In Hong Kong, you choose your high blood pressure.

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Eating a diet low enough in sodium (salt) can prevent the rise in hypertension risk as we age.


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Audio Transcript for the hearing impaired

For the first 90% of our evolution, we ate diets containing less than a quarter teaspoon of salt a day, because, for the first 90% of our evolution, we ate mostly plants. We went millions of years without salt shakers, and so our bodies evolved into salt conserving machines, which served us well, until we discovered salt could be used to preserve foods. Without refrigeration, this was a big boon to human civilization. Of course, this may have led to a general rise in blood pressure, but who cares if the alternative is starving to death since all your food rotted away? But where does that leave us now, when we no longer have to live off of pickles and jerky? We are genetically programmed to eat ten times less salt than we do now. Even many low-salt diets can be considered high-salt diets. That’s why it’s critical to understand what the concept of “normal” is when it comes to salt.

Having a “normal” salt intake can lead to a “normal” blood pressure, which can help us to die from all the “normal” causes, like heart attacks and strokes.

Doctors used to be taught that a “normal” systolic blood pressure is approximately 100 plus age. “Systolic” blood pressure means the top number, and indeed that’s about what we’re born with. Babies start out with a blood pressure around like 95 over 60, but then as we age that 95 can go to 120 by our 20’s, then 140 in our 40’s (the official cut-off for high blood pressure) and keep climbing as we age. That was considered normal, since everyone’s blood pressure creeps up as we get older. And if that’s normal, then heart attacks and strokes are normal too, since risk starts rising once we start getting above the 100 we had as a baby.

But if blood pressures over a hundred are associated with disease, maybe they should be considered abnormal, perhaps caused by our abnormally high salt intake—ten times more than what our bodies were designed to handle. Maybe, if we just ate a natural amount of salt, our blood pressures naturally would not go up with age, and we’d be protected. Of course, to test that theory you’d have to find a population in modern times that doesn’t use salt, or eat processed food, or go out to eat. For that, you’d have to go deep into the Amazon rainforest. Meet the Yanomamo people, a no-salt culture.

Lowest salt intake ever reported, which is to say a normal-for-our-species salt intake. And so, what happens to their blood pressure? They start out with a blood pressure of about 100 over 60 and end up with a blood pressure of about 100 over 60. Though theirs is described as a salt deficient diet, that’s like saying they have a diet deficient in Twinkies. They’re the ones, it seems, eating normal salt intakes apparently leading to truly normal blood pressures. Those in their 50’s have the blood pressure of a 20 year old. What was the percentage of the population tested that had high blood pressure? Zero, whereas elsewhere in Brazil, up to 38% of the population may be affected. The Yanomamos probably represent the ultimate human example of the importance of salt on blood pressure.

But look, it could be other factors: they don't drink alcohol, they eat a high-fiber, plant-based diet, get lots of exercise, and have no obesity. There’s a number of plant-based populations eating little salt that experience no rise of blood pressure with age, but how do we know what exactly is to blame? Ideally, we’d do an interventional trial. Imagine if we took people literally dying from out-of-control high blood pressure, so called malignant hypertension, where you go blind from bleeding into your eyes, your kidneys shut down, your heart fails, and withhold from these patients blood pressure medications so their fate is certain death, and then put them on a Yanomamo level of salt intake, a normal-for-the-human-species salt intake, and if instead of dying, they walked away cured of their hypertension—that would pretty much seal the deal.

Enter Dr. Walter Kempner and his rice and fruit diet. Patients came in with blood pressures of 210 over 140 and left with blood pressures down to 80 over 60. What was the reason he could ethically withhold all modern blood pressure medications and treat with diet alone? The drugs hadn’t been invented yet—this was back in the 1940’s. Now the diet wasn’t just extremely low salt, but strictly plant-based, extremely low fat, protein, and calories, but there is no doubt that Kempner’s rice diet achieved remarkable results, and Kempner is now remembered as the person who demonstrated, beyond any shadow of doubt, that high blood pressure can often be lowered by a low enough salt diet.

Forty years ago, it was acknowledged that the evidence is very good, if not conclusive, that a low enough reduction of salt in the diet would result in the prevention of essential hypertension—that rising of blood pressure as we age— and its disappearance as a major public health problem. It looks like we knew how to stop this four decades ago. In that time, how many people have died? Today, high blood pressure may wipe out 400,000 Americans every year; 1,000 unnecessary deaths a day.

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