Although the salt and heart disease connection has been refuted by meta-analyses, the US dietary guidelines continue to urge Americans to restrict salt. For those individuals with minimal sodium reserves, this seemingly innocuous dietary suggestion can create problems ranging from digestive troubles and chronic infections like Candida, to depression and difficulty recovering from stress. This article will cover:
- Why salt is important for health
- Why experts thought salt was bad and what we know now
Part Two of this article covers:
Salt is one of the most common minerals on earth and is primarily made of the elements sodium and chloride. Raw sea salt will include many additional elements.
Salt is critical to the human body. In fact, the body’s interior ocean is salty, and without salt, many chemical reactions that support enzyme function, energy production, hormone production, protein transport and many other biochemical processes simply will not work. Salt is important for bringing nutrients into all of our cells and also moving waste out.
One component of salt, chloride, is key for digestion in that it is a component of stomach acid or hydrochloric acid (HCl). Hydrochloric acid is critical in triggering enzymes that break down proteins and minerals in food. Think about the importance of digesting calcium and protein for bone health, just as an example. Without adequate stomach acid, minerals and nutrients needed for bones will not be absorbed. HCl also stimulates enzymes that break down carbohydrates. A classic sign of low stomach acid production is feeling like food sits heavily in your stomach after eating. Animal proteins which require stomach acid to digest, can especially create this symptom in those with inadequate HCl. Other signs of low stomach acid include heartburn, reflux, frequent burping, seeing food in the stool, gas and bloating. Those with chronic constipation or loose stools typically have issues with low stomach acid. Low stomach acid production can be linked with many chronic health issues such as hypothyroidism, hair loss, insomnia, ulcers, SIBO, adrenal fatigue and more.The effect of salt on digestion and therefore one's health is often under-stated. Without adequate HCl, the body will not receive balanced nutrition and as a result, many body systems suffer.
Both chloride and sodium are necessary for the firing of nerve cells. This means that every thing you experience, which is all processed through your nervous system, relies on salt. The sodium is used in the nerve cells to help build up the charge that allows the strong transport of energy from one nerve cell to the next. In order to use our senses, move our muscles, pump the heart, and do the million little activities our bodies accomplish daily without a thought, we need salt.
Salt is critical for the glands and our sodium levels are also impacted by our response to stress. Sodium is important in bringing iodine into the thyroid gland in order to make thyroid hormones, for example. The pancreas will also make more insulin in response to low sodium levels. When we experience high levels of stress, sodium in the body is used to give us an extra burst of hormones, neurotransmitters, and nerve signaling to respond. One place that we know sodium is stored is in the skin. If we experience pro-longed stress and do not replace the sodium stores we've lost, we have a harder time recovering or even coping day to day.
Studies demonstrate that those on a low salt diet may struggle with responding to stress over time if they have inadequate sodium stores. Medical studies, for example, show that higher sodium levels help reduce pro-stress hormones and social anxiety in rats (1). In a 2014 study involving 10,000 Americans, researchers found a relationship between salt intake and depression: Women whose diets were high in sodium were less depressed than other women (2)! In a 1991 experiment, men whose sodium intake was lowered to 2.4 grams a day (what the USDA recommends for everyone) complained of reduced sexual function more often than those who consumed three grams a day. “The most problematic [for men] was a combination of a diuretic and a low-sodium diet” (3) Since sodium is critical for stress response, it makes sense that over time when someone is under stress and restricts salt, they impair their ability to further respond to stress in a balanced way through time. This may show up as anxiety, depression or declining sexual function, for example.
As an alternative health consultant, I often help people with chronic fatigue, immune and digestive issues. Many people have suboptimal sodium and chloride levels as noted by a review of their bloodwork and they find that increasing raw salt is surprisingly helpful.
As sodium stores drop, the kidneys work harder to keep the sodium levels in the blood at a functional level. To do this, the pancreas raises insulin levels. The increase in insulin, when occurring chronically, results in many undesirable outcomes. As insulin raises, a person preferentially wants to eat carbohydrates because we cannot burn fat while insulin is high. Therefore, a person prefers to eat sugar and carbohydrates more and this often develops into a chronic downward spiral. The intake of carbohydrates in this scenario leads to further insulin production. Daily intake of more carbs and sugars leads to chronic inflammation which we know is the root of most disease. It also leads to obesity and an inability to burn fat and lose weight. Don't forget too much insulin production leads to hormonal imbalance: less testosterone for men, and a shift in estrogen and progesterone for women. A simple thing like reaching for the salt shaker when the body is craving it, helps establish a healthy pattern for the body so that blood sugar is better managed, and food is better digested (don't forget the HCl) to help recover from stress.
So how much salt are we talking about?
An adult human on average contains 250grams of salt (enough to fill 3-4 salt shakers). This is constantly lost through bodily functions (urine, blood, tears, semen). It’s essential to replace this salt. Scientists have found across most populations, when people are left to un-restricted, they tend to take in 3000 to 4000mg sodium daily which is almost 2 teaspoons in salt. From 1977 to current day, the US government recommends Americans restrict sodium to less than 2300mg daily which is about 1 teaspoon or less of salt. For any individuals at higher risk of disease, they were encouraged to restrict to 1500mg or less of sodium until 2015.
Where did government recommendations go wrong?
Compelling evidence suggests that while processed salt can indeed cause fluid retention and related health problems, numerous studies have, overall, refuted the salt-heart disease connection. A 2011 meta-analysis of seven studies involving more than 6,000 people found NO strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death. In fact, salt restriction actually increased the risk of death in those with heart failure. The risk for heart disease was 56 percent higher for the low-salt group than for the group who ate the most salt! (5) Now that you know a little bit about how important salt is for the health of tissues and muscles (of which the heart is one), you will understand why a circulatory system would suffer if salt is too restricted.
In 2015, Dietary Guidelines for Americans removed the severe sodium restriction recommendation (1500mg sodium daily) but kept recommendation that all Americans should restrict their sodium intake to less than 2300mg per day(4).
It's true that some people, 10-50% of those with hypertension to be exact, experience an increase in blood pressure from too much salt. These individuals are deficient in other minerals and too much sodium throws them out of balance. In other words, if you don't eat enough vegetables and whole foods to get adequate potassium, magnesium and calcium, and you are prone to hypertension, then too much sodium can cause issues. This has been demonstrated in medical studies. When a salt-sensitive person with high blood pressure meets or exceeds the recommended daily allowance for potassium, magnesium and calcium, they are no longer salt sensitive (6). We can do better for those with hypertension by educating them to eat more minerals and mineral-rich food and keep the salt for all it's benefits.
The general advice to restrict sodium intake to less than 2300mg is potentially causing immeasurable harm to those who do not have high blood pressure. Many studies have shown that salt restriction has no health benefit for those with normal or low blood pressure. Indeed, it actually can be detrimental to health. At least two thirds of Americans are needlessly restricting salt and potentially suffering from digestive issues, nutrient deficiencies, sugar cravings, insulin resistance, electrolyte imbalance, depression and anxiety (just to name a few!).
Part Two of this article presents ways to assess your sodium levels and to restore digestion, healthy immunity and resilience to stress through the use of salt.
1. Krause et al. 2011. Hydration State Controls Stress Responsiveness and Social Behavior. Journal of Neuroscience, 2011; 31 (14): 5470
2. Leshem and Goldsetine. 2014. Dietary sodium, added salt, and serum sodium associations with growth and depression in the U.S. general population. Appetite Aug;79:83-90
3. Wassertheil-Smoller et al. 1991. Effect of antihypertensives on sexual function and quality of life: the TAIM Study. Ann Intern Med. Apr 15;114(8):613-20
4. DiNcolantonio, J. 2017. The Salt Fix. Harmony Books, New York.
5. Taylor et al. 2011. Reduced dietary salt for the prevention of cardiovascular disease: a meta-analysis of randomized controlled trials (Cochrane review). American Journal of Hypertension. Aug;24(8):843-53.
6. McCarron, 1997. Role of adequate dietary calcium intake in the prevention and management of salt-sensitive hypertension. American Journal of Clinical Nutrition. Feb;65(2 Suppl):712S-716S