More salt is OK according to new study


Do you fear salt? Now yet another big study indicates that the fear of salt may be at least somewhat exaggerated.

When they examined the salt habits of over 100,000 people, it turned out that people who salted more than the recommended amount had the lowest risk of cardiovascular disease. Those who salted a lot less – according to official guidelines – had a higher (!) risk of disease. Pour on the Salt? New Research Suggests More Is OK

JSW: Low-Salt Diets May Pose Health Risks, Study Finds

The study should be taken with a grain of salt (pun intended) as this is, as usual, only statistics. But like previous studies, it suggests it might be OK to put salt on your food at home without feeling guilty, at least if your blood pressure is under control.

However, it may for many reasons, be wise to avoid ready-made foods and junk food (and bread) that have lots of added salt. This salt is to hide the boring taste of cheap, poor ingredients.


Crash Course in Blood Pressure


  1. Cameron Hidalgo
    I've read several studies on the amount of sodium in urine and sweat. It never made sense to me that the recommended intake is less than 50% of the average output. For larger men, whom are most often to get an even lower guideline from their doctors, this percentage is even lower. The science for sodium deficiency are well know and includes the usual worst case scenario side effect of death. Yet no one ever seems to worry that the recommended intake is so low.
    Reply: #2
  2. js290
    The idea that naturally limiting nutrients like salt and fat would somehow cause health problems is at best a faith based proposition and at worst out right fraud. A lot of "science" isn't much more than modern religion. Unfortunately, most people are educated to believe some authority rather than critically sniff out the BS.
  3. François
    Just like the "low fat, low cholesterol dogma", also based on shaky and skimpy evidence, the low salt dogma has recently come under attack with quite a few well-done studies suggesting exactly the contrary of the doomsday scenario painted by official organizations. And just like for the "low fat, low cholesterol dogma" under attack, the official organizations behind these recommendations have had a knee-jerk reaction of aggressive vicious rhetoric aiming to discredit the authors of these new studies. Let me quote part of a blog entry by my colleague Malcolm Kendrick: "On this note, several different people pointed me at a recent debate at the conference of the European Society of Hypertension (ESH) and the International Society of Hypertension (ISH) in Athens. Well, not a debate really, more of a tirade. Here is one part of the report

    ‘Any “controversy” over whether dietary salt is a cause of heart disease and stroke is the result of weak research methodology or commercial interference, Dr Norm Campbell (Libin Cardiovascular Institute of Alberta, Calgary) and Dr Graham MacGregor (Wolfson Institute of Preventive Medicine, London, UK) argued here….’1

    I shall translate their statement. If you do not believe that excess salt consumption is a cause of heart disease and stroke you are a flawed and misdirected scientist (weak research methodology), or you are corrupt (commercial interference). No other explanation is, of course, possible. You are either an idiot, or corrupt, and therefore – by definition – should be ignored. Or perhaps stoned to death for being an unbeliever." So much for good science and intelligent debate. Let us destroy the opponents of orthodoxy.

    One interesting point is that this war against salt is aimed at sodium. There is no such thing as pure sodium salt. It is sodium chloride. And a low chloride intake is very unhealthful. Chloride helps in acid-base balance in the body and is an independent factor in cardiovascular risk in hypertensive people. Those with the lowest level of chloride in their blood had a 20% higher mortality rate compared to other subjects. [ McCallum L, Jeemon P, Hastie CE, Patel RK, Williamson C, Redzuan AM, Dawson J, Sloan W, Muir S, Morrison D, McInnes GT, Freel EM, Walters M, Dominiczak AF, Sattar N, Padmanabhan S. Response to Effect of serum chloride on mortality in hypertensive patients. Hypertension. 2014 Mar;63(3):e15.]
    But though readily available, this fact is not known (or is willfully ignored) by the majority of people, physicians and dietitians.

    I'll side with Andreas when he says: "However,..., be wise to avoid ready-made foods and junk food (and bread) that have lots of added salt. This salt is to hide the boring taste of cheap, poor ingredients."

    This is a very important point. In many studies, high salt intake has been associated with increased risk of hypertension, cardiac disease and stroke. But association does not imply causation and we may be accusing an innocent bystander. A massive proportion of the salt intake of people who have a high one comes from bread and rolls, cold cuts and cured meats, pizza, salty snacks, processed poultry, and processed meals... Could it be possible that the problem does not come from the salt but rather from the high carbs of the breads and rolls or the processed meats and foods themselves? It would not be the first time that confounding factors muddied the waters.

    Processed meats have been clearly linked with cancer and heat disease risk. Because of the difficulty of doing a quality food questionnaire (most of these are crappy at the very best), corners are cut and lumping is done: red meat is lumped with processed meat, so the "experts" can accuse red meat of being unhealthful. It is not. Processed meats are. To a certain extent, industrial unprocessed meat coming from cattle fed high omega-6 grains is also rather unhealthful because the fat is much too high in omega-6. But meat coming from grass-fed cattle is very healthful. Especially fatty cuts. Don't hesitate to salt this meat if you feel like it. It is good for you.

    Reply: #6
  4. Lucy Pepper
    I've always gone by what my body tells me as to what level of salt I need. If I feel the need to seek it out, it's because I need some. If food tastes salty already and I can't eat it, it's because I don't. It's the sense Nature gave to us to keep salt in balance and Nature doesn't get it wrong. Only men in white coats do that.
    Reply: #7
  5. Boundless
    For a US audience, and perhaps elsewhere, it's also worth emphasizing that the unsupported recommendation to reduce salt also resulted in reduced use of iodized table salt (iodine is added by law here), which has quite likely contributed to an increase in thyroid problems, specifically hypothyroid ...

    ... which problems are routinely mis-tested (the almost worthless TSH), mis-diagnosed ("it's fine", when it's not) and mis-treated (synthetic T4 only), a situation that's at least as scandalous as the lipid situation.

    There are, however, more predictable ways to supplement iodine. What's added to table salt starts depleting as soon as the package is opened.

  6. erdoke
    Wait a minute. Lack of scientific evidence on either side will not prove anything.
    Fact is that human breast milk contains sodium in much lower levels (500 mg?) than what is indicated by any authorities. Also, potassium level is around 3-fold compared to sodium.
    Another fact is that ratio of sodium to other minerals such as potassium and magnesium are very important, maybe more important than the absolute intake. Just think of the Na-K pump and how much energy it might use and what homeostatic range it tries to maintain. I strongly believe that epidemiological studies only looking at sodium tell nothing.
    Why do we jump into conclusion mode without properly understanding how our body works? It reminds me of the vitamin A-D relationship where for decades it had been recommended that vitamin A is dangerous at relatively low levels (at least compared to what native tribes consumed and consume today), then it turned out that there is a vitamin D switch and above that D level huge doses of A cause no health issues. I think the actual interaction of different minerals is more important than absolute levels of the intake of any single mineral.
  7. erdoke
    Unfortunately our body can lose track in some cases. We live in a world of food abundance where once rare food components are available in unlimited daily amounts. When a living organism has evolved to crave for something the reason is often high value in some circumstances and/or scarcity. A good example is sugar. Building a fat store from sugary fruits and starchy vegetables used to be a definitive advantage. Now with unlimited availability of purified sugar it is mostly a curse.
    We need to investigate if salt falls into the same category or not. Especially that salt once meant a chemically more complex material than sodium-chloride. Maybe it was iodine and/or chromium and/or copper, etc. that often occurred together with NaCl and translated into a craving which satisfied the actual physiological need for it. As I described above, sodium itself is only ~500 mg/day in human breast milk (corrected value for daily intake of an infant and also for adult weight) while it contains potassium at a much higher level.
    "The mean contents of each component were as follows: energy, 66.3+/-13.3 kcal/100 mL; solid matter, 12.46+/-1.56 g/100 mL; ash, 0.19+/-0.06 g/100 mL; total nitrogen, 0.19+/-0.04 g/100 mL; lipids, 3.46+/-1.49 g/100 mL; carbohydrates, 7.58+/-0.77 g/100 mL; lactose, 6.44+/-0.49 g/100 mL; pH, 6.5+/-0.3; osmotic pressure, 299+/-14 mOsm/kg.H2O; chloride, 35.9+/-16.2 mg/100 mL; sodium, 13.5+/-8.7 mg/100 mL; magnesium, 2.7+/-0.9 mg/100 mL; phosphorus, 15.0+/-3.8 mg/100 mL; potassium, 47.0+/-12.1 mg/100 mL; calcium, 25.0+/-7.1 mg/100 mL; chromium, 5.9+/-4.7 microg/100 mL; manganese, 1.1+/-2.3 microg/100mL; iron, 119+/-251 microg/100 mL; copper, 35+/-21 microg/100 mL; zinc, 145+/-135 microg/100 mL; and selenium, 1.7+/-0.6 microg/100 mL."
    Reply: #10
  8. Mark John
    The nutritional requirements of a baby drinking its mother's milk and the nutritional requirements of an adult are very different. Comparing the two and expecting to derive any worthwhile conclusions is ill conceived and illogical.
    Reply: #9
  9. erdoke
    I hope it's clear what an example means.
    On top of that there are more showing that groups of people can live just fine on 0.5-1 g daily intake of salt. Read this, together with the 400+ references:
    On the other hand it would be nice to have your brief assessment about the most relevant differences between infant and adult metabolism with regard to sodium and chloride need. Adding in fancy adjectives will not increase the scientific credibility of your statements...
    Reply: #15
  10. Cameron Hidalgo
    Erdoke, salt is not a scarce resource. It is so common that most sweating creatures are able to just walk around licking the ground. It is why we give corralled horses salt licks, but wild horses are doing fine.
    Reply: #13
  11. Zepp
    Its realy dont that difficult.. hypertension is mostly linked to metabolic syndrome.. not to sodium!

    But if one persist to promote and eat a high glycemic diet.. insulin reasorb more sodium in the kidney!

    More salt in the blood.. more water.. higher blood preasure!

    Going to a ketogenic diet make the insulin drop and more salt is excreted by the kidney.. and one of the moste comon beginners problem is salt defiency!

    Dont blame salt for the result of a high glycemic diet!

    Reply: #35
  12. Paul the rat
    not related to the post, however a good review.

    Reply: #18
  13. erdoke
    Don't get me wrong, I'm not on either side in this case. I just have not seen a very convincing piece of evidence so far and for this reason I tend to suggest that some caution is needed. I just don't understand how sodium can be examined without looking at other metals and ions. Ratios of Na-K and alkali vs. alkaline earth metals are obviously very important. I would say more important than pointing out any of them. Somehow asking the basic questions is missing. For example:
    What is the minimum amount of sodium required by an average weight adult?
    What happens when this sodium comes not only as sodium-chloride, but a big chunk consists of nitrite, benzoate and glutamate?
    What is the ideal ratio of Na-K? What happens when somebody consumes a very different ratio for a longer period of time? For example 3:1 instead of 1:3?
    What is the ideal ratio of alkali and alkali earth metals? What happens when this ratio is out of balance?
    Coming back to availability. Hunter gatherers examined during the 20th century seemed to consume much lower levels of sodium than what can be found nowadays in Western diets. Sometimes as low as 500 mg. Natural food is not high in sodium.
  14. Zepp
    "As Taubes explained over a decade ago, “the data supporting universal salt reduction have never been compelling, nor has it ever been demonstrated that such a program would not have unforeseen negative side effects.” The 1988 Intersalt Study, designed to resolve contradictions in ecological and epidemiological studies, failed to demonstrate any linear relationship between salt intake and blood pressure. Now, in 2012, we have data that suggests long-term salt restriction may pose serious risks for much of the population. Yet major health organization guidelines still recommend the restriction of salt for all Americans, regardless of blood pressure status.

    In short, there is a healthy range of salt consumption for most people. When eating a whole foods diet, most people tend to consume an appropriate amount of salt simply due to an innate preference for saltiness. In fact, the consumption of salt around the world for over two centuries has remained in the range of 1.5 to three teaspoons per day, which appears to hold the lowest risk for disease.

    Our bodies may have a natural sodium appetite through which our ideal salt intake is regulated. By following a whole foods, Paleo diet, and eliminating processed foods, excess sodium in your diet will be drastically reduced. Thus, you can be confident in following your own natural taste for salt when adding it to your food during preparation. In other words, there are few reasons to deprive yourself of salt!"

    And you have right about pottasium!

    "Epidemiological studies have also reported that increased potassium intake is associated with reduced risk of CV disease, most notably for stroke,14 although the optimal level of daily potassium intake has not been established. Potassium intake is also a proposed modifier of the association between sodium intake and CV disease."

    Its still the junkfood diet thats the problem.. tastless, lot of sugar or/and salt.. for taste.. lack of other nutrients.. high glycemic load.. high insulin.. metabolic syndrome.. hypertension!

  15. robert
    "Urinary Sodium and Potassium Excretion and Risk of Cardiovascular Events"

    Taking just 1g of salt (400mg of Sodium) a day doesn't seem to be wise, especially in the context of a low-carb or even ketogenic diet. Personally I wouldn't want to go that low, I don't feel right with too little salt.

    Now think about what happens during a heat-wave, you sweat a lot try to rehydrate and don't get enough salt. People can and DO die from this. You will find this in the media every year.

    Reply: #16
  16. robert
    And another one!

    "Effects of Sodium Restriction on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterols, and Triglyceride"

    I for one certainly don't need any more adrenaline and other blood vessel constricting hormones coursing through my body.

    Here's a nice video by a doctor who deals with diabetes and kidney disease

  17. FrankG
    I agree that evidence is not compelling in either direction which to me says: there is little foundation for some arbitrary limit on "table salt"

    "Our bodies may have a natural sodium appetite through which our ideal salt intake is regulated. By following a whole foods, Paleo diet, and eliminating processed foods, excess sodium in your diet will be drastically reduced. Thus, you can be confident in following your own natural taste for salt when adding it to your food during preparation. In other words, there are few reasons to deprive yourself of salt!"

    This echoes my own feelings on the subject.. the last thing which wild animals, or even human animals, eating their natural diet stress about is "did I get enough, or too much of x, y or z ..?!?"

    If you don't, or can't, for some reason, trust your innate ability to completely nourish yourself with real whole food, locally sourced and in season; then why not take advice from the hard-won wisdom of your ancestors and look to the traditional culture of their homeland, for some direction -- there was often method in their madness :-)

    Reply: #20
  18. Murray
    Thanks, Paul. Missed you lately.
  19. Paul the rat
    Hey Murray, I was hiking in the Pyrenees. (sustained by lamb meet and goat cheese)

    This one is for the CICO half-wits.:

    Adv Exp Med Biol. 2013;789:323-8. doi: 10.1007/978-1-4614-7411-1_43.
    Oxidative metabolism: glucose versus ketones.
    Prince A1, Zhang Y, Croniger C, Puchowicz M.
    Author information

    The coupling of upstream oxidative processes (glycolysis, beta-oxidation, CAC turnover) to mitochondrial oxidative phosphorylation (OXPHOS) under the driving conditions of energy demand by the cell results in the liberation of free energy as ATP. Perturbations in glycolytic CAC or OXPHOS can result in pathology or cell death. To better understand whole body energy expenditure during chronic ketosis, we used a diet-induced rat model of ketosis to determine if high-fat-carbohydrate-restricted "ketogenic" diet results in changes in total energy expenditure (TEE). Consistent with previous reports of increased energy expenditure in mice, we hypothesized that rats fed ketogenic diet for 3 weeks would result in increased resting energy expenditure due to alterations in metabolism associated with a "switch" in energy substrate from glucose to ketone bodies. The rationale is ketone bodies are a more efficient fuel than glucose. Indirect calorimetric analysis revealed a moderate increase in VO2 and decreased VCO2 and heat with ketosis. These results suggest ketosis induces a moderate uncoupling state and less oxidative efficiency compared to glucose oxidation.

  20. Zepp
    "When a sodium-deficient animal tastes salt, it will excitedly ingest an unusually large quantity (see Supplemental Video). To explain this pronounced behavioural switch, we have proposed a model with three central components (Geerling & Loewy, 2006a), shown in Fig. 5. First, during chronic sodium deficiency, specific groups of neurones provide tonic, increasing signals for sodium need, which motivate salt-seeking behaviour. Second, once salt is tasted, the gustatory apparatus transmits a phasic signal representing sodium detection. Third, these two signals are integrated (along with various inhibitory signals) in one or more forebrain sites that ultimately drive motivated ingestive behaviour."

  21. Mark John
    On the other hand it would be nice to have your brief assessment about the most relevant differences between infant and adult metabolism with regard to sodium and chloride need. Adding in fancy adjectives will not increase the scientific credibility of your statements...

    I would have thought my statement to be self evident, but clearly you still have issues relating back to when you were a baby. How many adults do you know who are still suckling? Or conversely, how many babies do you know who are tucking into bacon and eggs, followed by a cup of tea?

    And referring to "fancy adjectives", what "fancy adjectives"? Maybe you should read more or ask someone to buy you a dictionary for Christmas.

    Reply: #22
  22. erdoke
    You claimed:
    "The nutritional requirements of a baby drinking its mother's milk and the nutritional requirements of an adult are very different."
    I must remind you that this blog post is about salt, even the first two words of the title go as "More Salt".
    Following this logic I linked the above two and asked "about the most relevant differences between infant and adult metabolism with regard to sodium and chloride need".
    Please forgive my poor English and I admit without being ashamed that – as a foreign speaker – from time to time I do need a dictionary (though not for looking up adjectives when the only thing I want to say is 'You are wrong'), but regardless of my language skills I was still not able to find a single word in your post being relevant to the topic and especially not to my question.
    I am a kind guy, so will continue to wait for the evidence that an adult requires several times more sodium (proportionally to body weight) than an infant. Let us stick to that part of the discussion...
  23. erdoke
    Cameron, Frank, Zepp and Robert,
    Thanks for your comments.
    I must stress again that I do not advocate very low salt intake here or anywhere else, nor I limit my sodium intake to 500 mg per day. I am just not convinced about the outcome of a few epidemiological studies in which they suggest that NaCl is best kept between 3 and 6-7 grams daily.
    I tend to agree that salt (Na and Cl) content of nutritionally dense, whole natural foods is very likely sufficient for adults. However, it seems to me that all natural foods are relatively low in sodium AND high in potassium. On the contrary, most packaged and junk foods are high in sodium, low in potassium and on top of that sodium often comes in other forms than NaCl, such as glutamate, nitrite and benzoate. This leads me to the metal and ion balance questions rather than pointing at sodium alone.
    Reply: #28
  24. wildduck
    This subject interests me as having recently invested some time weighing and measuring all my food for a month, I have found my typical daily sodium intake to be 750-1000mg. When I see headlines telling me "eat salt", I worry, because I don't restrict salt - I just don't crave it or even think about it. Is this because I already naturally eat the sodium I require as an individual, or should I make a special effort to add salt to food? (It doesn't taste that good when I try...)
    Reply: #26
  25. Mark John
    I am a kind guy, so will continue to wait for the evidence that an adult requires several times more sodium (proportionally to body weight) than an infant. Let us stick to that part of the discussion...

    Maybe you could construct the study that an ethics committee would pass so you can get your evidence? You'll be waiting for a ling time! Maybe you could start drinking colostrum in the meantime...?

    Reply: #29
  26. erdoke
    Is it sodium or salt? Salt (NaCl) is close to 40 % sodium by weight. 1000 mg (1 g) sodium translates to almost 2500 mg salt. I think that is perfectly fine if your potassium intake is significantly higher than that and Ca-Mg (or more precisely all polyvalent metals) are proportional to the sum of Na-K. Not by weight, but by sum of ion charge.
  27. Mark John
    Look guys, salt is good for you. Eat a LCHF (or at least limit the carbs) diet and sprinkle on as much salt as you want.

    "One of the most pervasive and stupid things that we are currently told to do is to reduce salt intake. This advice has never been based on controlled clinical studies, ever. Yet, as with the cholesterol myth, the dogma that we should all reduce salt intake has become impervious to facts. I find that the ‘salt hypothesis’ is rather like a monster from a 1950s B movie. Every time you attack it with evidence it simply shrugs it off and grows even stronger."

  28. Zepp
    Im all in with you.. the question about salt/sodium is much more complicated then just a matter of simple dosing!

    First of all the advice to reduce salt is for those on a Wallmart diet.. but the advice is totaly contradictionary.. to lower there salt and get other nutrients like pottasium they should stop buying the cheap junkfood on Wallmart in the first place.

    Second.. they should instead buy real whole food.. and take as much salt to that as they like.. becuse there taste buds are better to judge about that.

  29. erdoke
    @Mark John
    It is not coincidence that I have been insisting on getting evidence. Common scientific belief or dare I say consensus is that sodium need in fact decreases with age, so when we talk about breast fed infants with relatively low sodium intake the projection is normal that adults will require even less.
    Regarding #27, there are a few traps when talking about sodium and potassium salts:
    – It is not true anymore that sodium salts other than NaCl are so irrelevant in our diet that urinary excretion is almost a perfect tool to measure salt intake. Na-nitrate/nitrite, Na-glutamate and Na-benzoate has been constantly increasing during the past decades. This obviously means that sodium and chloride are not necessarily proportional anymore.
    – Potassium in natural foods almost exclusively comes together with organic anions such as citrate. These – either directly or indirectly – often used as buffers in the body. In processed foods however, potassium is usually accompanied by inorganic anions, for example chloride.
    – Potassium together with its organic anions in sufficient quantities (and those mean proportionally high to sodium) has an adverse effect on high sodium intake: lowering blood pressure, normalizing demineralization of bones, decreasing risk of developing kidney stones, etc. Without information included on potassium intake, dietary sodium is just half relevant.
    – Maintaining an imbalance between high extracellular concentration of sodium and high intracellular concentration of potassium is so important in the body that the energy consuming enzymatic process responsible for achieving this consumes at least 20 %, but can draw up to 40 % of our resting energy expenditure! Breaking the ideal ratio of Na-K in the diet puts stress on this system and causes high losses of energy.
    - BP increasing effect of high sodium intake better manifests over a longer period of time.

    I hope by now you also see some reasons to be concerned about studies only looking at sodium as urinary excretion (i.e. without factoring in junk food and potentially low potassium) and only for a few weeks.
    As salt intake has very big variations nowadays and some people do eat 16+ g (more than 4 teaspoons) daily, furthermore as the number of higher risk individuals such as diabetics, people struggling with hypertension, etc. has been ever growing, the advice of reducing sodium intake is getting relevant for more and more folks out there. Just to reiterate my personal view on this: When eating nutrient dense natural foods, it is probably OK to listen to natural cravings and add more salt when feeling like it. However, feeling free to add plenty of salt on top of a high(ish) sodium SAD is a poor interpretation of the study referenced in the original post above.

  30. Mark John
    It is not coincidence that I have been insisting on getting evidence. Common scientific belief or dare I say consensus is that sodium need in fact decreases with age, so when we talk about breast fed infants with relatively low sodium intake the projection is normal that adults will require even less.

    How do you square those two circles (sentences)? You insist on getting evidence yet then rely on belief! Science isn't meant to be belief or consensus.

    Reply: #31
  31. erdoke
    Honestly, I just did not think that you had been any more satisfied with a bunch of references. Do you happen to have any science based objections to the quoted reasoning? I'm fully open to your ideas that break the mentioned consensus.
    Otherwise you seem to do an especially good job in always reacting to the least relevant part of a post. I may uncover a secret with this statement, but I actually prefer discussing ON topic facts and hypotheses to never ending virtual mind fencing...
  32. Mark John
    I actually thought that it was the most relevant part of your post as it betrays your thinking.
    It's very difficult to argue against beliefs.
  33. Heather Z
    I LOVE salt, and I have awesome blood pressure! I've always wondered why "sodium" is the bad guy, while I hear very little about salt's partner, chloride. It's an electrolyte too isn't it? It's vital to our health too, isn't? Chloride doesn't even make it on the food lable along with sodium and potassium, why not?! What role does chloride play with sodium and potassium? Just focusing on sodium is out dated compartMENTAL thinking. I want to know how salt helps make hydroCHLORIC acid in our stomachs, which is neccessay to digest food. Low or weak acid means low digestion, and INdigestion, meaning low or no digestion. This in turn leads to malnutriction and disease. So, I want the whole story, of salt. Why doesn't anyone research that? Until then, they can pry my salt shaker out of my cold dead hand when I'm 90+!
  34. Raineabout
    I've been on Ketogenic diet for 3 months BUT have had feet/leg cramps at night for many, many years. Recently increased Himalayan Salt intake for 5-6 grinds on meal to 30 grinds with cucumber and AMAZINGLY the cramps have stopped. I figure I was sidetracked for years by suggestions that I needed magnesium or magnesium/calcium!!!

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