SALT /sôlt/ A chemical compound made up of two elements, sodium and chloride (NaCl).
The idea that too much salt is bad for our health is something very few question.
According to conventional wisdom, too much salt in the diet increases blood pressure, which can lead to hypertension and as a result stroke, heart failure or heart attack.
The World Health Organisation recommend adults eat no more than 5g (1 tsp) of salt a day.
So, is there anything wrong with this recommendation? Let us take a closer look at the evidence…
Salt is Essential
It is actually the sodium in the salt that our body needs.
One of the first things we need to understand is that sodium is important for many biological processes within the body.
Some of these essential functions include;
- Maintaining the fluid in our blood cells.
- Transmitting information in the nerves and muscles.
- Carrying nutrients into and out of the cells.
- Maintaining and regulating our blood pressure.
Since the body cannot make sodium, we are reliant on our diet for getting enough into the body, so that these important processes can happen without issue.
Professional athletes know the importance of maintaining healthy sodium levels, which is why they make sure to replenish lost sodium after strenuous workouts or training sessions.
Can Sodium in the Body be too Low?
Basically, if your sodium levels get diluted, the body’s fluid levels increase and the cells begin to swell. This swelling can cause a number of health problems, some mild, some severe.
Anything from a low salt, high water diet, to an underlying medical condition can be the cause.
At its worst, hyponatremia is a very serious condition, leading to brain swelling, coma and even death.
Obviously, this is worst case scenario, but it is worth bearing in mind that sodium does play a vitally important role within the body.
The overall message to the general public, however, remains pretty loud and clear, that most should be limiting their salt intake.
So, is this good advice? And how does it stand up against the available scientific literature?
What the Scientific Research Says
Here are some important research studies on reduced salt diets…
The DASH Diet
Health professionals usually refer to the 2001 DASH (Dietary Approaches to Stop Hypertension) trial as evidence that a lower salt intake is beneficial for improving health.
The DASH trial was 30 days long, and it concluded that eating significantly less salt would modestly lower blood pressure;
The reduction of sodium intake to levels below the current recommendation of 100 mmol per day and the DASH diet both lower blood pressure substantially, with greater effects in combination than singly.
While that may sound like the health benefit we’re after, it said nothing about whether this lowering of blood pressure would do anything at all to reduce hypertension, prevent heart disease, or prevent premature death.
In other words, did this lowering of blood pressure actually have a good effect on the body?
Rather than the research showing inconclusively that a lower salt diet is heart-healthy, it seems many studies have ended up with the unsatisfactory conclusion — we simply can’t say for sure!
Study results are inconclusive
A study from 1998 (sample size 20,729), concluded that no particular dietary recommendation could be justified;
This observational study does not justify any particular dietary recommendation. Specifically, 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.
A 2006 study (cohort, 7,154 subjects) queried the ‘survival advantage,’ saying;
The inverse association of sodium to CVD mortality seen here raises questions regarding the likelihood of a survival advantage accompanying a lower sodium diet. These findings highlight the need for further study of the relation of dietary sodium to mortality outcomes.
A 2007 study (cohort, 1,448 subjects), said this;
The effect of sodium and potassium intake on CVD (cardiovascular disease) morbidity and mortality in Western societies remains to be established.
A 2011 review (6,489 participants), concluded in a similar fashion;
There is still insufficient power to exclude clinically important effects of reduced dietary salt on mortality or cardiovascular morbidity in normotensive or hypertensive populations.
A 2011 Cochrane review (167 studies in sample), was rather unsettling in its conclusion;
We do not know if low salt diets improve or worsen health outcomes.
Low salt risky for those with normal blood pressure
Italian researchers in 1987, found reducing salt in those with normal blood pressure may actually be harmful;
These results suggest that “sodium sensitivity” of blood pressure may be more evident with increasing age. Further, sodium restriction in all normotensive adults may not be innocuous.
(Define innocuous: harmless, safe)
Low salt risky for heart failure patients
A 2008 study, found that a reduced sodium diet may be harmful for congestive heart failure (CHF) patients;
Sodium depletion has detrimental renal and neurohormonal effects with worse clinical outcome in compensated CHF patients.
Low sodium levels associated with fractures in elderly
In 2011, researchers looked at subjects (5,208 elderly) from the Rotterdam Study. It was concluded;
Mild hyponatremia in the elderly is associated with an increased risk of vertebral fractures and incident nonvertebral fractures but not with BMD (bone mineral density). Increased fracture risk in hyponatremia also was independent of recent falls, pointing toward a possible effect on bone quality.
A 2009 Cochrane review, said there was not enough information to assess the effect of changes in salt intake on health or death;
Intensive support and encouragement to reduce salt intake did lead to reduction in salt eaten. It also lowered blood pressure but only by a small amount (about 1 mmHg for systolic blood pressure, less for diastolic) after more than a year. This reduction was not enough to expect an important health benefit. It was also very hard to keep to a low salt diet. However, the reduction in blood pressure appeared larger for people with higher blood pressure.
I have already mentioned the 2011 Cochrane review, but it is worth noting in full the closing thoughts of the study authors.
They suggest advice to reduce salt may lead to harmful increases in certain hormones and lipids, as well as echoing what I’ve said above — we simply don’t know for sure if the advice to lower salt is helpful;
We are commonly advised to cut down on salt. The previous version of this review looked at mostly short-term strategies to reduce salt intake. In the present updated version separate analyses of studies with a duration of 2 to 4 weeks or longer were performed. Low salt diets reduced systolic blood pressure by 1% in white people with normal blood pressure and by 3.5% in white people with elevated blood pressure. The effect was similar in trials of 4 weeks or longer. There were increases in some hormones and lipids which could be harmful if persistent over time. However, the studies were not designed to measure long-term health effects. Therefore we do not know if low salt diets improve or worsen health outcomes.
Health recommendations should not be generalized
One of the clearest things coming across from this review of the evidence, is the need to make specific advice, tailored to each individual, rather than giving advice that is more of a one-size-fits-all approach.
A 2011 prospective population study (3,681 subjects), demonstrates this fact;
Our current findings refute the estimates of computer models of lives saved and health care costs reduced with lower salt intake. They do also not support the current recommendations of a generalized and indiscriminate reduction of salt intake at the population level. However, they do not negate the blood pressure−lowering effects of a dietary salt reduction in hypertensive patients.
What This Means For You Personally
According to conclusions from many of the available studies, the overall benefit of a reduced salt diet has been rather underwhelming.
However, I am not saying you can now go out and eat all the processed foods you like, since you don’t need to worry about your salt intake anymore.
That is certainly not the case.
Dian Griesel, Ph.D., and co-author of the book TurboCharged: Accelerate Your Fat Burning Metabolism, Get Lean Fast and Leave Diet and Exercise Rules in the Dust, explains it this way;
The optimal level of salt in our diets has been a controversial subject for at least 20 years. There is no disagreement that high blood pressure (even moderately high) is a risk factor for heart disease and stroke. However, salt consumption does not seem to have the same effect on everyone. In addition, there is usually no distinction on the type of salt used.
This is absolutely right. All forms of salt are not equal.
One of the big problems with people’s diets is that the sodium most are consuming comes from processed foods.
There is an overabundance of salt in processed foods, and while we need sodium in our body, we shouldn’t be getting it from such heavily processed sources.
Choose Your Salt Wisely
There is a plethora of ‘natural’ salt products on the market these days. And, you would be forgiven for getting a bit confused as to which is the best choice.
Sea salt vs table salt
In the past, I have made the mistake of buying ‘sea salt’ thinking it would be a better choice over regular ‘table salt,’ but that is not necessarily the case.
The truth is that virtually all salt is sea salt, because they all came from the sea at one time or another. Technically, processed table salt could still be called sea salt, so the term is essentially meaningless.
All salt deposits contain the same mixture of elements to begin with, but it is how they are processed that makes the difference in the quality of the end product.
What to look for when choosing healthier salt alternatives
One way you will know if your salt of choice is a good option, is to simply look at the color.
Full spectrum salt always has an off-white color. So, if your salt is pure white, it is not full spectrum salt.
Full spectrum salt contains the full spectrum of 84 minerals and trace elements. Standard table salt does not retain these trace elements, as a result of the heavy processing it goes through. It also contains certain additives, such as anti-clumping agents, and iodine fortification.
Take Away Points
The main thing I want you to get from all of this, is that you should not be happy to accept a one-size-fits-all approach for your health.
So, if you are someone who is sensitive to salt, a reduction in your salt intake is probably wise. Then when you do use salt, go for a natural alternative, such as those mentioned above.
Majority of people
For the rest of us, we should all make a conscious effort of avoid the hidden salt in foods, which come from refined and heavily processed foods.
Not only are these foods really bad for health, but combined with the fact manufacturers always use a heavily processed version of salt, these are not the kind of foods you should be eating regularly.
Aim to eat lots of fresh, colorful, natural foods most of the time, as well as using small amounts of full spectrum salt in your cooking and at the table.
Strenuous exercise and hot climates
Also remember that if you exercise strenuously, or live in a very hot country, salt can be a regular part of your diet, necessary to replace import minerals lost through sweating, without any concern for health.
Ultimately, adding unrefined salt to a diet that is already rich in whole, healthy foods is perfectly healthy.
By limiting your intake of processed foods, the amount of sodium you will actually be getting in your diet will already be drastically reduced compared to the standard American diet.
So, what are your thoughts on the salt myth? I’d love to hear from you in the comments below…