Salt has a rich history and used to be considered a highly valued commodity. Roman soldiers were paid in salt. The Greek slave traders traded salt for slaves (this is where the statement “not worth your salt” comes from). Even the Bible refers to the importance of salt, comparing follower of Christ to it: “You are the salt of the earth.”
Salt has been used not only to flavor foods, but to preserve them for future use (sauerkraut, pickles, kimchi, etc.).
In some cultures people consume a lot of salt–the average Japanese farmer consumes 27 grams per day; in 1959, the daily ration of Korean soldiers included 11,000 mg of sodium daily; and the Kuna of Panama consume a very high salt diet with no effects on blood pressure until they move to the city.
By nature, humans are salt seekers. We have taste receptors for salt and sugar, which is indicative of what we should eat. Hyenas and cats, for example, have different taste receptors than humans (they cannot taste sweet), but have taste receptors for aminos and protein because they are carnivores. (1)
Salt is a powerfully pleasing taste to humans. Our tongues’ tip is covered with taste buds for detecting saltiness. We are designed to seek foods containing essential minerals, including sodium.
While sodium restriction these days is one of the most widely publicized non-medication recommendation for heart disease and stroke prevention, there is a lack of research to support these hypothesis. On the contrary, more and more studies point the opposite to be true…low sodium intake can cause health problems.
My Salty Love Affair
While I have no weakness for processed sweets, I do enjoy a savory treat every now and then. Imagine how disturbing it was for me to hear in my early health seeking days that salt was not healthy for me. I approached this subject from every angle possible for a period of time, while contemplating my salt-less future–no added salt intake to moderate salt intake, and had to make a decision about how to proceed for myself and my family. To salt or not to salt…that was the question.
I remember getting my copy of The Pleasure Trap book signed by Alan Goldhamer, who proposes a no-added-salt approach, last year. While I find his knowledge and work remarkable, I could not swallow the no-salt advice… at least not without a grain of salt :). I could not imagine eating a meal, especially if it was cooked, without adding a dash of salt to it. “My food would not be worth eating,” I thought. After all, a little bit of salt can bring out flavors of certain foods. For meat eaters, imagine eating a salt-less piece of stake–not something you would enjoy. I resented the very thought of having to give up salt, and it seems like I had a very good reason.
Low Sodium Intake Can Cause Health Problems
It is my goal to provide not my opinions, but valid, well structured scientific research to the Vegalicious community. In fact, it is people’s opinions and preferences, rather than hard science, that create fad diets, such as the Atkins diet, South Beach and the Paleo diets, and give people bad advice, sending a lot of them down a long winding spiral to poor health. Today I want to share a few studies with you that will show you that salt is not the enemy we must fear, and is not something we should work hard to avoid.
1. Low sodium intake does NOT improve blood pressure
According to a presentation made at the European Society of Cardiology 2013 Congress, there is not much improvement in blood pressure resulting from restricting sodium intake, which means that recommendations to the general population to reduce salt intake are not necessary or helpful.
Dr. Andrew Mente (McMaster University in Hamilton Ontario), reported that in his study of almost 100,000 people, none of the populations studied had intake of sodium at or below the 2.3 g per day recommended by most health authorities. (2,3)
In this study, sodium and potassium intake was measured using urine excretion. Intake was between 4,200 and 4,800 mg per day in North America, Europe, South Asia, Africa and South America. Sodium intake was over 5,500 mg per day in China. Only 3.1% of the study subjects were consuming less than 2.3 g of sodium per day, and less than 1% of study subjects were consuming less than 1.5 g per day.
The researchers then looked at changes in systolic blood pressure as it relates to 1-gram increases in sodium consumption. Response was only significant in certain groups–hypertensive patients, elderly and those consuming more than 5 g per day. Dr. Salim Yusuf said,
Sodium is linked to BP, but it is at very high levels that it is linked in an important way. At lower levels, the effect is so modest it isn’t worth it.
The study was 10 times larger than any other study examining the issue of sodium. The researchers concluded that more effective approaches to lower hypertension through sodium restriction should be targeting those populations which are most likely to benefit. Yusuf said, it is important to acknowledge that almost no one in the world is consuming the low level of sodium currently recommended by health experts and the government, and that we are asking people to do something 99% of the population cannot and will not do.
From a practical point of view it makes no sense and from a scientific point of view it makes no sense.
2. Sodium intake is NOT linked to higher mortality rates
In 2007, a study involving more than 100 million US adults concluded that people who eat more salt have lower risk of death from heart disease and stroke. The authors of the Third National Health and Nutrition Examination Survey (The NHANES III study), showed an inverse relationship between salt and cardiovascular death (4).
Observed associations of lower sodium with higher mortality were modest and mostly not statistically significant. However, these findings also suggest that for the general US adult population, higher sodium is unlikely to be independently associated with higher CVD or all-cause mortality. (5)
3. Salt restriction can cause adverse health effects
An article in the British Medical Journal showed adverse health effects resulting from salt restriction. Studies do not show that eating less salt affects blood pressure for most people.
Lowering sodium intake may have adverse effects on vascular endothelium through stimulation of the renin-angiotensin system and on serum total and low density lipoprotein cholesterol concentrations. In cohort studies, lower salt intake in people with hypertension has been associated with higher levels of cardiovascular disease and in general populations with greater all cause mortality. (6)
4. Moderate sodium intake is life saving
A study in JAMA showed that while high levels of salt intake (8,000 mg of sodium per day) is associated with increased risk of heart attack, stroke, hospitalization and death from heart disease, low intake also was a problem. At between 2,000 and 3,000 mg per day, there was a 20% increase in the risk of deaths related to cardiovascular disease and hospitalization for congestive heart failure. In other words, both extremely high and restricted sodium intake are correlated with more events as compared to moderate salt consumption. Moderate salt consumption was defined as 4,000-6,000 mg per day. (7)
The researchers noted that risk did not start to increase until sodium level exceeded to 6,500 mg per day. This is considerably more sodium than the health “experts” are proclaiming to be safe today. The World Health Organization has recommended salt intake of 2,000 mg per day and the American Heart Association is even more restrictive at 1,500 mg per day.
5. Restrictive sodium intake is NOT helpful
According to a report issued by the Institute of Medicine, scientific evidence does not support reducing salt consumption down to levels recommended by the U.S. government and other health authorities. For a long time, doctors recommended restricting salt intake to 1,500 mg or about ½ teaspoon per day, insisting that salt restriction would prevent heart attacks and strokes for people at higher risk of cardiovascular events (anyone older than 50, African Americans, and people with high blood pressure–about half of the U.S. population).
The Institute of Medicine’s report, developed by an expert committee, found no reason for anyone to reduce salt consumption below 2,300 mg per day. The committee’s findings confirmed the results of several studies published during the last few years showing that not only is salt restriction to such low levels not helpful, but that in many populations, it can increase the risk of events salt restriction is supposed to prevent such as heart attacks and death. (8)
6. Salt restriction does not improve health outcomes
According to Dr. Michael Alderman from Albert Einstein College of Medicine, salt restriction is not always effective for improving health outcomes. Alderman stated in a recent commentary in the Journal of the American Medical Association that a low-salt diet was associated with better clinical outcomes in only 5 of the 11 studies he examined. In the other six studies, patients consuming a low-salt diet experienced the same and sometimes even worse outcomes than those patients who did not restrict salt intake. (9)
7. No direct relation between salt consumption and hypertension
A study published in the American Journal of Clinical Nutrition showed that salt consumption has remained the same since 1957. Yet the incidence of hypertension has increased significantly during this same time period.
38 studies were reviewed that examined sodium excretion for 26,271 participants between 1957 and 2003. During this period of time, average sodium consumption was 3,526 mg per day–significantly more than the allowance for salt in the current dietary guidelines, but fairly constant. (10)
8. Most healthy populations do not restrict sodium intake
A new study confirms a recent analysis from the Institute of Medicine which showed that both high and low sodium intake can cause health problems. Researchers looked at the association between sodium intake, cardiovascular disease, and all-cause mortality using data from 25 studies.
The researchers concluded that between 2,645 and 4,944 mg of sodium per day resulted in better health outcomes, and that within this range there were no meaningful differences. They also stated that this level of sodium intake is consumed by most of the world’s population. (11)
Salt is Important
1. Salt is essential to bone health.
About 25% of the salt content of the body is stored in the bones and helps to make bones hard. The body will draw on its salt stores in order to compensate for low sodium levels in the blood stream, and to neutralize acidity resulting from poor diet. While calcium is body’s primary defense to dealing with acidity, the body will deplete its salt stores first, before accessing stored calcium.
2. Salt is responsible for the health of cell membrane
Salt helps to maintain osmotic equilibrium between both sides of the cell membrane, and helps in moving substances across the cell membrane. If everything happens as it should, nutrients easily cross the membrane into the cells, and waste products easily exit the cells.
3. Sodium improves overall well-being
Our well-being–physiological, emotional and mental –depends on correct electrolyte and fluid balance, and this includes sodium.
4. Salt helps in the utilization of water
Salt helps to escort water across the cell membrane. Salt deficiency can result in dehydration and can lead to higher blood pressure as the body tries to compensate.
5. Salt is important for thyroid health
Unrefined sea salt is a source of naturally-occurring iodine, needed for thyroid function.
6. Salt is important to digestion
Salt also plays an important role in digestion–water and salt are components of the bicarbonates needed to neutralize the highly acid contents of the stomach prior to entry into the intestines.
What Causes Health Issues
While many health care professionals are promoting low sodium diets, they ignore factors that do contribute to poor cardiovascular health, such as the type of salt consumed, the ratio of sodium to other nutrients in the diet, and that salt becomes dangerous to our health only when it keeps bad company.
A sodium study involved collecting data from adults who purchased lunch from 11 fast food chains. 6,500 meals were analyzed. The average meal contained 1,751 mg of sodium. Fried chicken meals were the worst, containing an average of 2,300 mg of sodium.
The data on the meals also included average calories per meal. Example: for Burger King, the average was 1008 calories; for McDonald’s 908 calories; for Wendy’s 907; Popeye’s 1050; Domino’s 1550 and Taco Bell 909.
Taking all of the sodium out of these meals would not make any difference. They would still be high in calories, animal protein and fat. Animal protein and fat are more directly linked to hypertension than salt is. (12)
In reality, it is not the salt consumption that is problematic, but rather the consumption of refined and processed versions of the real foods, combined with poor dietary habits, that creates ill health effects.
Salt becomes dangerous because of the company it keeps–meat, dairy, fried foods, oils and other junk ingredients.
Unnecessary Roadblock to Health
While there are people who are salt sensitive and must avoid salt in order to reduce their blood pressure and maintain optimal health; most people do not need to do so.
It is unfortunate that people are victimized by an inaccurate message to consume less salt, which takes away attention from real health problem contributors. With salt restriction, in most cases, health does not improve, people stay sick, stuck taking drugs. A more effective message would be stop eating meat, dairy products, including cheese, and junk foods.
It is difficult enough to convince some people to eat a truly healthy diet (whole foods, plant based) without adding an unnecessary roadblocks as hindrances to change.
When we adopt a truly healthy diet (whole foods, plant based), our consumption of processed foods and ingredients is sharply reduced, while the amount of whole, plant foods goes up. Naturally, salt is reduced on a whole foods plant-based diet, while potassium consumption goes up. This shift in salt and potassium consumption is usually enough for most people, and further salt restriction is not required most of the time.
If we truly want to enjoy optimal health, instead of eating bland meals, we should reduce or eliminate the animal foods, cut out processed foods and fat, and lose weight, and most of us will be able to achieve normal blood pressure readings in just a few weeks, if not days.
Guidelines for salt consumption
Use nutrient-dense, unrefined sea salt, which does not contain toxic ingredients, like aluminum, found in refined and processed salt.
Consume a whole foods, plant-based diet as I teach in the Body by Plants program. The structure of the diet will reduce the amount of salt consumed, since animal foods and processed foods will be cut out.
Instead of cooking with salt, which would destroy many of the nutrients in it, add salt to your dishes before serving–that way you will get to keep important nutrients and use less salt overall.
Any Salty Thoughts?
I hope that this article gave you a little reprieve, so you do not have to worry about eating bland foods. If you are like me, you can now exhale and enjoy a delicious whole foods, plant based diet.
What is your experience with salt? Have you been told that you must reduce it to be healthy?
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References
(1) Jiang, P. et al. Proc. Natl Acad. Sci. USA http://dx.doi.org/10.1073/pnas.1118360109 (2012).
(2) Population-wide sodium guidance “makes no sense” in most countries SEPTEMBER 4, 2013 Shelley Wood
(3) Andrew Mente, Giuseppe Mancia, PURE-Sodium: Heterogeneity in the associations of urinary sodium and potassium with blood pressure: The PURE sodium study.
(4) Cohen HW, Hailpern SM, Alderman MH. Salt intake and cardiovascular mortality. Am J Med. 2007 Jan;120(1):e7.
(5) Cohen HW, Hailpern SM, Alderman MH. Sodium intake and mortality follow-up in the Third National Health and Nutrition Examination Survey (NHANES III). J Gen Intern Med. 2008 Sep;23(9):1297-302.)
(6) Hooper L, Bartlett C, Davey Smith G, Ebrahim S. Systematic review of long term effects of advice to reduce dietary salt in adults. BMJ. 2002 Sep 21;325(7365):628.
(7) O’Donnell MJ, Yusuf S, Mente A, et al, “Urinary sodium and potassium excretion and risk of cardiovascular events.” JAMA vol 306;20:2229-2238
(8) Sodium Intake in Populations: Assessment of Evidence
(9) Michael H. Alderman “Reducing Dietary Sodium: The Case for Caution.” JAMA, February 3, 2010; 303: 448 – 449.
(10) Bernstein, A, Willett, W. “Trends in 24-h urinary sodium excretion in the United States, 1957-2003: a systematic review” American Journal of Clinical Nutrition 2010; 92:1172-80
(11) Graudal N, Jurgens G, Baslund B, Alderman M. “Compared with usual sodium intake, low and excessive sodium diets are associated with increased mortality: a meta-analysis.” Am J Hypertension
(12) Johnson CM, Angell SY, Lederer A, et al. “Sodium content of lunchtime fast food purchases at major US chains.” Arch Intern Med 2010; 170:732-734.
Credits
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Bacon image source in the cover is http://www.npr.org/blogs
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