In 2010, the revised US Dietary Guidelines were released. One of the revisions was to restrict sodium intake to 2300mg per day or 1500mg if older than 50, or of any age who are African American, have hypertension, diabetes or chronic kidney disease. This is unfortunately a further reinforcement of the mantra that sodium (and salt by default) is bad. It has been the recent belief/assumption that high dietary levels of sodium is problematic because it raises blood pressure and high blood pressure leads to health problems. Elevated blood pressure is a universally accepted sign of a health problem so it makes sense to stop doing things that elevate blood pressure. Since we know that sodium raises blood pressure sodium/salt should be reduced. Shame on you sodium. What did we ever do to you…?

Rethinking Sodium & Salt

Let’s lay it on the line right away. I think the current thinking and popular beliefs on sodium are skewed and misplaced. Although there is some evidence that excessive refined salt and sodium intake can be problematic in a fraction of the population, there is little evidence it is necessary to restrict sodium, particularly from real salt, for the general population. Here are the basics:

– Sodium is vital to human function. Humans need it to survive and thrive. With too little sodium many critical functions are impaired. Without it, we die.
– Salt, chemically known as NaCl (sodium chloride), is the main source of dietary sodium in the general population and therefore salt is often used interchangeably with sodium.
– Humans, along with other animals, have a well established taste for and desire to obtain sodium.
– Elevated dietary intake of sodium is only related to hypertension (chronic high blood pressure) in a fraction of the population (estimates range from 1-10%). These people are known as “salt sensitive”. Hypertension is most commonly a symptom of metabolic dysfunction, stemming from stress or insulin resistance.
– Research has not validated the claim that reduced levels of sodium contribute to living longer.
– Lowering sodium recommendations is good in terms of getting people to buy less prepared foods. Sodium is a problem in microwave dinners, chips and foods in a box. Sodium is not a problem in the amounts people add (in the form of salt) to flavor food they make themselves.
– Limiting sodium intake has many potential detriments. Low sodium levels are most commonly experienced as cognitive impairment (lethargy, fuzziness, fatigue, brain fog, inability to focus) or muscular problems (spasms, cramps, weakness, seizures). Avoiding salt and sodium can be a big health hazard.
– Processed and refined table salt is likely not a great food substance or additive, due to excessive heating, bleaching and removal of minerals and nutrients.
– Unprocessed salt (known as real salt) is a health food and a viable source of minerals for nearly everyone.
– There is some evidence that higher intakes of sodium (3500-5000mg/day) is the most health promoting level.
– Don’t be wary of sodium and salt. High sodium content on a label is simply a red flag that you’re eating a food product. Worry about the fact you’re eating a food product more than the sodium itself.

Digging Deeper Into The Salt Mine

As always, let’s take a step back. Is it possible that the belief that excess sodium causes high blood pressure is skewed? Yes. Why? Once again, the medical and health community as a whole has taken some research out of context, forgotten to filter it with common sense and then failed to acknowledge contrary evidence. End result: Sodium has been wrongfully accused. Was it at the scene of the crime? Yes. Did it do anything wrong? No.

Sodium Is Essential
Sodium (chemically known as Na), the 6th most abundant element in the Earth’s crust, is an essential element to all animals and most plants. Important in regulating blood volume and involved in blood pressure changes, sodium also controls osmotic equilibrium and pH balance in the body. The minimum requirement for normal biological functioning is about 500mg a day. Currently the Recommended Daily Allowance is 1500mg and the Tolerable Upper Limit is 2300mg per day. Where these recommendations came from is part mystery and part politics, meaning they are not highly “scientific.” The average American has an intake around 3500mg each day, meaning most of us overdo according to the health world. Since it has been established that mega doses of sodium can cause acute water retention and temporary increases in blood volume and pressure and high blood pressure is correlated to high dietary sodium intake, it was concluded that sodium consumption causes systemic and chronic high blood pressure. Just like in the cholesterol debacle, we noticed a physiological response and an association was found between high levels and a disease state so we jumped to the conclusion that since we think high is bad, the answer is to drive levels lower, maybe as low as possible. Another mistake that has dramatically altered people’s dietary habits, possibly for the worst. Low levels of sodium intake alter several body processes/balances and can lead to a host of ailments, most commonly cognitive impairment (brain fog, attention/focusing decline, lethargy) and muscular problems (spasms, cramps, fatigue/weakness and seizures). As an important electrolyte, sodium is also vital to performance and is very important to anyone who exercises, particularly endurance based exercisers and athletes, or those that live in warmer and drier climates.

To be fair, excess sodium does lead to chronic elevated blood pressure in 1-10% of the population (depending on the researchers and source), known as the “salt sensitive” people. For the rest of the population, excess sodium may raise blood pressure temporarily but does not cause high blood pressure in the context of the disease state that is associated with health problems. For the record, to my knowledge, the salt sensitive connection has never been studied with real salt. My guess is that you would see even less of the population respond negatively to real salt.

So if sodium is not the main contributor to elevated blood pressure, what is? Stress and insulin resistance and the resulting hormonal cascade are much more to blame. Both of these raise levels of the hormone Aldosterone, which pulls sodium and other minerals into the blood, raising blood volume and blood pressure. Once again, sodium is not the root problem but is more of an innocent bystander. It is involved but its presence doesn’t cause the problem. Correlation does not mean causation.

So how does one reduce blood pressure? By lowering levels of stress on the body and restoring insulin sensitivity. Stress reduction can come from a number of avenues and becoming more sensitive to insulin happens as a result of restoring overall body health, possibly most importantly through more natural based eating habits and moving the body around more regularly. Reducing the amount of refined carbohydrates (particularly sugar and sweetened beverages) is a great place to start. This is where common advice to limit sodium and salt comes in handy. By limiting high levels of sodium you are virtually forcing people to eat less processed food. This is good. But since it is commonly misconstrued that eating anything low in salt helps, common advice misses the mark. When someone snacks on some processed low sodium or salt free food thinking it’s won’t affect their blood pressure they are gravely mistaken. It’s the quality of the food that counts, not the sodium content.

Smart Salt Use

Ok, so if excess sodium doesn’t cause high blood pressure, does that mean we can have as much salt as we want? Not necessarily. It depends on what kind and how you use it.

Real Food
For people focusing on a real food, naturally based, nourishing diet, salt isn’t much of an issue. When you eat real food, you get low to moderate levels of sodium. Only people who eat pre prepared, packaged and/or preserved food have to worry about excess sodium. In fact, people who eat a real food diet (particularly plant based diets) sometimes run into an issue of too little sodium, especially when they are physically active and deplete body sodium levels. We need sodium for optimal functioning and this is where salt can be of a great health benefit. The issue then becomes getting good salt that is health promoting and limiting the more refined versions (that are not dangerous- unless highly over consumed in the form of food products but are not necessarily health promoting either).

Salt Quality
One of the biggest issues with salt in recent years is food industrialization. The salt we have been consuming isn’t really salt. It is a refined, heated and chemically treated substance that resembles salt. Real salt is a whole food, contains dozens of minerals and nutrients, and can be incredibly health promoting. Lately, with the real food movement, real salt has become more popular in the mainstream. Sea salt (Celtic/Himalayan) is a step in the right direction but is often still processed and heated. Real salt, which is minimally processed and not heated, contains dozens of nutrients in a complex relationship and in an unaltered form. This is the salt we crave physiologically. This is the salt humans have been eating, chasing and trading for thousands of years. This is the salt we should still be eating. This is the salt that is good for us.

Potassium
An important piece to the salt puzzle, and potentially why it has confused us for so long, is potassium. These two minerals work in harmony in the body and when out of balance things go haywire. Too much salt/sodium can be a problem if potassium isn’t also high to balance. Too little sodium is a problem in and of itself but particularly if potassium is high (which happens in the plant based, salt limiting eating population quite often. Think of not the total amount of sodium you consume but how balanced it is with potassium. For much more on this relationship, check out the breakdown on Potassium.

Here’s a link to the Real Salt I like.

The Bare 5 Bottom Line on Salt:
1. Sodium only causes high blood pressure in a fraction of the population. Stress and insulin resistance are the culprits for the vast majority.
2. Low sodium levels are likely more of a problem than high.
3. Refined salt is not health promoting. Cutting it out is a great way to force yourself to eat more real food.
4. Real salt is a whole, healthy food.
5. Eat as much real salt as you see fit.

Thanks for reading, have a real salty day!