We hear about it constantly. The problem with our diet is too much “salt, fat, and sugar.”
But is that really true?
If you’ve been following my work for a while, you know I wholeheartedly agree that excessive sugar is an issue and wholeheartedly disagree that fat is something we should avoid.
Pick up any health magazine or book and you’ll read about how salt will:
- make you puffy and bloated
- spike your blood pressure like crazy
- damage your heart and arteries
You’ll inevitably be reminded to limit your salt intake, remove the salt shaker from the table, and use herbs and spices in its place…
You know the drill.
But what if all these worries about salt were unfounded?
Aside from intentionally including salt in ALL of my recipes (including those in my freebie ebook, “Veggies: Eat Them Because You Want To, Not Because You Have To”), I really haven’t laid out the research for you.
After getting more than a few requests to cover this topic, it’s time to dispel some of the most common myths about salt.
Why We Need Salt
Salt is vital to the normal function of our bodies. The sodium and chloride it contains are key for:
- electrolyte balance (to keep your heart ticking and your cells talking)
- maintaining the correct plasma volume in your blood stream (regulates fluid levels)
- neural signaling (so you can think straight and move your muscles on command).
Salt also supports normal stomach acid levels by supplying chloride (remember stomach acid is hydrochloric acid). Adequate stomach acid is necessary for the absorption of minerals and vitamin B12, protein digestion, and killing off pathogenic bacteria (and other ickies) before food leaves our stomach. In addition, salt plays an important role in food preservation, preventing unfriendly organisms from growing in our foods in the first place.
That said, the pervasive opinion in the medical and nutrition world is that salt is something we need to limit.
But before you cut back on salt, you’ll want to read the top 5 myths about salt. You might be surprised by what the research really says.
Top 5 Myths About Salt (and why less isn’t always better)
Myth 1: We Eat Too Much Salt
Despite the media continually harassing us for eating more salt than ever, there’s just not data to back that up.
Dietary recall studies are notoriously inaccurate. In short, we lie about what we eat. (Int J Obesity, 2015)
The most accurate measure of sodium intake is via 24 hour urinary sodium excretion (how much salt is in your pee) because about 95% of daily dietary sodium is excreted in the urine.
An analysis from Harvard of 38 studies from 1957 through 2003 show pretty consistent urine sodium excretion across 5 decades. In other words, Americans eat the same amount of salt as we always did (~3700 mg of sodium/day). (Am J Clin Nutr, 2010)
But somehow hypertension rates have increased dramatically since the 1980’s. Why?
There are a lot of reasons, but we can’t single out salt.
Myth 2: Salt Raises Your Blood Pressure
Not so fast, friend.
Salt doesn’t always cause your blood pressure to go up.
In fact, according to researchers from the University of Virginia School of Medicine, only about 25% of the population is salt-sensitive. And 15% of the population have increased blood pressure on a low-salt diet. (Clinica Chimica Acta, 2013)
That’s right. There’s no guarantee that eating more salt is always harmful or that reducing it is always beneficial.
In one recent study, salt intake had a “statistically insignificant” impact on blood pressure levels in individuals without preexisting hypertension. (Amer J Hypertens, 2015)
Similarly, an analysis of the extensive National Health and Nutrition Examination Survey found no link between sodium intake and blood pressure (even after adjusting for age, sex, race, body mass index, diabetes, and estimated glomerular filtration rate <– that last one is a measure of kidney function). (J Clin Hyperten, 2014)
Even the conservative Academy of Nutrition and Dietetics (which guides the practice of dietitians in the US) suggested removing salt from the “nutrients of concern” list in 2015, expressing “concern over blanket sodium restriction recommendations in light of recent evidence of potential harm to the larger population.”
That’s a BIG move for an organization that’s extolled the benefits of salt restriction for decades.
If anything is clear from recent research, it’s that salt does not always raise blood pressure.
Myth 3: Eating Less Salt is Healthy for Everyone
Like I mentioned above, only 25% of the population is salt-sensitive (and therefore DO need to watch their salt intake).
But what about the remaining 75% of us?
Isn’t it still dietary common sense to eat less salt?
“The relationship between salt intake and cardiovascular risk is not linear, but rather fits a J-shaped curve relationship. Thus, a low-salt diet may not be beneficial to everyone and may paradoxically increase blood pressure in some individuals.” (Curr Opin Nephrol Hypertens, 2013)
The study authors goes on to explain:
“There are other potentially harmful effects of low salt intake, leading to plaques and ultimately blockages in the arteries.” – Robin Felder
Even more concerning is the significantly increased mortality rate (death rate) associated with below-usual sodium intake. (Amer J Hypertens, 2015)
Unfortunately, deciding who should eat more or less salt isn’t crystal clear.
Some people have kidney problems or take medications that require a low-sodium diet, but when it comes to salt-sensitivity, there’s no consensus in the literature for how to unmistakably identify folks who are or are not salt-sensitive. (Not yet, anyways. That’s an area of research that Robin Felder and others are exploring.)
But there is one thing that causes people to become salt sensitive…
Myth 4: Salt Sensitivity Is Always Out of Your Control
We know there are some genetic factors that can influence salt-sensitivity, but it turns out what you eat plays a major role.
(Shocking, I know…)
It turns out that excessive intake of sugar, especially fructose, can trigger salt sensitivity.
“Animal studies have shown that high-fructose diets up-regulate sodium and chloride transporters, resulting in a state of salt overload that increases blood pressure. Excess fructose has also been found to activate vasoconstrictors, inactivate vasodilators, and over-stimulate the sympathetic nervous system.” (J Hypertens, 2015)
And if you’re tempted to ignore that study because it’s not done on humans, check this out:
A systematic review of 12 studies on sugar-sweetened beverage intake encompassing 409,707 individuals came to a consensus (rare in the literature, by the way).
All 12 studies found that the more sugary beverages people drank, the higher their blood pressure (and this correlation was statistically significant in 10 of the 12 studies). (Amer J Cardiol, 2014)
What sweetener is used in the majority of sugar-sweetened beverages?
Why, high-fructose corn syrup, of course!
If we’re gonna bother with a public health campaign to lower blood pressure, our focus should be on SUGAR (particularly refined fructose), not salt.
In addition, diets high in added sugar are unmistakably linked to the risk of excess weight gain. Not surprisingly, hypertension and obesity tend to go hand in hand.
And there’s plenty of researchers pointing this out:
The “epidemic of obesity may be a more important determinant of the increased prevalence of hypertension than sodium intake.” (Am J Clin Nutr, 2010)
Myth 5: I Have High Blood Pressure, So a Low-Salt Diet is Right for Me
Maybe, but maybe not.
The majority of salt intake in the American diet comes from processed foods – about 75% (Curr Opin Nephrol Hypertens, 2013).
So if a “low-salt” diet just means cutting back on processed foods (in other words, eating more real food), you’re on the right track.
You might be surprised to hear that 36% of the sodium consumed in the US comes from cereal and cereal-based products – the greatest contributor, by far, compared to all other food groups.
(Side note: This begs the question – Have we unfairly blamed salt for high blood pressure rather than processed carbohydrates? Did researchers fall for the Nutritionism Trap by focusing solely on sodium?)
If you’ve been eating more bread, cereal, and oatmeal in the name of health, you’re probably not doing your blood pressure any favors – and not just because of the sodium content (read The Healthy Breakfast Mistake and CGM Experiment for more on that).
Breads and cereal products are high in carbohydrates. And it turns out lower carbohydrate diets have been shown to “decrease the severity of hypertension.” (Nutrition, 2014)
Low-carb diets are also highly effective tools for weight loss and normalizing insulin/blood sugar levels, both of which directly impact your blood pressure. (Nutrition, 2015)
Most people become more efficient at excreting sodium via the kidneys on a low-carbohydrate diet (so much so that you may need to diligently eat more salt on a low-carb diet, as explained in this post).
All details aside, if you focus your efforts on eating more unprocessed, real foods, you may see big improvements in your blood pressure.
Conversely, if you focus solely on salt and obsessively tally up your sodium intake (like calories or macronutrients), you might find yourself in a bit of a pickle.
One analysis that tested the feasibility of a low-sodium diet (in other words, how to comply with the diet in the real world), found:
“The lowest-sodium food patterns that were nutrient-adequate and theoretically achievable were very high in fruit juices.” (Amer J Prevent Med, 2012)
But fruit juice is a highly concentrated source of sugar (especially fructose). That’s no bueno considering that fruit juice intake is linked to weight gain (see 5 Signs You’re Eating Too Much Fruit for more on that).
And remember how blood pressure responds to fructose? (for a refresher, see myth #4)
So if you have high blood pressure and you have a few extra pounds to lose, you’ll want to steer clear of fruit juice, sweetened beverages, high intakes of grain products and eat more fresh, unprocessed food in its place.
What Type of Salt is Best?
Now that we’ve worked through the top 5 myths about salt, you’re probably wondering what kind of salt is best to eat.
I prefer to use unrefined sea salt. It tastes better (in my opinion), doesn’t have added “flow agents,” (chemicals to keep it from clumping in your salt shaker), and contains a variety of trace minerals. (J Sensory Studies, 2011)
The only downside of sea salt is that it doesn’t contain much iodine (most refined salt is iodized) and this is a key nutrient for thyroid function and prenatal health, among other functions.
Knowing that, I make sure to consume other sources of iodine in my diet – fish, seaweed, eggs from pasture-raised chickens, and grass-fed dairy products (if you’re not sure you can tolerate dairy, read this).
Let’s all just relax a bit about salt. Remember, 75% of us are NOT salt-sensitive. Most of the salt Americans consume comes from processed foods.
When you’re cooking at home, you’ll need salt to make your food taste good, especially bitter green vegetables (kale chips, anyone?).
If your struggle with sticking to a real food diet centers around food being “tasteless” or “bland,” you’re probably not using enough salt when you cook.
And contrary to popular belief, when your food tastes good, you’re often satisfied with less. Many of my clients are surprised they can lose weight and maintain it eating such a tasty diet!
(Full disclosure: I swear if you put a bag of low-sodium chips in front of me, I’ll polish off the whole bag, but give me the real deal and I’m satisfied with a handful. It’s as if my body isn’t satisfied until it’s had enough salt… Unlike most dietitians, if a product says “low sodium” I’m much less likely to buy it.)
If you’re cooking most of your food from scratch and at home (and particularly if you lean towards a lower carbohydrate diet), you probably have more wiggle room in your diet for salt than you think. Similarly, if you exercise a bunch and sweat heavily, you’ll want to ensure you’re eating enough salt.
Lastly, if you’re pregnant, you might need to pay even more attention to salt. It turns out that sodium needs go UP in pregnancy. Read more on that here.
Until next week,
PS – For tips on how to make vegetables taste good, suggestions for how much salt to use (and recipes which all measure the amount of salt so you don’t have to be a master chef to get it right), grab a copy of my free ebook below, “Veggies: Eat Them Because You Want To, Not Because You Have To.”
Join thousands who are finally enjoying veggies thanks to this freebie! When you know how to make real food taste good, you’ll be less tempted by processed foods.
PPS – Before you go, I’d love to hear from you.
- Do you limit your salt intake? Why or why not?
See you in the comments below!
UPDATE: If you have questions about salt related to babies, I recommend you read my in-depth article on salt & baby food. Many people are warned not to give their babies any salt, but are the infant sodium requirements really accurate? Read more on this here.
20 CommentsLeave a comment
thanx lily i usualy consume less salt but now that i know the difference i will change my eating habits
Lily – you are my hero! I attempted low salt diets multiple times and have always felt worse. I retain fluids, gain weight, feel sluggish and fatigued. Now I have an explanation.
Since those early experiments, I just threw in the towel and went back to eating an amount of salt that feels right for my body and I feel better than ever (and my blood pressure is totally normal). If anyone tries to tell me I’m hurting myself or killing my heart for eating salt again, I’m sending this article!!!
Our bodies are pretty darn smart about telling us what works and what doesn’t!
I’ve always been a salt-aholic. I’m 54 and my blood pressure has remained on the lower end of normal my whole life. When I was a kid I used to snack on the little round salt-licks for rabbits.
Thanks for laying out all the research, Lily. I’ve always suspected some of this, but it’s nice to have evidence to back it up.
For most people, salt is NOT the enemy. I’m shocked to read the stats on what % of people are salt sensitive. I certainly fall into th non-salt sensitive category. I get terrible muscle cramps and a racing heart if I don’t eat enough.
Glad you found the explanations and research about salt myths helpful, Christopher.
Brilliant article. I think I fit into the salt sensitive category as I DO get water retention if I eat too much, but now that I read this, I think I only get puffy if I’m eating a bunch of salt AND a bunch of sugar. When I have lower carb, high salt foods (pickles, olives, etc), it’s a non issue. This makes so much sense now. I’m going to be more careful with my sugar/fructose intake and see if that helps. Maybe I don’t need to diligently eat a low salt diet after all!
Report back and let us know what you discover in your salt sensitivity experiment, Archer.
I’ve had to cut back on my sodium because I have a genetic problem with kidney failure. However, I’m never afraid of anything high in salt–especially after working out because you need sodium from sweating!
Great article, Lily! I really value your practical, evidence-based guidance on nutrition and use it to improve the health of our diet. Re: salt – we eat very few processed foods and use salt without restriction in cooking and eating. Blood pressure for both my husband and I is the same as in our 20’s, and that was a long time ago! I guess we are in the 75% …
Awesome Karen! Same goes in our household. Guess we’re part of the “lucky” 75%. 😉
Good article ! I hardly ever used salt, thinking it is bad for me
I get very exhausted in hot weather, and knowing my grandson (who has cystic fibrosis ) has to take salt tablets because of salt loss through sweat, I tried taking a salt tablet – then I felt so much better !
We definitely need some salt in the diet, and ‘health advisors ‘ don’t always get the advice right – in fact over the years so many recommendations have been overturned.
Your common sense articles are so sensible and balanced , thank you , I’ll carry on reading your website.
Glad you found it helpful, Margaret. 🙂
I would like to know if you are receiving notes from me.
Lily, do you know if salt can help balance blood sugar, esp. help mitigate reactivate hypoglycemia?
That’s a great question. It appears that eating more salt blunts the glucose & insulin response to a glucose tolerance test, so it probably also reduces reactive hypoglycemia. https://www.ncbi.nlm.nih.gov/pubmed/3050268
Great find, Lily! I wasn’t able to figure this out by Googling it, so I really appreciate this. And it also helps me understand why my blood sugar is more stable when I eat a lot of salt and why eating sweet makes me crave salt. Thank you!
Lily, I have a 13 month old baby and it seems everything I read says he should not be eating salty foods, I should not be salting his food, etc. I am wondering your thoughts on babies and salt intake. Thanks!
I was always sort of “shamed” for adding salt to my meals. When I was 22 years old I had a heart scare and in the end, my cardiologist said that I should eat more salt (2 pickles a day) and drink a ton of water. So I stopped caring what others thought I should eat when it came to salt and just added it if I wanted it. It made me like eggs so I know it has definitely helped my health! Thanks Lily!
That’s so interesting about fructose and salt. I’m type 1 diabetic, so unfortunately, I have to consume juice somewhat frequently for hypoglycemia. How much juice do you think pushes one over the edge to salt sensitivity territory?