Ka Wai Ola - Office of Hawaiian Affairs, Volume 3, Number 5, 1 May 1986 — He Mau Ninau Ola [ARTICLE+ILLUSTRATION]

He Mau Ninau Ola

Some Healih Quesfions 6y Kekuni Blaisckit, MD,

Q: E kauka, why is it that pa'akai is bad for me, yet my mo'opuna eat plenty salty foods, like ham and potato chips, and they seem to be ola no? A: The main ehemieal of eoneem in pa'akai (salt) related to your ninau is sodium. Sodium is an essential element in the kino kanaka (human body), especially

īn wai Kino (oody tluids), such as the koKo (blood) and wai (fluid) around all of the other tissue cells in the kino, and in the membranes of all kino cells. However, the amount of sodium needed by the kino makua (adult body) daily is only about 200 mg — less than a "pineh" of pa'akai. Yet. too many of us po'e Hawaii these days 'ai (eat) more than 20 times that daily requirement i kela me keia la (daily). When we are 'opio (young) and ola (healthy), our pu'upa'a (kidneys) readily excrete unneeded excess sodium into our mimi (urine), so no obvious harm results then. However, as we become makua (adults), some of us have pu'upa'a that develop pilikia excreting daily excesses of sodium. The extra sodium stays in the kino and holds wai (water) with it . The increase in fluid in the circulation from too mueh sodium seems to be a major mechanism for koko pi'i (high blood pressure). So, if you have kokopi'i, this may be an important reason for you to restrict your intake of pa'akai. Limiting sodium in mea'ai (food) is a basic way to control kokopi'i. Some po'e, even without kokopi'i, may have pu'uwai (heart) failure, ma'i pu'upa'a (kidney disease), or ma'i akepa'a (liver disease), whieh ean cause sodium and wai retention and resulting pehu (swelling). Perhaps you have one of these other ma'i. Not only restriction of dietary sodium, but "water pills,"

such as thiazide or furosemide, may be prescribed by your kauka to promote pu'upa'a excretion of sodium and wai with re!ief of pehu. Does this apply to you? Since 1962, experiments have shown that certain strains of 'iole (rats) are "sensitive" to too mueh sodium, for with time, they readily develop kokopi'i after high-sodium feeding; while other 'iole strains are "sodium-resistant" and do not exhibit kokopi'i with a high-sodium diet. Perhaps an analogous situation occurs in some families with kokopi'i, or in some lahui, like us po'e Hawai'i, in whieh the prevalence of kokopi'i may be greater than 50 percent in persons over age 50. Nolaila, some have reasoned that two factors appear to play major roles in the development of kokopi'i related to sodium: (1) Age. Many makua demonstrate a progressive rise in blood pressure with age. This may be a reflection of high intake of sodium over the course of years, beginning in childhood, sensitizing the pu'upa'a to retain kino sodium and wai. (2) Heredity. Some po'e appear to inherit a peculiar sensitivity to high sodium intake causing their pu'upa'a, with time, to retain sodium and wai, whieh eventually leads to kokopi'i. In 1978, a study of our Polynesian cousins on the southwestern Pacific Tokelau ato!ls revealed that their traditional low intake of sodium apparently protected them from the "normal" rise of b!ood pressure with age observed in western societies; for when these po'e Tokelau migrated to urban Aotearoa (New Zealand), their rise in blood pressure seemed to be related to their adoption of a western high-sodium diet. If and how such mechinisms apply to us lahui Hawai'i are now being investigated in the Moloka'i heart study by Kauka Emmett Aluli, Helen Kanawaliwali 0'Connor and UH Kauka David Curb of Na Pu'uwai on that island. We eagerly await their results. Meanwhile, in the future He Mau Ninau Ola columns, we will pane (answer ) more ninau e pili ana i ka pa'akai a me ke kokopi'i, how historically pa'akai became a food item in some, but not all, cultures, and some practical ways to enjoy a tasty low-sodium diet.

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