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Diabetics are told to eliminate sugar. They are told they should not eat fat. Protein is a problem, too, because excess amino acids are converted into urea and sugar. If it's food, diabetics are told they can't eat it.

Doubts Cast on Standard Dietary Guidelines for Sodium Consumption

Diabetics are told they can't eat it, and they can't even have the salt that they would sprinkle on top—that is, until now.

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Publishing in the journal Diabetes Care, Australian researchers recently reported that diabetics with the highest levels of sodium in their urine had the lowest risk of dying over a 10-year period.

It's not ethical to force one group of diabetics to eat lots of salt and compare them to another group of diabetics you don't allow to eat salt and see what happens. Like many researchers before them, the research team at the University of Melbourne in the Australian state of Victoria relied on long-term observation.

They chose a group of 638 men and women who had type 2 diabetes, most of them in their 60's, half of them obese. These are precisely the people who would be told they have to cut back on fat and salt. What these researchers did differently was, instead of asking their study participants how much salt they ate every day, they measured urine samples to determine precisely how much excess sodium was being excreted.

Over the 10 years of the study, 175 participants died, mostly of cardiovascular disease. But diabetics who had 2,300 milligrams more salt than the average had a 28 per cent better chance of staying alive, even after allowing for kidney disease and age at the beginning of the study. There are some very simple reasons why this would be so.

Why Normal Consumption of Salt Can Be Healthy for Diabetics

The Australian study illustrates a very simple and well-established principle of basic biochemistry, so basic it's usually overlooked.

Insulin transports sugar into cells with the help of sodium. Every time one molecule of sodium goes out of the bloodstream and into a cell, three ions of sodium have to go with it. If you don't have the sodium in the bloodstream, insulin doesn't work.

If insulin works better, then blood sugars are lower, and diabetic complications are less frequent, too.

But isn't salt supposed to be bad for you? Yes, it is. There's absolutely no doubt that excessive sodium intake, especially without the potassium provided by fruits and vegetables, increases blood pressure. However, getting the potassium compensates for a certain amount of excess sodium, at least 2,300 milligrams a day, one might assume. The consequences of uncontrolled diabetes plus high blood pressure are even worse.

Another group of Australian scientists, at a research institute also located in Melbourne, ran a second, simultaneous study that found similar results for type 1 diabetics.

There is always a possibility of too much of a good thing. As the doctors in the study counseled, the findings of this study do not mean it's time to run to the corner store and stock up on pretzels or to use a coupon for free pizza. But the study certainly does suggest that, all other things being equal, a low-salt diet is not helpful for preventing the most serious consequences of diabetes.

  • Ekinci EI, Clarke S, Thomas MC, Moran JL, Cheong K, Macisaac RJ, Jerums G. Dietary Salt Intake and Mortality in Patients With Type 2 Diabetes. Diabetes Care. 2011 Feb 2. [Epub ahead of print]
  • Thomas MC, Moran J, Forsblom C, Harjutsalo V, Thorn L, Ahola A, Wadén J, Tolonen N, Saraheimo M, Gordin D, Groop PH, for the FinnDiane Study Group. The Association Between Dietary Sodium Intake, ESRD, and All-Cause Mortality In Patients With Type 1 Diabetes. Diabetes Care. 2011 Feb 9. [Epub ahead of print]
  • Photo courtesy of Dubravko Sorić by Wikimedia Commons : commons.wikimedia.org/wiki/File:Salt_shaker_on_white_background.jpg