Sodium restriction and insulin resistance: A review of 23 clinical trials | DiNicolantonio | Journal of Metabolic Health
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Affiliation
Home ▶<br>Vol 6, No 1 (2023) ▶ DiNicolantonio
Abstract
Introduction
Study 1
Study 2
Study 3
Study 4
Study 5
Study 6
Study 7
Study 8
Study 9
Study 10
Study 11
Study 12
Study 13
Study 14
Study 15
Study 16
Study 17
Study 18
Study 19
Study 20
Study 21
Study 22 and 23
Mechanisms for how low-salt diets induce insulin resistance1,20,27,28
Acknowledgements
References
About the Author(s)
James J. DiNicolantonio<br>Department of Preventive Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, United States of America
James H. O’Keefe<br>Department of Preventive Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, United States of America
Citation
DiNicolantonio JJ, O’Keefe JH. Sodium restriction and insulin resistance: A review of 23 clinical trials. J. insul. resist. 2023;6(1), a78. https://doi.org/10.4102/jir.v6i1.78
Review Article
Sodium restriction and insulin resistance: A review of 23 clinical trials
James J. DiNicolantonio, James H. O’Keefe<br>Received: 20 Sept. 2022; Accepted: 06 Feb. 2023; Published: 14 Mar. 2023
Copyright: © 2023. The Author(s). Licensee: AOSIS.<br>This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution,<br>and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Many clinicians recommend low-salt diets for lowering blood pressure but there may be unintended consequences such as worsening insulin resistance.
Aim: This paper aimed to find human clinical studies looking at low-salt diets on markers of glucose and insulin.
Methods: We reviewed PubMed using the search terms ‘sodium’, ‘insulin’ and ‘insulin resistance’ and found 23 human clinical studies testing low-salt diets showing negative harms on insulin or glucose.
Results: Twenty-three human clinical trials have shown that low-salt diets lead to systemic or vascular insulin resistance, glucose intolerance, elevated fasting insulin and/or elevations in glucose and/or insulin levels after an oral glucose tolerance test.
Conclusion: We discovered 23 human clinical studies showing that low-salt diets worsen markers of insulin and glucose. Caution is advised when recommending salt restriction for blood pressure control as this may lead to worsening insulin resistance.
Contribution: This review has revealed that low salt diets can induce insulin resistance.
Keywords: salt; sodium; insulin resistance; insulin; hyperinsulinaemia; glucose.
Introduction
Many clinicians recommend low-salt diets for lowering blood pressure but there may be unintended consequences such as worsening insulin resistance. Indeed, a lack of sodium has been shown to increase insulin levels, which may be a compensatory mechanism to help the kidneys retain sodium. Additionally, low-salt diets elevate stress hormones, such as noradrenaline, aldosterone, renin and angiotensin-II, which contribute to vascular stiffening and vascular and systemic insulin resistance.1,2,3 Several lines of evidence suggest that salt restriction may increase mortality and cardiovascular events.4,5,6 This review will discuss 23 human clinical studies that have shown negative effects with sodium restriction on glucose and insulin. There is also a brief discussion at the end regarding trials that have shown no effect, or even worsening insulin sensitivity, on a high-salt diet.
Study 1
Feldman and Schmidt randomised eight male participants (25–40 years old) with normal and high blood pressure to moderate salt restriction (1725 mg of sodium per day) versus a normal-salt intake (5405 mg of sodium per day) for 1 week in a crossover, double-blind design.1 The authors...