What Is The Sweet Spot For Salt In Our Diet?

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What Is The Sweet Spot For Salt In Our Diet?

Salt has been a prized commodity throughout human history, with animals seeking salt licks and humans trading it for gold. However, modern dietary guidelines recommend limiting sodium intake to prevent cardiovascular disease. But is this advice backed by solid evidence? Let's explore the latest research on salt consumption and its impact on health.

The Salt Controversy

While high blood pressure is a known risk factor for heart attacks and strokes, the link between salt intake and heart attacks and strokes in healthy individuals is not conclusively proven. A critical review by Stolarz-Skrzypek et al. (2012) looked at how salt intake affects heart health and blood pressure in a large group of people over several years. Here's what they found:

1. Hypertension-related deaths: Surprisingly, people who consumed more salt had fewer deaths from hypertension problems such as heart attacks and strokes. Those in the lowest salt intake group had the highest death rate, while those in the highest salt intake group had the lowest.
2. Risk of high blood pressure: The amount of salt people consumed didn't seem to affect their chances of developing high blood pressure. All groups had similar rates of new high blood pressure cases.
3. Blood pressure changes: Over time, people's systolic blood pressure (the top number) increased slightly each year. When researchers looked closely, they found that for every extra 100 units of salt consumed, systolic blood pressure went up by about 1.7 points. However, the bottom number (diastolic) didn't change. And as per point 1 and 2, the slight increase in blood pressure did not result in an increased rate of hypertension diagnosis, heart attacks and strokes.

Therefore while eating more salt was linked to small increases in systolic blood pressure, it didn't lead to more cases of high blood pressure or heart problems. Surprisingly, people who ate less salt had a higher risk of dying from heart-related issues. This study challenges the common belief that lower salt intake is always better for heart health.

Limitations of Previous Studies

When we eat sodium (mainly from salt in food), our bodies use what it needs, and the kidneys filter out the excess sodium, which is then passed out of the body in urine. Because most of the sodium we consume is eventually excreted through urine, measuring the amount of sodium in urine over 24 hours gives researchers a good idea of how much sodium a person has been eating.

This method is helpful in research because it’s hard for people to remember and accurately report every bit of salt they consume. By analyzing urine samples, scientists hope to get a clearer, objective estimate of dietary sodium intake, which they can then link to health outcomes, like blood pressure or risk of heart disease.

The recommendations for lowering salt intake are often based on studies like The INTERSALT study, which found an association between increased sodium excretion by the kidneys and higher blood pressure.

However, as the afore-mentioned comprehensive study by Stolarz-Skrzypek and colleagues indicated, a rise in blood pressure does not necessarily mean a person develops hypertension or an increased risk of heart attack and stroke. Instead, up to a certain point, a rise in sodium excretion could actually result in a decrease in hypertension-related deaths, not an increase. Having enough salt is important for health, as the minerals in salt are necessary for certain bodily functions. The question then becomes, how much is too much?

Recent Research Findings - The Salt Sweet Spot

Two studies provide new insights:

1. Mente and colleagues found that the association between sodium excretion by the kidneys and blood pressure was strongest in those excreting 6 grams of sodium per day or more.?
2. O'Donnell and colleagues discovered that both high (>6g/day) and low (<3g/day) sodium excretion were associated with increased risk of death and cardiovascular events. In other words, too low sodium elimination could be as harmful as too high.?

These studies support the conclusion that there is such a thing as too much salt, however while too much salt can be harmful, so can too little salt. The question is, how much salt can we consume to stay within the range of excreting 3-6 grams of sodium per day?

To answer this important question we need to look at studies that compared salt intake to sodium excretion. For example, 1 gram of salt contains roughly 400 mg of sodium, but that does not mean that this is equal to 400 mg of sodium excretion.?

In a study by Modesti and colleagues, sodium excretion was 145.2 mmol/day in men, and 134.7 in women corresponding to a dietary salt intake of 9.4 g/day and 8.8 g/day respectively.

We need to convert the given information into comparable units and then calculate the appropriate salt intake range. Let's break it down step by step:

1. The target sodium excretion range is 3-6 grams per day.
2. From the given information:
3. We need to find how much salt intake corresponds to 3-6 grams of sodium excretion.
4. First, let's find the conversion factor: For men: 9.4 g salt / 145.2 mmol sodium = 0.0648 g salt per mmol sodium For women: 8.8 g salt / 134.7 mmol sodium = 0.0653 g salt per mmol sodium
5. These are very close, so let's use an average of 0.065 g salt per mmol sodium.
6. Now, we need to convert our target sodium range (3-6 g) to mmol: 1 gram of sodium = 43.5 mmol 3 g sodium = 130.5 mmol 6 g sodium = 261 mmol
7. Using our conversion factor: 130.5 mmol 0.065 g salt/mmol = 8.48 g salt (lower end) 261 mmol 0.065 g salt/mmol = 16.97 g salt (upper end)
8. Converting grams to teaspoons (1 teaspoon of salt ≈ 6 grams): 8.48 g / 6 = 1.41 teaspoons (lower end) 16.97 g / 6 = 2.83 teaspoons (upper end)

Therefore, to maintain a sodium excretion rate of 3-6 grams per day, one should consume approximately 1.4 to 2.8? teaspoons of salt per day (or for easier to use numbers, 1.5 to 3 teaspoons per day).

The World Heart Organization (WHO) recommends that adults consume no more than 5?g of salt per day, which corresponds to just under 1 teaspoon of salt per day. Based on these multiple studies, this recommendation may need to be revised.?

It's important to note that the sweet spot of 1.5 to 3 teaspoons of salt per day is for total salt intake, including salt in prepared foods and not just added salt to home-cooked foods.?

The Role of Diet Quality

Research widely indicates that the largest source of dietary salt in North America comes primarily from processed and restaurant foods, not from the addition of salt to taste in home-cooked foods.

The Center for Disease Control (CDC) and related health organizations, based on comprehensive surveys like the National Health and Nutrition Examination Survey (NHANES), consistently report that over 70% of sodium intake in the average North American diet comes from these processed and commercially prepared foods, rather than from salt added during cooking or at the table. Packaged breads, pizza, sandwiches, processed meats, and canned or packaged soups are among the top contributors to daily sodium intake. Processed foods are also lacking elements that alter the effect of salt on our health, including potassium and water intake.

The Importance of Potassium and Hydration

Higher potassium intake is associated with lower blood pressure. Processed foods not only often contain hidden salt, they are also low in potassium. In contrast, whole foods like fruits and vegetables are rich in potassium, which has been shown to lower blood pressure.

Additionally, proper hydration may be crucial in determining the impact of salt on the body, as suggested by the work of Hasbal and colleagues. Drinking enough water is very important to dilute the salt eaten in our diet and help counteract the potential harmful effects of too much salt.

Another consideration is that eating salt, which is composed of various minerals, is different from drinking mineralized water. Drinking mineral water, which contains naturally occurring minerals like calcium and magnesium, has several health benefits. Research indicates that mineral water can support hydration more effectively than regular water due to its electrolytes, which help maintain fluid balance in the body. Unlike high-sodium foods, mineral water typically contains safe levels of these minerals and does not contribute to high blood pressure or hypertension.

In fact, minerals like magnesium and calcium in mineral water may benefit bone health and heart function. A study by Coen and colleagues on different types of mineral water found that both low- and high-calcium waters increased hydration levels without negatively impacting blood pressure or kidney health. Mineral water is a safe and effective option for hydration, offering added health benefits without increasing blood pressure risks.?

Table Salt vs Natural Salts

Table salt and natural salts like Himalayan salt differ in their composition and processing. Table salt, also known as refined salt, is typically mined from underground salt deposits and heavily processed to remove minerals and impurities. It consists of about 97-99% sodium chloride and often contains anti-caking agents to prevent clumping. Most table salt is also fortified with iodine, an essential nutrient for thyroid function.

In contrast, natural salts like Himalayan salt and Celtic salt are minimally processed and retain trace minerals from their original sources. Himalayan salt, mined from ancient sea salt deposits in Pakistan, contains at least 10 different minerals and trace elements. Celtic salt, also known as "Sel Gris" or "gray salt," originates from the coastal region of Brittany in France, particularly from the salt marshes of the Guérande region. This type of salt is harvested from tidal pools along the coastline, where seawater evaporates slowly due to sun and wind, allowing salt crystals to form.

I personally choose to use natural salts so as to benefit from the variety of different minerals and trace elements like chromium which, even in very small amounts, can have positive impacts on our health. However, these natural salts lack iodine, which is added to table salt for thyroid health. Therefore I make sure to add sources of iodine, like seaweed, to my diet. For example, I throw pieces of dried seaweed into the cooking water of my rice, soups and stews.

Practical Recommendations for Safe Salt Intake

1. Reduce processed food consumption and focus on whole foods.
2. Season home-cooked meals with salt, aiming for a total of 1.5 to 3 teaspoons of salt per day from all foods, including processed items.
3. Monitor your dietary salt intake, especially from hidden sources in processed foods. Eliminating processed foods allows for tastier, wholesome home-cooked meals. A diet high in processed foods may leave you with insufficient salt allowance to safely season your home-cooked dishes to taste.
4. Depending on the types and amounts of processed foods you consume, you might be consuming too much salt even without adding any to your cooked meals. The best way to ensure safe salt consumption is to significantly reduce or eliminate processed foods, which will enable you to monitor your salt intake more effectively based on what you add to your meals.
5. Aim for adequate hydration, approximately 2.5 to 3.5 liters of water daily, including mineral water (see this video on how to mineralize your water using natural salt: GO TO VIDEO).
6. Strive to eat a variety of vegetables and fruits daily for a healthy natural intake of potassium, which can help reduce your risk of hypertension.
7. Consult with your healthcare provider if you have existing health conditions, and consider monitoring your blood pressure at home with a blood pressure cuff, which can be easily purchased online or at local health stores. This is particularly important if you are consuming a diet high in processed foods.

Conclusion

While studies are helpful, it is important to be aware that Individual responses to salt can vary. Finding your personal "salt sweet spot" requires careful self-monitoring, raising one’s awareness around the hidden salts in processed foods, and, when necessary, guidance from healthcare professionals.?

References

1. Coen G, Sardella D, Barbera G, et al. "Urinary composition and lithogenic risk in normal subjects following oligomineral versus bicarbonate-alkaline high calcium mineral water intake." Urol Int. 2001;67(1):49-53. PMID: 11464116.
2. Cook NR. "Salt intake, blood pressure and clinical outcomes." Curr Opin Nephrol Hypertens. 2008 May;17(3):310-4. PMID: 18408484.
3. Hasbal et al. "A study on the early metabolic effects of salt and fructose consumption: the protective role of water." Hypertens Res. 2024 Jul;47(7):1797-1810. Epub 2024 May 15. PMID: 38750219; PMCID: PMC11224018.
4. Mente et al; PURE Investigators. "Association of urinary sodium and potassium excretion with blood pressure." N Engl J Med. 2014 Aug 14;371(7):601-11. PMID: 25119606.
5. Modesti et al. "Daily urinary sodium and potassium excretion in Chinese first-generation migrants in Italy." Int J Cardiol. 2019 Jul 1;286:175-180. Epub 2018 Dec 13. PMID: 30583922.
6. O'Donnell et al; PURE Investigators. "Urinary sodium and potassium excretion, mortality, and cardiovascular events." N Engl J Med. 2014 Aug 14;371(7):612-23. Erratum in: N Engl J Med. 2014 Sep 25;371(13):1267. PMID: 25119607.
7. Stamler J. "The INTERSALT Study: background, methods, findings, and implications." Am J Clin Nutr. 1997 Feb;65(2 Suppl):626S-642S. doi: 10.1093/ajcn/65.2.626S. Erratum in: Am J Clin Nutr 1997 Nov;66(5):1297. PMID: 9022559.
8. Stolarz-Skrzypek K, et al.; European Project on Genes in Hypertension (EPOGH) Investigators. "Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion." JAMA. 2011 May 4;305(17):1777-85. PMID: 21540421.

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