Salt: the story that won’t die

I’m done worrying about what this person or that person says about salt these days.  The health and nutrition minders have split into two groups:

  1. Salt is poison and we should eat almost none (although, oopsie!, the sodium in salt is actually an essential nutrient)
  2. Salt is not a big deal

When it comes to nutrients, such as sodium, there is always the possibility that while some is good, a lot is bad.  This goes for water.  It’s hard to drink excess water, but sometimes a person does that and ends up in serious trouble (brain swelling, coma).  Fat soluble vitamins are another classic example: too much vitamin A or vitamin D can cause serious problems.  Extremely high doses of vitamin C can cause kidney stones.  Iron overload causes a host of medical problems and is sometimes hard to distinguish from other problems, making diagnosis difficult.  The list goes on.  Suffice it to say you can get too much of a good thing.

Now we have the latest salt rant from Dr. James DiNicolantonio, an associate editor for the a British Medical Journal’s Open Heart and a cardiovascular researcher, who not only says salt is fine, but eating too little will “.. make you fat and ruin your sex life.”   Surprise!  He’s written a book about this very topic — The Salt Fix — wherein he explains how:

  • too little salt leads to insulin resistance and increased fat storage
  • a low salt diet reduces sex drive, contributes to erectile dysfunction, and decreases fertility.
  • low salt intake adversely impacts trauma recovery

He observes, correctly, that like other mammals, humans have been seeking out salt since time began.  He also notes that Koreans, for example, have a relatively high sodium intake — 4 grams/day — but have low rates of hypertension and coronary diseases.  At which point he makes the classic mistake of assuming that association equals causation, or in this case non-causation.  Koreans may eat a lot of sodium, but they also have a very unique diet, with lots of fermented foods and lots of vegetables.  Don’t tell me sodium is the only significant nutritional factor.  He makes the same mistake the anti-salt crowd makes: looking only at salt intake, rather than to the whole diet as a factor in heart disease.

His article does have an interesting discussion about the history of anti-salt research, much of which was done with rats bred to be sodium-sensitive (normally rats are not sodium-sensitive).  Surprise again!  If you feed sodium-sensitive rats a lot of salt, they develop health problems.  Translating those results to humans is problematic, but apparently that’s the intellectual leap researchers made.  He talks about the assumption behind the belief that excess salt in the body causes high blood pressure: the simplistic idea that sodium accumulates in blood, causing more water to pour into blood vessels to dilute the sodium, leading to higher blood pressure.  If that’s truly how some scientists think, it’s almost laughable (in any case, it’s recently been refuted).   Then there’s a rather exaggerated explanation for how low salt diets lead to insulin resistance which leads to obesity.  Not sure that train of thought holds up.  There is an unstated assumption that people actually are following the punitive 1.5 gram/day sodium limit imposed suggested by the American Heart Association, which I doubt.  And certainly eating a drastically low sodium diet could lead to adverse effects, but such a diet is likely to have other nutritional issues that can cause problems.

Dr. DiNicolantonio says he’s reviewed over 500 research papers on salt, and he offers a couple of interesting points:

  1. left to their own devices, people around the world tend to eat about 1-1/2 teaspoons of salt a day, or about 3.5 grams of sodium, more than twice the AHA limit of 1.5 grams.  If true, it’s interesting.  Protein is another nutrient that tends to be consumed at remarkably similar levels around the world, regardless of food supply or dietary customs.
  2. a reasonable range for intake is 3-6 grams sodium/day, the equivalent of 1-1/3 to 2-2/3 teaspoons of salt.  Keep in mind, that’s the total, which includes all sodium found naturally in foods, which can add up before you even pick up a salt shaker.  Processed foods contain significant sodium, as do restaurant foods.  Breads and bakery items have considerable salt.  Even meats and dairy foods in their natural state have sodium; cheese is higher because salt is used in cheese production.

So the salt battle continues.  I’m sure the anti-salt people will come out of the woodwork to criticize his book and his ideas, and on some counts they may have a point (insulin resistance?? sex life???).  But I’m all for questioning the anti-salt hysteria.  Certain people in the health community are on a bizarre puritanical quest to strip all the pleasure and enjoyment out of food and eating.  No sugar, no salt, no caffeine, no alcohol, no grains, no carbs, no white food, no juice.  Food should be tasteless and eating should be another grim chore.  If we got down to bread and water, they’d complain about the gluten in the bread.

The one thing I can predict: this controversy is not going away anytime soon.  There will be more books, more dire warnings, more low salt diets, more recommended restrictions, more disagreeable processed foods with a “low sodium” health halo, more anti-anti-salt treatises.

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