THE SALT MYTH

It’s summer, and it’s a hot one. During months like this, I take special care to watch my electrolytes, making sure that I don’t get too depleted. But there’s one electrolyte that has been the center of controversy and confusion for years: salt. 

 

We take it as fact that salt is bad for our health. It has been blamed as a main culprit of high blood pressure and heart disease. Doctors often advise us to cut salt from our diet for various health reasons. But there is another side to the salt story that needs to be told, because just like most stories, this one is not black and white.

 

Studies on salt haven’t been as clear over the years as one might expect. In fact, this past February, a study that was presented at the American College of Cardiology’s Annual Scientific Session revealed surprising results. The researchers analyzed eight randomized controlled trials from 2008-2022, and one from 1991. They also included data about sodium intake and specifically heart failure patient deaths and hospitalizations. “Researchers found that (heart failure) patients following a diet with a sodium intake target below 2.5 grams per day were 80% more likely to die than those following a diet with a target of 2.5 grams per day or more.” Just for reference, less than 2.3 grams of salt per day is the current FDA recommendation. This study flies in the face of what we’ve been told. 

 

In 2016, a team of researchers found that the results from studies on salt were too polarized for a consensus. They reviewed 269 academic reports published between 1979 and 2014 and said they found no definitive proof that cutting salt intake reduces the risk of heart attacks or strokes for people in perfect health. They found that 54 percent of the conclusions were supportive of the hypothesis; 33 percent, not supportive; and 13 percent inconclusive.

 

And yet the WHO and FDA continue to place lower restrictions on salt consumption in an attempt to reduce heart-related fatalities. In 2021, the FDA asked the food industry to voluntarily reduce the amount of sodium in their products by about 12%. And they have reason for concern: heart disease is the leading cause of death in the United States, and most of the salt in our diet comes from processed and packaged food.

 

But while reducing salt can lower blood pressure, the direct causation for lowering risk for cardiovascular disease has been tougher to prove.

 

In trying to analyze the data, here are a few things to consider:

 

All salts are not created equal. Regular table salt is a highly refined version of the salt that is good for us. It is heated at extreme temperatures, bleached, and made up almost exclusively of sodium-chloride, with the remaining percentage points consisting of chemicals and anti-caking agents, along with a tiny amount of iodine that has been added back in. 

 

In contrast to table salt, unrefined, full spectrum sea salt contains a lower percentage of sodium-chloride; the rest is made up of over 80 trace minerals and elements that naturally occur in the human body and are essential to our health. 

 

Table salt indeed has toxic and inflammatory properties, and it’s clear that the amount of sodium-chloride in a typical American diet is excessive. But even so, most of the perceived damage done by salt may simply come from the fact that it often goes hand-in-hand with processed food. The amount of salt that we personally sprinkle onto and cook into our food, makes up only about 13-30% (the FDA estimates 30%) of our total salt consumption; the rest comes from processed food. 

 

It’s likely that the trans-fats, saturated fats, sugars, refined carbohydrates and chemicals in our processed and fast food are the real culprits of heart disease. Studies in the past that showed lower rates of heart-related diseases when salt intake was reduced, also included reduction of these other ‘bad for you’ items; salt may be guilty by association. 

 

In response to studies that refute the eat-less-salt argument, Investigative Science and Health Journalist, Gary Taubes, author of Why We Get Fat, said this in a 2012 NY Times Article titled, Salt, We Misjudged You: “This attitude that studies that go against prevailing beliefs should be ignored on the basis that, well, they go against prevailing beliefs, has been the norm for the anti-salt campaign for decades. Maybe now the prevailing beliefs should be changed.”

 

So where do we go from here?

 

Here’s what we do know:

There are real medical concerns for why too much salt (sodium chloride) is bad for your health. Excessive sodium in the blood (called hypernatremia) can cause a host of problems, including burdening the kidneys, water retention in order to restore balance, which causes pressure on the blood vessels and more work for the heart. Symptoms of hypernatremia could be anything from extreme thirst, nausea, vomiting, weakness, and on the extreme end, it could lead to heart disease, seizures, stroke, or a coma. Hypernatremia can be caused both by eating too much salt or due to dehydration (not drinking enough water, excessive sweating, vomiting, etc.). Excessive sodium in the blood also causes the body to excrete it through urine, taking calcium with it, which increases the risk of Osteoporosis. As you can see, there’s plenty of reason to make sure you’re not eating more salt than your body needs. (1)

 

On the flip side, let’s take a look at why salt is essential for our health, and why the first study I  mentioned showed that death was more likely for heart failure patients who ate too little salt. Sodium helps regulate the pH balance in our cells, helps absorption of nutrients, controls levels of water in our body, preserves flexibility in our joints, helps to prevent depression, and helps to keep calcium available in solution in your blood so that it won’t be leeched from your bones, thereby preventing risk of Osteoporosis.  

 

Since sodium is an electrolyte, dehydration, fatigue and muscle cramping can occur if you don’t have enough salt in your diet. My father once recounted to me his experience on a trip with an extreme mountain biking group during a particularly grueling ride. Even after drinking tons of water, my father found himself feeling completely dehydrated. He was so depleted that he had to pull over, unsure of his ability to continue on. Noticing his condition, a member of the group handed him a bag of potato chips. Within minutes, my father felt better and had enough energy to finish the ride.

 

Although I’m not recommending potato chips as a solution, it’s obvious that salt was what brought my father back to form.

 

I once had a client who cut salt out almost completely because she’d heard (as we all have) that salt is bad for your health. We had just started working together. She went to a flea market on an exceptionally hot day, and despite drinking plenty of water, she got dizzy and passed out. The paramedics told her that her blood pressure was way too low. She later recounted the story to me and when I asked about her electrolytes, she revealed that she had stopped eating salt. She had clearly lost too many electrolytes on the hot day, and although she was hydrating, her body couldn’t properly absorb the water due to lack of salt. 

 

Having too little salt in your body is called hyponatremia. The symptoms can include headaches, nausea, vomiting, exhaustion, mental confusion, passing out, and more seriously it could lead to seizures or a coma. 

 

As you can see, both excessive and deficient sodium in the body can cause health risks. It seems that the answer then lies in the balance.

 

The Harvard T.H. Chan School of Public Health says that our body needs about 500 mg of sodium daily for our most basic bodily functions, and that Adequate Intake (AI), the lower limit recommended, is 1,500 mg per day. Again, this is the bare minimum, and does not take into account one’s lifestyle and exercise habits, and the potential loss of salt and electrolytes through sweat or other means. 

 

It has proved too difficult however to determine a toxic upper level of salt. As we know, the FDA recommends no more than 2,300 mg per day for chronic disease reduction. But the real answer is to not eat more salt than your body needs, which likely differs for each person, dependent on their exercise level, climate, current medical conditions, etc. For some, especially athletes, the FDA recommendation may be too low.

 

TIPS FOR HEALTHY SALT CONSUMPTION:

 

In my personal opinion, if you prepare the majority of your own meals, you should certainly feel free to sprinkle full spectrum sea salt onto your food. To find out if your sea salt is full spectrum, just look at the color. If it’s pure white, it’s likely missing the trace minerals. Two of the highest quality full spectrum salts available are Celtic sea salt (grayish brown in color) or Himalayan Pink salt. 

 

In addition to these full spectrum salts, Acupuncturist Mikio Sankey, PhD., who practices in Los Angeles, advocates the importance of getting enough organic sodium (Na, without the chloride) from fresh vegetables and food sources such as celery (especially juiced), carrots, okra, beets, kale, figs, dried apricots, coconuts, sea kelp (great source of iodine), roasted sesame seeds and sunflower seeds, to name a few. This will ensure you get the sodium your body needs to function properly.

 

Finally, although it flies in the face of everything we’ve been told for the past 40 years, I would consider easing up on your fear of sodium, and instead focus on reducing processed, packaged and fast food in general, including dressings and processed sweets and drinks (i.e. sodas and glazed doughnuts, which can contain large quantities of salt despite tasting sweet). Eat more real whole foods instead.

 

You can also prioritize a consistent exercise routine to help lower blood pressure and reduce stress (a factor that raises blood pressure). Exercise also helps eliminate excess salt through sweat. And make sure to drink enough water. Whether we can be certain that salt is a direct contributor to heart disease or not, these tips will help ensure that you are covering your bases.

 

Beyond that, it’s important to listen to your body. If you experience symptoms of either hyper or hyponatremia, adjust your salt intake accordingly. And remember this important takeaway: salt is essential for your health.

 

Happy Summer!

  

(1) https://www.hsph.harvard.edu/nutritionsource/salt-and-sodium/