diet

Low-salt diet

Overview of the hyposodic diet

"Low -salt diet" means low-sodium diet.

Sodium is a particularly abundant mineral in the western nutritional style; for this reason, unlike other minerals (such as iron, calcium, potassium, magnesium etc.), in the vast majority of cases it creates complications due to its EXCESSIVE dietary intake (while a food shortage is rather rare).

Excess sodium in the diet is related to the onset of arterial hypertension (IA).

The low-salt diet involves the consumption of salt-free foods (NaCl) added, avoiding those salted during industrial or home processing.

Obviously, the hyposodic diet also excludes all additive molecules containing sodium, such as sodium glutamate and sodium bicarbonate.

In addition to limiting the intake of sodium compared to Western dietary habits, the low-salt diet acts on the complications induced by excess sodium through other aspects of a chemical-nutritional nature. From studies concerning the pressure regulation of the human organism it emerged that, besides the regulatory nerve center, also the vascular tone (peripheral vasodilation or vasoconstriction) and the relationship between excretion / reabsorption of the nephrons play an essential role in the onset of hypertension blood. Therefore, taking into account that both arterial compliance and renal function are mechanisms strongly influenced by some nutritional molecules, the hyposodic diet is structured by intervening not only on sodium but on many aspects of overall nutrition.

The hyposodic diet is a nutritional therapy aimed at containing the levels of arterial hypertension (defined as such when the minimum pressure is permanently above 90mmHg and the maximum one always exceeds 140mmHg). This metabolic pathology, which proportionally increases the cardiovascular risk, can be induced or favored by some etiological or predisposing elements; among them they are recognized as subjective and objective. On the other hand, what unites every type of arterial hypertension is the ANOMALA and non-physiological alteration of the mechanism in question.

Hypertension - outline

Arterial hypertension affects about 20% of the population; moreover, only ¼ of the diagnosed hypertensives can maintain normal blood pressure (thanks to adequate drugs and / or behavioral interventions). Arterial hypertension can be:

  • primary (or essential) when it does not depend on other diseases;
  • secondary, when it subordinates to cardiac or renal pathologies (only 5% of the cases).

Primary hypertension is mainly determined by:

  • overweight
  • increased tone of the sympathetic nervous system
  • reduced sodium renal filtration
  • nervous stress
  • sedentary and aging
  • genetic factors
  • dietary factors ( excess of sodium, lack of potassium, excess of saturated fats at the expense of essential polyunsaturated fats, hyperglycemia, alcohol abuse, abuse of other nerves, etc.).

Among all these elements, some are subjective (such as genetics), others objective (such as food or overweight) or promiscuous.

In subjects suffering from hypertension it is possible to intervene on several fronts: diet (low salt), supplements (see below), level of physical activity (increasing it) and use of drugs (diuretics, vasodilators, etc., even in combination with each other).

Arterial hypertension can determine and more often contribute to the onset of unfortunate events such as ischemic heart disease and cerebral vascular syndrome, with the risk of death or permanent disability; what makes it an extremely dangerous metabolic pathology is the absence of significant symptoms up to the diagnosis of the first admirable clinical signs or of the first complications.

NB . Hypertension exponentially increases its harmful effects when it is associated with type 2 diabetes mellitus, dyslipidemia, obesity and visceral deposition (therefore also of metabolic syndrome, of which it represents a constituent element).

Sodium - outline

Sodium is the main cation of extracellular fluids. Its metabolic function is essential and any defect would certainly be harmful to the body. However, as anticipated, in the western diet sodium is typically taken in excess, which is why in the presence of hypertension it is necessary to reduce it through a low-salt diet.

The main functions of sodium are of regulation of the extracellular volume, of the osmotic pressure of the extracellular fluids, of the acid-base balance, of the electrophysiological phenomena of the nervous and muscular tissues, of the nervous impulse etc.

During renal passage almost all the sodium is reabsorbed and its retention-excretion is modulated by the action of the hormone aldosterone. The ability to expel sodium with urine DOES NOT exceed 0.5-10% and the only mandatory losses of the body are with faeces and urine (about 7%).

The excess of sodium in food causes an increase in the osmotic pressure of the extracellular fluids and the consequent recall of intracellular fluids, with an increase in the volume of the former compared to the latter. "Perhaps" is for this reason that the chronic increase in sodium food is directly related to the onset of arterial hypertension.

In the low-sodium diet, sodium is reduced through 2 essential precautions:

  • ELIMINATION of discretionary sodium (the one added in the kitchen with sodium chloride - constitutes about 36% of the total sodium of a "typical" Italian diet)
  • ELIMINATION of artificial foods containing added sodium (all foods processed by salting or containing certain additives).

PLEASE NOTE: fresh and unprocessed foods "rarely" contain high concentrations of sodium, except for bivalve molluscs, however poorer than mineral compared to salami, cheeses, salted or pickled foods, snacks, fried foods etc.

Hyposodic diet - not just sodium

In the course of the article it has already been mentioned that the low-salt diet is NOT based simply on the abolition of discretionary salt and food products that contain added sodium; in particular, the low-salt diet FOR THE HEALTHY SUBJECT (which does not have primary renal or other impairments) guarantees:

  1. Energy supply aimed at achieving or maintaining the ideal BMI and abdominal circumference in terms of reducing cardiovascular risk
  2. An excellent supply of potassium, magnesium, calcium and water
  3. A minimum intake of saturated or hydrogenated fatty acids (and indirectly also of cholesterol) as opposed to a generous intake of essential polyunsaturated fatty acids, especially of the ω ‰ 3 family (EPA, DHA and α-linolenic acid)
  4. A suitable glycemic load and index, therefore moderate
  5. A minimum or no intake of alcohol and nervini (eg caffeine).

Furthermore, the low-salt diet is to be associated STRICTLY:

  • to the abolition (if present) of smoking
  • to the regular practice of a physical or sports physical activity protocol, composed of aerobic (predominant) and possibly also anaerobic type sessions.
  • Furthermore, it is recommended that the sources of social and psychological stress are moderated significantly.

Hyposodic diet "in practice"

Having already listed the key nutritional principles of the low-sodium diet, the practical "commandments" for implementing it will be explained below:

  1. In case of overweight or obesity, reduce ALL portions by 1/3 (about 30%)
  2. Consume at least 5 meals a day (quantities and portions are easily identifiable; the meal is correct if after 120-180 'from the term appetite arises)
  3. Remove the salt and stock cube from the cabinets and shelves of the house (so as not to fall into temptation)
  4. Remove all types of boxes, jars, cans, cans, snacks, etc. present in the pantry and on the shelves of the house; preserved foods are ALWAYS rich in sodium or sugar or alcohol. Even the pickled foods have undergone a processing (cooking) in water and salt
  5. Eliminate the junk-food present in the pantry and on the shelves of the house
  6. Replace all preserved foods or derivatives with fresh ones; for example:
    • raw ham with steak;
    • tuna in oil or in brine with fish fillet;
    • matured cheese with milk or yogurt (sometimes, occasionally, with fresh cheese);
    • jams or fruit preserved with fresh fruit;
    • vegetables in a jar with fresh vegetables;
    • POSSIBLY replace pasta, bread (especially preserved baked goods) and refined starchy foods with WHOLES and INTEGRAL cereals and legumes (boiled or in the form of risotto or minestrone),
  7. Replace as much as possible the meat with blue fish as it is rich in ω ‰ 3 (fresh tuna, alletterato, ricciola, bonito, greenhouse, leccia, lampuga, mackerel, lanzardo, alice, sarda, herring, needlefish, boga etc.)
  8. Season with raw vegetable oils rich in omega-3 (soy, hemp, walnut, kiwi, etc.) and cook only with extra virgin olive oil
  9. Replace normal water with low water
  10. Limit the coffees to a maximum of 2 per day and the alcohol to a maximum of 2 alcoholic units per day
  11. Eliminate smoking
  12. Perform physical exercise on a daily basis for a time of 40-60 '
  13. Limit stressful situations

Supplements to be associated with the sodium diet

The supplements useful in case of a low-salt diet are those that meet the nutritional requirements NOT reached through the diet itself. In general, with a good level of physical activity, the caloric expenditure is high enough to allow the attainment of the recommended rations through the consumption of only food; on the other hand, hyposodic diet cases are not uncommon for very elderly, bedridden, infirm, obese, sedentary individuals, etc., who need a restriction that does not always guarantee all the nutrients in the appropriate quantities. In this case, the integrators of:

  1. Potassium: which, being the main intracellular cation, has an effect diametrically opposite to that of sodium; its IPOtensive efficacy is obviously not proportional to the intake doses but it is still very useful.
  2. Other mineral salts: especially calcium, iron and magnesium; there are no recommended doses but it would be desirable to take sufficient quantities to cover the subjective needs.
  3. Polyunsaturated fatty acids of the omega-3 family, possibly predominantly EPA and DHA (biologically more active); there are no recommended doses but it would be useful to take from 0.5 to 2.5% more (compared to the total calories) in addition to those already present in the diet.

Furthermore, a good hypotensive action has been highlighted against:

  1. Arginine amino acid
  2. Plants, extracts and diuretic and / or hypotensive vegetal derivatives.

Conclusions - efficacy of the hyposodic diet in the treatment of hypertension

The hyposodic diet is always effective in reducing blood pressure, but the extent of the improvements obtainable depends very much on the pathological nature and underlying causes.

In a secondary hypertension, the hyposodic diet subordinates to the treatment of primary diseases and assumes a marginal or even optional role. For primary forms, however, it is more incisive; when hypertension is mainly determined by being overweight, the most important nutritional aspect is to give a negative caloric balance and promote weight loss. On the contrary, when overweight is moderate and a diet rich in salty foods is highlighted, the hyposodic diet is crucial. Finally, if there is a suspicion of a strong genetic and hereditary component, the hyposodic diet is important but acts as a complement / preventive agent to be inevitably associated with drug therapy.