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Hi SELF Family,
If you take lisinopril, losartan or another blood pressure pill your doctor chose to protect your kidneys, salt decides how well that pill works. Researchers in the Netherlands tested this head to head. Adding a second kidney-protecting pill at full dose cut the protein leaking from damaged kidneys by 21 percent. Cutting salt cut it by 51 percent.
Protein in your urine is one of the earliest signs that your kidney filters are under too much pressure. Your lab report shows it as UACR, the urine albumin-to-creatinine ratio, in milligrams per gram (mg/g). A UACR under 30 mg/g is normal. Pills like lisinopril and losartan protect your kidneys by lowering the pressure inside those filters, which is why the protein leak is the number doctors watch when they prescribe them.
A second pill cut the protein leak 21 percent. Cutting salt cut it 51 percent.
The trial followed 52 adults whose kidney disease was not caused by diabetes. Every one of them was already taking lisinopril 40 mg, the top dose. Each person went through four 6-week periods in random order. In two of the periods they added valsartan 320 mg, a second kidney-protecting blood pressure pill, also at the top dose. In the other two periods they took a placebo pill. Each pill was paired once with a low-salt diet and once with their regular diet.
On their regular diet, people ate about 4,200 mg of sodium a day. On the low-salt diet, they got down to about 2,400 mg. Adding the second pill cut the protein leak by 21 percent. Cutting salt cut it by 51 percent. Doing both cut it by 62 percent. Cutting salt also brought the top blood pressure number down from 134 to 123, while the second pill only moved it to 131. These people never got under the 2,000 mg target, and cutting salt still beat the pill.
Lisinopril and valsartan work by easing the pressure inside your kidney filters. A salty diet pulls extra fluid into your blood and pushes that pressure back up. Salt takes back a large part of what your pill was built to do.
A protein leak is still a lab number. What you care about is keeping your kidneys off dialysis.
So researchers went back to two large trials of people with type 2 diabetes and kidney disease, and they looked at the 1,177 people whose salt intake had been measured. Some of those people took an ARB pill, losartan or irbesartan, and the rest took blood pressure pills that work a different way. In the third of people who ate the least salt, the ARB cut the risk of serious kidney events by 43 percent and the risk of heart and blood vessel events by 37 percent. In the two-thirds of people who ate more salt, the ARB showed no kidney advantage over the other pills.
Your job this week is to get your sodium under 2,000 mg a day. Under 2,000 mg is the limit the international kidney guidelines set for people with kidney disease. The average American eats about 3,400 mg a day. Here is where that sodium hides.
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Where your sodium hides
Packages: More than 70 percent of the sodium Americans eat comes from packaged and prepared foods, not from the salt shaker.
The label: Find the percent daily value for sodium. A food with 5 percent or less per serving is low in sodium, and a food with 20 percent or more is high.
The big sources: Sandwiches, pizza, burritos and tacos, soups and salty snacks are on the FDA's list of the foods that supply the most sodium.
Cans: Buy beans and vegetables labeled no salt added, or drain and rinse them before you cook.
Flavor: Cook with garlic, onion, lemon, black pepper and herbs.
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Low-salt food tastes bland at first, and your taste buds adjust. When researchers had adults cut their salt for 5 months, the amount of salt they liked best in soup and crackers went down.
Skip salt substitutes made with potassium chloride if you have kidney disease or take lisinopril, losartan or a similar pill, because those substitutes can push your potassium dangerously high. Check your blood pressure at home for the first two weeks. If your readings run low or you feel lightheaded when you stand, call your doctor, because you may need less medicine.
Get your UACR checked now, and check it again in about three months. A lower UACR means less protein is leaking through your kidney filters.
Salt is the first of five daily habits in the new video. The video shows how a sweet drink makes your kidneys hold on to salt. It shows which protein makes your kidney filters work harder within hours of a meal and which protein leaves them alone. It covers the walking habit tied to a lower risk of dialysis and the sleep habit tied to 79 percent higher odds of losing kidney function fast. It also shows what happened when 631 people tested the kidney habit almost everyone recommends. Watch Improve Your Kidney Function in 2 Weeks (5 Daily Habits)
With gratitude,
Dr. Sean
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