Salt Sanity

I like salt.  In moderation.  On tossed salad.  On eggs.  On hamburgers.  On potatoes.  On tomatoes.  I’m probably something of an outlier in my profession, since everyone else is officially anti-salt.  We’re supposed to repeat the mantra of Low Sodium and we’re supposed to support official doctrines about limiting salt intake to prehistoric levels, not seen since early humans got most of their salt from the blood of animals they killed.  I don’t support those doctrines and I don’t chant the official mantra.  Therefore I was encouraged to read that there are other health experts out there that agree with me and then some.

The 15 experts in question are described as the “joint working group of the World Heart Federation, the European Society of Hypertension and the European Public Health Association.”  Their basic argument is that sodium intake of 3-5 grams/day is reasonable and compatible with low risk for high blood pressure.  They believe the 1.5 gram/day recommendation currently being touted by the American Heart Association is unreasonable, because population-wide hypertension rates will not be significantly improved by such a drastic restriction.  They also note that there is no good research evidence one way or the other about what exactly is an “optimal” sodium intake.  The most we know is that population-wide intakes above 5 grams/day are linked to increased rates of hypertension.  By the way, 5 grams of sodium a day is the amount in just over 2 teaspoons of table salt.

Well, what does all this mean in terms of your actual food?  First, all these gram numbers refer to sodium not to salt.  Table salt is sodium chloride.  One gram (or 1000 mg) of salt has 388 mg of sodium.  The rest is the chloride.  So salt is about 38.8% sodium by weight.  1.5 grams of sodium represents 3.9 grams of salt, or about 2/3rd of a teaspoon.  That’s not much.  You might say “oh I don’t use much salt on food.”  And in fact you might not shake that much on your food throughout the day.  But salt is added to many foods, especially processed foods, and you have no control over that.  Bakery products, bread, sauces, soups, frozen entrees, deli meats, snack foods, cured meats, cheese, cereals and on and on.  In fact the only foods that don’t have added salt are raw meat, fresh fruit, fresh vegetables, grains like rice or oatmeal and dairy products like milk.  And even then, whole unprocessed foods have some natural sodium content.  So in order to achieve the 1.5 gram/day sodium limit, you’d be eating a really strange diet: no use of table salt whatsoever.  No processed foods whatsoever.  Probably no bakery products, no cheese.  Definitely no chips or fries.  No restaurant food, no take-out.  It would be a very bland diet indeed.  Is anyone actually doing this?

Salt has several positive aspects in the human diet

  1. Sodium is a nutrient.  Without sufficient intake you are in big trouble, especially if you sweat a lot.
  2. Sodium adds flavor to food.  These anti-sodium fanatics always remind me of a paragraph in a novel I read awhile ago: a new kitchen maid prepared the roast one day, and the family raved about the flavor.  The cook was peeved, what was wrong with her cooking?  The new maid had added salt to the meat, making it tastier.  The cook’s job was now hers.
  3. Salt has a long history of use in food preservation, allowing people to survive winter or famines or long trips, before there was refrigeration and modern food storage.
  4. Salt production drove human history for centuries, as different civilizations traded goods with each other in order to get salt, or settled in areas with a natural salt supply.  Salt production made some regions very wealthy.

Why all this controversy?

One major glaring reason: it’s really, really hard to do controlled studies of sodium intake for a long enough period of time to produce meaningful results one way or another about optimal intake.  You’d have to lock up thousands of people in a clinical lab and feed them carefully measured food for years and follow all their health issues.  But of course, just the fact of restricting someone and serving them a controlled diet (for years) is going to affect the results, regardless of sodium intake.  And then there’s the lack of realistic life events.  What about the changing effect of ambient temperature on sweating?  Or changes in fluid intake and balance?  Or illnesses?  Or age?

Then there’s another glaring problem: high salt diets are unbalanced diets.  They’re likely full of highly processed food, fast food, junk food, with low intake of fresh whole foods like vegetables and fruits and, as a result, likely inadequate potassium intake.  And it’s well known that insufficient potassium intake affects blood pressure.  So just blaming the sodium in a high sodium diet is wrong.  The whole diet is wrong.  Trying to tinker with just the sodium part of that equation isn’t going to help.  Switching to processed foods labeled “low sodium” doesn’t fix the unbalanced diet.

One final glaring problem: obesity is a known risk factor for hypertension.  In fact, just losing excess weight can bring down blood pressure dramatically.  So again, blaming the sodium content of a diet may miss the fact that the diet is also high calorie, leading to obesity.

Here’s what I do.  I salt foods that taste better with a bit of salt.  I don’t buy many processed foods at all, rarely eat salty snack foods and rarely eat fast food.  I doubt I even come close to 3 grams of sodium a day, but I don’t bother reading labels or adding up sodium milligrams.  And it seems to work out fine.

For more detailed information about the role of salt in human history, Mark Kurlansky’s book “Salt” is a good read.

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