Salt intake and cholesterol levels
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High Salt Intake and Increased Cholesterol Levels
Several studies in both animal models and humans have found that a high-salt diet can increase blood cholesterol levels. In animal studies, rats fed a high-salt diet showed significantly higher total cholesterol and LDL cholesterol compared to those on a normal-salt diet. This effect was linked to the activation of specific liver enzymes, such as CYP51, which are involved in cholesterol synthesis, and the SREBP2/PCSK9 pathway, which reduces the liver’s ability to clear LDL cholesterol from the blood 14. Similar findings were observed in pregnant rats, where high salt intake led to increased total cholesterol, LDL, and other atherogenic lipid ratios, suggesting a detrimental effect on lipid profiles .
Salt Intake and Cholesterol in Human Populations
Research in different human populations has shown mixed results regarding the relationship between salt intake and cholesterol levels. Some cross-sectional studies in hypertensive women found that lower sodium intake was associated with higher blood cholesterol, especially in those with excess weight. In these cases, sodium intake and age were significant factors influencing cholesterol levels, with an inverse relationship between sodium intake and cholesterol in overweight hypertensive women 26.
A large population-based study in Nepal found that people with high blood cholesterol tended to consume less salt than those with normal cholesterol, possibly due to dietary changes after diagnosis or medical advice. However, overall, the population’s salt intake was much higher than recommended, and high salt intake was associated with other risk factors like higher BMI and hypertension .
Effects of Salt Reduction on Cholesterol
Intervention studies that gradually reduced salt intake in families found no adverse effects on cholesterol. In fact, a modest reduction in salt intake led to small but significant decreases in total and LDL cholesterol, as well as blood pressure and triglycerides. These results suggest that reducing salt intake according to public health recommendations can have beneficial effects on cardiovascular risk factors, including cholesterol, without causing harm .
Mechanisms Linking Salt and Cholesterol
The mechanisms by which high salt intake increases cholesterol appear to involve the upregulation of liver enzymes and pathways that promote cholesterol synthesis and reduce cholesterol clearance. Specifically, high salt activates the SREBP2/PCSK9 pathway, leading to increased circulating PCSK9 and decreased LDL receptor levels, which in turn raises LDL cholesterol in the blood 14.
Public Health Recommendations and Considerations
Most health organizations recommend reducing salt intake to less than 5 grams per day to lower the risk of cardiovascular disease. While some observational studies have suggested a possible increase in cholesterol with very low sodium intake, especially in certain subgroups, the majority of evidence supports salt reduction as a safe and effective strategy for improving cardiovascular health 8910.
Conclusion
High salt intake can increase cholesterol levels, particularly LDL cholesterol, through effects on liver metabolism and cholesterol regulation pathways. While some studies in specific populations have found an inverse relationship between sodium intake and cholesterol, especially in hypertensive women with excess weight, intervention studies show that gradual salt reduction is beneficial for cholesterol and overall cardiovascular risk. Reducing salt intake remains a key public health strategy for preventing heart disease.
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