When it comes to nutrition—as with most things in life—we tend to look for black and white answers, gravitate toward extremes, and label things as “good” and “bad.” We’re often guilty of finger-pointing, isolating single nutrients (and foods that contain them) as the culprits to all our health problems. Unfortunately, that type of tunnel vision has led us to getting it wrong about quite a few things, including dietary fat, the low-fat mantra, and cholesterol, to name a few. And in recent years, the long-standing recommendation to restrict dietary sodium, which we’ve been told causes hypertension (i.e., high blood pressure), is being called into question. Did we get it wrong again? Is salt bad for you?
Is Salt Bad For You?
The simple answer: No, salt is not bad for you, and avoiding salt can actually be a huge mistake. In fact, according to leading cardiovascular research scientist Dr. James DiNicolantonio, “Salt may be one solution to—rather than a cause of—our nation’s chronic disease crises.”
Say what? Go ahead, I’ll give you a moment to pick your jaw up off the floor if you’re in disbelief. Heck, you may be feeling downright betrayed after being misled down yet another wrong path. Eating the right amount of salt—more accurately, the essential mineral sodium—is important for many reasons.
NOTE: Salt and sodium are often used interchangeably, but they’re not the same thing. Salt contains both sodium and chloride, and salt is usually about 37 – 40% sodium. In other words, one gram (1,000 mg) of salt (i.e., sodium chloride) typically provides about 370 – 400 mg of sodium.
Sodium is perhaps best known as being one of the body’s electrolytes, which are minerals the body needs in relatively large amounts. Electrolytes are aptly named because they carry an electric charge when dissolved in bodily fluids, such as blood. Most of the body’s sodium is located in the blood and in the fluid around cells.
Sodium is vital for helping the body keep fluids in a normal balance, and sodium plays a key role in normal nerve and muscle function. Because controlling blood volume is so critical, the body has a system of checks and balances in place to maintain proper sodium concentrations, with the kidneys playing a key role. For example, when blood volume or sodium levels are too low, sensors in the body trigger the following steps to increase blood volume:
- The kidneys stimulate the adrenal glands to secrete the hormone aldosterone, which causes the kidneys to retain sodium and excrete potassium. When sodium is retained, less urine is produced, which causes blood volume to increase eventually.
- The pituitary gland secretes the hormone vasopressin (also called antidiuretic hormone), which results in the kidneys conserving water.
What’s important to realize here is that the body is designed to naturally control fluid and sodium intake. If we’re mindful about what our bodies are telling us, then they will give us the clues about what we need, including salt. However, there are many factors that can “override” the system including:
- Actively restricting salt intake
- Drinking too much water
- Working in heat
- Vomiting and/or diarrhea
- Kidney issues and other health problems
- Certain medications
When it comes to sodium, it’s all about balance. For otherwise healthy individuals, it’s key to understand that problems arise when sodium is diluted in the blood (which is called “hyponatremia”), and as listed above, there are key behaviors that can contribute to this. The most common are actively restricting salt intake and only replacing water/fluid (not sodium) when exercising. For example, although sweat rates vary among individuals, climate, and types of activity, on average, people lose about 600 mg of sodium per hour of exercise.
Because the brain, nervous system, and muscles are particularly sensitive to changes in sodium levels, some common signs of not getting enough sodium include:
- Sluggishness, low energy, and lethargy
- Difficulty concentrating and confusion
- Muscle cramps and spasms
- Lack of coordination
Something else many folks don’t know about sodium is it increases insulin sensitivity, which is important for healthy glycemic control and glycemic variability. In fact, research shows a low-salt diet increases insulin resistance in healthy folks.1,2 Of course, insulin resistance is bad news, and it is closely linked to a wide variety of health problems, including type 2 diabetes, obesity, cardiovascular disease, Alzheimer’s disease, certain cancers, and more. In fact, some scientists have described it as “a unifying theory of chronic disease.”3
On the other hand, eating more sodium, rather than less, would be better for our health according to Dr. DiNicolantonio, who says that eating the right amount of this essential mineral can help:4
- Beat sugar cravings
- Manage weight
- Improve athletic performance
- Increase fertility
- Thrive with a healthy heart
Is Salt Bad For You and Your Blood Pressure?
The 2015 – 2020 Dietary Guidelines for Americans recommend limiting sodium intake to 2.3 grams per day. The World Health Organization recommends that folks limit sodium to less than 2 grams per day, and the American Heart Association (AHA) takes sodium restrictions even a step further, advising that an ideal limit is 1.5 grams per day for healthy adults.
The heavy emphasis on reducing salt intake is targeted with a belief that this will lead to a reduction in blood pressure levels with the assumption that this will translate into a decrease in cardiovascular events. After all, high blood pressure (hypertension) has been ranked as one of the leading causes of worldwide disability-adjusted life years (DALY). And of course, hypertension is closely associated with heart disease and mortality. Along those lines, high blood pressure is considered a major modifiable risk factor for cardiovascular disease.
How does salt fit into the picture? Of course, we’ve long been led to believe excessive intake of sodium can lead to hypertension.5 It’s as simple as that, right? Cut the salt, lower blood pressure, and voilà, we’re good to go, right?
Not so fast. There is surprisingly little evidence to support this theory—which is all the sodium-blood pressure connection is…a theory. In fact, according to Dr. DiNicolantonio, “There is no definitive proof that a normal salt intake causes hypertension.” Dr. DiNicolantonio suggests that:5
- Salt intake may not be the villain we’ve been told.
- Salt restriction may paradoxically cause hypertension and cardiovascular events.
- The “other white crystal” sugar, not salt, may be the principal driver of hypertension and heart disease.
That’s right, if you want to play the blame game, you can point your finger at sugar, not salt, as the real villain contributing to high blood pressure and cardiometabolic disease (e.g., obesity, type 2 diabetes, heart disease). As you’ll see below, the predominant sources of dietary sodium are industrially processed foods, which also tend to be high in added sugars (not to mention industrially processed vegetables oils, which have their own slew of negative health consequences). Added sugars may contribute to high blood pressure and blood pressure variability by increasing heart rate and promoting inflammation, oxidative stress, insulin resistance, and obesity.6,7
Dr. DiNicolantonio is certainly not alone. Many researchers agree that “very limited evidence is available to support these recommendations” set by government agencies for lower sodium intakes. In a recent study presented at the American Society for Nutrition Scientific Sessions, researchers from Boston University School of Medicine analyzed dietary data from 2,632 healthy men and women ages 30 – 64 years who were part of the Framingham Offspring Study over 16 years to address the question of the long-term effect of dietary sodium on blood pressure.
According to the researchers, “These long-term data from the Framingham Study provide no support for lowering sodium intakes among healthy adults to below 2.3 grams/day as recommended.” However, the researchers did find a clear inverse association between potassium, magnesium, and calcium and blood pressure change over time.8
Interestingly, instead of a linear relationship (where increasing sodium consumption leads to corresponding increases in blood pressure), recent research suggests the relationship between sodium consumption and heart disease is U-shaped, with an increased risk at both high and low sodium intake.9 In fact, a recent Lancet study found that consuming less than three grams of sodium per day was associated with a greater risk of all-cause mortality and major cardiovascular events compared with more moderate intakes regardless of blood pressure status (e.g., normal or hypertensive).
In the same systematic review study, the researchers found that higher sodium intake (more than six grams per day) was only problematic in hypertensive folks. These findings led the authors to conclude, “These data indicate that lowering sodium is best targeted at those individuals with hypertension who also consume high sodium.”
Oops…We Did it Again
“The real message here is that we focus too much on sodium and ignore other nutrients that have been known for a good long while to be intimately associated with blood pressure,” says Lynn L. Moore from the Boston University School of Medicine, whose study supports the suggestion that potassium, magnesium, and calcium are important dietary contributors to the regulation of blood pressure.
According to Dr. Andrew Mente, lead author of the Lancet study mentioned above and researcher at McMaster University, “It’s not really a sodium story; it’s a potassium story. If you eat an all-around healthy diet with plenty of potassium, that is the best way to lower your blood pressure, rather than focusing on sodium.”
Dr. DiNicolantonio shares a similar viewpoint that balancing sodium and potassium is extremely important. “If potassium intake is high, most people don’t need to worry about sodium. Target high-potassium foods in the diet and let your body tell you how much salt it needs each day.” While bananas are notorious for their potassium content (and they are indeed a good source), there are many other foods that are even better sources, including potatoes, white beans, yogurt, milk, sweet potatoes, salmon, dark green leafy vegetables, and avocados.
The point here is that, as so succinctly and perfectly put by Dr. Brian Strom from the University of Pennsylvania Perelman School of Medicine, “Changes in diet are more complex than simply changing a single mineral.”
Salt May Not Be Bad, but Processed Foods Still ARE
What tends to surprise folks is that more than 70% of the sodium Americans consume comes from processed and restaurant foods—NOT from adding table salt to food during cooking or at the table. Sodium is typically added to processed foods for three main reasons:
- To enhance flavor by adding a salty taste, enhancing the sweetness of sugary items, masking “off notes,” and making foods more palatable in general.
- To preserve freshness and increase shelf-life by preventing the growth of bacteria.
- To improve texture and appearance by making a product seem thicker/fuller, enhancing color, helping a product retain moisture, stabilizing texture, and preventing unwanted chemical changes.
Believe it or not, bread is the major source of sodium in most people’s diets. Deli meat, pizza, sandwiches, soups, salty snacks (like chips, popcorn, pretzels, and crackers), and cheese are among the other top sources of sodium.
Now, just because I’m arguing that salt isn’t bad for you doesn’t mean you should start eating more processed garbage. We still want to focus on minimally processed whole foods, which provide much greater nutrient-density, including health-boosting vitamins, minerals, fiber, protein, healthy fats, polyphenols, and more. And we want to use the best sources of salt we can find (and afford) that are packaged not just with sodium but other essential minerals (like iodine, magnesium, and potassium, for example).
So, where do we turn? Dr. DiNicolantonio provides a great hint, “Sodium chloride, aka salt, constitutes 90% of the entire ocean’s mineral content—the same percentage of mineral content found in our blood.” In other words, we want to turn to sea salt, but not just any will do. We want unrefined sea salt that’s harvested from clean waters. While nature intended for sea salt to provide our bodies with sodium (and chloride), it doesn’t hurt to look for one that provides trace minerals, including iodine, potassium, and magnesium.
And remember what I mentioned above about balancing sodium and potassium? Salt can be a gateway to eating more nutrient-dense foods like vegetables. For example, adding salt to bitter or bland foods, like dark leafy greens, can increase their consumption because salt is a flavor enhancer. Nuts are another example, and a higher intake of vegetables and nuts is associated with a reduced risk for hypertension and heart disease as well as various beneficial health outcomes.5
How Much Salt is Too Much?
If salt is not as bad for you as you’ve been told, then how much should you be consuming? This is a great question, yet a very difficult one to answer. Despite our inclination to seek those black and white answers, the truth is (once again) that the answer is “it depends.” In other words, there really isn’t a blanket recommendation for sodium intake that fits for everyone. Having said that, many experts agree an appropriate target for dietary sodium for healthy adults is likely to be somewhere between 3 and 4 grams per day.
The take-home point is that most people don’t need to actively restrict salt intake. On the contrary, many people should be actively salting their food and adding salt to their water (and coffee), particularly folks who are physically active and eating mostly minimally processed whole foods.
According to Dr. DiNicolantonio, “You don’t determine your salt intake, your body does. And your body knows best. You don’t consciously restrict water intake because your body tells you when it’s thirsty. The same thing occurs with salt.” In other words, the human body has a built-in system—“salt thermostat” if you will—that helps us get just the right amount.
If you’re following a low-carbohydrate diet, then you may need to pay even closer attention to your sodium intake. Along with an increase in water excretion, keto typically leads to a depletion of sodium and other electrolytes (like potassium, magnesium, calcium, and chloride). This results, at least in part, to a reduction in insulin, which leads to an increase in electrolyte excretion. If you’re exercising regularly, which we strongly recommend, then you should be getting 3 – 5 grams/day of sodium and 2 – 3 grams/day of potassium.10
Is Salt Bad For You? Our Top Takeaways
- Is salt bad for you? No. It’s essential, and like we’ve seen with many of its predecessors, it’s not about a single nutrient (in this case, sodium) that’s the culprit. For many people, avoiding salt may be a huge health mistake.
- Individual differences apply. Having said that, we have to pay respect to nutrigenetics. In other words, just like it’s irresponsible to say salt is bad for you across the board, some folks may be particularly “salt sensitive,” meaning their bodies may not be as efficient at excreting sodium as effectively as others. And, these folks may be inclined to experience an increase in blood pressure in response to increasing salt intake.11
- Don’t be afraid of salt. Adding salt during cooking, at the table, etc., is NOT the problem.
- Ditch the processed junk. Even if we’ve been misguided to believe that salt is bad for you—and that’s not true—the major source of sodium for most people is heavily processed food (i.e., packaged/prepared). It is still a very good idea to focus on minimally processed whole foods, which are more nutrient-dense.
- The wrong white crystal. While I’m not necessarily a fan of playing the blame game, there’s compelling evidence that added sugar, not salt, may be a driving factor in hypertension and cardiometabolic disease. Considering that added sugar is usually along for the ride with sodium in processed foods, this is yet another reason to ditch the industrially processed junk.
- Really, don’t be afraid of salt. When your diet is predominantly minimally processed whole foods, it’s even more critical that you actively include salt in your diet to make sure you’re getting plenty of sodium.
- Sweatin’ to the oldies. If you’re active, the need for salt is magnified because you lose sodium in your sweat. Although sweat rates vary among individuals, climate, and types of activity, on average, people lose about 600 mg of sodium per hour of exercise. Along those lines, it’s generally advised that active people rehydrate with about 600 mg of sodium (about 1.5 grams of salt) diluted in 1 liter (about 32 ounces) of water per hour of exercise.12
- Get salty. Here are some of the ways I incorporate salt (specifically Real Salt®) into my diet:
- Rise and shine. Believe it or not, we lose water and electrolytes throughout the night that are obviously not replaced while sleeping. So, first thing in the morning—before drinking anything else—I add about a ¼ teaspoon of sea salt to 16 – 20 ounces of water. I also add the juice from half a lemon for flavor and a squeeze of polyphenols (antioxidants).
- The best part of waking up is salt in your cup? I have that cocktail before my morning coffee, which I actually add some salt to also. What? Yep, I add a pinch of salt to the coffee grounds. I find that it enhances and balances the flavor and cuts out some of the bitterness (I don’t add anything else to my coffee). Salt may even improve the quality of the water, and we all know your coffee is only as good as the water. But here’s a big thing that most people don’t know: Caffeine accelerates excretion of sodium. In other words, if you’re drinking coffee or other caffeinated drinks, you need more salt. It’s estimated that 90 mg of caffeine (one cup of coffee) results in an additional 400 mg of sodium lost in the urine (about 1 gram of salt).13
- Crusty. I salt meat and fish before cooking. It not only adds flavor, it helps seal in the delicious juices. This works especially well when searing and sautéing.
- Gateway to eating more veggies. Simply put, salt is a flavor enhancer, and it makes many foods, including vegetables, taste better. Whether I’m roasting, steaming, pressure cooking, braising, stewing, or sautéing vegetables, I almost always add some salt (often, with its ride-or-die partner in crime, grass-fed butter). Even when I’m eating salads, I’m fond of adding a little bit of sea salt—often with other spices like turmeric, basil, fenugreek, pepper, or whatever else I can find in the spice cabinet.
Want to learn more? Dr. James DiNicolantonio, a doctor of pharmacy and leading cardiovascular research scientist at Saint Luke’s Mid America Heart Institute, is a real crusader and my go-to resource for setting the record straight on the low-salt myth. I can’t more highly recommend Dr. DiNicolantonio’s book The Salt Fix: Why the Experts Got it All Wrong—and How Eating More Might Save Your Life if you or someone you care about has doubts or questions in the “is salt bad for you” conversation.