Salt Awareness Week – 10 things to be aware of
March 11-17 2013 is “Salt Awareness Week” in the UK – what exactly might we like to be aware of?
Let’s get some definitions out of the way first. Salt can be unrefined or refined. Unrefined salt is also known as sea salt. Unrefined (sea) salt comes with many valuable minerals and natural elements. Refined salt is also known as table salt. This is made up of sodium and chloride. There are approximately 2.4g of sodium in 6g salt. This means that approximately 40% of salt is sodium. You’ll see sodium on food labels, rather than salt.
Here are 10 things that you may find interesting about salt…
1) Like every other government target, the salt dictat has no evidence base
The NHS wants us to eat “no more than 6g salt per day.” (Ref 1) (which equates to 2,400mg sodium). Why? I have no idea and nor does the NHS. Why not 7? Why not 5? Why have a target at all? Goodness only knows. Just like 5-a-day, 14/21 alcohol units, 20-30g saturated fat, 18g fibre – none of these precise targets has precise evidence.
The NHS web site is supposed to provide evidence for government policy. Here is “Salt – the facts” which opens with “Many of us in the UK eat too much salt. Too much salt can raise your blood pressure, which puts you at increased risk of health problems such as heart disease and stroke” and then it goes on to tell you how to cut your salt intake. I don’t know about you but I found those ‘facts’ quite underwhelming.
2) We need to consume salt (and potassium) or we die
We die without salt. It’s as simple as that. Unlike cholesterol, which is also utterly life vital, our body doesn’t make salt. The term “essential nutrient” in nutrition mean that it is essential that we consume the nutrient. Salt is thus an essential nutrient. Fortunately it is in the majority of real foods, including water, and so ingestion of this vital mineral is not difficult.
Potassium is another essential dietary mineral. The potassium/sodium balance, is absolutely critical to the overall functioning of every cell in the human body. If salt levels fall too low, a condition called Hyponatremia can develop, which can be fatal. (Ref 2)
3) Salt has nothing to do with obesity
The inclusion of salt in the Academy of Royal Colleges obesity report (Ref 3) was quite bizarre because salt has nothing directly to do with obesity. It has no calories, no macronutrients (no fat, no protein, no carbohydrate) and therefore cannot directly impact obesity.
There may be an indirect argument that salt could encourage people to eat things. However, I would argue that people may desire doughnuts or biscuits (combinations of flour, sugar and salt), but that they would be unlikely to crave, say, anchovies, unless salt deficient for some reason. I would then expect a salt-deprived person to stop consuming anchovies once any salt deficiency were corrected and not to binge on them. The ‘but for’ test therefore points to the refined carbohydrates, containing salt, being substances of desire and not salt per se.
4) CASH has it in for salt
A charity called Consensus Action on Salt and Health (CASH) exists purely to campaign against salt. As the web site says: “CASH was set up in 1996 as a response to the refusal of the Chief Medical Officer (CMO) to endorse the COMA recommendations to reduce salt intake.” (COMA stands for Committee On Medical Aspects of Food Policy).
The COMA report merely says (and I quote) “The panel recommends that the dietary intake of common salt should not be increased further and that consideration should be given to ways and means of decreasing it.”
The worst thing that the COMA report could say about salt was: “High salt intakes have frequently been linked with the prevalence of high blood pressure in communities but a mechanism whereby salt could lead to the development of essential hypertension has not been established.”
Hang on a second – so there are alleged “frequent links”, for which no evidence is presented and we don’t even know how salt could impact hypertension (high blood pressure)… (I’ll answer this for them in a minute – we’ve known how since Carl Von Voit’s work in 1860).
The COMA report continues “Cross-cultural studies show a statistical association between estimates of salt intake and the average blood pressure of a community but detailed investigations within a single community frequently fail to demonstrate such a relationship.” And CASH was set up because the CMO failed to take action against salt?!
5) ‘High’ blood pressure is in fact normal
If you look at figures 1 and 2 in this highly referenced article, the actual population normal/average blood pressure is 140/86. The European Society of Hypertension and the World Health Organisation both define blood pressure of 140/90 as the baseline for high blood pressure. So normal has been redefined as high. This enables drug companies to medicate many more people.
6) Salt can increase blood pressure, but so what?
There is a very simple mechanism by which salt can increase blood pressure (of which the COMA report didn’t seem to be aware). Salt provides sodium. The normal concentration of sodium in blood plasma is 136-145mM (mmol/Litre). One of the easiest ways for the body to maintain the concentration of sodium is to increase fluid levels if sodium rises. If we consume salty food, we want to drink more (that’s why bars put free bowls of peanuts on the counter) so step 1 is for the increased intake of sodium to lead to an increase in fluid intake. Step 2 means that the additional fluid is more likely to be retained because the body is back in sodium concentration equilibrium, albeit with more sodium and more water.
Water retention in the human body can raise blood pressure. However, there are three points to make here:
i) Raised blood pressure is a symptom. It’s not a problem per se. What the salt antagonists fail to provide is any evidence for a substantial and/or sustained increase in blood pressure as a direct result of any defined level of salt consumption.
ii) Salt opponents also fail to provide any direct causation between salt consumption and end point disease (e.g. heart disease) regardless of whether or not salt impacts blood pressure.
iii) A completely overlooked point is that any rise in water retention from consuming even a couple of grams of salt is incomparable to the impact of consuming 100g of carbohydrates – which we are encouraged to consume (a few times a day) in illogical parallel with the discouragement of salt intake.
We can store up to 500g of glycogen if we consume carbohydrates that are not used up for energy. We know that each gram of glycogen is accompanied by four grams of water. Hence we can gain 2.5kg (c. 5lb) overnight by consuming carbohydrates above human need. This is way more significant in terms of water retention and blood pressure than any impact of a couple of grams of salt – and yet carb consumption is recommended and salt consumption is demonised. Yet another example of our completely incomprehensible dietary advice.
7) Even if salt impacts blood pressure, and even if this matters, reducing salt intake substantially would have negligible impact
The 1994 COMA report (Ref 4) states: “Its [The review group] recommendation was to reduce salt consumption by an average of 3g/day. It has been estimated that this would reduce average systolic blood pressure by about 3.5mm Hg.” [systolic blood pressure is the first of the two numbers we get].
Gary Taubes noted the same in The Diet Delusion: “cutting our average salt intake in half, for instance, which is difficult to accomplish in the real world – will drop blood pressure by perhaps 4 to 5 mm Hg in hypertensives and 2 mm Hg in the rest of us.”
So, halve your salt intake and your blood pressure may go from 130/X to 127/X?
If you have ever had your blood pressure read frequently (while in hospital or getting ready for an operation or a baby), or if you have one of those blood pressure machines at home, you will know that you hardly ever get the same reading twice in a row. Even within a couple of minutes, your blood pressure can vary by more than a handful of points – more than the amount it could possibly change by if you managed to halve your salt intake.
8) CASH’s evidence on “Salt & Health” is completely lacking
For the seven years after its formation, Consensus Action on Salt & Health was relying upon the 1994 COMA report. Since 2003 they have relied upon a Scientific Advisory Committee on Nutrition (SACN) report, called “Salt and Health”. (Ref 5)
Feel free to read the 134 page document. The summary will give you the key elements. The summary opens by saying: “Increased blood pressure, or hypertension, is the most common outcome that has been associated with high levels of salt intake. Hypertension is a major risk factor in the development of cardiovascular disease. The relative risk of cardiovascular disease increases as blood pressure rises even within what is considered the normal range of blood pressure, indicating that large numbers of people are at risk.”
i.e. the most common (the only?) outcome that salt intake has been associated with is increased blood pressure. If there were any direct association between salt intake and any actual disease, it would have been claimed.
Increased blood pressure in turn is then claimed to be a “major risk factor in the development of cardiovascular disease.” I disagree. High blood pressure (BP) (even when properly defined as actual high BP and not normal BP i.e. 140/86) is a symptom, not a cause. This makes blood pressure a condition observed at the same time as heart disease and not a risk factor. (It is far more likely the opposite direction of causation – heart disease causes high blood pressure – hence the symptom).
Notwithstanding this – the argument against salt still boils down to – we think salt is associated with blood pressure and we think blood pressure causes heart disease. So, by inference, they want us to think that salt causes heart disease.
The jewel in the crown of the anti-salt lobbyists is “The International Study of Salt & Blood Pressure” (Intersalt Co-operative Research Group, 1988). This study collected data on 24-hour urinary sodium excretion and blood pressure of over 10,000 adults in 52 population samples from 32 countries. Associations (note, not causation) were found between sodium excretion and blood pressure readings – until the four populations with very low salt intakes were removed from the analysis and then any statistical significance disappeared. (That latter point about the statistical significance disappearing was the view of the SACN Salt and Health report to give credit for honesty – it wasn’t my playing with numbers that led to this finding.)
Dr David Brownstein’s book Salt your way to health noted the findings from the Intersalt study as follows: “Although there was a slight relationship between blood pressure and sodium excretion in INTERSALT, a ‘smoking gun’ could not be found. This study showed a mild decrease in blood pressure (3-6mmHg systolic and 0-3mmHg diastolic) when there was a dramatic decrease in salt excretion.”
9) There is no evidence that salt causes heart disease; there is evidence that low salt is associated with heart attacks
A study of approximately 3,000 hypertensive subjects (men with high blood pressure) found that there was a 430% increase in myocardial infarction (heart attack) in the group with the lowest salt intake versus the group with the highest salt intake. (Ref 6) Knowing how vital salt is for human health, this should not be surprising – low-sodium diets have been shown to cause multiple nutrient deficiencies, including nutrients vital for heart health (calcium, magnesium, potassium and B-vitamins). (Ref 7)
The SACN report concluded: “There are insufficient reliable data on long-term effects of salt on cardiovascular disease outcomes to reach clear conclusions.” Quite.
10) Eat real food and never worry about salt
Nature puts sodium in real food – we would be dead if this hadn’t happened. Meat, fish, eggs, dairy products, water etc, all contain sodium. These substances also all contain potassium – the balance is taken care of for us. How clever. The most salty foods (seafood) tend to be found in sunnier climes where a) people need more salt to protect against fluids lost in sweat and b) where potassium rich fruits tend to be found as a counterbalance. Clever again.
Salt is not going to kill us. Lack of salt will kill us frighteningly quickly. We should ideally use sea salt rather than table salt – just to get the added minerals and elements – but table salt is not going to harm us either. Processed food contains a lot of added sodium – that’s not what’s going to harm us. The processed food per se is going to do that. The processed food, with its trans fats, sugars, flour, empty calories, lack of nutrition and addictive combinations of manufactured ingredients, is the source of harm – not any sodium contained within.
So just eat real food and don’t worry about salt.
p.s. The interesting twist to researching salt is that the motive for attacking this substance has not been as obvious as usual. The motive in the anti-fat movement is clear – it gives the ‘food’ industry the green light to make highly lucrative fake low-fat food. The motive in the anti-cholesterol movement is clear – it gives the drug industry the green light to make drugs worth tens of billions of dollars and ‘food’ companies can make spreads and other ‘cholesterol-lowering’ fake foods.
The common bad relationships between the ‘food’ industry and health campaigners can be found in the salt world. Check out p12 of the April 2012 Action on Salt annual report – the usual suspects from the ‘food’ industry are warmly thanked for their support.
Who gains by demonising salt? The lo-salt company clearly does. The founder of Consensus Action on Salt & Health, Professor Graham MacGregor, has personally done well out of founding the organisation. MacGregor is now chairman of action on salt. MacGregor is also chairman of the Blood Pressure Association. He sits on the board for the World Hypertension League and recently served as President of The British Hypertension Society. MacGregor was awarded 37th place on the Independent on Sunday’s list of people who have made Britain a “much, much better place.” (Ref 9) Salt has given MacGregor’s life purpose – I believe that he believes that salt is a bad thing. I also think that he is wrong.
As a final thought – have you heard of the expressions “salt of the earth” or “worth his/her salt”? We describe someone as the salt of the earth when they are as good and worthy as anyone can be. The word salary comes from the Latin word salarium and has the root sal or salt. In ancient Rome, salary meant the amount of money given to a Roman soldier to buy salt, which was an expensive but essential commodity. This explains the “worth his salt” expression. Our language is telling us the truth, our government is sadly not.
6) Alderman “Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men.” Hypertension. 1995
7) Engstrom et al “Nutritional consequences of reducing sodium intake.” Ann. Intern. Med. 1983.
p.s. (This was the Monday newsletter for 17 March 2014)
38 thoughts on “Salt Awareness Week – 10 things to be aware of”
One of my many bugbears as a GP is some of the pointless (in my view) preventative medicine that we are asked to do. You won’t be surprised to know what I think of demonising fats and prescribing statins! I have long felt that medicating the ‘mild hypertensive’ group to be harmful because side effects etc outweigh any benefit, and I was pleased to see what the researchers in The NNT (link above) think. If you go on it, have a look at their conclusions re statins.
Many thanks for your comment. I am very familiar with the statin NNTs (although they seem to randomly change from time to time). When people hear these they tend to reject statins funnily enough!
Best wishes – Zoe
A question on limits on consumption for salt. Shouldn’t targets be in mg/kg of body weight? I am twice the size and weight of my wife and what works for her (in general) does not work for me. Just wondering.
This just shows how unscientific all made up targets are. “8 glasses of water a day” – no evidence base – and, like you and your wife, my hubby is twice the size and weigh (almost) of me! Five a day – no evidence base – same for everyone. 30g of fiber, or whatever the latest made-up number is, where does that come from!?
Best wishes – Zoe
I loved this article, and it’s such a relief to know that I can live longer if I eat food that is tasty!! Thanks so much for your work. I’m just wondering what you think about genetic tests that are claiming some of us need to cut down on salt. My blood pressure is probably around 120/?? (120 on 80 or 90 – can’t remember). It’s always been about the same. I’m a skinny guy, never been able to put on weight (no medical issues, I think), and everyone on my mothers side is the same, and they all live long lives. Everyone on my father’s side has obesity/diabetes/heart disease and live average lifespans.
I recently had a test done by one of the genetic testing labs to see if I could learn more about my health. I’m very skeptical about what I’ve learned from them, since they told me (in a report) that I have high sensitivity to salt, to carbs and to saturated fat. Apparently, each piece of their dietary advice is backed up by a minimum of three peer reviewed studies, conducted in humans. Because of the presence or absence of a few particular genes, their advice to me was to cut down on salt and keep saturated fat under 8% (to avoid hypertension, obesity and heart disease). Since going keto 6 months ago, I don’t think that will be happening (except for the carbs). I pointed out to them that there are 10’s of thousands of people on high-fat diets, all posting their progress and results online, all ecstatic about their results. And that conventional salt advice is probably not all it’s cracked up to be. They responded by sending these links:
Is there any merit in these sorts of studies? The results from the genetic report just don’t seem to fit how my body responds to food. Just curious. Thanks.
First, you may find this post interesting – your BP is below average, rather than normal! https://www.zoeharcombe.com/2014/06/diabetes-cholesterol-bp-normal-is-no-longer-normal/
That’s not good or bad – it just is what it is – but just so that you don’t fall for the 120/90 is high nonsense. They do the same with cholesterol – make up a number 5 and then medicate everyone to get below that made up number.
Given that you’d die very rapidly without salt, fairly rapidly without sat fat (because you can’t eat fat without eating sat fat and you’d die without essential fats and fat soluble vitamins) but you wouldn’t die if you didn’t eat carbs again (so long as you did eat fat/protein), I’d take a report warning against all three with a pinch of salt ha ha.
Forgive me for not reading the papers: a) I’ve got better things to do b) it would raise my BP and c) nothing will change what I’ve written in this post about salt having no impact on any end outcome – other than that you die without it.
There will be some genetic tests that will tell you some things e.g. genuine FH genes or propensity for cancer etc but food sensitivities? Not convinced personally…
Sounds like you’re doing real food/low carb, which is a pretty smart choice. I’m not keto personally – no need and it seems too restrictive unless you need to go this route (for diabetes and/or obesity) – but if it works for you, it’s a load better than the gov dietary advice!
Pass the salt!
Best wishes – Zoe
I can relate to a lot of what you say Zoe, I was on Ramapril to treat high blood pressure but then read some of the science of my condition and realised the blood pressure was a symptom of an issue at cell level. A few months cooking from scratch, and reducing my alcohol consumption did the trick and I’ve been drug free now for over 2 years. I take my blood pressure regularly though, 122/79 earlier in the week so still fine.
I had a similar experience with late onset eczema where the NHS were treating my symptoms and not the root cause. A low sugar diet and lots of natural yoghurt solved that issue too. I’ve written to my MP regarding my experiences, the letter was forwarded to the House of Commons for consideration as the NHS is wasting money treating symptoms. The response was disappointing.
The drug companies have an unhealthy interest in feeding us drugs unfortunately which doesn’t help the matter
Many thanks for sharing these – adding to the library of individual stories where people have done as you did and made smart lifestyle changes and improved their health without meds. No wonder you wonder why the NHS/government doesn’t encourage this!
Best wishes – Zoe
I live in South Africa, in this region since 1969. I am 73 years of age and my blood pressure frequently measured in a home meter is between 105/65 and 115/70. I believe high blood pressure, other than that associated with disease, is associated with the consumption of sugar sweetened drinks. The manufacturers of sugar sweetened drinks would benefit from demonizing salt by blaming it and removing the spotlight from their products.
I do not take sugar sweetened drinks including not sweetening tea or coffee, my mother always dissuaded me from adding sugar to tea, saying that unsweetened tea is more refreshing. Good advice!
I do add salt to my food, often adding soy sauce to stir fries etc. I will worry about my intake of salt if my BP rises. Untill then I will enjoy tasty food.
The problem here is not on WHAT it is on QUANTITY… as with everything else….
And the data is a bit outdated…
Sea salt in a bath is also good for eczema. There are many good properties about salt that don’t include consuming it.
You write: “High blood pressure (BP) (even when properly defined as actual high BP and not normal BP i.e. 140/86) is a symptom, not a cause. This makes blood pressure a condition observed at the same time as heart disease and not a risk factor. ”
This bit I don’t agree with. Some 30 or more years of evidence tells us that reducing blood pressure in essential hypertension reduces mortality and morbidity from cardiovascular causes, irrespective of how that reduction is achieved, and across age groups. I’m a GP not a researcher, so I can’t quote the studies, but there have been a lot of them since the original Veterans Administration study.
‘Normal’ is not a relevant concept in this context. Absolute risk reduction is.
I’m a British expat living in Southern Africa – when I first came here I had my blood pressure checked by a nurse and it was on the low side … she advised that I add more salt to my food :-)
Hi Zoe, I have always had generally low blood pressure in the region of 90/60, which means that my circulation is quite poor. When I’m super stressed, I might reach the dizzy heights or 130/100, which is still below average, according to your article. At the same time my sodium levels appear to be absolutely fine, a tad above the middle of the normal range. I dont use much salt in cooking because I don’t like the taste – I’ve sent meals back in restaurants because I thought they were unbearably salty, and had very strange looks from people who clearly don’t taste the extra salt like I do. It looks like I don’t need or want the additional salt. I guess this is anecodotal evidence that salt doesn’t impact blood pressure. So what does? I think I’d probably feel a lot better if my blood pressure was a bit higher. I feel cold a lot of the time, and on my (very occasional) stressed out day, I don’t feel the cold any more, which is a nice offset to the stress. But despite all my sleuthing, I haven’t been able to turn up any good information about what causes low blood pressure. Interested in your thoughts. Pauline
Hi Pauline – both Andy and I have low BP and the worst problem we experience is light headedness when we bend down to tie shoe laces or stroke the pets. We’ve just got used to getting up slowly and carefully. I hadn’t thought about the feeling cold point. Feeling the cold is more a symptom of poor circulation. I don’t think low blood pressure would equate to poor circulation any more than high blood pressure would equate to great circulation!
Blood pressure is a measure – not a cause of anything per se. The ’cause’ of low blood pressure is therefore good health! I suspect you are slim, fit and healthy and that you don’t eat much processed food. You can artifically increase your BP by doing unhealthy things – eat processed food – especially refined carbs with white flour and sugar. Drink fizzy drinks at the same time so that the body stores the water to match the stored glycogen from all the carbs you ate, but can’t use up. Smoke. Stop exercising and watch depressing soap operas – that should work!
Seriously – BP tends to rise with age so enjoy having a great starting base and enjoy having your body’s dashboard telling you that you’re in great shape!
Best wishes – Zoe
Great article Zoe. Just found out you studied Maths and Economics at Cambridge. Shame more of our MPs didn’t. We wouldn’t then have to suffer the influence of bizarre cults such as CASH.
Quote from BBC news website : – (Professor Randall Thompson) said it is commonly thought that if modern humans could emulate pre-industrial or even pre-agricultural lifestyles, that atherosclerosis would be avoided.
“Our findings seem to cast doubt on that assumption, and at the very least, we think they suggest that our understanding of the causes of atherosclerosis is incomplete, and that it might be somehow inherent to the process of human ageing.”
Maureen Talbot, senior cardiac nurse at the British Heart Foundation, said: “This small study takes us back in time to give an insight into the heart health of people in the ancient world.
“However, we simply don’t know enough about the diet and lifestyle of the people studied to say whether behaviour or genetics lies at the root of the heart problems observed.
“We can’t change the past, but lifestyle choices can help to affect our future.
“By eating well, quitting smoking and keeping active, you can help to protect your heart.”
Is there a case here of one person ignoring the facts to make sure her job is protected over the next few years :-)?
My favorite saying is from King Lear, “I love you as meat loves salt.” It takes him quite a while to discover the truth and the sentiment behind that statement, but it is true and quite apt nonetheless.
Check you out Leila! Shakespeare will be turning in his grave this week! :-)
I know that. Equating chloride with chlorine (a poison) is incorrect. And sodium (which explodes in water )with Na+ is Incorrect
Water is a chemically bonded union between two hydrogen atoms and one oxygen atom, hydrogen borrows one electron from oxygen and oxygen borrows one electron from each of the hydrogen atoms. Just to makr the outer electron shells of both hydrogen and oxygen. The water molecule looks like a tiny boomerang and has a slight negative charge at the oxygen end and a slight positive charge at the hydrogen end. So water molecules can weakly attach to each other
Sodium chloride are dissolved into Na+ (lost an electron) and Cl- (recieved one extra electron) so those ions are dissolved in water and has about 180 water molecules in a cloud around each ion.
Do not confuse chlorine with chloride. Or sodium with salt. The body does not break down the compound. That is like talking about hydrogen and oxygen when referring to water!
I’ve also found that salt restriction has such a small effect on blood pressure (~4/2mmHg for hypertensives) that it’s illogical to blame high salt diets for hypertension. Blood pressure and sodium concentrations are among the most tightly regulated things in the body. If the blood volume is higher than normal the body can regulate blood pressure though vasodilation (a very powerful regulatory mechanism), lowering cardiac output or increasing salt and water loss through the kidneys.
Salt restriction has some potentially negative effects including massively increasing the renin-angiotensin-aldosterone system, and also increasing adrenaline, noradrenaline, oxidative stress and insulin resistance. It seems salt restriction is a stressor
By the way, I don’t think there’s good evidence for acid-base theories of osteoporosis are they relate to acidity/alkalinity from the diet (in regards to the comment on chloride)
That being said there are some people who are salt sensitive. I don’t know much about that, though it may be related to insulin resistance and/or kidney dysfunction
Zoe, a recent Reuters article with the title “Too much salt may trigger autoimmune diseases – studies” claims salt may trigger autoimmune response, specifically with regards to multiple sclerosis. I, for one, don’t believe a word of it, especially now considering what you just told us about salt. I mean, it doesn’t make sense that we should restrict salt intake to prevent MS or high BP or anything else associated with salt intake, when doing so leads to deficiency and in extreme case death.
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Your blood values were very interesting. Your T3/RT3 looks like mine on low carb. I’m always just a tad under range. I don’t have a functioning thyroid; I had RAI 20 years ago or more. Anyway, I can only tolerate a tiny amount of exogenous T3 and it hasn’t really helped me with the weight loss anyway, but it does make me feel better.
I was just reading, a few days back, about a certain gene configuration that seems to be the cause of the physiological insulin resistance some of us get from a low carb diet. I looked up the gene–I had my genes done at 23andme.com–and I have one copy of the allele that causes it.
I wish I could remember the gene and the article. If I track it down I’ll let you know.
Hmmm, as a 14 year old schoolboy, I was taught that the kidneys maintained the correct level of salt in the body. Too much salt in the blood, and the kidneys removed some of it. Too little salt in the blood, and the kidneys stopped removing it.
I think that as long as I have working kidneys, I can consume as much, or as little, salt as I care to.
I hate these one-issue health facists like SALT (I always thought they were a bunch of weirdos ever since they formed their little action group).
Remember that the glomeruli in the kidneys excrete 1 000-2 000 grams of salt (c 2.2-4.4 lb) per 24 hours. This means that the kidneys excrete 0,7-1,4 grams per minute! So there is no way we can retain salt. The problem is that we have to reabsorb enough salt to maintain 136-145 mmol/L in the blood by three blood pressure increasing hormones, renin, aldosteron and angiotensin II. Normal excretion of salt via urine is 9-18 g per 24 hours. Thus we have to eat the same amount of salt as we excrete, otherwise we will die PDQ due to salt deficiency. If you loose 4 grams of salt in the blood the concentration decreases from 141 mmol/L to 121 mmol/L. Then you need intensive care to survive.
If you decrease salt intake from 9 grams to 3 grams per day the levels of renin, angiotensin II and aldosteron will increase tenfold. Also, the body tries to keep up the Na concentration by decreasing the blood volume which decreases the blood pressure by 0-6 mm Hg.
Also, the EFSA found in 2005 no scientific support for an upper limit of salt intake in food.
All research about salt and blood pressure follows the same scedule. One arm with a low salt intake of 6-9g salt and an exterme low salt arm with 3 g salt/day. Due to decreased volume the blood perssure is lowered a tiny amount. But where is the third arm with 20-30 g salt? Of course it’s not there as it would show no increased blood pressure compared to 9 g. The problem is not getting rid of any excess, the problem is to reabsorb more than 99% from the primary urine unless you eat at least 9 g salt per day.
So eat good food with enough salt to taste.
CASH and WASH organisations seem to be unaware of the bodys homeostasis, normal physiology, biochemistry and endocrinology. And there are quite a few professors that are in these salt depleting and death increasing organisations.
Read more here http://kostkunskap.blogg.se/2012/may/livsmedelsverkets-rad-om-salt-leder-till-dod.html and (Please use Google translate if you don’t understand Swedish)
And also my comments on salt to the public consultation from Nordic Nutrition Recommendationd 5 (NNR5)
Hi Björn – the honour is all mine! Lovely to have your comment and great links. My interest in salt was first sparked by you when you explained to thincs why elderly Parisians were dropping like flies in the scorching summer a couple of years ago!
Bye for now – Zoe
Hi Zoe and Bjorn! Whenever I have a question to get answered, I always consult Zoe’s pages. My blood pressure has been reading ‘high’ for some time now (155-165/78-82) and my doctor has been after me to use BP meds as I did suffer a heart attack when I was much heavier.
Thanks to Zoe, I’ve dropped 120 lbs so far and have kept it off since losing it in 2011-early 2012. I know I could stand to lose another 40+ and am thinking that is why my BP is higher than normal. Also, I need to exercise more regularly and am starting some stress reduction techniques like mindful breathing.
Of course one of the first things my doctor told me is to cut out all added salt (something that depressed me as I like to have a little salt on meat, chicken, eggs, etc. but don’t like too much. I find I use a very normal amount of salt, so I’m thrilled with this information.
I finally gave in this past Monday, and filled a script for Valsartan 80mg/HCTZ 12.5mg. I felt I had no choice and was thinking I didn’t want something happening to me only to hear my family ask why I didn’t ‘do something’ about my higher BP. I’m still not sure whether I should take it just long enough for my renewed efforts to lose more weight kick in or stop it altogether after taking it for a few days.
I just wanted to thank you both for your very informative comments and your article, Zoe.
I feel better already. All the best to you both, as well as the other excellent commenters here
Hi TeeDee – well done on your incredible weight loss and maintenance and all the other great health thinking you’re doing. Just walking will help with both movement and stress reduction. We walked the dog for 45 mins at 6am this morning – frost on the ground, sun rising beautifully – that’s a great start to the day.
Have you seen this article? https://www.zoeharcombe.com/2014/06/diabetes-cholesterol-bp-normal-is-no-longer-normal/
Normal BP is 140/90. This has been redefined as high and I can see no reason for this other than a financial one. You become a customer for medication if you are declared above normal. The fact that normal was moved is not questioned. I personally wouldn’t worry if my BP were anywhere on the normal scale and I would need a seriously convincing argument to take BP meds. If my BP were genuinely high (way above 140/90) I would want to know why and treat the cause – not shut my body up from telling me that there’s a problem by medicating away the symptom. Plus I know that all meds have side effects – I don’t know of any drug that has one impact and one alone.
I’ve just checked the patient info for Valsartan (http://www.drugs.com/cdi/valsartan.html) and I can’t believe what I’m reading from what you’ve written above – let alone from what your doc should know about you…
There’s a caution for those with a history of stroke or recent heart attack!
There’s a caution if you’re on a low salt diet.
Check out possible side effects (about two thirds of the page down):
“All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Cough; diarrhea; dizziness; headache; joint or back pain; mild stomach pain; tiredness.
Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing or swallowing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue; unusual hoarseness); blurred vision; burning, numbness, or tingling; change in the amount of urine produced; chest pain; difficulty swallowing; fainting; irregular heartbeat; muscle pain, weakness, or cramps; shortness of breath; sudden, unexplained weight gain; swelling of the hands, ankles, or feet; symptoms of liver problems (eg, dark urine, loss of appetite, pale stools, severe or persistent stomach pain, yellowing of the eyes or skin); symptoms of low blood pressure (eg, fainting, light-headedness, severe dizziness); unusual bruising or bleeding.”
I hope the bold on the “unexplained weight gain” shows up.
The best thing you’ve done for your health is to lose a fantastic amount of weight and keep it off and doc wants to give you something that could jeopardise this – and which you don’t need!
I won’t tell you what I’m thinking right now!
Best wishes – zoe
Thank you so much, Zoe. I’m speechless right now and have some reading to do! I can’t thank you enough for taking the time to look into this.
Has everyone else, like me, tried and failed to find the right words to respond to Jessica?
Just to clarify what you refer to as salt is Sodium Chloride (NaCl). The Sodium is the vital part and although we could not live without we do not need added Na to our foods as we can obtain all the Na we need from eating other animal and plants.Like us their cells have electriolyte in similar proportions and contain the right amounts of Na. The Chlorine in the NaCl molecule is what is the most damaging when consumed in excess as we do today can cause the most damage. Apart from being toxic it also acidifies the body causing loss of Ca++ from bones. Moreover domestic watehr supplies are treated with Chlorine bleach in many cases and this enters our system through what we drink/eat and when we shower/bathe through inhalation of Cl rich vapours.
It is the chlorine that should be labelled and not the Na!
Hi Paleo! Nice addition on the chlorine. Underground Wellness first alerted me to the dangers of showering!
Best wishes – Zoe
p.s. just searched the 134 page Salt & Health document. The word chlorine does not appear once. The word chloride appears 13 times in the context of the full name for table salt – sodium chloride.
Thanks, Zoe! Of course, salt is another natural nutrient that is (nowadays) very cheap and easy to obtain, and that requires absolutely no “value-added” processing. Hence it is unprofitable and to be avoided.
What still puzzles me is that salt is an indispensable part of the processed food industry’s favourite appetite-forming combination: processed carbs, trans fats, salt, and sugar. You find that basic formula elaborated in hundreds of ways, from rice pudding to naan bread.
“It has no calories, no macronutrients (no fat, no protein, no carbohydrate) and therefore cannot directly impact obesity.”
Just one point – the above suggestion would seem to indicate that fat and protein have a direct impact on obesity. I thought it was the case that if it contained carbs and sugar, it would impact obesity but otherwise it’s fine. Unless you’re like me, and pretyy much can’t eat any amount of anything :-)
Jessica, I don’t think Zoe was in any way associating fat and protein with obesity. I’m sure she was speaking generally about macronutrients, and the fact that salt has none. She was merely making the point that salt cannot be a direct cause of obesity because there are no calories in it, among other things.