Everything you need to know about salt and its health effects
By Dr. Nathalie Beauchamp, DC
IMPORTANT NOTICE: For individuals with conditions such as high blood pressure or kidney dysfunction, it’s paramount to follow the expert medical recommendations of your primary healthcare provider. The information provided in this blog is not universally applicable since health is not a ‘one-size-fits-all’ matter.
Salt has played a vital role in human history for thousands of years. Its significance stretches back to ancient times when it was a highly valued commodity and a catalyst for economic and cultural development. As civilizations developed, salt became a form of currency. In ancient Rome, soldiers received part of their wages in salt, known as “salarium,” from which the word “salary” is derived. This is where the saying ‘worth one’s salt’ stems from. Soldiers, who often spent long periods away from home and engaged in physically demanding activities, required salt to replenish electrolytes lost through sweating. Thus, it became customary for the Roman army to provide a portion of their wages in the form of salt.
Before modern refrigeration techniques, salt was crucial in preventing the spoilage of meat, fish, and other perishable foods. The process of salting food inhibits the growth of bacteria and other microorganisms, thereby extending its shelf life. This led to higher levels of salt consumption compared to the present day.
Sodium and blood pressure
For many years, excessive salt intake was widely believed to be a primary factor contributing to high blood pressure, also known as hypertension. This belief was based on the understanding that salt retains water, increasing blood volume and raising blood pressure. Consequently, efforts were made to promote low-sodium diets and encourage individuals to reduce their salt consumption.
This notion was popularized through the publication of the Dietary Approaches to Stop Hypertension (DASH) study in 1999. The DASH study was a large-scale clinical trial sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the United States. It aimed to investigate the effects of different dietary patterns on blood pressure, focusing on the impact of salt intake.
The DASH study’s findings indicated that a dietary pattern rich in fruits, vegetables, low-fat dairy products, whole grains, and lean proteins and limited in saturated fats, cholesterol, and sodium (salt) substantially impacted blood pressure levels. Specifically, the study demonstrated that reducing salt intake played a significant role in lowering blood pressure. Participants who followed the DASH diet, which included a reduced sodium intake, experienced a substantial decrease in their blood pressure compared to those who followed a typical Western diet.
As a result of the DASH study, public health campaigns and guidelines began to emphasize the importance of reducing salt intake for maintaining healthy blood pressure levels. As a result, many people started adopting lower-sodium diets, and the food industry responded by offering reduced-salt or salt-free alternatives. Despite these efforts and the overall reduction in salt intake, blood pressure levels continued to rise.
This unexpected phenomenon challenged the traditional understanding of the salt—blood pressure relationship and prompted scientists to delve deeper into the underlying mechanisms. Research in recent years has revealed that the interaction between salt and blood pressure is more intricate than previously thought. One key aspect that emerged from these studies is the concept of salt sensitivity. Some individuals, known as salt-sensitive individuals, are more prone to experiencing an increase in blood pressure in response to high salt consumption. For others, salt intake may have a minimal impact on blood pressure.
Furthermore, it became apparent that other factors, such as genetics, age, obesity, and underlying health conditions, play a significant role in the development of hypertension. For example, individuals with a family history of high blood pressure or certain gene variants may be more susceptible to the hypertensive effects of salt. Additionally, dietary patterns, beyond just salt intake, can influence blood pressure. Lifestyle factors, including physical inactivity and stress, and diets high in processed foods, added sugars, unhealthy fats, and a lack of fruits and vegetables, can contribute to hypertension, irrespective of salt consumption.
While the DASH study contributed significantly to our understanding of the relationship between salt intake and blood pressure, it’s worth noting that the topic remains a subject of ongoing research and debate. Subsequent studies have further explored this association, and some have presented more nuanced findings that emphasize the individual variability in salt sensitivity among different populations.
Salt vs. sodium—What is the difference?
When considering the spectrum of essential nutrients, sodium doesn’t typically get top billing. Yet, this humble mineral is integral to our body’s most fundamental functions. Often referred to interchangeably, salt and sodium are not the same thing. Sodium (Na) is an essential mineral and electrolyte your body uses to maintain fluid balance, muscle function and nerve impulses. On the other hand, salt is a combination of sodium and chloride, chemically known as sodium chloride (NaCl). Like sodium, chloride (Cl) is an essential electrolyte that is instrumental in maintaining fluid balance, acid-base homeostasis, and electrical neutrality. Table salt consists of approximately 40% sodium and 60% chloride. Therefore, it is vital to note that consuming 3,400 mg of salt is vastly different from consuming 3,400 mg of sodium.
The body’s need for sodium
As an essential electrolyte, sodium plays a crucial role in various physiological processes within the body.
Fluid balance– Sodium is essential for maintaining the balance of fluids both within and outside of cells. It works in conjunction with other electrolytes like potassium and chloride to regulate osmotic pressure and ensure proper hydration. Sodium concentration helps determine the distribution of water between cells and the extracellular space, influencing blood volume and overall fluid balance.
Nerve Function– Sodium is involved in generating electrical impulses in nerve cells, known as action potentials. These impulses are vital for transmitting signals throughout the nervous system. When a nerve impulse is triggered, sodium ions rush into the nerve cell through specialized channels, resulting in depolarization and the propagation of the electrical signal.
Muscle Contraction– When an electrical signal from a nerve reaches a muscle, it triggers the release of calcium ions, which then allows sodium ions to enter the muscle cells. This influx of sodium causes the muscle fibres to contract, leading to movement. Without sufficient sodium, muscle function can be impaired.
Blood Pressure Regulation– Sodium works in conjunction with other electrolytes and hormones, such as aldosterone, to regulate fluid balance and blood vessel constriction. Excess sodium can lead to fluid retention, increasing blood volume and raising blood pressure. Conversely, inadequate sodium intake may result in low blood pressure.
Acid-Base Balance– Sodium helps regulate the body’s acid-base buffering systems, ensuring that the blood and other bodily fluids maintain a stable pH level. Sodium bicarbonate, a compound derived from sodium, is a crucial component of the body’s bicarbonate buffering system.
Nutrient Absorption– Sodium facilitates the transport of glucose, amino acids, and other nutrients across the intestinal lining, ensuring their efficient uptake into the bloodstream for distribution to various tissues and organs.
It is important to consider that individual needs for sodium intake can vary based on several factors, such as age, sex, activity level, and certain health conditions. For individuals who sweat more, such as athletes or those living in hot climates, their sodium requirements may be slightly higher than average. On the other hand, some individuals may be more sensitive to sodium and need to be cautious about their intake. If you have specific health concerns, it’s best to consult with a healthcare professional to determine the appropriate sodium intake based on your individual needs. They can provide personalized guidance to ensure a healthy sodium balance for your unique circumstance.
The consequences of excess sodium
High blood pressure– Sodium attracts water and increases the volume of blood in our bodies, putting additional strain on the blood vessels and leading to elevated blood pressure levels. Over time, high blood pressure can increase the risk of heart disease, stroke, and kidney problems.
Fluid retention– Excess sodium disrupts the fluid balance in our bodies, causing water retention. This can lead to swelling in the extremities, such as the ankles, feet, and hands.
Kidney damage– The kidneys play a crucial role in regulating sodium levels. However, consuming excessive sodium overworks the kidneys, impairing their ability to filter waste products effectively. Prolonged strain on the kidneys may lead to kidney damage or even kidney disease.
The effects of insufficient sodium
Hyponatremia– When sodium levels in the body drop too low, a condition called hyponatremia can occur. Symptoms of hyponatremia include fatigue, nausea, headaches, confusion, and muscle weakness. In severe cases, it can lead to seizures, coma, or even be life-threatening.
Electrolyte imbalance – Sodium is an electrolyte responsible for maintaining the balance of fluids both inside and outside cells. Inadequate sodium levels disrupt this delicate balance, affecting various bodily functions. Electrolyte imbalances can cause muscle cramps, dizziness, nausea, and irregular heartbeat.
Dehydration– Insufficient sodium can contribute to dehydration, as water alone cannot adequately rehydrate our cells without the necessary electrolyte balance. Dehydration can lead to fatigue, dry mouth, increased thirst, and impaired cognitive function.
Considerations for low sodium diets
Reducing sodium intake is likely beneficial if you are eating the typical Standard American Diet of highly processed foods or struggle with high blood pressure.
When doctors advise a low-sodium diet, they are often referring to reducing the consumption of sodium chloride and added sources of sodium from processed foods. The primary reason for recommending a low sodium/low salt diet is to manage conditions like hypertension. However, reducing salt intake can also affect chloride channel function in the body.
Chloride channels, which control the passage of chloride ions, are vital for maintaining the body’s electrochemical balance. They regulate cell membrane potential, manage ion and fluid transport, control neurotransmitter release, and maintain cell volume. Sodium, in conjunction with chloride channels, contributes to the balance of positive charges in the cells, influencing overall cell excitability. This coordination between sodium and chloride is crucial for the proper functioning of neurons and muscle cells.
Different chloride channels are expressed in various cells and tissues, encoded by specific genes and are tightly regulated. Factors like developmental stages, hormones, cellular signalling pathways, and environmental stimuli can influence these channels’ expression.
Individuals with specific health conditions, like certain kidney disorders or electrolyte imbalances, must closely monitor their chloride intake. In these instances, healthcare professionals may offer personalized dietary advice in such cases, ensuring the appropriate intake of both sodium and chloride.
How much sodium do we really need?
The Dietary Guidelines for Americans recommend a sodium intake of less than 2,300 mg per day for adults and children aged 14 years and older. (4) This equates to approximately one teaspoon of salt. The American Heart Association recommends an even lower limit of 1,500 mg per day, particularly for those with high blood pressure.
For a long time, sodium restriction has been considered a fundamental aspect of managing heart failure. However, recent research challenges this notion. A study conducted by researchers at Rush University Medical Center discovered that sodium restriction was actually associated with a significant increase in the risk of heart failure and death. In patients with chronic heart failure symptoms, the study concluded that “sodium restriction may have a detrimental impact on the outcome.”
While it is widely recognized that excessive sodium intake can contribute to high blood pressure, the relationship between low-sodium diets and heart disease mortality is complex. A systematic review and meta-analysis published in the American Journal of Hypertension in 2016 analyzed data from multiple studies and found that low-sodium diets were not associated with a significant reduction in cardiovascular events or mortality. This suggests that there may not be concrete evidence to support the notion that low-sodium diets universally reduce heart disease mortality.
Dr. James DiNicolantonio, a cardiovascular research scientist and author of “The Salt Fix: Why the Experts Got It All Wrong — and How Eating More Might Save Your Life,” has gained recognition for his work on the topic of sodium and its impact on health.
In his book, Dr. DiNicolantonio presents an alternative perspective on the role of salt in our diets, challenging the prevailing belief that sodium should be heavily restricted for optimal health. He highlights that the occurrence and prevalence of numerous chronic diseases began to escalate when salt consumption decreased and questions the validity of the low-sodium diet recommendations issued by governmental and medical organizations. He suggests that the guidelines to limit sodium intake to very low levels, such as 1,500 to 2,300 milligrams per day, may be unnecessary and potentially harmful for certain individuals. Instead, he proposes that a moderate salt intake, within a range of 2,500 to 3,500 milligrams per day, may be more appropriate for most people.
One of the main arguments put forth by Dr. DiNicolantonio is that the negative health effects associated with sodium consumption are primarily linked to excessive intake from processed and packaged foods, rather than naturally occurring sodium in whole foods. He emphasizes the importance of distinguishing between the two and focusing on reducing processed food consumption rather than indiscriminately slashing salt intake.
Furthermore, Dr. DiNicolantonio highlights the potential benefits of a moderate salt intake for specific health conditions. He discusses evidence suggesting that moderate sodium consumption may actually be beneficial for individuals with certain health conditions, such as insulin resistance, diabetes, and low blood pressure.
The positive impact of salt consumption on health
Moderate and appropriate levels of salt consumption can actually have positive effects on our well-being. Inadequate sodium levels or deficiencies can contribute to issues such as impaired athletic performance, erectile dysfunction, sleep difficulties, and an increased risk of heatstroke.
When salt is consumed approximately 90 minutes before physical activity, it can help improve athletic performance. Studies indicate that this additional salt intake allows individuals to exercise for an additional 21 minutes, with a heart rate of approximately 10 beats per minute lower, and at a reduced body temperature. Engaging in an hour-long exercise session can result in the loss of approximately half a teaspoon of salt through sweat. When coupled with an intake of less than half a teaspoon of salt, it can quickly lead to sodium deficiency. To combat this, Dr. DiNicolantonio recommends daily consumption of 1.5 teaspoons of salt, equivalent to roughly 3,500 milligrams of sodium. It is important to note that all salt is not created equally! Naturally sourced and unrefined salts are recommended. Keep reading to learn more about healthy salt sources.
Appropriate sodium levels in the body aid in the reduction of stress hormones, including angiotensin II, renin, aldosterone, noradrenaline, and adrenaline. These hormones, when elevated, can elevate arterial stiffness, potentially leading to conditions such as high blood pressure, diabetes, and chronic kidney disease. Salt also plays a crucial role in maintaining the balance of calcium and magnesium. In instances where the body lacks salt, it will draw it from the bones to sustain normal blood levels, consequently depleting magnesium and calcium reserves.
Electrolytes are essential
Electrolytes are minerals in your body that have an electric charge. They help balance the amount of water in your body, maintain a healthy pH level, and are critical for nerve and muscle function. Their levels are regulated by kidneys, and they are replenished through the foods and fluids we consume.
In addition to sodium and chloride, other essential electrolytes, such as magnesium, calcium, bicarbonate and potassium are vital in maintaining the delicate balance of our bodily functions and influence various aspects of health, including blood pressure, bone density, and heart and kidney health. In essence, altering the level of one element affects the levels of others within the body. When discussing the impact of sodium on the human body, it is crucial to understand the intricate nature of electrolyte interactions.
Magnesium acts as a cofactor in numerous enzymatic reactions involved in sodium regulation. Low magnesium levels can disrupt the sodium-potassium pump, leading to sodium retention. Chloride follows sodium in various processes, and changes in chloride levels can affect sodium handling in the kidneys. Bicarbonate helps regulate blood pH and impacts kidney function. Similarly, calcium influences sodium levels through various mechanisms, including the regulation of sodium channels in cell membranes. This interaction directly affects the overall concentration and impact of sodium on various physiological processes.
Potassium and sodium synergistically regulate each other’s levels within cells and are essential for nerve impulse transmission and muscle contraction. Sodium, being the primary extracellular ion, can cause water retention and potential blood pressure increase if in excess. On the other hand, potassium, predominantly intracellular, aids in relaxing and widening blood vessels, thereby reducing blood pressure. Together, they help maintain fluid distribution, control blood volume, and influence the sensitivity of blood vessels to other blood pressure-regulating factors.
Elevated potassium levels can reduce the risk of cardiovascular issues. Processed foods, often high in sodium and low in potassium, disrupt a healthy potassium-sodium balance. Potassium also helps regulate body pH levels, aiding blood pressure control. Significant research, including a major 2011 study, linked high sodium and low potassium intake to increased risk of heart disease, emphasizing the importance of a balanced sodium-potassium ratio for cardiovascular health. (10)
With the myriad of electrolyte drinks and sport drink mixes on the market, it can be challenging to determine which ones to choose. Some products have added vitamins and amino acids that can help to support other aspects of health. On the other hand, many of the popular sports drinks available are essentially artificially dyed sugar water. Read labels carefully! While electrolytes are essential for hydration and muscle function, it’s worth noting that excessive electrolyte consumption may not be necessary for everyone.
Salt sources
Celtic, Himalayan and natural sea salts have been increasingly popular over the years as more health-conscious alternatives to traditional table salt. Contrary to traditional table salt, which is heavily processed and often includes anti-caking agents and added iodine, these salts are typically minimally processed, preserving their natural mineral content. It’s also important to remember that iodine is an essential nutrient that helps maintain a healthy thyroid, and those who switch entirely to natural salts should ensure they’re getting enough iodine from other sources such as seafood and fish, seaweed, eggs and prunes.
Celtic salt—Celtic sea salt is harvested from the coastal regions of France. It contains small amounts of minerals like magnesium, calcium, potassium, and other trace elements. These additional minerals give Celtic salt a distinct flavour and slightly moist texture.
Natural sea salt—Natural sea salt is produced through the evaporation of ocean water or water from saltwater lakes, usually with minimal processing. Depending on the water source, this leaves behind certain trace minerals and elements. The minerals add flavour and colour to the sea salt, which also comes in a variety of coarseness levels.
Himalayan Pink Salt—Himalayan salt is pink rock salt mined from the Khewra Salt Mine in Pakistan, one of the world’s oldest and purest salt mines. It contains small amounts of calcium, iron, potassium, and magnesium, making it slightly lower in sodium than regular table salt. Himalayan salt is known to have fewer toxic pollutants, such as plastic microparticles, commonly found in processed and sea salt.
Sneaky sodium sources
The majority of the sodium we consume comes from salt. However, sodium can be listed on food labels using different names, often indicating the presence of sodium-containing ingredients or compounds. Here are some other names for sodium that you may find on processed food labels:
Monosodium glutamate (MSG)– While primarily a flavor enhancer, MSG contains sodium as a component. It is commonly found in savory processed foods.
Baking soda–Also known as sodium bicarbonate, this ingredient can be a source of sodium in baked goods and certain processed foods.
Baking powder– Similar to baking soda, baking powder contains sodium bicarbonate and other ingredients, such as cream of tartar, which can contribute to sodium content.
Sodium nitrite and sodium nitrate – These are preservatives used in processed meats, such as bacon, ham, and hot dogs.
Disodium phosphate–A food additive used as an emulsifier, disodium phosphate can contribute to the sodium content of processed foods.
Sodium benzoate– This preservative is commonly used in acidic food products like carbonated beverages and condiments.
Sodium citrate– A sodium salt of citric acid, it is often used as a flavouring and preservative in various processed foods.
Sodium alginate– Derived from brown seaweed, sodium alginate is used as a thickening agent in processed foods like sauces and dressings.
Sodium caseinate– A sodium salt derived from casein, it is often used as a food additive in processed dairy products, coffee whiteners, and some non-dairy creamers.
Sodium lactate– Used as a preservative and flavouring agent in processed meats, baked goods, and beverages.
Sodium metabisulfite– This compound, containing sodium and sulphite, is used as a preservative in certain processed foods and beverages, such as dried fruits, wine, and beer.
Sodium propionate– A sodium salt of propionic acid, it is utilized as a mould inhibitor and preservative in bread, baked goods, and other processed foods.
Sodium stearoyl lactylate– An emulsifier and dough conditioner, sodium stearoyl lactylate is used in baked goods, processed desserts, and dairy products.
5 tips for becoming sodium smart
- Regularly monitor your blood pressure—Besides your yearly doctor visits, it’s important to keep track of your blood pressure regularly. You can easily find blood pressure machines for free at most drugstores, pharmacies, and even grocery stores. Alternatively, you can purchase an inexpensive blood pressure cuff to use at home, allowing you to measure the impact of your diet on your blood pressure.
- Be vigilant about reading labels—Sodium can be deceptive, especially if you frequently consume processed or fast foods. Take the time to read labels and be aware of the sneaky sodium sources in your foods.
- Assess your exercise and activity levels—With summer upon us, we tend to sweat more, even during regular activities. Your sodium loss may be significantly higher if you engage in outdoor workouts or have a physically demanding job. Consider adjusting your diet and hydration accordingly to replenish lost electrolytes.
- Enhance your water with high-quality salts—Consider adding a pinch of high-quality Celtic, Himalayan, or sea salt to your water. These natural salt sources contain additional minerals and electrolytes compared to highly processed table salt.
- Opt for electrolyte supplements like LMNT—Avoid reaching for neon-coloured sports drinks loaded with additives, sugar, and unwanted ingredients. Instead, consider using electrolyte supplements such as LMNT, which provide essential electrolytes without unnecessary additives.
Achieving a healthy lifestyle is all about balance. By understanding the significance of sodium in the body and its connection to other essential electrolytes, you can make informed decisions about your individual dietary needs, lifestyle choices, and health factors. Every step we take in the direction of a more mindful approach to our sodium and salt intake is a step towards a healthier and more vibrant life.
Dr. Nathalie Beauchamp, B.Sc., D.C., IFMCP is the author of the book—Hack Your Health Habits: Simple, Action-Driven, Natural Solutions For People On The Go and the creator of several online health education programs. Dr. Nathalie’s mission is to educate, lead and empower people to take control of their health.
Photo credit: © RusN via Canva.com
