Putting salt back into your diet

Jul 29, 2017

Americans eat too much salt. And that causes high blood pressure, heart attacks and strokes. Right? That’s been the message for the last several decades. But what if salt wasn’t really the culprit?

This week’s guest on “Take Care” believes cutting salt intake causes more harm than good. Dr. James DiNicolantonio is the author of "The Salt Fix: Why the Experts Got It All Wrong, and Why Eating More Might Save Your Life." DiNicolantonio is a leading cardiovascular research scientist and doctor of pharmacy at Saint Luke's Mid America Heart Institute.

DiNicolantonio’s premise completely overturns the conventional wisdom about salt consumption.

To start, he says 80 percent of people with normal blood pressure actually don’t get a reduction in blood pressure when they reduce their salt intake. DiNicolantonio says reducing the salt you consume simply dehydrates you.

DiNicolantonio says what he calls the “low-salt dogma” was based on expert opinion 40 years ago. It got put into the national dietary goals in 1977 and has been included ever since. But, he says, that low-salt recommendation was not based on science.

While many experts on hypertension disagree with DiNicolantonio, he says the low-salt recommendation isn’t necessary because the human body can regulate its salt level itself. The kidneys get rid of excess salt.

DiNicolantonio says if you’re craving salt, that’s generally an indication that you’re deficient in salt. He notes that he’s had three family members -- including two with high blood pressure -- who were put on low-salt diets and wound up in the hospital with low-sodium levels in the blood and severe dehydration. He says when someone restricts their salt intake, they’re going against their body’s own internal drive.

“We should listen to those salt cravings,” DiNicolantonio said.

Cutting back on salt can also have other negative consequences, DiNicolantonio says. It can make the body insulin resistant, causing an elevation in the fat-storing hormone insulin. Which, DiNicolantonio says, increases the risk of pre-diabetes, diabetes and obesity? He also says less salt increases stress hormones.

“This is an essential mineral. We should never have demonized salt.”

So how much salt should we be consuming? DiNicolantonio says that studies show that between 1 1/3 teaspoons and 2 2/3 teaspoons salt per day put the body at the lowest risk of heart disease, strokes and early death. But that’s higher than what’s in most dietary guidelines, which generally recommend less than a teaspoon of salt.

When monitoring your salt intake, DiNicolantonio says it’s also important to look at any factors that cause you to lose salt from your body. Three big things that cause a reduction of salt in your body -- caffeine, exercise and hot weather.

DiNicolantonio says caffeine prevents your kidneys from reabsorbing salt. So you end up spilling salt in your urine when you consume caffeine. If you are in very hot weather, your body can lose ½ teaspoon of salt through sweating. If you’re exercising vigorously, he says you can lose 1 teaspoon an hour. Combine heat and exercise, and your body is going to sweat out even more salt, DiNicolantonio says.

He says salt is beneficial to exercising because it increases blood circulation, so it reduces the risk of muscle cramping, aches, fatigue, dizziness. DiNicolantonio says even consuming sport drinks are not enough to match the salt you’re sweating out.

An unintended consequence of pushing low-salt DiNicolantonio says, is that it’s given sugar “a free pass.” When salt is taken out from (or not added to) processed food, sugar or artificial sweeteners are often added instead to help increase flavor. And, if you eat low-salt potato chips, he says, your body is going to crave eating 2-3 times the amount of chips to get the salt it wants. So he says low-salt diets may be contributing to overeating and overconsumption of carbohydrates and refined sugar.

So how should we consume salt? DiNicolantonio says don’t confuse his recommendations with a license to eat more high-salt processed foods. He says populations with long average life spans have diets high in salt that they get from real food -- things like seafood and vegetables that are fermented in salt.

“If you can eat real food and add the good salts to that food, you’re going to wind up eating more of those bitter, healthy greens, nuts, seeds that you never would have eaten.”

Now, of course, there is a major caveat. There are certain health conditions that cause the body to retain salt. Those patients need to be careful about salt intake. But often, DiNicolantonio says the problem is not eating too much salt, but whatever is causing the body to retain salt. He says that condition is what needs to be addressed.

So, consult your doctor.

But DiNicolantonio’s main advice for most people: cut refined carbs and sugar and you can fix salt-sensitive high blood pressure.

“Salt is your key to eating healthy and exercising. What is better than a natural substance than your own body controls its intake?”