To Salt or Not to Salt?

By Kiran Dhaliwal & Jessica Turton


Someone has probably told you at some point to cut back on your salt intake, especially if you have high blood pressure. For years we have been led to believe that salt increases our blood pressure and therefore increases our risk of heart disease. However, sodium (contained in salt) is an essential nutrient required for life, so are we over-restricting this salty crystal and is it really as bad as it is often made out to be?



Salt vs sodium


Let’s back it up for a minute. Salt and sodium are not the same thing but are often used interchangeably. Salt is the white crystal you add (or don’t add) to your food and is made up of 40% sodium and 60% chloride. One teaspoon of salt contains about 2200 mg of sodium.


Salt can be utilised in various ways, including [1]:

· as a flavour enhancer to food, particularly bitter foods

· as a binder and/or stabiliser

· as a food preservative (bacteria can’t thrive in the presence of high amounts of salt)


Why is sodium important


Sodium is the essential mineral contained in salt (and other things) that is critical to human health and we essentially cannot live without it.


Sodium is needed for:

· muscle and nerve function

· hydration (ie a proper balance of minerals and water in the blood)

· blood pressure

· energy production

· nutrient absorption and digestion


Dangers of low sodium intakes


Research shows that low sodium intakes are associated with increased cardiovascular events, unfavourable blood lipids and all-cause mortality [2-4]. A 2014 meta-analysis reported that sodium intakes below 2645 mg/day were associated with poor health outcomes [3]. This study also reported that sodium intakes between 2645-4945 mg per day were associated with the most favourable health outcome [3]. This "sweet spot" for sodium equates to about 2 teaspoons of salt a day, and is significantly higher than the sodium targets recommended by most health professionals (1200-2000 mg/day).


Even for populations at high risk of cardiovascular disease, such as those with hypertension or diabetes, there has not been evidence supporting additional benefits of lowering sodium intake to less than 2300mg/day [5].


Low sodium intakes can have negative impacts on cardiovascular health by contributing to unfavourable blood lipids and insulin resistance [2]. Cardiovascular research scientist Dr DiNicolantonio reports in his book ‘The Salt Fix’ that when left unrestricted, humans naturally consume around 3000-4000 mg of sodium per day, and he suggests that we should not be overriding these instincts by purposefully restricting our sodium intakes [6]. We recommending reading James' book if you are interesting in learning more about the science behind sodium and our health (http://thesaltfix.com).



How much sodium do we need?


Like with everything nutrition-related, there isn’t a one-size-fits all recommendation for daily sodium intake. However, a large study with over 100,000 people from 17 countries was conducted to investigate the relationship between sodium intake and risk cardiovascular disease or death from any cause [7]. It was found that a sodium intake between 3000-6000 mg per day (around 1.5-3 tsp of salt) was associated with the best health outcomes, when compared to lower or higher sodium intakes [7]. This is relatively consistent with the 2014 meta-analysis which reported a sodium intake of 2645-4945 mg per day as being the most beneficial [3].


Signs that you might not be meeting your sodium requirements include:

· increased heart rate

· low energy levels

· dizziness on standing

· muscle cramps

· headaches and/or migraines

· gastrointestinal issues

· weight loss resistance


At the end of the day, sodium is essential, and we all have individual requirements for this important mineral. It is important to consult with a qualified health professional who can assess your individual circumstances, health history, signs/symptoms, pathology, medications and dietary intake to help you figure out your sodium requirements and provide you with practical strategies for meeting this.


Types of salt


There are many different types of salt available and common varieties include: table salt, sea salt, Himalayan pink salt and kosher salt.


The different types of salt may vary in taste, colour and texture. In case you are wondering which ones are the better than others, the truth is that they all contain similar amounts of sodium – which is the nutrient of interest in this article! However, the other minerals contained in salt (e.g., potassium, iodine, magnesium) can vary greatly depending on the type.



At Ellipse Health, we have a soft spot for Redmond Real Salt (https://redmond.life/realsalt/) as it is the highest mineral containing salt – 1.5 teaspoons of Redmond salt contains 100% of your requirements for iodine – another essential mineral that is important for proper thyroid function and general health.


The bottom line


When it comes to nutrition, there are always going to be conflicting messages being announced that leave you feeling overwhelmed and confused. Salt, in particular, has been unnecessarily demonised. The purpose of this article is to help you see salt in a new light. In clinic, we often see individuals suffering the complications of over-restricting salt.


Of course, highly processed foods which contain sodium alongside lots of refined carbohydrates and inflammatory oils/fats are not good for anyone! However, if you are eating a healthy whole foods diet, then you may need to add salt to ensure you are meeting your sodium requirements.


This article is not individualised advice. It is important to have your dietary intake and individual circumstances assessed by a savvy health practitioner who understands this topic in detail before making any decisions on whether you should change your diet. Consider booking a consultation with an Ellipse Health Dietitian here (link). You can book an appointment with our team here: https://www.ellipsehealth.com.au/team.






References


1. Salt and Sodium. The Nutrition Source. 2020. Available from: https://www.hsph.harvard.edu/nutritionsource/salt-and-sodium/

2. McGuire S. Institute of Medicine. 2013. Sodium Intake in Populations: Assessment of Evidence. Washington, DC: The National Academies Press, 2013. Advances in Nutrition. 2014;5(1):19-20.

3. Graudal N, Jürgens G, Baslund B, Alderman M. Compared With Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated With Increased Mortality: A Meta-Analysis. American Journal of Hypertension. 2014;27(9):1129-1137.

4. Taylor R, Ashton K, Moxham T, Hooper L, Ebrahim S. Reduced Dietary Salt for the Prevention of Cardiovascular Disease: A Meta-Analysis of Randomized Controlled Trials (Cochrane Review). American Journal of Hypertension. 2011;24(8):843-853.

5. Taylor R, Ashton K, Moxham T, Hooper L, Ebrahim S. Reduced Dietary Salt for the Prevention of Cardiovascular Disease: A Meta-Analysis of Randomized Controlled Trials (Cochrane Review). American Journal of Hypertension. 2011;24(8):843-853

6. Dinicolantonio J. The Salt Fix. London: Little, Brown Book Group; 2017.

7. O'Donnell, M., Mente, A., Rangarajan, S., McQueen, M., Wang, X., Liu, L., Yan, H., Lee, S., Mony, P., Devanath, A., Rosengren, A. and Lopez-Jaramillo, P., 2014. Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events. New England Journal of Medicine, 371(13), pp.1267-1267.