The truth about salt

It doesn't get much attention lately, as most of what's said about it is to just eat less of it... One must ask himself, is that always the best advice?

In the article from JamaNetwork.com, “A Great Craving For Salt By a Child With Cortico-Adrenal Insufficiency,” Lawson Wilkins explains:

Special food cravings or aversions have received only passing interest in modern medicine and have been almost entirely neglected in modern nutrition. This is due to the prevalent view that appetite cannot be trusted as a guide to the proper selection of foods.

Results of experiments on rats using the self-selection technic indicate, on the contrary, that a very close relationship exists between appetite and nutritional needs of minerals and vitamins, as well as of fats and proteins. In human beings, there are only a few instances that throw light on the relationship between appetite and dietary needs. It was reported that when very young normal children were given free access to a large number of natural foods they made selections which resulted in normal growth and development.

A Great Craving For Salt By a Child With Cortico-Adrenal Insufficiency was a study published on March 9. 1940. By Lawson Wilkins.

It describes a case of a child who, starting from 11-months of age had a very unusual craving for salt. In a letter responding to questions regarding their child's special appetite, the parents explained how the child would throw up almost everything except for the mother's milk. At the advice of a doctor, the parents tried giving the child crackers. He threw those up too... but soon he started just licking all the salt of the crackers and then would ask for more. Once the boy figured out what was in the salt shaker, the mother said he refused to eat anything unless the salt shaker was also on the table. He ate the plain salt by dipping his finger into it and bringing it to his mouth. It was estimated that the child was eating an extra teaspoon of plain table salt a day in addition to his food already being saltier than his parents. Based on weight, the adult equivalent of that would be about 20-30 extra grams of salt per day.

Later it was found that this massive craving for salt wasn't just a quirk of the palate, the child's body was urging him to get what it needed. He was admitted to the hospital at age of 3 and unfortunately, after only 7 days on the hospital's low salt diet, he suddenly died.

The final paragraph of this paper says ` A boy 3 years old with deficient adrenal-cortical tissue, manifesting various symptoms of adrenal insufficiency, had a marked craving for salt. It would seem that this boy, by increasing his salt intake kept himself alive for at least two and a half years.`

As this case illustrates, we can`t live without enough salt, but of course, healthy people can survive on far less than what this child needed.

In 2005, the US federal government's dietary guidelines set a maximum limit for sodium at 5.75 grams per day - this is about as much sodium as is in just one and a half large dill pickles. It was estimated that reducing Americans' intake of salt by half a teaspoon a day (about 5.75 grams) would prevent 92,000 heart attacks and save the country $20 billion on healthcare-related costs.

Their logic behind this is relatively straightforward: `In large amounts, sodium pulls fluid from the body's tissues and into the blood which raises the blood volume and the heart pumps harder. The result: high blood pressure.` Chronic high blood pressure stresses the heart and arteries leading to heart disease. So, less salt should mean less disease. Now, hypertension is currently at an all-time high - 1 in 3 Americans have it. But is salt to blame?

Let's talk history now, our dietary salt intake used to be far higher than it is now, mainly out of necessity. Before the industrial era, salt was the most common and effective food preservative. As Mark Kurlansky points out in ` Salt: A World History`, we know that the salt intake in Europe was very high at least from the 1500s when it was as much as 40 - 100 grams, thanks to foods like salted fish. This amount would literally be like consuming the entire contents of one to two-ounce shakers as you would see in a diner. If these massive quantities of salt were causing hypertension including heart disease, then people at the time must not have cared much about...sudden death...considering the first report of heart disease didn't occur until the mid-1600s.

Then, from the early 1800s until the end of World War 2, western societies consumed between 15 & 17 grams of salt per day - Based on military archives data. After World War 2, when refrigeration began to displace salt as the main means of food preservation, salt consumption in the US dropped dramatically to about half that rate, or about 9 grams per day, based on 24-hour urinary sodium data, has remained flat for the last 50 years. So, despite this historically low and steady salt intake, the prevalence of hypertension is now 3x (three times) as high as it was in the first half of the 1900s. Salt intake is still high according to health guidelines, but this doesn't explain how hypertension keeps going up while salt consumption stays steady.

Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. Blood is carried from the heart to all parts of the body in the vessels.

The South Koreans eat a wide variety of salty foods with the easiest example being kimchi - cabbage and other vegetables preserved in salt and spices. Kimchi is eaten at literally every meal. The average South Korean consumes around 4000mg of sodium per day, almost twice as much as the US dietary guidelines recommend. Despite this, South Korea has the lowest rates of coronary heart disease in the world, according to 2014 data from the WHO - World Health Organization. In fact, the data from September 2015. paper funded by the Korea Food Research Institute shows that the quartile groups that consumed the most sodium had the lowest rates of hypertension, coronary heart disease & stroke. This has been dubbed `The Korean Paradox.` And, as Dr. James DiNicolantonio points out: `you could swap out Korea for any one of 13 other countries and get a lot more `paradoxes` regarding high salt intakes. In his very thorough book called `The Salt Fix`, Dr. NiColantonio makes the case that reducing salt intake is not only unnecessary but potentially harmful to health.

Salt has several very important functions: It's needed by the heart to pump blood properly, it's needed by the stomach to facilitate digestion, and it is necessary for bone formation and bone strength. It's a key component in cell-to-cell communication and the optimal transmission of nerve impulses to and from organs like the brain & heart. As is explained in The Washington Manuals Endocrinology Subspecialty Consult, at particularly low sodium levels, the patients may present with neuropsychiatric signs and symptoms, ranging from muscular weakness, headache, lethargy, ataxia & psychosis to cerebral edema, increased intracranial pressure, seizures, and coma. On the other side of the spectrum, consuming particularly large quantities of salt can of course have terrible consequences. According to a 1913 article, in the Chekiang province, and probably other provinces of China, the drinking of a saturated solution of salt was a common mode of committing suicide. People would down an entire pint to pint and a half of saturated salt solution - they usually drank the brine used for pickling the cabbage. But for it to kill someone, all this salt had to be consumed very very quickly in order to overcome the powerful filtration ability of the kidneys.

This is why 16th century Europeans could consume so much salt - while 100 grams of salt is a massive amount, it can be simply processed by the kidneys if ingested at a normal pace. So, if humans had to consciously restrict their salt intake in order to stay healthy, this would suggest that our regulating systems like kidneys aren't very powerful at all, but our history suggests otherwise. In order for our cells to work properly, systems had to develop so they could regulate the concentration of salt, and other components of our blood and extracellular fluid. The kidneys of course are very important in this respect.

Mammals who get their food from the sea such as the sea lion, sea otter, walrus & polar bear, ingest large amounts of salt. But the salt content of their blood is not very different from that of terrestrial mammals. From our perspective, these animals' kidneys must be able to excrete massive quantities of salt. But the basic physiology of the kidneys is the same in humans. Through the process of osmoregulation, the water and sodium levels in our body are constantly balancing each other out. If the blood sodium levels drop too low, water from the blood will enter our tissues to maintain this balance. When there is an increase in sodium in the blood, the kidneys simply excrete the excess into our urine. As is explained in the book The Salt Fix, if our blood and fluid levels of sodium get high, we start to reabsorbing less salt from the kidneys and absorb less salt from the foods we eat - the liver can signal the intestine to reduce sodium absorption. And if sodium begins to accumulate, our bodies also tend to harmlessly shunt excess sodium through the skin or organs.

Dr. DiNicolantonio points out that these kinds of capabilities suggest that the human body is well adapted to handle the salt overload, but not salt deficit. So if it is easier for the body to handle excess salt rather than insufficient salt, we should expect to have data showing higher rates of mortality from the lower salt intake. Well, this data is available. In 2014. article in The New England Journal of Medicine analyzed the mortality & cardiovascular event rates of 102,000 people assessed for urinary sodium and then followed them for 3.7 years.

The article concluded that an estimated sodium intake between 3 grams and 6 grams per day was associated with a lower risk of death and cardiovascular events. But, what's important is that the adverse effects to health increase much more rapidly when you are under this range, rather than above it. Based on the data, eating six times as much salt as recommended by the US dietary guidelines would pose less of a risk to your health than actually following the guidelines.

Animals have a very strong innate drive to acquire salt specifically, just like they would go to great lengths to acquire water or food when thirsty or hungry. Elephants will uproot entire trees to get at the salty soil under the roots, gorillas will chew on rotting wood to eat the salty microbes and some animals will drink urine due to its sodium content. While we humans went even further and even used salt as a currency before.

So the bottom line, sodium intake of 3-6 grams (about 7-15 grams of salt) seems to be an ideal range for most people. But, if you are losing more salt from sweating a lot or being on a low carb diet this range may be shifted upwards to say 4-7 or 5-8 grams of sodium, or more.

The healthiest & purest of all of the salts seems to be Pink Himalayan Salt, It`s made up of 98% sodium chloride & contains trace minerals, such as potassium, magnesium & calcium. All of those give the salt a light pinkish tint. You can get it here.

`The Salt Fix` book is available here.

All research & credit goes to What I've learned.