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Category: Nutrition

Overconsumption of Sodium

The Real Scoop On Salt

By: Austin Perlmutter, MD, Medical Student, Miller School of Medicine

If you’re like the average American, you’re a bit of a salt addict. More technically, you’re consuming excessive dietary sodium. For most of us, this isn’t too concerning, and this mindset is reflected in our data. We know the average human needs around 500 mg of sodium each day for basic body functions, but Americans consume on average 7 times this number each day. Don’t get me wrong, salt is crucial for the body’s proper function. But, at the excessive levels we’re consuming, salt leads to serious complications like high blood pressure, heart attack and stroke.

In 1975, researchers wanted to determine the effects of our high-salt diet on health. To accomplish this goal, they decided to venture into the rainforest of northern Brazil. Here, they studied the Yanomamo tribe, a group of persons with minimal exposure to the outside world, and coincidentally, a “life-long extreme restriction of dietary sodium.” The fascinating data showed that in this population, blood pressure stabilized after the second decade of life, and did “not systematically increase during subsequent years of life.” If we know that only 11% of males and 7% of females in their 20’s are hypertensive, but that 67% of men and 79% of women will be hypertensive after age 75, then the impact of preventing age-related changes in blood pressure is tremendous.

At a population level, statisticians predict that our overconsumption of sodium will lead to 500,000 extra deaths over the next 10 years. This means that our extra bag of pretzels may have effects far beyond inducing cravings for a glass of water. Despite suggestions that low salt diets are dangerous, well conducted research continues to show health benefits of lowered salt intake. 

Beyond just sodium, the ratio of sodium to potassium in the diet predicts death. A large study published in the Journal of the American Medical Association found “higher sodium-potassium ratio is associated with significantly increased risk of CVD and all-cause mortality.” Keep this in mind, because the imbalance between sodium and potassium is generally considered to be the main problem in this disease process.

Our diet tends to be very rich in sodium and low in potassium, and therefore most of us have an excess of sodium and a deficit of potassium. Our cells should be filled with potassium, and when they can’t get enough, they suck up sodium from the blood. High sodium inside cells then leads to changes in vascular physiology associated with hypertension. In addition, the lack of potassium promotes glucose intolerance, another factor highly associated with development of hypertension and vascular complications. Obviously we need some salt, but our balance is way off.

To sum it up, we’re eating too much sodium and too little potassium. On a practical level, most of us simply aren’t aware of how much sodium or potassium we’re eating, and are rather desensitized to the excessive salt added to most of our foods. Luckily, we can stop this damaging process, and potentially reverse some of the harm our salt-rich diets have already inflicted. We need to eat more potassium and less salt, but of course, this may present a challenge if we don’t know how. Here are the keys to your success:

  1. Start reading nutrition facts: The nutrition facts label requires sodium content for the enclosed food product. It’s probably reasonable to shoot for 1500mg of total daily salt intake, so snacks and meals with high sodium should be used sparingly within that limit
  2. Avoid foods with high hidden salt content
    1. Processed meats, snack foods, soups and sauces are rich in sodium content. Unless you know how much salt is in a product, be very wary.
    2. Restaurants tend to use lots of salt to improve flavor of foods, and people tend to severely underestimate the salt content of restaurant food. Sauces and dishes mixed with meat are among the worst culprits.
    3. It’s in the grain foods! Breads and rolls are the top source of American dietary sodium!
  3. Know your own foods. If you prepare your own food, you’re in a great position to monitor your sodium intake. Obviously, adding salt with a shaker either during preparation or after serving a meal is a contributor to total sodium intake. However, be aware of the ingredients you use and how much sodium each of them may contribute to the final product. Real foods tend to be much lower in sodium than their processed alternatives. This means that use of unadulterated vegetables, meats, nuts and grains grants you a far lower sodium intake than buying prepared versions.
  4. Up your potassium intake.
    1. Potassium may be a crucial piece in preventing the side effects of high dietary sodium. Less than 2% of Americans actually get their daily recommended value of potassium, even though we know a potassium deficit may increase risk for disease.
    2. Vegetables like kale, chard, spinach, collard greens, lima beans, Brussels sprouts, zucchini and broccoli are very healthful overall, and contain high levels of potassium.
    3. For protein, meats including beef, poultry, fish and lamb are other good sources of dietary potassium, as are nuts like pistachios and almonds (remember, unsalted).
    4. Fruits such as cantaloupe and banana are high in potassium, but sugar content may negate the health benefits. Avocado is technically a fruit, is high in potassium, and is a much more healthful alternative.
    5. If you have kidney problems or are taking prescription medications, make sure to speak with your physician prior to initiating a higher potassium diet

For more information, order your copy of Grain Brain today and join Dr. Perlmutter’s email list.

  • Despite the fact that I eat very clean, low carb, grain free, and avoid caffeine and alcohol, I’ve had a history of high blood pressure tendencies. Not long ago, however, I substantially upped my potassium intake (through supplementation), and have seen a drop of about 10 points on systolic blood pressure.
    You describe the relatioship of sodium/potassium and blood pressure so well in this article. Thanks for sharing.

    • David Perlmutter

      Happy to do so Dr. Mike. Glad you find this informative and well-articulated.

      • Giannis Euthimiou

        Cocoa is good for patients with autoimmune diseases;

  • JackL

    My staples for potassium – V8 low sodium (800-900mg potassium/cup) and sun dried tomatoes (1800-1900mg potassium/cup) – I get close to half my RDA just from these every day.

    • TechnoTriticale

      Sodium aside, if you drink the nominal serving size (8 fl. oz., 240mL) of V8, you’ll be getting 80% carbs, 20% protein, and zero fat. Net carbs is 8 grams, all sugars. Even the nominal serving size may bump your blood sugar.

      Most people are apt to drink rather more than 8 oz., and will blow their whole meal budget for total and net carbs (whichever they are counting), plus spike their blood sugar. There is a claim that the “natural flavorings” include MSG.

      This stuff is way less hazardous compared to pop, but if I were inclined toward a veggie drink, I’d blend my own. Add some Resistant Starch for extra credit, since no prepared product is likely to have that.

      • JackL

        Within the maximum 50-60g carbs per day that the Doc recommends, 8 is acceptable (12 in fact as I have 1.5 cups per day) – tomatoes have carbs, as do many other good foods. Zero carb intake is not the goal. And I have no quarrel with MSG – V8 is probably the only product I use that contains it.

  • Barbara Watson

    What about Himalayan salt? Does it have potassium, and is that a better alternative to table salt or sea salt?

    • Eve-Loraine

      Sodium 388g, Potassium1700mg per KG. I don’t know whether that ratio is helpful.

      • Barbara Watson

        Interesting! Thanks!

  • Jan Coffman

    I also thank you for the excellent information! You tell us the very important “why not” details that we don’t get elsewhere. Kudos!

  • primenumbers

    As I don’t have access to the full paper cited above: ” Despite suggestions that low salt diets are dangerous, well conducted research continues to show health benefits of lowered salt intake. ” – does it look also at overall mortality? The abstract mentions “prehypertensive individuals” – by what means are the results of the study extrapolated to health individuals?

  • Rob

    What about the claims from Gary Taubes that it is a myth that salt increases BP?

  • Herbie G

    Very informative doc

  • Daniel

    In several places, one of which is Phinney and Volek’s books, I’ve read that someone in nutritional ketosis needs a higher intake of salt. I believe they recommend 1 to 2g a day for such an individual. Any thoughts?

    • Jim

      I am reading their book ‘The art and science of low carbohydrate performance’ now and am also finding their call for high sodium intake confusing. In this book they are recommending 2 grams of sodium per day at least in addition to what we consume in our low carb diet. They go through great pains to explain their seemingly convincing case. Unfortunately I am not a physician so do not know which path to choose, theirs or Dr. Perlmutter’s who recommends their books on this website. Either way I am now whining. I am happy to live in a country where we have the freedom of speech to write books that are conflicting to others views. See ‘America’ the movie.

  • acupuncture physician

    Interesting topic–though I disagree adamantly with this article. No mention is made of the difference between table salt (like Morton’s)–and natural salt (Like Himalayan, Celtic or Real Salt). Table salt/Morton’s is bleached, stripped of minerals, and contains sugar and other undesirable ingredients. Real Salt, Himalayan, or Celtic salts, are natural and loaded with minerals. Most of us are lacking in minerals due to our poor soil and diets. David Brownstein, MD recommends liberal consumption of real, natural salt for everyone, even hypertensive folks.

    • StayingAlert

      It needs to be pointed out that David Brownstein’s (mentioned in the above post) web site sells the types of salts mentioned above. The conflict of interest is obvious, so the recommendations should be viewed skeptically (i’ll avoid the obvious pun).

      The dominant nutritional feature of salt is sodium, which most of us in the U.S. consume in excess. The sodium content of sea salt, Celtic salt and Himalayan is virtually the same as that of ordinary table salt. Sea salt (including Celtic salt) contains some other trace minerals, particularly magnesium, and may have color or taste features desired by some. But from an overall nutritional point of view, there is very little difference between table salt and sea salt or Himalayan salt (mined in Pakistan). Ordinary table salt has the virtue of added iodine, required for normal thyroid function.

      I am a physician (M.D.) who is knowledgeable about our salt nutritional requirements and disagree with most of the statements in “acupuncture physician’s” post. While it is true that Himalayan and sea salts (including Celtic salt) contain trace minerals not found in ordinary table salt, the value of these is negligible to most of us who eat a balanced diet. I know of no responsible physician who would recommend “liberal consumption” of “natural” salt for everyone, including those with hypertension. On the contrary, excessive (over 1,500 mg per day) sodium consumption should be avoided for most of us. If you like the taste or color of these “special” salts, by all means enjoy them — in moderation. Do not be fooled, however, by marketing hype and exaggerated claims of nutritional or health benefits.

  • Giannis Euthimiou

    Cocoa is good for patients with autoimmune diseases;

  • Erik

    I like MD Natacha Campbell McBride’s take on NaCl versus un-refined sea salt.

  • Mellan

    Coconut water is high in potassium.

    • susan henderson

      No wonder I always feel good drinking it.

  • susan henderson

    For 40 years my blood pressure was always, quite low. Not until I gained weight did my blood pressure normalize. So normal the nurses praise my reading.

    When I cut out all sugars and carbs I get extremely tired and lightheaded.My intake of salt has been limited since I no longer have a huge craving for salt.. I am wondering if I should actually drink water with added salt to bring blood pressure to a more normal level.

    Do you have any suggestions?

    P.S. Thank you for your book. I was swinging back and forth for years on diet, but have known for sometime that sugar and carbs are bad for me. You have totally convinced me this diet is the way to go.

  • Jim

    You are recommending on average 1,500mg of sodium per day for someone on the ”Grain Brain” diet eating 60 grams of carbs per day. What if someone were to drop his carb intake to 30 grams per day?
    Thank you.

  • dherself

    I began Grain Brain 4 weeks ago. Things went well for 3 weeks, and then I began experiencing extreme dizziness, culminating in a trip to the ER this past week for high blood pressure reading. I’m a 70-year old woman in good health, active. I’ve never had BP problems. I’ve been reading all I can about what could have caused this. I’m thinking high sodium intake. Stupidly now that I think back on it, when looking for things to eat, I found various salami slices wrapped around mozzarella cheese. No gluten, no carbs, and I didn’t find a restriction for salami in the Grain Brain book. So I ate these freely, especially the first several weeks on the diet. I also ate bacon often. Now I’m on a low dose high blood pressure medicine until I can see my family doctor later this week. I am now avidly tracking my salt intake and not going over 1500mg plus getting potassium-rich foods. I’m hoping this will help me bring the BP down so that I won’t need medication. I just read a study posted by Dr. Perlmutter about probiotics and hypertension which suggests that probiotics may help lower BP. Nowhere in the study does it say that any of the participants were currently taking BP medication, so my question is can I take probiotics with BP medication?

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