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The Salt Myth: Busted.

Nick Pineault October 24, 2013 9 Comments
The Salt Myth: Busted.

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Everyone knows that salt is bad for you.

Eating salt increases your blood pressure and leads to hypertension.

Eggs are bad too.

They raise cholesterol.

Stop.

What if I told you that everything you heard about salt and sodium is just another nutrition lie?

I know this is hard to believe.

After all, every health institution, nutritionist and fitness website under the sun tells you to avoid salt.

But after you read the next few hundred words, you’ll know better.

Where It All Started…

Melinda Moyer, who writes for Scientific American, pointed out in her 2011 article that the fear of salt has been around for a pretty long while. (1)

In 1904, French scientists reported that some of their patients who suffered from hypertension were real salt lovers.

But the fear of salt went mainstream when Brookhaven National Laboratory’s Lewis Dahl revealed his study results “proving” that salt causes hypertension. He caused high blood pressure in rats by feeding them the human equivalent of 500 grams of sodium a day.

The thing is — who the heck consumes 500 grams of sodium a day?

No one does.

The average daily sodium intake for Americans age 2 years and older is 3,436 mg, (2) which is 145 times lower than the amount that this study used…

But never mind the non-sense around this study or the many studies that failed to support the idea that salt causes hypertension in the following years.

In 1977, the the U.S. Senate’s Select Committee on Nutrition and Human Needs started to recommend that Americans slash their salt intake by 50 to 85% from now on.

More Than 40 Years Later. Still No Proof.

A few decades after that new salt-reducing recommendation, studies have yet to find evidence that salt causes hypertension.

As Dr. Mercola pointed it out in his article, research on salt and hypertension must be pretty depressing for the associations who demonize salt… (3)

That’s simply because studies prove it again and again. Salt does NOT cause hypertension in healthy individuals.

The evidence is crushing:

J Chronic Dis 1987: The number of people who experience drops in blood pressure after eating high-salt diets almost equals the number who experience blood pressure spikes; many stay exactly the same. (4)

Intersalt study, BMJ 1988: Conclusion: There is no relationship between sodium and hypertension; in fact, those who ate the most salt had a LOWER median blood pressure than those who ate the least salt. (5)

DASH-sodium study, NEJM 1997: Conclusion: “A diet rich in fruits, vegetables, and low-fat dairy foods and with reduced saturated and total fat can substantially lower blood pressure. This diet offers an additional nutritional approach to preventing and treating hypertension.” (6)

(In the DASH study, researchers simultaneously reduced salt intake and sugar intake for their test subjects, and there’s a very strong possibility that sugar reduction helped those people lower blood pressure)

NHANES I, Lancet 1998: Conclusion: “These results do not support current recommendations for routine reduction of sodium consumption, nor do they justify advice to increase salt intake or to decrease its concentration in the diet.” (7)

Cochrane review 2003: Conclusion: “There is little evidence for long-term benefit from reducing salt intake.” (8)

NHANES II, Am J Med 2006: Conclusion: Lower sodium diets led to HIGHER mortality rates among those with cardiovascular disease, which “raised questions regarding the likelihood of a survival advantage accompanying a lower sodium diet.” (9)

Rotterdam Study, Eur J Epidemiol 2007: Conclusion: “From this and other epidemiological studies we conclude the effect of dietary salt on clinical cardiovascular endpoints and overall mortality within the range of intake commonly observed in Western countries has not yet been established.” (10)

Clin Sci (Lond) 2008: Low-sodium diets result in WORSE clinical outcomes for people with congestive heart failure, due to “detrimental kidney and neurohormonal effects.” (11)

Cochrane review 2011: Conclusion: Cutting down on the amount of salt has no clear benefits in terms of likelihood of dying or experiencing cardiovascular disease. (12)

Rotterdam Study, JBMR 2011: Conclusion: “Mild hyponatremia in the elderly is associated with an increased risk of vertebral fractures and incident nonvertebral fractures, but not with bone mineral density. Increased fracture risk in hyponatremia also was independent of recent falls, pointing toward a possible effect on bone quality.” (13)

JAMA 2011: Conclusion: “Systolic blood pressure, but not diastolic pressure, changes over time aligned with change in sodium excretion, but this association did NOT translate into a higher risk of hypertension or cardiovascular disease complications. Lower sodium excretion was associated with higher cardiovascular disease mortality.” (14)

Meta-Analysis AJH 2011: Conclusion: “Despite collating more event data than previous systematic reviews, there is still insufficient power to exclude clinically important effects of reduced dietary salt on mortality or cardiovascular disease morbidity.” (15)

I can predict that the next studies still won’t be able to prove that salt causes hypertension, because it doesn’t.

Attention!

What’s The Difference Between Salt And Sodium?

Salt and sodium get confusing really fast.

Here’s what you need to understand: Salt (NaCl) is made from sodium and chlorine ions that don’t weight the same amount.

To convert any amount of salt in sodium: Simply multiply the amount of salt (in mg) by 39% to get the amount of sodium (in mg).

Example: 10 grams of salt (10,000 mg) X 39% equals 3,900 mg of sodium.

The Dangers of Low Sodium

It should be clear by now that salt does not cause hypertension.

But it turns out that we NEED salt to be healthy, and that consuming very little salt shows a laundry list of risks:

  • Increased insulin resistance (16)
  • Increased blood triglycerides, LDL cholesterol and stress hormones (17)
  • Increased risk of stroke and heart attack (18)
  • Increased arterial plaque formation (19)
  • Overtraining-like symptoms, including hypertension and sleeping disorders (20)

If you’re an athlete or if you exercise a lot, a low-sodium diet will slow you down and may even be dangerous.

My buddy and renown strength coach Jason Ferruggia recommends most of his clients to increase their salt intake for that very reason. (21)

The Dangers of High Sodium

High levels of sodium don’t seem to be a problem for healthy individuals. But that’s not the case for people with particular health conditions:

People with impaired renal function: Even if the evidence is not clear (22), patients with chronic renal disease may improve their condition by reducing their salt intake. (23, 24)

People prone to kidney stones: High sodium leads to higher levels of calcium excretion in the urine — which can be be a problem for people trying to heal their kidneys. (25)

People with osteoporosis: Same reason as the above. High sodium leads to calcium loss, which is a risk factor for people with low bone density. (26)

People that are sensitive to sodium: Researchers have found that certain people are genetically pre-disposed to react negatively to a high salt intake. The only way to determine if that’s your case is to ask your doctor for a sodium sensitivity test. (27)

(I’d worry about sodium sensitivity only if you have health problems like high blood pressure, hypertension, kidney or renal malfunction.)

Unless you fall in one of the 4 categories above, there’s no real reason why you’d want to limit your salt intake religiously.

Which leads me to the question…

How Much Salt Should You Consume?

According to the American Diabetes Association (ADA): between 2300 and 1500 mg of sodium per day. (28)

According to the American Heart Association (AHA): less than 1500 mg per day. (29)

According to the American Dietetic Association (the other ADA): between 2300 and 1500 mg. (30)

In reality, these recommendations are way too low for healthy people.

Like Dr. Chris Kresser recommends (31), I think people should consume about 3,000 to 7,000 mg of sodium per day, which means 1.5 to 3.5 tsp. of salt.

I personally salt my meals a lot, because I think it’s key to enhancing the flavor.

But again, I don’t consume much processed foods. And the fact is that 75% of the sodium that Americans consume comes from processed foods. (32)

So if you avoid those terrible processed foods anyway (which is highly recommended if you care about your health and waistline at all), you should be fine using salt on your meals whenever you feel like it.

Eat Salt & Avoid Problems

Low salt consumption may cause health problems for most people.

High salt consumption will be a problem for people with renal or kidney problems, salt-sensitive or affected by osteoporosis.

But there’s another way to avoid any problems related to salt consumption: getting enough potassium.

Like every mineral in the body, sodium needs to be counterbalanced by another mineral.

The problem is… while our ancestors used to eat about 11,000 mg of potassium and about 700 mg of sodium daily (16 to 1 ratio) (33), people today eat about 3,200 mg potassium and 3,500 mg of sodium per day and end up with a ratio of 0.9 to 1.

Many studies now show that your potassium/sodium may be more important that your total sodium intake. (34)

Some research has even shown that a high potassium intake can pretty much reverse any salt-sensitivity symptoms. (35)

What Kind of Salt Should I Use?

Fair question.

I recommend avoiding common table salt.

Some health bloggers argue that table salt is metabolized differently than unrefined salt, and that the latter is way healthier. But I couldn’t find any research on the subject.

One thing is clear though. Unrefined salt is closer to what can be found in nature.

Refined table salt:

  • 97.5% sodium chloride
  • Processed at 1,200 °F
  • 2.5% added chemicals like ferrocyanide, fluoride and aluminosilicate (not sure how dangerous they are, but I don’t want them in my food anyway…)

Unrefined salt (rock salt, sea salt, etc.):

  • 84% sodium chloride
  • 16% of other naturally occurring minerals, including trace minerals like silicon, phosphorous and vanadium
  • One kind I use daily is Himalayan pink salt like this one from The Spice Lab’s

Bonus: Do You Need Iodized Salt?

A lot of people — after hearing the truth about salt and my recommendations about unrefined salt — ask me if they’ll be at risk for iodine deficiency if they stop consuming iodized salt.

The answer is no.

As The Harvard Health Letter points out (32):

To get all your iodine from salt, you would need more than half a teaspoon of iodized salt a day. That’s two-thirds of the daily allotment of sodium (1,500 milligrams) recommended by the American Heart Association.

It makes more sense to get your iodine from food. That way you can cut back on salt and not worry about losing out on this important element. Ocean-caught or ocean-farmed fish and shellfish tend to be naturally rich in iodine. Other good sources include milk, cheese, yogurt, eggs, and vegetables grown in iodine-rich soil.

There you go.

In other words, getting iodine from salt doesn’t make more sense than getting any of your nutrients in the form of a sugary fruit juice.

Point made.

Let’s Sum It Up

If you read this far, your head is probably spinning.

Let me sum up what’s important to remember here:

1) Salt does NOT cause hypertension.

2) Eating very little salt can lead to a host of health problems.

3) Eating too much salt can be a problem for people with kidney and renal diseases, osteoporosis or genetic salt sensitivity.

4) A daily sodium consumption of between 3,000 and 7,000 mg seems optimal — which means 1.5 to 3.5 tsp. of salt.

5) Increasing your potassium intake to make sure you consume way more potassium than sodium will help you avoid most problems associated with salt consumption.

6) I recommend sticking with unrefined salt instead of processed table salt.

7) You don’t need to get your iodine from iodized salt. You can get plenty of this nutrient in your diet.

 

The salt myth has been officially busted.

 

Nick

 







 

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9 Comments

  1. Laurie October 24, 2013 at 9:56 am

    I think the quality of salt is important. The crap in processed foods likely is not as beneficial as the heaps of Himilayan salt that I consume. I love salt!

    • Nick Pineault October 25, 2013 at 10:38 am

      Salt lovers unite! :)

      Nick

  2. Judi October 27, 2013 at 2:25 pm

    Thanks, Nick! I always learn something from your posts, but today article on salt was particularly helpful.

    • Nick Pineault October 30, 2013 at 10:17 am

      Hey Judi,

      You’re welcome!

      Nick

  3. Matt October 31, 2013 at 7:12 pm

    And what about the water retention? Is that a myth too?

    • Nick Pineault November 12, 2013 at 6:55 am

      From what I’ve read, sodium does cause water retention, but only if you consume a LOT at once.

      This is temporary though.

      Nick

  4. Sandra November 23, 2013 at 8:51 pm

    Hi Nick
    In the UK government guidelines are no more than 6g of salt per day. That seems a lot more sensible than the 1.5g you mentioned for some USA authority.
    Personally, I can’t stand the stuff. I NEVER put salt on my chips for example; that’s practically a crime in England!
    However, in my quest to improve my parents (and mine in process) diet, I bought some Cornish sea salt from local organic shop. Now I’m an addict!
    This stuff comes in flakes and is amazing. I always thought the Scots were mad to add salt to their porridge; now I know why. Just a couple of those weirdo flakes transforms my porridge into tasting like almonds.
    It costs three times as much as normal table salt, but who cares when it really does make stuff taste better. It’s a pain to use though. But I just throw some in a coffee grinder, and 5 seconds later have salt you can use like normal table salt… only much, much, much tastier.
    I even add a pinch to mum’s banana milkshakes (when she’s not up to eating solid food as she can’t stand those Nutrisip drinks prescribed by doc) as it makes the bananas taste more bananary somehow.
    I’ve no idea what kind of nutrition my mum’s getting on her off days, but she loves my banana milk shakes. They’re silky smooth according to her and not ‘slimy’ like Nutrisip drinks.
    For every pint of local full fat organic milk (actually cheaper than supermarket and delivered to door too in glass bottles) I add two bananas, two organic egg yolks, couple of drops of vanilla extract, a good dollop of extra thick Cornish cream, a tablespoon of local wild flower honey and a good pinch of Cornish sea salt. Blitz in liquidiser for about 45 seconds, and HEY PRESTO a food drink mum will actually drink.
    I hope to god I don’t give her Salmonella food poisoning from raw egg yolks. But it’s either that or she slowly starves to death.
    This drink turns a rather unsavory brown within about an hour or so. Any tips on how to prevent that happening.
    It tastes the same, but mum won’t touch it when this begins to happen (she’s a slow sipper) and I have to make another fresh one.

  5. William June 9, 2014 at 12:56 am

    “Bonus: Do You Need Iodized Salt? The answer is no.
    As The Harvard Health Letter points out (32):
    “To get all your iodine from salt, you would need more than half a teaspoon of iodized salt a day. That’s two-thirds of the daily allotment of sodium (1,500 milligrams) recommended by the American Heart Association.”
    “Like Dr. Chris Kresser recommends (31), I think people should consume about 3,000 to 7,000 mg of sodium per day, which means 1.5 to 3.5 tsp. of salt”
    You say you think people should consume 1.5 to 3..5 tsps of salt a day.. at just 1.5 tsps of iodized salt it would give you twice the daily allotment of iodine while staying within your salt consumption allotments.

  6. super-brave June 10, 2014 at 12:53 pm

    Hello Sandra, i read your message to Nick and i thought it may be useful if i shared something with you about your mothers’ banana shake. I remember the pediatrician once told me raw eggs yield no positive nutritional effect whatsoever because the body doesn’t recognize/benefit at all from them unless they’re cooked. They go straight to the waste if consumed raw, that’s what he said. I haven’t yet found anything that contradicts this.
    Also wanted to tell u something else on the tip u request for keeping the banana shake from going brown. Have u tried sprinkling/juicing a little drops of lime/lemon in it. Limes/Lemon halts oxidation so maybe it could help. Otherwise, make her a smaller portion, you are still gonna have to make her a fresh one anyway if it goes brown, is what you said..

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