Shaking up the Salt Myth: Healthy Salt Recommendations | Chris Kresser
HCTP Banner

Shaking up the Salt Myth: Healthy Salt Recommendations

by

Last updated on

iStock.com/sasimoto

As you may realize by now, salt has had a very colorful history, both in the development of human civilization as well as public health politics in the past century. While salt was originally prized by many cultures for thousands of years, in the past century it has been demonized; some have gone as far as calling it the single most harmful substance in the food supply. Yet as we know, sodium plays a crucial role in optimal health, and too little salt intake can be dangerous in the long run.

In Shaking up the Salt Myth: The History of Salt, I described the history of salt production and use, and its place in the Paleolithic and Neolithic diets. In The Human Need for Salt, I explained the physiological roles of salt in the human body and the basic dietary requirements for salt. In The Dangers of Salt Restriction, I examined potential negative health consequences of restricting salt unnecessarily. In When Salt Reduction May Be Warranted, I described conditions in which salt restriction may be necessary, and other minerals that are essential in determining blood pressure.

In this final article, I will describe the types of salt I recommend, and how much salt is ideal for most people.

How much, and what kind of salt to include in the diet

According to research, there exists a range of sodium intake that likely confers the best health outcomes for most people. As I explained in part 3, findings from a 2011 study demonstrate the lowest risk of death for sodium excretion between 4000 and 5990 milligrams per day. (1) Sodium excretion greater than 7000 milligrams or less than 3000 milligrams per day was associated with a higher risk of stroke, heart attack and death. This lowest risk range equates to approximately two to three teaspoons of salt per day.

Figure 1: Mean sodium intake among the participants of the Japanese National Nutrition Survey: 1973–2000

The average American consumes about 3700 milligrams of sodium a day. This value has remained constant for the last fifty years, despite the rise in rates of high blood pressure and heart disease. (2) As a comparison, the Japanese, with one of the highest life expectancies in the world, consume an average of 4650 milligrams of sodium per day, and have a lower risk of cardiovascular disease than most other developed countries. (34) Their average sodium intake has consistently hovered in the low risk range over the past 30 years, despite attempts by public health organizations to reduce Japanese salt consumption. (5) A caveat is that the Japanese also have a high risk of stroke, so their extremely high salt intake is not necessarily recommended as a model for our own intake. (6)

While salt recommendations vary between individuals based on age, gender, physical activity, and health conditions, I feel that the data supports an intake between 3000 and 7000 milligrams of sodium, or 1.5 to 3.5 teaspoons of salt, per day.

People who are quite active or sweat a lot should consume salt on the higher end, and those who are less active may want to consume on the lower end. Of course, there may be some conditions where moderate salt restriction is warranted, but for the majority of healthy individuals, salting to taste will provide an appropriate level of sodium in the diet.  Natural sources of sodium include sea vegetables, fish, shellfish, and meat, plus certain plants such as beets, carrots, celery, spinach, and turnips.

What type of salt should you buy?

One question frequently brought up in the Paleo community is what type of salt is best. This is a difficult question to answer. There are a wide variety of salts available on the market, all claiming health benefits over the others. While the answer to this is unclear, there is some research demonstrating a difference in mineral content and flavor intensity of certain salts that would be better options than common table salt.

A fascinating 1980 study examined the different indigenous, pre-industrial methods of salt production, and their respective mineral contents. (7) Some salt production methods included drying marine algae or fish eggs, fermenting marine fish blood and entrails, and even using sea water soaked in peat that was dried and burned to create salty ash. This study compared the mineral contents of these traditional salts with industrial table salt, as well as a variety of sea salts and other “health salts” on the market. The indigenous salts were found to be higher in combined essential and nonessential trace elements than both the table and sea salts.

Most of us do not have access to these traditionally prepared salts. Fortunately, sea salt and other commercially available natural salts have been shown to contain a higher trace mineral content than refined table salt. (8) In this study, the mineral content of sea salts differed depending on the harvesting location, but all salts tested contained various amounts of trace minerals (with the exception of table salt), and had small amounts of calcium, potassium, magnesium, sulfur, zinc, and iron. The various natural salts also had different time intensity profiles, due to the variety of minerals, so less of the salt is necessary to achieve the same level of flavor intensity compared to table salt.

Types of salt that are not recommended

One sea salt that is not recommended for dietary consumption is Dead Sea salt, due to its high bromide content. (9) The Dead Sea has the highest bromide concentration of any large body of water in the world, and bromide toxicity can occur after consumption. Some argue that sea salt is no longer healthy due to the level of pollution in our oceans today, though evidence for this is scant. (10) If this is a concern, there are salts produced from ancient geological oceans, like Real Salt from Utah beds or Himalayan pink salt, which would not have the same level of pollution as salt from much of the world’s oceans.

Regular table salt, conversely, is heavily processed, generally devoid of trace minerals, and commonly contains undesirable additives such as anti-caking agents like sodium silicoaluminate or sodium ferrocyanide. Therefore, generally avoiding table salt is a good idea, though care must be taken to ensure adequate iodine intake from other sources once iodized table salt has been removed from the diet.

Don’t stress the salt!

The amount of conflicting research that exists on salt is astounding. Hundreds of studies have been conducted on salt intake, and a consistent pattern has never been established for sodium’s role in a variety of negative health outcomes. At a minimum, it seems absurd that so much time, energy, and money is spent on trying to reduce the amount of salt that Americans eat, considering how weak the evidence is on this issue.

Ultimately, my perspective is that adding unrefined salt to a whole foods Paleo diet is perfectly healthy. By limiting grains and processed foods, the amount of sodium in your diet will already be drastically reduced as compared to the standard American diet.

A bit of salt can make certain healthy foods, particularly bitter vegetables, far more palatable. Considering the evidence I’ve presented in this series, I believe that salt restriction for the general population is not only unnecessary, but potentially dangerous.

Now, I’d like to hear from you. Have I changed your perspective on salt? Do you disagree with my analysis of the data? Tell me your thoughts!

190 Comments

Join the conversation

  1. I eat a lot of salt, and unfortunately it’s the bad processed table salt. Yet my blood pressure 99.9% of the time is 90s/60s. Am I an example of how high salt intake is not as detrimental to health as they say? Or does it mean something else entirely?

  2. Hi Chris,
    I’ve looked around for articles on your site and found that you’re obviously not a fan of soy. I’m trying to find an answer to whether or not I should be consuming or avoiding tamari and miso. I guess I’m really hoping that it’s an ok salt alternative, but I’m really not sure if it gets your stamp of approval. I consume it daily. Please help 🙂

  3. I stumbled upon this article while searching on Google for more info on sodium concerns I have been having.

    I’m generally 90 – 95% Paleo but as of late, due to trying to add muscle …I noticed my intake of protein wasn’t coming even close to 1 to 1 or even .8 to 1 grams/protein to lean body mass just eating to satiety (Mark Sission Style).

    So I have been eating in the gray area side of things by using APPLEGATES 100% Grass-fed Beef Dogs & Cold Cuts to help me up my protein intake and that got me to notice how much sodium i’m also taking in by this type of shortcut.

    Example: If i’m throwing 3 slices of turkey in between some lettuce and then eating a beef dog…that’s like 740mg’s of sodium from one meal.

    I suppose this is better than just downing a Whey protein shake but from the article above I think I should be ok?? Considering I’m only doing this once a day generally an the rest of my food is made from scratch. (Beef Stews, Paleo Chili’s etc).

    Thoughts?

    • I think you’re fine, especially if you have no blood pressure issues and you aren’t sodium sensitive.

      • Appreciate the answer Chris.

        Yeah, so far so good in regards to having no blood pressure issues or sodium sensitivity. I suppose I am due for a full blood lipid panel considering I haven’t had one for a couple of years now and also barring that I have gone Paleo since.

        It’s kind of funny, the more and more I learn about the actual science of how we are genetically meant to eat, every once in a while conventional thinking will pop its head out from around the corner and remind you of who used to be boss the past 29 years (my age). Like sodium? NOOOOOOOO! lol

        Whelp, just have to get better at planning out my week in advance and making the best of my meals. 🙂

        Again, Thanks Chris…

        ~Mike

      • Chris when do you think you will be taking new clients? I have Hashi’s and need some help with a true professional that can read labs.

        • Unfortunately, it may be a while. I have about 60 people on a wait list, and they’ll be given the first opportunity when I re-open my practice. Have you tried the Paleo Physician’s Network?

  4. I’d like to stress the necessity of finding another source of iodine if you eliminate iodized table salt. As someone who suffered from iodine deficiency, I’m surprised that this very real danger only received one sentence in this post. Plus, there weren’t any recommendations on other sources of iodine, which seems like a large oversight. Ocean caught seafood & sea vegetables can be great sources, or you can supplement iodine through the use of Iodoral or Lugol’s Solution under the supervision of a professional.

  5. Hi Chris. Have you heard of Dr. Hal Huggins’s work on salt? He says (oddly enough) that Morton’s pickling and canning salt is the only way to go. Wondering your thoughts on this?

  6. Cool article Chris, I especially liked the recommendations section. With all of the different brands out today and all of the marketing its tough to know what is good and what isn’t!

  7. Nice article. I am glad you did all that research on better types of salt to eat. I suspect that most people when eating healthy can follow their taste buds to know how much salt is best for them. Your body will let you know if you need more with cravings. And if you add too much, your body will inform you it tastes too salty. You have salt taste buds for a reason so let them work for you. Salt is an ancient food and our body knows how to regulate it properly. Processed foods do have a lot of salt but I suspect the main prob with processed foods is not the salt but all the other crap in them. Or if you have kidney probs, you may have probs with salt but then the real question is what caused the kidney probs in the first place? (I bet it wasn’t salt..)
    -Eva

  8. Hi Chris,
    I was hoping you’d mention “Wright Salt”, formulated by Dr. Jonathan Wright of the Tahoma Clinic. It is a “reduced-sodium salt formula based on the novel salt used in Finland – the nationwide use of this
    salt was associated with a 60% decrease in deaths from stroke and heart disease in a 1996 study.” Controlled studies in Taiwan and Australia have shown similar results. 1/4 tsp (1.5 g) has 324 mg
    sodium and 54 mcg iodine and is a “proprietary blend of Sodium chloride, Potassium chloride, Magnesium sulphate, Lysine hydrochloride, Silicon dioxide, Zinc chloride, Copper glycinate, Selenium and Potassium iodide.”
    Read more at: http://www.tahomaclinic.com/wp-content/uploads/2011/01/WrightSalt-1.pdf

    Would like to know your thoughts on “Wright Salt” with it’s lower sodium / potassium ratio.

  9. A month ago I was asked by my health practitioner if I perhaps was restricting my salt intake. I did, and had for a few years already, I never thought my cravings for salt actually meant I needed salt because all I had ever read was that it was best to limit your salt intake.
    At that time, I’ve had ME/CFS for 8 years, with ups and downs and I was suffering from adrenal fatigue and leaky gut, despite being on a strict Paleo diet for 3 years. Of course more measures were needed to heal my gut and reduce stress, and I’m not there yet, but adding some salt to my meals has made a huge difference in my energy levels. This once again proves that listening to your body is key.

  10. Chris I think your teaspoon amounts as equivalent to the milligram amount is not accurate as there are approx. 4000 milligrams per teaspoon or 4 grams

  11. I’m a big fan of celtic sea salt. Taking that has fixed orthostatic intolerance (dizziness on standing) that was part of CFS. Definitely feel more energetic with additional salt added to food. I have been able to avoid taking Florinef long term for this reason (I have low aldosterone which means I have trouble retaining salt – my adrenals are somewhat pooped). I also take Slow K though as I had a test done which showed low potassium in red blood cells. Getting electrolyte balance right is tricky – my muscle strength, energy and BP (both sitting and standing) are all better with added sea salt and the Slow K balancing that out nicely.

    Thanks for this series of articles – I’m going to be taking the previous article and references along to my doc in regards to my Mum who has very low sodium but high-ish BP. Very very helpful as always Chris!

    Really fascinating to see the Paleo community catching up on all things adrenal at the moment too….I first learnt about the important a few years ago in a thyroid/adrenal group – Stop the Thyroid Madness.

    • Allison/Chris:

      I just read in the “Stop the Thyroid Madness” that taking more salt actually lowers aldosterone and sodium. What is your take on this.?

      (I also just joined one of their groups. I have Hashi’s and low adrenal function with bad hypothyroid symptoms. But my TSH has always been normal. I’m debating wether I should try Armour or HC to pick up my energy. At least short term while addressing the Hashi’s.,

  12. I recently had a ComprehensivePlus Hormone Profile which measured among other things mineral secretion in a 24 hour period. Mine results were 278 mmol for sodium (which I think is 5,000 milligrams) and 74 potassium with a sodium/potassium ration of 3.8. I was told that my sodium is too high. Also on the results for aldosterone, it was 3.2 ug, which I was told was indicative of high salt. I was told to cut my salt intake. I only consume sea salt and I don’t think I consume all that much. So is this in line with low risk and it’s just convential medical wisdom saying my results are too high?

  13. I find my taste guides me well with salt intake, especially if the food is relatively simple. Adding some salt to steak for instance tastes great, but bacon usually becomes too salty after a few slices. I believe people on higher carbohydrate diets retain more salt/sodium, so that is something to consider.

  14. Good article, on the topic of how much salt is enough?… Arthur Guyton taught us that salt intake in itself is not a problem, even in high doses i.e. Japanese population; natriuresis under healthy conditions eliminates the sodium the body does not need. To me there are two cases in which salt should be limited and monitored.

    1) Pathophysiological conditions that alter or impair sodium excretion: HTN and diabetes, which are the two most prominent chronic medical conditions, have serious impact on the kidneys and the glomerular filtration rate. This, in turn, leads to sodium retention and starts a cyclical cascade of further increasing blood pressure (water follows salt) –> renal injury –> increasing blood pressure etc. There are also several conditions that can alter sodium excretion by means of altered cellular and hormonal signaling i.e. Cushing’s, Addison’s, etc.

    2) Epidemiological studies have shown that age and race are important in salt consumption. The kidney’s ability to the filter the blood (GFR) is indirectly proportional to a person’s age; therefore the older the individual the less salt they would need to remain euvolemic. Race also plays a large role, especially in the US, where a disproportionately percentage of the African-American population suffers from HTN. Geographically African-Americans evolved in an arid area with little water, therefore water retention became a necessary means of survival, these genes were selected for, and as a result African-Americans have a more active renin-angiotensin system which conserves more sodium. Place this individual in an environment with free access to water and salt and obviously you now have a problem.

    In conclusion, renal function should be the primary indicator as to how much salt one can safely intake daily.

    • And how does one measure renal function for salt intake? The usual BUN and creatine?

      Would not simply measuring serum sodium and chlorine be more direct?

  15. I have thought about salt intake a lot, as I have a health condition that causes me to retain fluid occasionally. Since I converted to Paleo and eliminated all processed foods from my diet well over a year ago, and am pretty active in endurance activities, I have added sea salt to the mix.
    Thank you for writing this series of articles.

  16. I agree with your analysis and thanks for the through series of articles on this subject! Can’t remember using table salt, have always used sea salt, the French fleur the sel and Himalayan pink salt (Trader Joe’s) this is also a great site for salts: http://www.saltworks.us/gourmet-sea-salt.asp Concern is: iodine which can cause a lot of trouble when you don’t get enough. I take Norwegian kelp tablets every day, but wonder if there are other ways to get sufficient iodine?

  17. Chris, what are your thoughts on pure morton canning and pickling salt that is free of any additives? In my opinion, it seems like a viable option since it’s hard to find a salt that is free of contaminants and anti caking agents. For people eating a nutrient dense diet, it seems like additional trace minerals from sea salt are not completely necessary and could potentially contain other unwanted toxic properties.

[if lte IE 8]
[if lte IE 8]