By Dr. Mercola
Salt has been portrayed as a dietary villain for decades and blamed for rising rates of high blood pressure, heart disease and stroke. The vast majority of salt consumed by Americans comes from processed foods, including those you might not consider to be overtly salty.
In fact, foods like bread, chicken dishes, egg dishes and pasta dishes make up close to one-third of Americans’ salt intake, according to the U.S. Centers for Disease Control and Prevention (CDC).1
The U.S. Food and Drug Administration (FDA) is now in the process of developing voluntary targets for sodium reductions in food but has not indicated when the targets might be released.
FDA May Finally Respond to Decades’-Old Petition
The Center for Science in the Public Interest (CSPI) filed a petition in 2005 urging the FDA to reduce sodium in the food supply and revoke its GRAS (generally recognized as safe status). The original petition was filed even earlier than that, in 1978, when CSPI called for a cap on salt in processed foods.2
In 1983, another CSPI petition resulted in sodium content being added to foods’ product labels. The FDA claimed they were close to releasing the sodium-reduction guidelines in 2014, but by February 2015, still nothing had been released. As for what caused the delay, Politico reported:3
“There are competing theories about what, exactly, delayed the targets. Some former FDA officials blamed their counterparts at Health and Human Services.
"It was at HHS for ages," one source said. Some said the increasing debate about the state of sodium science dampened the White House's appetite to move on the issue.
Others said the administration worried about stoking too many debates about ‘nanny state’ nutrition policies at once.”
Finally, in October 2015, CSPI filed a lawsuit against the FDA to spur the agency to set a deadline for releasing their voluntary sodium-reduction guidelines. It seems their strategy may have worked, and they’ve given the FDA until June 1 to respond, but not everyone is happy about the potential salt-reduction guidelines.
Food Industry Fights Back Against Potential Sodium Targets
The Grocery Manufacturers Association (GMA) has a lot at stake should the FDA suggest food companies slash salt in their junk-food products.
Salt is one of the key ingredients that makes processed foods taste good, and although the FDA’s reduction targets would be voluntary, not required, it would set the tone that the less sodium in a product, the better.
The war on salt itself is controversial, and there’s increasing evidence that salt is not the dietary villain its been made out to be. However, the salt in most processed foods is also heavily processed, which is a type of salt you’re better off avoiding.
You’d be better served by cutting back on processed foods in your diet altogether, as opposed to picking and choosing processed foods with low salt, but the FDA believes the voluntary targets for sodium reduction have the “potential for major public health gains.”4
GMA, whose more than 250 members include some of the biggest food and beverage companies in the U.S., is poised to fight back against even voluntary reduction targets and has already suggested that the FDA may be basing their guidelines on outdated research.
Salt Industry: Salt Reduction Will Result in a Cocktail of Chemicals in Your Food
Aside from junk-food makers, the salt industry has much to lose if Americans start consuming less salt. They’ve even pointed out a probable downside to removing salt from processed foods—the addition of chemical replacements.
The replacement of saturated fats in foods with synthetic trans fats—now known to contribute to heart disease, among other diseases—is one example of public-health policy gone wrong, and forcing the issue of salt restriction could be another.
Morton Satin, the vice president of science and research at the industry group The Salt Institute, told Politico:5
"We don't think this is justified … What is the impact? We're going to have salt replaced by a cocktail of chemicals. They can't just take out salt. They have to make the food tasty."
Another industry leader noted, “What we can't do is make all these changes and then have the government turn around and say actually this was wrong—oh and all the substitutes you're using are worse.”6
Should Salt Be Restricted?
At the crux of the issue is whether salt is actually bad for you. To be clear, consuming sodium-rich processed foods is far from healthy—but is it the salt, in particular, that’s the problem?
The heart benefits of restricting salt intake have been questioned for some time. In 2011, a systematic review of data involving 6,500 people found evidence was lacking to recommend salt restriction.7
Among people with high blood pressure or normal blood pressure, salt restriction was not significantly associated with overall mortality or cardiovascular mortality. Among those with congestive heart failure, meanwhile, salt restriction was associated with increased mortality risk.
An update to the review, published in 2014, also found “there is insufficient power to confirm clinically important effects of dietary advice and salt substitution on cardiovascular mortality” among people with high blood pressure or normal blood pressure.8
Yet another meta-analysis found that people with heart failure who limited their sodium intake had a 160 percent higher risk of death than those who did not.9
Some studies have shown a modest benefit to salt restriction among some people with high blood pressure, but the evidence does not extend to the rest of the population.
What Happens When You Don’t Eat Enough Salt?
The FDA and the Food Safety Inspection Service (FSIS) recommend limiting your daily sodium intake to less than 2,300 milligrams (mg).
They advise a further reduction to 1,500 mg (just over one-half teaspoon) for people who are age 51 and older, African American, or who have hypertension, diabetes or chronic kidney disease (this encompasses about half of the U.S. population).
However, in 2013 the Institute of Medicine (IOM) concluded there wasn’t enough evidence to recommend reducing salt below 2,300 mg.10
In fact, there are very real risks from eating too little salt, and population-wide recommendations to restrict salt intake to very low levels could in fact increase rates of a wide range of diseases.
For instance, in one study a low-salt diet led to an increase in insulin resistance, which is a risk factor for type 2 diabetes—and the change occurred in just seven days.11 Research published in JAMA also found that consuming less than 3,000 mg of sodium per day may increase your risk of dying from heart disease.12
A low-sodium diet is even linked to increases in LDL cholesterol and triglycerides13 and an increased risk of death for diabetics (another population that’s often advised to restrict their sodium intake).14
The Life-Threatening Complication of Too Little Sodium
There’s also hyponatremia, in which your body has too little sodium, causing fluid levels to rise and your cells to swell. Hyponatremia is most common in older adults and athletes (whose sodium levels may become depleted by excessive sweating and drinking too much water).
This swelling can cause a number of health problems, from mild to severe. At its worst, hyponatremia can be life threatening, leading to brain swelling, coma and death. But mild to moderate hyponatremia has more subtle effects that you or your health care provider may not even connect with a sodium-deficiency problem, including:
✓ Nausea, vomiting, and changes in appetite
✓ Loss of energy
✓ Urinary incontinence
✓ Nervousness, restlessness and irritability, and other mood changes
✓ Muscle weakness, spasms or cramps
Sodium May be Dangerous If You Don’t Eat Enough Potassium
If you eat a lot of processed foods and not many vegetables, there’s a good chance your sodium-to-potassium ratio is unbalanced. If you’re not sure, try a free app like My Fitness Pal, which allows you to enter the foods you eat and then calculates the ratio automatically.
It's generally recommended that you consume five times more potassium than sodium, but most Americans get two times more sodium than potassium. It’s this imbalance that may lead to many of the health issues associated with excess salt consumption.
Your body needs potassium to maintain proper pH levels in your body fluids, and it also plays an integral role in regulating your blood pressure. It’s possible that potassium deficiency may be more responsible for hypertension (which is a risk factor for heart disease) than excess sodium.
Imbalance in your sodium:potassium ratio can lead to hypertension, and the easiest way to achieve this imbalance is by consuming a diet of processed foods, which are notoriously low in potassium while high in sodium. According to a 2011 federal study into sodium and potassium intake, those at greatest risk of cardiovascular disease were those who got a combination of too much sodium along with too little potassium.15
According to Dr. Elena Kuklina, one of the lead authors of the study, potassium may neutralize the heart-damaging effects of salt. Tellingly, those who ate a lot of salt and very little potassium were more than twice as likely to die from a heart attack as those who ate about equal amounts of both nutrients.
Focus on Reducing Processed Foods in Your Diet to Optimize Your Sodium:Potassium Ratio
Releasing voluntary guidelines to reduce sodium levels in food is a misguided way to improve public health. A far better option would be to discourage the consumption of processed foods altogether. Most processed foods are still going to be virtually worthless for your health even if they contain a bit less sodium.
According to the FDA, 77 percent of Americans' sodium intake comes from processed and restaurant foods; when you reduce processed foods in your diet, you’ll automatically reduce your intake of processed salt as well. This is what public health agencies should be stressing. If your sodium:potassium ratio is out of balance, here’s what can help:
- First, ditch all processed foods, which are very high in processed salt and low in potassium and other essential nutrients
- Eat a diet of whole, unprocessed foods, ideally organically and locally grown to ensure optimal nutrient content. This type of diet will naturally provide much larger amounts of potassium in relation to sodium
- When using added salt, use natural salt. I believe Himalayan salt may be ideal, as it contains lower sodium and higher potassium levels compared to other salts16