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How Bad is Salt, Really?

How Bad is Salt, Really?

by Kristin Wartman, Contributor to Holistic Nutrition on

For something that’s so often mixed with anti-caking agents, salt takes a lot of lumps in the American imagination. Like fat, people tend to think of it as an unnecessary additive — something to be avoided by seeking out processed foods that are “free” of it. But also like fat, salt is an essential component of the human diet — one that has been transformed into unhealthy forms by the food industry.

Historically, though, salt was prized. Its reputation can be found in phrases like, “Worth one’s salt,” meaning, “Worth one’s pay,” since people were often paid in salt and the word itself is derived from the Latin salarium, or salary.

Those days are long over. Doctors and dietitians, along with the USDA dietary guidelines, recommend eating a diet low in sodium to prevent high blood pressure, risk of cardiovascular disease, and stroke; and doctors have been putting their patients on low-salt diets since the 1970s. But a new study, published in the May 4 issue of The Journal of the American Medical Association (JAMA), found that low-salt diets actually increase the risk of death from heart attack and stroke — and in fact don’t prevent high blood pressure.

The study’s findings inspired much criticism and controversy — as research that challenges conventional dietary wisdom often does. When The New York Times briefly reported on it, even the title conveyed the controversy: “Low-Salt Diet Ineffective, Study Finds. Disagreement Abounds.” The Times reports that the Centers for Disease Control and Prevention “felt so strongly that the study was flawed that they criticized it in an interview, something they normally do not do.” According to the Times, Peter Briss, a medical director at the Centers, said that the study was small, that its subjects were young, and that they had few cardiovascular events — making it hard to draw conclusions.

But most of all, Briss and others criticized the study because it challenges dietary dogma on sodium intake. These experts claim that a body of evidence establishes sodium consumption as a serious driver of cardiovascular disease. But if you take a careful look at the evidence, you’ll see that the case against sodium crumbles under the weight of its contradictions. Gary Taubes wrote about the controversy on the benefits of salt reduction more than 10 years ago in a piece for Science called “The (Political) Science of Salt.” He portrayed a clash between the desire for immediate and simple answers and the requirements of good science. “This is the conflict that fuels many of today’s public health controversies,” Taubes asserted.

The JAMA study published early this month is not the first to find that a low-salt diet may be detrimental. In 2006, data from the NHANES II study showed that death from heart disease and all causes rose with lower salt consumption. Published in the American Journal of Medicine, the report found:

Lower sodium has been associated with stimulation of the sympathetic nervous system, that, in turn, has been associated with adverse [cardiovascular disease] and mortality outcomes. Sodium restriction may also influence insulin resistance.

The insulin resistance association is compelling since so many Americans are exhibiting signs of insulin resistance, the precursor to diabetes. Michael Alderman, a blood-pressure researcher at Albert Einstein College of Medicine and editor of the American Journal of Hypertension, said in an email, “The problem with reducing sodium enough to change blood pressure [is that it] has other effects — including increasing insulin resistance, increasing sympathetic nerve activity, and activating the renin-angiotensin system and increasing aldosterone secretion. All bad things for the cardiovascular system.”

There are those who will argue that any study claiming that sodium is not as harmful as previously believed are connected to the salt lobby, but this is untrue. The most recent JAMA study has no such connection and many real-food advocates, myself included, believe that salt is an essential part of a healthy diet. Alderman was once an unpaid consultant for the Salt Institute but no longer is, according to the Times article.

There is also a strange psychological component to this debate as is often seen in the nutrition world: When a message has been hammered in and repeated millions of times over the course of decades, whether or not that message is actually true becomes irrelevant — and the people invested in presenting that message, whether for monetary gain or not, are especially resistant to any evidence that might be contrary. When asked about this phenomenon and the standard recommendations on salt, Alderman said, “They are based upon the hope that the blood pressure effect of lowering sodium would translate into a benefit in health. Opposition to these findings — which only adds to a substantial body of similar information — is that these folks have long held the faith that lowering sodium was a good idea. They have opposed randomized trials with the bogus argument that a randomized controlled trial would be too tough and expensive. Not so. They choose faith over science, but it’s not a theological issue.”

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3:24PM PDT on Aug 11, 2012

Should have read "a day" after the "below 1500mg"

3:21PM PDT on Aug 11, 2012

Salt is too be nothing more then a flavor enhancer, and it doesn't take very much to enhance flavors when one uses spices and herbs along side it. We use very little in my house since my mother is on a diet that calls for less salt, and grandmother recently had open heart surgery on a faulty valve caused by water retention due to a high sodium diet and I cook for her as well. Both have diabetes and we have found that for processed foods low sodium foods have higher sugar count and low sugar foods have higher salt count so a lot of meals are made by hand,. It is tough when grandmother can't walk, mother works, I go to school and my youngest brother is just learning to cook eggs (13 years old and he is finally getting over his fear of the oven that his father put into my brother when he told him that the oven will kill him if he tries to use it), even more so tough when I have to make sure that the level of salt for each person is below 1500mg (the doctors said that 1500mg or lower is healthy anything higher then that could be bad)

And Amber B, yes, salt, if in too high of doses, can cause heart attacks because it will increase high blood pressure which can lead to a heart attack. If fact any food has a chance of causing a heart attack if you actually think about it. Moderation of all real food one eats is great for a person.

10:39AM PDT on Mar 28, 2012

We use a little Sea Salt. That way you don't need much.

6:08PM PDT on Mar 15, 2012

use a good pink salt, a whole salt not a processed one, like Himalayan salt.

3:21AM PST on Mar 4, 2012

I thought salt was bad, so I cut back to a minimum, and suffered with low blood pressure for months before I realised what was wrong. Healthy people can excrete excess salt. It's also helpful to keep your potassium levels up. I'm glad to see research defending salt.

2:51AM PST on Mar 2, 2012

well thats a new spin on an old belief

2:12PM PST on Mar 1, 2012

I use himalayan salt.

7:24AM PST on Mar 1, 2012

they ( my Doctors) say it is and ~I trust my docs..

7:13AM PST on Mar 1, 2012

food for thought

2:41AM PST on Mar 1, 2012

Well, we live in a pre-packaged world. If you're the type that eats many foods from packages including TV/frozen dinners, lunchables, canned heat & eat foods, etc... and then for what you call "healthy" get lunch meats that are low in fat but high in salt which would include ALL processed meats such as ham and many cold cuts... then yeah, you're getting way too much salt.

I start with fresh ingredients, and cook from there. If I were to cut back on salt, I'd be way below the suggested normal. Plus I prefer pepper, so it's easy to mix spice into everything I make.

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