Who is Right in the Salt Debate?

For decades, a sometimes furious battle has raged among scientists over the extent to which elevated salt consumption contributes to death, with one camp calling it a “public health hazard that requires vigorous attack” and another claiming the risks of dietary salt excess are exaggerated, even to the point of calling sodium reduction “the largest delusion in the history of preventive medicine” The other side calls this denialism ethically irresponsible, especially when millions of lives are at stake every year.

To describe two sides of the debate may be falling into the trap of false equivalency, though. As the superhero-sounding “World Hypertension League” points out, there is strong scientific consensus that reducing salt saves lives, and, like the climate change debate, most authorities are on one side. On the other? Only the industry affected, their paid consultants, and a few dissenting scientists.

As I discuss in the video below, nearly all government appointed bodies and nutrition experts who have considered the evidence have recommended we collectively cut our salt intake about in half—a reduction described as extreme by those defending the industry. After all, just a small fraction of Americans actually get their sodium intake that low. Therefore, the salt skeptics say, the human experience for very low levels of sodium consumption is “extremely sparse.”

Extremely sparse? The reality is the exact opposite. The human experience is living for millions of years without Cheetos or a salt shaker in sight. We evolved to be salt-conserving machines, and when we’re plunked down into snack food and KFC country, we develop high blood pressure. But in the few remaining populations that don’t eat salt and only consume the small amounts of sodium found in natural foods like we had for millions of years, our leading killer risk factor, hypertension, is practically non-existent. When you take people with out-of-control hypertension and bring them back down to the sodium levels we were designed to eat, the ravages of the disease can even be reversed.

If salt hidden in food kills millions of people around the world, why are efforts to cut dietary salt being met with such fierce resistance? Salt is big business for the processed food and meat industry. So, according to the head of the World Health Organization’s Collaborating Center on Nutrition, we get the familiar story. Just like the tobacco industry spent decades trying to manufacture doubt and confuse the public, the salt industry does the same, but the controversy is fake.

The evidence for salt reduction is clear and consistent. Most of the “contradictory research” comes from scientists linked to the salt industry. However, it takes skill to spot the subterfuge because the industry is smart enough to stay behind the scenes, covertly paying for studies designed to downplay the risks. All they have to do is manufacture just enough doubt to keep the so-called controversy alive.

The likes of the World Hypertension League have been described as a “mere pop-gun against the weapons-grade firepower of salt-encrusted industries” who look disdainfully at the “do-gooder health associations…who erect roadblocks on the path to profits.” Lest we forget, notes an editorial in the Journal of the Canadian Medical Association, high blood pressure is big business for the drug industry, too, whose blood pressure billions might be threatened should we cut back on salt. If we went sodium-free and eliminated the scourge of hypertension, not only would Big Pharma suffer, what about doctors? The number-one diagnosis adults see doctors with is high blood pressure, at nearly 40 million doctor visits a year, so maybe even the BMW industry might be benefiting from keeping the salt debate alive.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations—2015:Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016:How Not to Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

Related:

How to Treat High Blood Pressure With Diet
Choosing to Have Normal Blood Pressure
Why Was Heart Disease Rare in the Meditteranean

79 comments

Marie W
Marie W1 years ago

Thanks for sharing

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Quanta Kiran
Quanta Kiran2 years ago

noted

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Julie W
Julie W2 years ago

I read this a few years ago - well, an abbreviated version of it.://academic.oup.com/ajh/article/24/8/854/226112/The-Cochrane-Review-of-Sodium-and-Health

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Julie W
Julie W2 years ago

Maybe it's not that black and white . I have always had low blood pressure, and nearing 80, I still have. But I have always eaten salty food. No problems with BP with my two pregnancies - not that we were aware of the salt issue then. So it's possible salt affects people differently. I do use Himalayan salt and black salt occasionally, rather than the pure sodium chloride from the supermarket. But without any form of salt, food has no flavour.

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Jane R
Jane R2 years ago

I absolutely love salt. I use it when I cook and I add it to the food on my plate even before I taste it. I do the same with pepper. I can't eat bland food.

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Mary B
Mary B2 years ago

Get rid of Trump and his cabnet and the collective blood pressure of the people of the United States will go down immediately. Personally, I'm keeping my salt, fat and various sweeteners.

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Elena Poensgen
Elena Poensgen2 years ago

Thank you

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Elena Poensgen
Elena Poensgen2 years ago

Thank you

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Cindy Black
Cindy B2 years ago

Well, Dr. Greger, I just adore you and follow every bit of your advice. HOWEVER, I do love salt. I used to eat it out of my hand! I HAVE cut that out, but I still add salt to most of my food and never check a label for salt. At 69 I look and act about 42 and my BP is around 110/65. It seems like your latest video (on your own site) indicated that salt could hurt you even if it's not raising BP. I'll have to do some more research to make sure I didn't just hear you wrong.. Cheers, Cindy

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Debbi -
Debbi -2 years ago

Close to thirty years ago my husband had high blood pressure & 'white coat' syndrome. A specialists told him he had to cut his salt intake. At the time we were worried about his chance of having a heart attack so it didn't occur to ask how much sodium a day was 'low.' The next morning we watched a show on PBS about health, and at one point the moderator stated that a low sodium level was 1,000 mgs.

When food shopping I read every single label. At the time not all labels gave the sodium content. If it was stated, I didn't buy it. He was always a generous salter so when his breakfast had enough salt for me, he said it tasted like cardboard. I kept him on a 1,000 mgs of salt for a week then we returned to see his doctor. The doctor was amazed by the improvement of his blood pressure. It had dropped from 180 to 140.

Do I believe high levels of salt increase blood pressure? Of course I do. I took part in a real like experiment. Today it much easier to maintain a low sodium diet without the food tasting like cardboard.

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