like “Study Linking Illness and Salt Leaves Researchers Doubtful” and quoted a skeptical researcher, “(This study) is of the same substandard quality as most of the so-called compelling evidence (for low-sodium diets)” (1). It seems fair to say that many of us might lead longer, healthier lives if, among other things, we ate less salt. After all, if the Yanomami do fine for a year on the amount of salt we eat in a day, maybe we could eat less salt. But not everyone agrees. The salt war may be as bold as The Butter Battle of Dr. Seuss. And so it goes… But Do Some Athletes Need More Salt? The answer is yes. Some athletes, in some settings, need more salt. The settings are “sweaty settings” because a main cause of heat cramping — better termed sweat cramping — is “salty sweating.” This lesson has to be relearned every few generations. Take the recent lesson from a metal mine in Queensland, Australia. Miners go a mile deep, where it is very hot and humid. Miners sweat heavily, drink mostly plain water, get dehydrated, and suffer from heat exhaustion and cramping. The proposed solution? Better hydration, self-pacing, and adding salt to drinks to match that in sweat (4). They learned the same lesson 70 years earlier in a coal mine in Queensland. It seems that they forgot. Contrarians favor fancy theories like “altered neuromuscular control.” By this new theory, prolonged exercise can cause neuromuscular fatigue that, via a spinal arc, increases excitation and/or decreases inhibition of the alpha motor neuron to cause cramping (13). Supporting this theory was a study on Ironman triathletes in South Africa. At the end of the race, those few who were cramping had slightly lower serum sodium levels (than those not cramping), but the small difference, although statistically significant (no prerace values were obtained), was judged to be “not clinically significant.” Do the math, however, and those who were cramping (vs. those who were not) had “lost” 8 to 9 g of salt during the race (15). Where did the salt go? Out in sweat. Other studies on athletes in action reinforce “salty sweating” as a key culprit in heat cramping. Michael F. Bergeron, PhD, FACSM, has solid field evidence in tennis showing that exercise-related muscle cramps are prompted by extensive sweating and a sodium deficit (2), and we have shown in National Collegiate Athletic Association football and in the National Football League (NFL) that large acute salt and fluid loss in sweat is typical of those prone to heat cramps (5). Other researchers also find large sweat salt and fluid losses in NFL backs and linemen (9). Pearl 1: The faster you sweat, the saltier your sweat becomes. Why? Because when sweating fast, your sweat travels through the sweat duct too fast for maximal reabsorption of sodium (3). So, even after you acclimatize to the summer heat and “save salt” in your sweat — so it no longer tastes salty or burns your eyes — when you go all out, as in the first football game of the year, you heat up faster and sweat faster and “saltier” and can suffer from heat cramping late in the game. Pearl 2: To prevent heat cramping, get more salt in your diet and in your sports drinks on the field. Think of it like this: “The solution is saline.” After all, we came from the sea. And so it goes …." @default.
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• W2314009289 date "2014-01-01" @default.
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• W2314009289 title "The Salt Paradox for Athletes" @default.
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