Shaking up the Salt Myth: The Dangers of Salt Restriction

“In an era when dietary advice is dispensed freely by virtually everyone from public health officials to personal trainers, well-meaning relatives, and strangers on check-out lines, one recommendation has rung through three decades with the indisputable force of gospel: Eat less salt and you will lower your blood pressure and live a longer, healthier life.” Gary Taubes, 1998

 

In my last two articles, I discussed the history of salt in the human diet and the physiological need for salt. Many proponents of the Paleo diet suggest limiting salt based on evidence of low salt intake during the Paleolithic era. This limitation meshes with recommendations made by various health organizations, such as the USDA and the American Heart Association, who suggest limiting sodium to at least 2,300 mg per day and even as little as 1,500 mg per day. (1, 2) And if our Paleolithic ancestors ate a low salt diet, then it certainly must be healthy, right?

Not necessarily. Recently, evidence has been mounting against universal salt restriction guidelines. A low-salt diet may cause serious health consequences and higher overall mortality, especially in the presence of certain chronic health conditions and lifestyle factors. In this article, I will discuss scientific evidence that contradicts salt restriction recommendations, as well as potential health risks of consuming a diet too low in salt.

Serious health consequences of long-term salt restriction

While salt-induced hypertension is typically blamed as a cause of heart disease, a low salt intake is associated with higher mortality from cardiovascular events. A 2011 study in the Journal of the American Medical Association demonstrates a low-salt zone where stroke, heart attack and death are more likely. (3) Compared with moderate sodium excretion, there was an association between low sodium excretion and cardiovascular (CVD) death and hospitalization for coronary heart failure. These findings demonstrate the lowest risk of death for sodium excretion between 4 and 5.99 grams per day. (Figure 1.)

Figure 1. Estimated 24-Hour Urinary Excretion of Sodium and Composite of Cardiovascular Death, Stroke, Myocardial Infarction, and Hospitalization for Congestive Heart Failure

Another 2011 study confirmed this observation; not only was lower sodium excretion associated with higher CVD mortality, but baseline sodium excretion did not predict the incidence of hypertension, and any associations between systolic pressure and sodium excretion did not translate into less morbidity or improved survival. (4)

Low salt diets contribute to an increase in hormones and lipids in the blood. A 2012 study in the American Journal of Hypertension found that people on low-salt diets developed higher plasma levels of renin, cholesterol, and triglycerides. (5) The authors concluded that the slight reduction in blood pressure was overshadowed by these antagonistic effects, and that sodium restriction may have net negative effects at a population level.

In addition, low sodium intake is associated with poor outcomes in Type 2 diabetes. A 2011 study study showed people with Type 2 diabetes are more likely to die prematurely on a low-salt diet, due to higher all-cause and cardiovascular mortality. (6) Additionally, a 2010 Harvard study linked low-salt diets to an immediate onset of insulin resistance, a precursor to Type 2 Diabetes. (7) These studies call into question the appropriateness of guidelines advocating salt restriction for patients with Type 2 diabetes.

Restricting salt is also problematic for athletes, particularly those participating in endurance sports. (8) Recent studies have shown that endurance athletes commonly develop low blood sodium, or hyponatremia, even in the absence of cognitive symptoms. In the 2002 Boston Marathon, it was found that 13% of 488 runners studied had hyponatremia, and studies of other endurance events have reported the incidence of hyponatremia to be up to 29%. (9101112)  While the majority of these sodium deficient athletes are asymptomatic or mildly symptomatic with nausea and lethargy, severe manifestations such as cerebral edema, noncardiogenic pulmonary edema, and death can occur. (13) It is extremely important that athletes engaging in high intensity or long duration exercise be sure they adequately replace the salt lost through sweat.

Salt restriction may be especially dangerous for the elderly. Elderly people with hyponatremia have more falls and broken hips and a decrease in cognitive abilities. (1415) Hyponatremia is a common finding in the elderly, with an especially high prevalence in those with acute illness. (16) This is another population at risk for serious health consequences due to universal sodium restriction.

 Why is the government still recommending salt restriction?

Conventional healthcare experts have been recommending salt restriction ever since the 1970s, when Lewis Dahl established “proof” that salt causes hypertension. (17)  In his research, he induced high blood pressure in rats by feeding them the human equivalent of over 500 grams of sodium a day; 50 times more than the average intake in the western world. (181920) Dahl also invoked evidence that cultures consuming higher levels of salt tend to have higher blood pressure than those who consume less salt. (21)

Figure 2. Correlation of average daily salt (NaCl) intakes with prevalence of hypertension in different geographic areas and among different races, from Dahl, 2005

However, when Intersalt researchers investigated this possible association, while controlling for confounding factors, the correlation between blood pressure and salt intake almost disappeared. (2223) For some reason, this contradictory evidence is still being used today to justify restricting salt intake.

In 1998, Gary Taubes wrote an article for Science magazine highlighting the clash of public policy with controversial scientific evidence for salt reduction. (24) He described how most of scientific discord over salt reduction has been overshadowed by the public attention given to the benefits of avoiding salt.

As Taubes explained over a decade ago, “the data supporting universal salt reduction have never been compelling, nor has it ever been demonstrated that such a program would not have unforeseen negative side effects.” The 1988 Intersalt Study, designed to resolve contradictions in ecological and epidemiological studies, failed to demonstrate any linear relationship between salt intake and blood pressure. Now, in 2012, we have data that suggests long-term salt restriction may pose serious risks for much of the population. Yet major health organization guidelines still recommend the restriction of salt for all Americans, regardless of blood pressure status.

In short, there is a healthy range of salt consumption for most people. When eating a whole foods diet, most people tend to consume an appropriate amount of salt simply due to an innate preference for saltiness. In fact, the consumption of salt around the world for over two centuries has remained in the range of 1.5 to three teaspoons per day, which appears to hold the lowest risk for disease. (25)

Our bodies may have a natural sodium appetite through which our ideal salt intake is regulated. By following a whole foods, Paleo diet, and eliminating processed foods, excess sodium in your diet will be drastically reduced. Thus, you can be confident in following your own natural taste for salt when adding it to your food during preparation. In other words, there are few reasons to deprive yourself of salt!

In my next article, I will discuss the conditions in which salt reduction may be warranted, and nutrients that may be more important than sodium in controlling blood pressure and promoting overall health.

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Comments Join the Conversation

  1. Peter Schroth says

    The link in note 4 to the American Journal of Hypertension doesn’t work, because that journal has moved to Oxford.

  2. Old Fogey says

    I’m glad this topic is being discussed. Now what about the dramatic increase in potassium levels due to substitution of sodium chloride with potassium chloride in foods, especially so-called “low Salt” or “healthy Salt” products.
    I’m led to believe that the body can’t regulate potassium directly, and uses sodium levels as an approximate gauge of electrolytes. If we flood ourselves with potassium and remove sodium, I’m pretty sure we wouldn’t live to tell anybody about our mistake.

  3. Allan Holtz says

    Fascinating article. I am 64. I started a running addiction at age 43 and since then I have run about 60,000 miles including finishing 40 foot races of 100 or more miles. I also have 38 in-completes at the 100-mile distance. I will be attempting the Lean Horse 100 mile race next Saturday. First when I started running I avoided all fat and had issues with dry skin. Then I added Udo’s Choice oil as a supplement (2 tablespoons 5 days a week). I avoided salt and had issues with cramping during marathons and longer races. Now I consume lots of Succeed S-Caps (NaCl, Na citrate and other electrolytes) during running events of longer than 3 hours. I also do NOT worry about adding salty things like ketchup to some foods when I eat out. I now eat at buffets 3 days a week and at home 4 days a week. I started eating lots of pasta and now I eat very little pasta, but LOTS of lightly cooked vegetables (like broccoli, cauliflower, squash – winter and summer types, peas, corn, green beans, carrots, brussel sprouts, kale, kohlrabi, collard greens, swiss chard, asparagus, potatoes, tomatoes), fruit (strawberries, blueberries, blackberries, bananas, watermelon, cantaloupe, honeydew, pineapple, pears, apples, grapes, peaches, plums), nuts (pecans, almonds, walnuts) and meats, (salmon and some other fish, chicken and turkey (without skin), sirloin steak, pork tenderloin) and oatmeal. I do not eat wheat products or desserts very often. I am 68 inches tall and currently weight 151-154 pounds depending on how much salt I had. My testing suggests I am 10-12% body fat. My blood pressure is 100-115 over 58-65 with a resting pulse of 42-49. My LDL is about 140 and my HDL is about 75. Before I started the running addiction my HDL was under 30 and I weighed 2-=26 pounds more. My glucose is 60-80 and my triglycerides are 90. A combination of exercise and appropriate whole foods (based on individual tolerance) I think will allow anyone’s body to be at their optimum health.

  4. David Boothman says

    Over the past few years I’ve come to think of those responsible for propagating official health advice as clueless bunglers. The problem seems to have started around 1950 and got progressively worse. So when self-appointed experts began recommending salt restriction I immediately smelled a rat and went back to look at the past fifteen years of my own annual blood test data. The result was not unexpected; my sodium level was consistently maintained just below the lower limit of the recommended guideline range. Now, my diet has been anything but consistent over this period so apparently evolution has, as we might expect, equipped the body with a sodium control mechanism.. No doubt the data linking hypertension to salt intake is derived from the few people who the medics see with hypertension problems resulting from a dysfunctional sodium control system. I believe there is even research data to support this conclusion. However when there is insufficient dietary sodium the control mechanism would be unable to function. And this is why for generations farmers have provided unlimited access to salt licks to ensure this problem doesn’t happen. Notably, the animals are simply given access without restriction. Once again we have the bunglers regulating something taken care of by evolution, something they apparently never studied, along with any consideration of all-cause mortality.

    • Samantha says

      Salt licks (a non essential compound as inorganic sodium chloride) have no metabolic correlation to essential organic sodium, a required nutrient.

      NaCl is an addictive substance in pharmacological expression.

      Most farmers would expect and want their herds to remain nearby where an addictive substance was made available.

  5. Angela says

    I have been told and agree not all salt is made the same and sea salt is the best to use. Maybe someday you will discuss the differences? And my mother has it ingrained in her mind we need Iodine salt, is there research on that? I agree our bodies tell us how much salt we need. My 12 year old daughter was constantly putting LOTS of salt on her food. We were always telling her to stop putting so much salt on her food. We had her tested (because she has food sensitivities and we were afraid she was malnourished) She was actually sodium deficient.

    • Samantha says

      Sodium chloride, salt or NaCl, is the worst possible way to satisfy the bodies need for organic sodium.

      No doubt, without an adequate or required abundant supply of an essential nutrient, organic sodium, the nearest evil, inorganic salt, was the only available substitute.

      This salt (sodium chloride) in no way fulfils essential sodium deficiency, it is merely an attempt to grab sodium in any form available, even if that form is second rate, or even toxic, to satisfy low organic sodium.

      In the long run, sodium chloride, instead of abundant organic sodium could be a metabolic nightmare in the making.

  6. Evan Eberhardt says

    Dr. Joel Wallach (“Dead Doctors Don’t Lie”) made quick work of the salt paranoia decades ago by pointing out that a salt lick is the first thing put out on farms for cows to have at as much as they want. I also recall watching a show on elephants in Africa that make some epic pilgrimage every so often to a natural salt dense area and gorge on salt. Yeah, clearly it’s deadly! Yet another Western medicine backwards piece of garbage advice. But that is the bulk of Western medicine, so one can hardly be surprised.

    I do have some reservations for refined salt however and personally only use Himalayan or other naturally occurring sea salts.

    • Sebastian says

      Under the headline “drug addiction” the medical world has exclusively been interested in psychoactive drugs. For diagnosis of substance dependence (addiction), seven criteria apply and fulfilling at least tree of them signifies addiction. When studied, salt intake according to these criteria, it is seen that most of them are fulfilled, showing that sodium chloride, which is not classified under the psychoactive drugs, is capable of producing addiction. Animals may become addicted.

    • Nicholas says

      “Dr. Joel Wallach (“Dead Doctors Don’t Lie”) made quick work of the salt paranoia decades ago by pointing out that a salt lick is the first thing put out on farms for cows to have at as much as they want.”

      Interestingly there is a massive referenced article on the fraudulent claims of the delusional Joel Wallach here if you want an insight into his misconceptions.

      http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/colloidalminerals.html

  7. Nichol says

    Reference number 5 link to the 2012 Journal of Hypertension article doesn’t link to anything specific. What issue was it from? I’m a nursing student and would love to read the entire article. Thanks!

  8. says

    I’ve been told by people who are not medical professionals that not all salt is created equally and should all be consuming the Pink Himalayan Salt as it is in some ways better salt.

    Is this true? If so, how is it better?

  9. says

    Yes, I have seen the effects of an inappropriately low-salt diet in some of my patients.
    It is particularly an issue for those with depleted adrenals. Poor adrenal function means they produce less cortisol and less aldosterone, which is needed to reabsorb sodium. And of course cortisol and aldosterone are built on a backbone of cholesterol. For some people improving fat digestion is the key that makes a difference.

    • Sebastian says

      With salt reduction, there is a small physiological increase in plasma renin activity and aldosterone. So might this actually be of benefit to your point about weak adrenals and lack of aldosterone?

      Instead, NaCl whips up adrenal activity, but is there much point to flogging a tired horse?

      Much better to feed it daily with nourishing organic salts of sodium, than suspect NaCl

      Fat digestion might simply be giving the permeable cell the correct fats first? So adjust two food stuffs and a number of issues might resolve themselves?

  10. Basel Shishani says

    In the studies you have referenced, was iodine in salt controlled for? For many in western countries iodized salt would be the main source of iodine in diet, which begs the question whether the correlations shown are linked to sodium or iodine.

  11. Nadine says

    Salt restriction + drinking large amounts of water (which is what is recommended) can’t be a good combination.

  12. pone says

    Someone please help me with the conversions here. The study Chris cites indicates 4 to 6 grams of salt excreted in urine per day is associated with lowest CVD risks. They are measuring by weight and not by sodium density? It’s a strange way to express this from urine measurement?

    By my calculations, one teaspoon of salt is roughly 4.8 grams of weight, so basically this study is saying that one teaspoon per day is a reasonable target intake?

    • Henry says

      Anyone excreting 4 to 6 grams of sodium chloride daily will sooner or later run into serious glomeruli filtration problems.
      500mgs of natural sodium from plants is plenty for the day, unless you are metabolically challenged and need a little more.
      You will also get your necessary chloride from plants.
      The RDA of salt requirements is a figure for corporations to exist, whilst their food sits on shelves. It is not a figure for human requirement, simply money driven, and sanctioned by bodies that are basically “owned” by billion dollar industries.

      • pone says

        Do you have a citation for glomeruli filtration problems? There are a lot of Paleo people doing more than four grams of sodium a day and not showing any adverse effects.

        • Henry says

          Hello Pone you say:

          There are a lot of Paleo people doing more than four grams of sodium a day and not showing any adverse effects.

          Four grams of salt or sodium? And how many years have the Paleo people been ingesting?

          The reason I am asking is you have mentioned:

          “The study Chris cites indicates 4 to 6 grams of *salt* excreted in urine per day ”

          Are we talking salt or sodium re quantities?

          • pone says

            My bad, we are talking salt. I was just asking for citations showing 4 to 6 grams of sodium chloride excretion would cause the problem you cited.

            • Henry says

              Effect of dietary sodium chloride on the development of renal glomerular and vascular lesions in hypertensive rats.

              Liu DT1, Birchall I, Kincaid-Smith P, Whitworth JA.

              Abstract

              1. The hypothesis that high levels of NaCl in the diet aggravates hypertension-associated renal vascular lesions was examined in unilaterally nephrectomized deoxycorticosterone acetate treated (DOCA) and two kidney one clip (2K1C) hypertensive rats, as well as normotensive controls. 2. High NaCl diet significantly increased systolic blood pressure (SBP) in DOCA rats, but had little effect on SBP in normal control rats, and did not affect the rise of SBP in 2K1C rats. 3. High NaCl diet was associated with a higher percentage of glomerular lesions and renal arterial and arteriolar lesions in DOCA and 2K1C rats (P < 0.05). 4. Thus high NaCl intake exacerbated renal arterial and arteriolar and glomerular lesions in both DOCA and 2K1C hypertensive rats. In 2K1C rats this effect may be in part independent of blood pressure.
              PMID: 8306519 [PubMed – indexed for MEDLINE]

              I grant you the 4-6 grams aren't indicated, but this amount of excretion and therefore intake of toxic NaCl is in my opinion, high, in fact very high. I am sorry the figures that you or I quoted, are not included, but in the spirit of saving one's kidneys from the eventual slow but sure damage in later life, that I have personally witnessed, 4-6 grams of salt is a high intake for anyone, even the metabolically challenged; who would be far better off using Organic salts of sodium from plants, which are the essential nutritive cellular sodium requirement, and not to substitute this with the short term gain, but long term damage of NaCl.

  13. Andie Paysinger says

    During the 1960s I worked for an internist, Irwin Salkin, M.D., F.A.C.P., who wrote an article that was published in the New England Journal of Medicine and detailed problems seen in patients where salt restriction had been extreme.
    I typed the document but do not retain any of the details after so many decades, but find it interesting that recent, widely quoted, articles detail findings similar to those he noted some FIFTY years ago.

  14. Mike says

    Thank you for this. I’ve been on a low salt diet due to high blood pressure and I’m now going to start rethinking that. I’ve had aches and pains, have noticed my heart beating harder than normal, and have generally felt fatigued and crummy ever since starting on the diet. It now seems that low sodium may be the cause. I also found a very informative New York Times article about this topic: http://www.nytimes.com/2012/06/03/opinion/sunday/we-only-think-we-know-the-truth-about-salt.html?pagewanted=all&_r=0

    • Sebastian says

      The problem with that interesting link, is that their is no mention of whether the salts in question were organic from plant base material, equalling useful metabolic sodium, or from inorganic salt, less useful for human metabolism.
      Rock based minerals are not so readily or easily absorbed by the body as plant based minerals. Plant based material fulfils all the electrolytes for a reasonably healthy person, and are the correct organic source for sodium and other salts.

      • Andrew says

        How did you come by this idea? I keep hearing people going on about plant-based this or that and can’t think of a single reason why the feel plant sources to be superior. There are good moral grounds perhaps but scientific and health grounds seem highly unlikely. Plus, there is no such thing as organic sodium.

        • Sebastian says

          Moral grounds are a reason to get minerals and electrolytes from plant based food?

          Well, perhaps they are for some, fine by me.

          As for the false notion that there is no such thing as organic salts of sodium, how has humanity in antiquity survived without the essential?

        • Samantha says

          Photosynthesis combines photons with inorganic matter to create organic matter, also known as plants.

          Do you think that powdered nails are a good source of iron for the body?

          • Andrew says

            Well, yes, powdered nails are a perfectly acceptable source of iron for the body. In fact, most fortified breakfast cereals contain iron filings (your powdered nails) and these dissolve in your stomach acid and are absorbed and used. Why on earth would they not be? If you doubt this,get a good magnet and put it against the side of a packet of cereal and shake it – you’ll see the “powdered nails” collect against the inside of the packet. Also, the distinction between organic and inorganic is basically a formal distinction between two branches of chemistry, and not somehow something different about the matter involved. So the sodium ions from any source are indistinguishable once they enter solution in your bloodstream. Finally, photons are immaterial particles whose role in photosynthesis is just to supply the energy for the matter (both organic and inorganic substrate, by the way) to be converted from one form to another.

            • Sebastian says

              I thought you would be an advocate of heavy metal acceptance in junk food. None the less, thank you for the response, I really do appreciate it.
              We will never agree. and come from totally opposing schools of thought.
              I will never choose to get my minerals from any other source than plants. The cell membrane is far too important to be plaguing it with ferrous from ground up nails.
              The chemical reaction may be the process or concept which fools people into believing that iron from nails is ok but the cellular response is in no way the same.

              Finally, photons are not “immaterial” particles. “Their role in photosynthesis is to supply the energy for the matter (both organic and inorganic substrate, by the way) to be converted from one form to another”… Exactly, converting disorganised inorganic salts, into organised organic salts.
              I wish we could meet, because these posts are limited for various reasons, and we can endlessly put varying views, but will always fundamentally disagree. I am tired of the way scientists view food, they gave us hydrogenated fats for decades, convinced the science was good, only to discover in fact, a toxic, lethal cellular disaster
              If you would like to swap a link, that would be a nice conclusion.
              I think this one among many is interesting.
              http://www.doctorsresearch.com/articles3.html

            • Samantha says

              “Even early nutritionists made an error in reasoning, by assuming that a chemical similarity in minerals also meant there was a nutritive similarity between organic and inorganic minerals. While it is true that the same minerals found in the human body are also found in the soil and water it is wrong to assume that the minerals in the soil are food for man. We are not soil eaters—we are plant eaters.

              It is necessary that the minerals in the soil be elaborated into organic compounds by the plant before they can be |assimilated by the body. The various mineral compounds produced by the chemist differ in their structure and in the relative positions of their component molecules than those produced in the plant.

              Over sixty years ago a German scientist named Abderhalden conducted a series of experiments comparing how several species absorbed different forms of iron. He found that animals fed with food poor in iron, plus in addition of inorganic iron, were unable in the long run to produce as much hemoglobin as those, receiving a natural iron-sufficient diet.

              While the inorganic iron may be absorbed into the body, it is not utilized in the formation of hemoglobin, but remains unused within the tissues. Abderhalden also concluded that any apparent benefit of the inorganic iron resulted from its stimulating effect.

              Chemically, it is true that iron in the bloodstream and iron in nails are the same and that calcium in rocks (known as dolomite) is identical to calcium in the bones.

              However, it is a grave error to believe that the body can digest and assimilate and utilize powdered nails and crushed rocks.”

  15. says

    You mentioned in the previous instalment that the potassium / sodium ratio may play an important role. I can’t help but wonder if a salt restricted diet is only detrimental when consuming small amounts of potassium as well. I don’t have time to check all the studies you referenced, but I wonder if that was the case for those participants. Someone that is exercising salt restriction but still sticking to low-sodium processed foods would most likely be not consuming a lot of potassium. Conversely, someone consuming whole foods (no salt added) will be getting lots of potassium while still not getting a ton of salt.

    • Henry says

      I’m not surprised. I eat nothing processed and live on vegetables fruits nuts seeds. Haven’t eaten sodium chloride for years. Get all the sodium and other “salts” from diet. Unless you are metabolically challenged there is enough sodium in above diet. Sodium and salt are not interchangeable terms.
      As for farmers using salt licks, this has no bearing on metabolic needs, as like humans, animals can become addicted to sodium chloride. They certainly wouldn’t die without it, neither would an ordinarily healthy human. I have experiential proof, as does the naturopath mentioned.

  16. says

    I can’t seem to find a link to articles you subsequently write on certain topics. For example, in this article you said, “In my next article, I will discuss the conditions in which salt reduction may be warranted, and nutrients that may be more important than sodium in controlling blood pressure and promoting overall health.” Is it possible that once you have written that article you could provide a link at the end of the previous article so that readers can follow the topic extensively? It would help immensely. Unless of course you already do and I’m just way too blind to see it :-)

  17. steve says

    I have severe pain in my knees and hips and recently been getting cramps in my fingers and calves, I sauna almost every day, could my symptoms be caused by lack of salt due to sweating. I am male, 55, and otherwise fit and well. My G.P. is useless and just keeps saying “wear and tear” keep taking the pain killers, I’d rather have a cure. Can anyone help please?. steve

    • Lisa says

      Yes! Eat tons of animal fats from pastured animals (grass fed) and bone broth (using organic/pastured animals) with lots of gelatine (you can add chicken feet) – you need to nourish and moisturize your bones and joints from the INSIDE! and get off the painkillers, get off the pharmaceuticals, without getting into big details here, they are making the problem worse.
      don’t take it from me, watch the oiling of america on you tube for free by sally fallon, watch anything by the following people:
      sally fallon and mary enig
      lierre keith, the vegetarian myth
      the catalyst show episodes called heart of the matter
      watch lectures by dr. sinatra, underground wellness,
      google anything regarding the cholesterol myth and about butter being GOOD for you. And of course right here on Chris Kresser, he goes into lots of detail in his articles about this.

      Just stay the course because it takes a while but this is really the key. Also another great tip is to have half a teaspoon of fermented cod liver oil – fermented! any health food store.

      I really hope you are not avoiding healthy fats. They WILL heal you. WILL.

      Good luck.

  18. coleman says

    i developed type 2 recently and was adviced to go on low salt diet. After six months my health started deteoriating badly,Problem with my vision, general weakness and also develop a huge appetite. Always having aches all over my body. I collapsed with driving one day and was ambulanced to the hospital ,to recomend low salt. I knew there was something wrong with my salt level. I told the doctor how i might need salt. Immediately i was given salt intravenously, i became o.k. I started adding salt to all my foods even my morning milk . I discovered after a week saltrying my foods. i don’t experience insulin surge again and i went to do my blood test and the diabetes symptoms all gone.
    I love this article of this writter. please tell the whole world that low salt diet is the cause of early death. The paleolthic people were never highly populated. May be because of low salt diet makes them to die young and also infertile. My wife has not conceived once since our 8yrs marriage living on low salt diet. A month of living on high salt diet gives her the conception she’s having now.

  19. says

    I have been on a no salt diet for some time, meaning no salt at all and i have to disagree with many things that are stated in this article. First of all the studies talk about a danger in a low sodium diet, but here the author is equating salt as the only source of sodium in a diet, implying that if one does not eat salt then one will not have enought sodium in their diet. This is definetly not true, as there are many good organic sources of sodium out there, celery being one example.. and humans are the only ones that apparently ‘need’ salt while most animals can go well without it.. plus salt is a mineral.. not organic source meaning the body does not assimilate it.

    • Carol says

      I agree. I don’t add salt to my food nor eat processed foods and NO restaurant foods. I looked at the sodium content of foods I eat and I still get sodium.
      I don’t crave sodium or i would eat it.
      I crave certain restaurant food and processed food I used to eat. When I eat them, like the ridiculously salty cookies at whole foods, then unpleasant symptoms occur.
      The unpleasant are numerous. I haven’t noticed any unpleasant no-added-salt symptoms. What would they be?

    • Andrew says

      Well said, the most basic and simple truths are that plants have organic sodium in abundance. For the average person, not metabolically challenged by health problems, plant based sodium would always suffice electrolyte needs.
      If we are metabolically challenged, then the plant kingdom has all the earths minerals to help set the balance right again.

  20. Greg says

    Good article. Those studies are still just correlations. For references 3-4, as well as the others you mentioned, sodium/electrolyte excretion is NOT synonymous with salt intake. That’s an important distinction to make because those studies only showed that sodium/electrolyte excretion has a “sweet spot” for CVD. For reference 5, the last thing any physician in their mind would do is to suggest increasing salt intake for hypertensives. The sodium/potassium balance may be the real culprit, among other possibilities…For references 6-7, diabetics obviously have to urinate more because of excess sugar in the bloodstream. A low-sodium diet in this case would obviously be the opposite of what is needed. According to TCM, the kidney-adrenal function weakens in old age, and salt acts to stimulate the kidneys. Therefore, the elderly do benefit from a moderate amount of salt and a low-sodium diet would be contraindicated.

    I must respectfully disagree with you about the salt/hypertension connection. According to TCM and Western Medicine, if you (or any other animal for that matter) consumes too much salt, it will most definitely increase your blood pressure, put strain on your heart muscle, and long term, it will damage your kidneys among other things. Fact is, the reason why the government imposes an upper limit of 2300 mg/day, as you mentioned, is that processed food is loaded with sodium, which is used as a food preservative. It is my understanding that Americans consume on average, way more than the recommended limit because of widespread usage of processed and junk food. The last thing anyone on a SAD diet should do is to increase their salt intake.

    Salt requirements vary widely by individual. But 1.5-3 teaspoons is quite high! In the long run, you risk numerous health complications. For those on a meat-centric paleo diet, salt intake must usually be higher to compensate for the excess of meat. Salt is alkalizing and lubricating and is therefore craved by those eating too much meat, which is what paleo entails. (There’s a reason why every steakhouse has a large salt-shaker on the table and Japanese people have been eating fish with soy sauce for centuries) TCM indicates as much. Whole, unrefined sea salt used in moderation in conjunction with a vegetarian grain/vegetable-based diet is beneficial, however.

    • Pone says

      You are not analyzing this correctly.

      First, my blood pressure when sodium is normal is 119 / 71. When I get low sodium my pressure jumps to 150 / 88. My pulse goes very high and I lose glucose control. So the first problem with your post is that you only look at what high sodium can do and you fail to address what low sodium can do. My low sodium went undetected by four doctors for three months and destroyed my health. I was on about 1/2 teaspoon per day.

      Second, you are committing the fallacy of designing the diet to treat the symptom without first understanding is the symptom the result of the diet. The hypertensive may be suffering because of low sodium. The correct solution for that patient is to normalize sodium levels.

      Here is how scary my low sodium became. If would walk for one hour low intensity and then drink water to satisfy thirst. But because of low sodium kidneys excreted all that water quickly. I would spend entire nights every hour getting up desparately thirsty and drinking, immediately urinating, never resolving dehydration. If would describe these symptoms to multiple doctors and not one could figure it out.

      It resolved immediately by adding salt to diet.

      • R.Rangarajan says

        I fully agree with Mr Pone’s situation…I have been going through similar situation for last few months…While Blood serum levels are about 135 for me,if I increase salt intake,the symptoms like palpitations etc vanish…Although BP is under control only with medication

        • Lisa says

          It’s true that we analyze quite a bit with absolute thinking and assuming we will all react the same.
          We have a very complicated set of different measurements, one thing creates another reaction, etc. Some laws or behaviours for how certain body parts and chemicals work may be the same but our starting points within our bodies vary WILDLY. We are like different types of cars with different types of engines where some parts work well and others work differently, the gears and belts may all generally operate the same, but the current state of ones parts and fluids are never identical to the other, plus wear and tear and enviro exposure is totally different! So keeping with this analogy, a mechanic cannot apply the exact same remedy to each vehicle with all these varying situations thinking it will all be the same result. it’s not logical! It doesn’t work for us either to say “all humans should stick to this amount of salt intake, period”. Some absorb more than others based on soooo many different factors, some just can’t retain it, some are not eating it, some are eating the wrong kind, or different kinds, some have more celery than others, added salt is different from inherent salt, plus testing isn’t always accurate because of factors – a test might indicate it’s there, but can’t indicate if it’s actually being used properly by the body? how can that be tested completely accurately? SOOO many factors.

          Also, One man’s meat is another man’s poison. perhaps one body just functions better at a different level. We already know that’s true.

          So arguing and accusing or whatever can really be a waste of energy just rile us up for no reason.

          Best thing we can do is share ALL the info, as much info as possible and let each person do their own research and determine what’s best for them. Become our own health managers.

          Good luck people .

          • Sebastian says

            Wonderfully considered comment and I thank you for that. I would like to add one point re the mechanic analogy, with which I whole heartedly agree.
            He would of course, no matter at all, what the engines symptoms were, never put contaminated oil or petrol in the engine if he could help it.
            So hopefully everyone would follow suit and never put contaminated, industrialised and processed junk food salt in their bodies, whatever their health. Same choice available as the mechanic. So often a different choice made by humans.

      • Henry says

        Glad you are better, but sodium and salt are not interchangeable terms, which is a huge problem in arguing “salt” needs. Actually humans need “salts” especially organic sodium. Sodium chloride is not a necessity for survival if equal amounts of organic sodium are used.

  21. Dianaedd says

    Frequently, the elderly people who have low sodiums are sickly, taking a lot of meds including ones that lower their serum sodium (such as diuretics), so it may be a stretch to say that the low sodium causes their problems primarily.

  22. jackie says

    also, it’s weird, because even though my sodium levels have been low for the past few years, i didn’t crave salt and always had to remind myself to salt my food. hm……?? i crave sugar more.

    • Lisa says

      Jackie, have a look at Dr. Natasha McBride’s you tube video talk called Food is the best Medicine, and if you can find it there’s another great interview she does with dr. mercola where she explains very well how processed foods with their chemicals have been DESIGNED to have that bliss point flavour that addicts us to precisely a can of some specific soda, or specifics foods like a pizza pop – a trademarked secret recipe food, and turns your brain into an addicted brain, where your natural cravings that really reflect what your body actually needs, is totally put on manual override by these chemicals so you will crave THEIR food and go buy it.

      Not that I am accusing you of eating processed foods, obviously you would not be here on Chris Kresser’s site :) but I am wondering/ musing even just for myself, if a history of eating processed foods even for a short period of time in our teenage years or at birthday parties or friends houses messed up our young developing brains and if we could still be healing from this derailed neurology.

      Just a thought I had while I read your post about you consciously adding salt, while still craving sugar.

      Good on you for being aware and conscious about these issues. Good luck

  23. jackie says

    i personally eat a lot of himalayan salt because my blood sodium level is chronically low (maybe because of adrenals?), but i just listened to an interview of charlotte gerson, of the famous gerson cancer therapy, and she says NO salt, ever. she is super healthy at age 90 or 91. so i guess just as tyler above said, everyone’s different. :-)

    • Lisa says

      jackie I am so glad you brought up this topic of the gerson therapy. I was a totally believer in it and embarrassingly was recommending it to anyone and everyone to look into, and now I understand that a) as you said everyone’ different (one man’s meat is another mans’ poison) and and b) I have learned from other sources that a veggie juicing diet is just a cleansing one, to cleanse from toxins.
      gerson protocol doesn’t advocate sugar which I agree with but I don’t believe gerson protocol is a good idea beyond the cleansing period. She advocates as a life style.
      I surprise myself because I was such a staunch believer in being a vegetarian and did NOT want to believe gerson might not be the miracle I thought it was. But I have since learned it can be a great healer just for the detox period, and I would rather step down and realize I was wrong about vegetarianism and veganism when I finally accepted the cholesterol/diet/heart evidence.
      it’s a relieve to live with the truth instead of my pride…
      anyways, good point jackie!

  24. says

    I’ve often wondered about salt. Since paleolithic man ate low amounts of sugar, wouldn’t it be similarly wise to reduce intake of salt likewise? Keep up the good work, Chris, very interesting.

    • Lisa says

      Good point, I used to be worried about salt intake as well however himalayan salt and sea salt have trace minerals we evolved with and need for our bodies, and have been abundant in many materials on the earth throughout human history. The exposure and necessity of salt is totally different than that of sugar. Firstly, sugar was only available from honey and sweet fruit which was rare (because fruits are sweeter today than they used to be – they are hybridized to be bigger and sweeter) plus they only were available once a year- when they fell off the tree, and fattened us up for the winter famine when less food was available). We live in abundance now with so many crazy choices for food available 24/7/365. We have to eat the way our bodies evolved to eat. So my opinion, based on the facts we have available to us, the research, the articles, is that we must limit sugars as much as possible and if we did eat it, have a tart whole piece of fruit with the fibre and flesh, not juiced, if we want to eat it at all (it’s not necessary at all actually) and salt – yes – eat the himalayan salt or at least sea salt or utah salt – NOT the processed table salt. Again, we’re back to avoiding denatured processed foods aren’t we? Eating as whole and natural and historical as possible right?
      Same thing, same thing, same thing.
      Sugar bad, healthy salt good. Once we reset our brains (avoiding processed food and grains) by letting our neurology guide our tongues/cravings and tastes, your body will very intelligently do the job of telling you when you need salt or when you’ve had enough. That’s what our bodies had always done – guide us with our tastes, then the processed crap messed up our neurology and made us addicted to garbage and chemicals. Great talk by Dr. Natasha Campbell McBride called Food is the best Medicine and she explained this neurology craving topic very well.

      GOOD luck and enjoy!

  25. says

    Chris, this is overall good advice – but most of the endurance athlete studies that you cite acknowledge that plasma sodium levels were often maintained, but the issue was overconsumption of hyoptonic fluids – in other words – drinking too much water and/or sports drinks during the event, effectively diluting the body’s fluids. Noakes himself will admit that sodium supplementation is not necessary, even for long, hot and humid events, due to endogenous sodium stores and decreased loss via kidney excretion.

    • says

      Good observation. I believe over consumption of fluids, particularly water, is actually a much bigger problem than most think. It’s under most people’s radar. Matt Stone has done a great job reporting on it and what can be done about it. Dilution of the fluids at the cellular level causes people to dump water – causing symptoms such as a very strong urge to urinate, anxiety, adrenaline rush, light headedness, fatigue, etc. This can be a devastating problem for people who have metabolic issues, hypothyroidism, “adrenal issues”, etc.

      People should check out this interview with: http://180degreehealth.com/2012/02/mild-water-intoxication.

    • says

      I wouldn’t get wrapped up in any diet rules out there. Everyone is different and each person’s body demands different foods, ratios, nutrients, etc. in it’s own unique way. Subscribing to set diet rules and recommendations is like driving down a road blind folded. Sure there are some great general guidelines to follow such as eating whole natural foods and staying away from PUFAs, gut irritants, etc. But it’s important to listen to your body’s needs and follow through with them. If you’re craving more salt or carbs .. it’s a good idea to follow your intuition.

      • ChrisG says

        I have to disagree with the intuition approach. I cut back on salt because I was eating it like a food unto itself. Routinely salting salty things..like cheese, and.eating salt by itself, etc. And apparently my body “needs” a lot of wine and pancakes too. With those sort of cravings, a few rules can keep things from getting crazy…

        • says

          Right, if you find yourself indulging in processed food at every meal or binge drinking, you’ve probably got some other issues to work out. Every now and then, in my opinion, it can be very beneficial to let yourself go and destroy a stack or 2 of pancakes or order that large pizza and take it down followed by some good craft beers. That can actually do wonders mentally.

    • Andrew says

      Industrialised table salt is metabolic poison.
      Sodium requirements can be satisfied by eating or juicing sodium rich plants. Were athletes encouraged to ingest organic plant based sodium rich drinks, instead of the fake unhealthy sports drinks they have been duped by, hyponatraemia would not be an issue.

  26. says

    Great post. I’m very interested in reading what you have to say about other nutrients involved in BP regulation (magnesium? potassium?) because I have high BP with NO other issues – i.e. I am lean, very physically fit, with normal blood sugar, cholesterol, everything. It’s just the BP that is elevated. Do you think tall people have higher BP because it takes more to pump that blood to our (farther out) extremeties?? :)

    • Ben says

      Great question, I’m personally very interested in this because I’m in much the same situation. Lean, eat paleo, health metrics appear good except BP. And also tall!

      In particular, there seems a lot of talk of the ratio of sodium to potassium in the diet being a (or the) key factor in blood pressure disregulation.

      Do we have a sense at all of how much sodium is taken in by hunter gatherer societies?

    • Philomina says

      I am in the same situation as Mary and Ben. The only thing I am having is hypertension. I am not tall. I have even lost some weight and nothing is happening. All my numbers are great. No high cholesterol, AIC is good, I mean everything is good except the blood pressure. I just started increasing my consumption of celery because I read that it provides nitric oxide.

  27. Mollie Player says

    It’s so amazing how long it takes for conventional advice to go out of favor. People are STILL talking about lowering fat … HUH???!!

  28. Richard Jones says

    I DEFINATELY crave salt on some foods, since cleaning up my food palate. The body demands, the body receives. :-)

    I have some Qs about gall bladder, for you Chris, where can I send them?

    -Richard

  29. says

    Great article. My mother suffers from terrible hypertension and several years ago, was prescribed a low-sodium diet. My mom was never one to eat much in the way of processed foods, the healthier the food, the better, so she took to this new diet with gusto. I watched as her health declined rapidly – her heart problems worsened, there were frequent mini-strokes, and memory was suffering. We didn’t know why this was happening. Years later, one doctor finally has the common sense to note that she was suffering electrolyte imbalance and mom was subsequently put on a higher sodium diet. Mom now adds fleur de sel religiously to her meals and her health has improved. She still suffers from hypertension, but she is much more stable and her memory has improved (despite the strokes).

    I now warn friends about recommending a low sodium diet to others. It’s better for them to recommend eliminating processed foods.

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