Doctor's Note

I’ve badly neglected sodium on NutritionFacts.org, but that’s all going to change. I have about a dozen salt videos queued up that dive deep into the existing controversies. It’s such an enormous topic that it was a bit intimidating at first. There are more than 8,000 articles on the topic in the medical literature, but that’s what you have me for! If you appreciate my efforts, please consider becoming a regular supporter by clicking on the donate button above.

For more on Kempner and his rice diet, see:

Canned foods are infamous for their sodium content, but there are no-salt varieties (Canned Beans or Cooked Beans?). Cutting down on sodium is one of the ways we could be Improving on the Mediterranean Diet. Beyond heart health it could also help our kidneys (How to Treat Kidney Stones with Diet). But if you cut down on salt, won’t everything taste like cardboard? See Changing Our Taste Buds.

More on hypertension in How to Prevent High Blood Pressure with Diet and How to Treat High Blood Pressure with Diet. What if you already eat healthy and still can’t get your pressure down? Try adding hibiscus tea (Hibiscus Tea vs. Plant-Based Diets for Hypertension) and ground flax seeds (Flax Seeds for Hypertension) to your diet. And make sure you’re exercising regularly (Longer Life Within Walking Distance).

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  • Misterimpatient

    What role, if any, do genetics play in blood pressure?

    • Darryl

      The heritability of blood pressure variations is estimated at 56-57% in the Framingham Heart Study (1). There have been many genome-wide association studies to determine which genes are responsible (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, most recent review for those with library access), largely to identify new drug targets.

      Genetics isn’t fate. My mother was hypertensive and on several BP lowering medications by age 35. Nine years past that age, and I’m still usually 112/60 at bimonthly blood donations, with no medication. I can’t claim an exceptionally low salt intake, but adherence to a low-but adequate protein, whole plant based diet has likely helped.

      • Misterimpatient

        When I was 306 pounds I took meds for BP. When I dropped to 185 my blood pressure dropped to 135/72 I was taken off the meds. As the standards for BP dropped, I was put back on. Before being put back on the meds for BP, I was back on them to help with Raynauds, which can be quite bad in our cold New England winters so I took it only in the winter time. I’m not convinced I actually need them, outside the winter. I eat no prepared foods (except for about 2 meals each week outside the home) and I am completely whole foods, plant based. I’ve been at a lower weight but feel better a bit heavier AND my blood chemistry is better when I am a bit heavier.

      • Lynn

        In my case, I think genetics is fate. I eat no salt, no oil, whole food plant based, I exercise a lot and my blood pressure still is about 135/85. It has always been that high, even when I was only twelve years old.

        • You want to avoid over treatment and make sure that your are measuring the BP correctly. You might find Dr. McDougall’s article, How I treat elevated BP, in his November 2009 newsletter of interest. (free on his website). Dr. Handler wrote an article that was published in 2009 entitled, The Importance of Accurate Blood Pressure Measurement. The factors associated with artificially high blood pressure were listed as talking or active listening, distended urinary bladder, cuff over clothing, inappropriate cuff size, legs crossed, smoking within 30 minutes of measurement, unsupported back or arm, terminal digit rounding and taking measurement in paralyzed arm. Noted also was that if standing pressures are lower than sitting the standing pressure should be used. As I review these factors makes me wonder how many BP I took in my career were artificially elevated. I’m also a fan of using home BP measurements over time with an accurate digital cuff over time to make treatment recommendations. Many programs in there “rush” to control pressures are over-treating BP and raising the risk of strokes and heart attacks. Dr. McDougall discusses this issue. Dr. Ivanovic’s article, “When does low normal blood pressure become too low? The J-curve phenomenon, in Acta Cardiol in 2014 discusses this issue. On no medication lower blood pressures are fine but lower pressures on medication is a very different issue. Good luck.

          • Misterimpatient

            Thank you for these suggestions.

          • My BP is artificially elevated when I visit the doctor (white coat syndrome). At home I measure at 123/80, at the doctor it’s 145/90!

          • As I mentioned in my above post I would read Dr. McDougall’s newsletter article. I would add that cultures that eat a plant based diet and are active actually run blood pressures <115/75. Even though "120/80" is considered "normal" I consider it a sign of arterial disease and would label it as "at risk". The Cochrane Collaboration study on BP showed that there was no benefit in treating BP's with medication in stage 1 Hypertension (i.e. 140-159/90-99) and 1 in 12 patients were harmed. So I don't typically advise treatment of BP of 145/90. To eat for healthy arteries you need to follow a whole plant based diet and avoid oils with weekly exercise in the 90-150 minute range depending on degree of exertion. The studies which are consistent with my clinical experience is that there is a "two phase" improvement.. the first fairly rapid as the nitrous oxide system is stabilized and a slower long term process including the partial reversal of blockages in the arterial system. By tracking your BP at home you can follow your progress. It may take years to get your "at risk" BP of 120/80 down into a more normal range but the journey will be worth the effort. Dr. Greger has many video's which address these issues. Good luck.

          • Jason

            Good advice. I’m 40. Was 308 pounds! ! I’m down to 268, and still working to drop another 80, 5’10” tall. My Dr. Put me on losartan (cozaar) and hctz/triamterene once a day. Before BP meds I was running 150 ish or slightly lower over mid 80 low 90. I’m a disabled vet, and they like to throw you a pill on everything. I recently got out of the ER for chest pain, with labs normal across the board, d dimer normal on both draws 4 hours apart, cholesterol 234….. but a resting heart rate of 50 to 60. Dr said heart rate was low but normal , yet for my size, he said he expected it to be higher so did another 12 lead 4 hours later after I had laid in the hospital bed all day. First 12 had my hr at 62, 2nd had my hr 48. No pvc, pac, qrs widening etc. P waves were good complexes tight, I wonder if I shouldn’t taper off the losartan slowly, and I’m a bean and legume eater, weekly. 3 to 4 days a week. Any recommendations or opinions on what would benefit me and help me keep a lower bp without pharmaceutical intervention? I have 4 kids, and would love to be free of these achors. Thanks. Love the videos and information (I know NO MEDICAL ADVICE CAN BE GIVEN) ideas….can be shared.

        • brit

          nothing wrong with your bp so don’t worry, that is not high

          • aribadabar

            It is high and it must be controlled unless you welcome MI/stroke down the road.

            Lynn: Have you happened to check if you are ApoE 4/4? That may explain the worsened BP as your lipid metabolism is severely crippled.

        • Do you only measure at the doctor’s office? I invested in a high quality cuff for home as my numbers are MUCH higher at the doctor’s office, leading to an inaccurate measure of my hypertension.

          • I support the use of home measuring of BP with good equipment and proper technique. The pressure should be measured at same time of day to eliminate circadian effect. Studies on the effect of the time of day shows BP lowest at 3 AM then rising before waking and reaching its highest point at about 10 AM (Millar-Craig et al., Lancet, 1978)(Millar Craig Clin Sci Mol Med Suppl, 1978). You should also be aware of the variability of BP by day of the week. It appears to be lower on weekends and highest at the beginning of the week (Juhanola et al., Blood Pressure Monit., 2015). These variations have been shown to affected by other conditions. For instance chronic renal disease tends to blunt the variability. Good luck.

          • Sanjay Sharma

            Can you suggest any best, reliable bp measuring macine?

      • Rodrigo Cardoso

        Nature versus Nurture is a dichotomy hammered in everyone’s head, even scientists. But it is virtually impossible to understand how biology works when out of the context of environment. Robert Sapolsky and Gabor Maté are delightful in this topic: https://www.youtube.com/watch?v=JB3rjgqsKHk

      • Janie

        Most definitely it is genetics. My cardiologist told me that I picked the wrong parents. It is very frustrating to say the least!

        • MarthaLA

          I would refer you to Rodrigo Cardoso’s (the entry just before yours to which I reply) link: as one of the featured persons says, not an accurate quote, but as I took from him, genetics may be predisposition, but it is not predetermination; outcomes are heavily influenced by environment, experience – including the environment and experience we ourselves create. Cancer growth can be turned on or off by diet (protein percentage of calories) as shown by T. Colin Campbell, regardless of the ‘cancer gene’. So, processed foods have added salt. If you ate a lot of processed foods as a 12-yr old, as far too many of us probably did, then you were expressing that factors influence on you. I am having the hardest time trying to reduce, let alone eliminate added salt from my diet. The best we can do is our best at each given moment.

      • peseta11

        When I see that a condition is ‘heritable’, I recall that wealth too is ‘heritable’, and similar genes are involved… but not proven to be relevant to inheritance (let alone wealth acquisition), beyond ability to outlast the elder donor.

    • FYI

      Their life expectancy is 45 years. Google them. It is really quite interesting.
      The Yanomami are an indigenous tribe (also called Yanamamo, Yanomam, and Sanuma) made up of four subdivisions of Indians which live in the tropical rain forest of Southern Venezuela and Northern Brazil. They live in the rain forest which is an environment that lacks salt. Interestingly, they are genetically enabled to not get hypertension even though they have chronically high levels of RAS. However, they have low longevity. The Yanomami, on their obligate low salt diet, have been used to set the guidelines. Their inability to develop high blood pressure has nothing to do with salt — it has to do with their genotype.

  • elsie blanche

    Does salt, even sea salt, have a harmful effect on the macrobiome in our mouths, stomachs….entire G.I. tract? Logic is telling me that salt kills good bacteria as well, and maybe our gut-health and autoimmune systems have been compromised. Any data on this?

    • Darryl

      There’s an association of salt intake with Helicobacter pylori infection, and salt intake appears to have a synergy with H. pylori in gastric cancer carcinogenesis (1, 2, 3). Otherwise, salt is fairly rapidly absorbed in the upper digestive tract and passed through urine, only 2% is passed through the colon where most of our gut microbiota reside (4.

  • Bob

    What is the minimum amount of sodium one must consume per day for optimum health?

    • Joseph Gonzales R.D.

      500 mg per day is the minimum.

      • Adrien

        How much sodium does one get from food – appromatively – if we eat a whole food plant based diet, without added salt ? Is this leave room for a pinch of salt a day or not ? Is 500 mg of sodium the equivalent of 1 grams of salt ? Is crystallized salt half sodium half chloride (just like table sugar is half glucose half fructose) ? If my memory is correct we need to be below 1,500 mg of sodium based on previous nutrition facts video, so between 500 mg and 1,500 mg is a good target. I use very little salt, and when I do it’s only on the surface of food not in the cooking water. I also use a low sodium salt which is 66% potassium chloride and 33% sodium chloride. Is all these measure are effective and enough to be in the good target or is it not ? I apologize for all the question at once.

        • Joseph Gonzales R.D.

          Hi Adrien. Sodium intake < 1500 mg is the optimal daly intake. I discuss more in depth in this comment. 500 mg = 1/2 of a gram. So not much. Eating a plant-based diet without added salt or packaged foods should put one near 500 mg per day naturally. I think all of your efforts are appropriate and if you are not eating many packaged or pickled foods than a small pinch of salt is fine, especially if you are only adding to the surface of food (a great way to go). Let mw know if that helps?

          Best,
          Joseph

      • DiabetesIsCured

        According to my cronometer, I am only getting about 400mg of sodium per day naturally occurring in my fruits and veggies. Should I start sprinkling salt to my food to increase my sodium? Is there any risks to having a salt free diet?

        • Bob

          This is what I’m wondering, especially if you are exercising and sweating.

          • Joseph Gonzales R.D.

            It’s hard to say. I don’t want to tell folks to start adding more sodium. Perhaps on extremely hot days where much sweating is performed than a boost of salt could help, but this is very rare. Dr. Greger says “drinking too much water without replacing electrolytes on hot days in people unaccustomed to the heat can lead to dangerously low sodium levels, but that doesn’t mean we shouldn’t in general lower our sodium intake.”

            400 mg should be fine. I suggest double checking with your doctor. Since sodium is found in whole plant foods in small amounts there is no way to have a zero sodium (salt-free) diet. As Dr. Forrester explains eating a WFPB diet will give you the amount of sodium you need. I would agree wholeheartedly!

        • Joseph Gonzales R.D.

          I replied to Bob. It’s a tough question, but 400 mg (if that is indeed what you are consuming) should be okay.

          • Another View

            The reasons behind this shift can be briefly summarized as follows: The chemical messengers (hormones) that humans produce to throttle back salt losses from the body are compounds called renin, angiotensin, and aldosterone. These hormones begin to be produced in increased amounts when sodium intakes drop below about 3200 mg/d. The lower the intake gets, the more of these protective compounds is produced. These are what are called in physiology “rescue” mechanisms, which means they function to tide an organism over a temporary problem (as from sudden blood loss or dehydration), until the animal (or human) can access the salt and water it needs to restore central blood volume. In that sense, they’re just like adrenaline, which is also produced in times of stress (though of a different sort). They’re both emergency tools, automatically deployed by the body in times of need.

            The principal problem with the 2005 IOM recommendation (under 1500 mg sodium per day) was that, if followed, it would create a situation in which these rescue mechanisms were being constantly deployed. There has been evidence for years that sustained high levels of renin, for example, actually increase the risk of heart attacks and cardiac death, particularly in patients who already had heart disease. Until recently the IOM had simply focused on the blood pressure effects of sodium intake reduction – believing apparently that any decrease in blood pressure was good for you – and ignoring (or unaware of) the harmful effects of living 24/7 with high levels of the rescue hormones. Belatedly the emphasis has now shifted from blood pressure (with implications for health) to the actual health outcomes themselves.

            Another problem with the 2005 IOM recommendations – indeed with most IOM nutrient intake recommendations – is that they treat individual nutrients in isolation http://blogs.creighton.edu/heaney/2013/06/10/the-sodium-story/

      • Julot

        Much less, so bad the video doesnt say Yanomamo sodium intake was between 20 and 150 mg of sodium a day and they were healthy, doing excercise and working.

        http://nsm08.casimages.com/img/2014/09/22/14092201582117279112545495.jpg

        • Raspberry Miam

          Encore là avec tes Yanomamo ? Tu préfères te baser sur une population quarantenaire que sur les centenaires dont le mode de vie a déjà fait ses preuves ? Profite bien de ton impunité, puisque Pauline supprime les commentaires de ceux qui te contredisent ou ne sont pas d’accord avec toi, et se charge de mettre un pouce vert à tous les tiens. Vous finirez par apprendre que la censure ne mène nulle part, elle ne fait que desservir votre cause. Tout le monde a le droit de s’exprimer, c’est le droit le plus basique, que vous soyez d’accord ou non. Vous pouvez très bien ne pas lire si ça vous embête. Mais si vous trouvez que c’est justice que d’enlever leur liberté d’expression aux gens (et de les accuser arbitrairement de vous avoir insulté, puis de supprimer les preuves afin que l’on ne puisse que vous croire) vous n’avez aucune leçon de morale à donner, en particulier les vegan.

          • Pauline? C’est qui? Et comment vous sais qu’elle supprime les commentaires contradisantes?

          • Raspberry Miam

            Pauline est une YouTubeuse qui se fait passer pour une frugivore et pratique allègrement la censure sur sa chaîne. La moitié de mes commentaires a été supprimée aujourd’hui, dont mes réponses à Julot au sujet de ses allégations non fondées sur le sel ; et deux ou trois commentateurs ont été bannis de sa chaîne, moi y compris, tout comme bien d’autres avant nous.

          • Julot

            Calme toi lol c’est la chaine de Pauline, pas ma chaine, si c’était le cas je ne supprimerais pas ce type de commentaire inclus dans le débat~

        • Joseph Gonzales R.D.

          Who is Andrew? Are these recommendations valid?

          • Raspberry Miam

            Seemingly, “Andrew” is this former newspaper reporter, now webmaster: http://www.raw-food-health.net/about-the-author.html. This article is from his website and can be found here: http://www.raw-food-health.net/Nutrition-Requirements.html. This is the source of his allegations regarding salt: http://www.who.int/dietphysicalactivity/Elliot-brown-2007.pdf.

          • Joseph Gonzales R.D.

            Okay so he pulled them from WHO recommendations. Thanks for letting me know! I still have not been able to find a reference for 150 mg per day. I did find this: “For all countries for which recent
            data are available, dietary sodium intakes are much higher than the physiological need of 10–20 mmol/d (230–460 mg/d).”

          • Raspberry Miam

            The accuracy of these sources are doubtful, they are the result of personal investigations from non-professional individuals. It is generally admitted in the French raw vegan movement that the actual daily sodium intake recommendations (1 gram) is much too high, that is why that kind of disputable sources are used to justify it.

          • Julot

            A very long term raw foodist frugivore based on science, check his YT channel if you want, very interesting~

          • Joseph Gonzales R.D.

            I see now. Thanks for confirming. I think I tackled this question, as well as Dr Forrester. He says following a plant-based diet with no added salts and no processed foods will give one enough sodium.

      • jj

        Joseph, is the following accurate ?

        NaCl (salt) breaks up into ions and separate based on polarity in the body. Na+ (sodium) is inside the cells and its job is to attract and hold onto water, thereby hydrate. The job of Cl- is to maintain optimal hydration fluid levels outside of the cell. Note that Na is positively charged (+) and Cl is negatively charged (–) and these polarity differences result in voltage differences. Cells without proper quantity of Na+ and Cl- are not capable of voltage generation of the right magnitude. One of the functions of this specific voltage magnitude is the enabling of the sodium-potassium pumps that are located on the membrane of the neuron. Without proper voltage for the pumps, they may not be able to open to the outside or to the inside of the neuron. When a cell cannot open to the outside or to the inside, no exchange of nutrition can take place. Cells without sodium cannot retain water and remain dehydrated.

        We have several other issues without the proper electrolyte fluids inside the cells. Electrolytes carry magnesium, for example. Magnesium is used by the cells like a key to open the pumps. If there is no magnesium inside the cells, even if there is plenty of water and salt, the pumps cannot open. Phosphates provide the energy for the magnesium to open the pumps and so phosphates are also needed inside the cell. There are high voltage calcium channels in neuron membranes as well. Without high voltage, the calcium channels cannot work. Thus, even if there is enough voltage to hydrate the neuron and to create neurotransmitters, they are stuck without functioning high voltage calcium channels

        • Joseph Gonzales R.D.

          Oh my–let me grab my Biochemistry book! I am not sure. Where was this pulled, and may I have a reference? Any biochemists around who could lend a hand?

        • Israel Navas Duran

          No, it’s wrong. Most of the sodium of the body is in the extracellular fluid (basically interstitial fluid and blood plasma). Sodium is required in the cells (around the cell membrane) for membrane transport of other components, and transient membrane depolarisation (e.g., in neurones and in muscle fibres and muscle cells). Water is retained inside the cells due to the presence of other ions (mostly potassium), hydrophilic groups of macromolecules (mostly proteins with sulphate and amino groups, glycogen) and other smaller solutes but in much lesser concentration (free sugars, free amino acids, free nucleotides).

          • jj

            Interesting

      • And veggies have enough sodium naturally where I don’t think low sodium would be an issue, as my wife mistakenly believes. She thinks I need to add SOME salt to my food when I clearly see that almost all foods have some sodium in them.

    • Wade Patton

      Apparently zero from watching this very video. The electrolytic balance in our systems is such that your body won’t excrete salt when it has none extra.

      • Adrien

        Zero added salt and zero sodium isn’t the same thing. Watching this video it’s look like zero added salt is best, but that’s not mean you get zero mg of sodium in your diet. I’m not even sure if you can get zero mg of sodium per day, unless you fast. Electrolyte must come from somewhere, since air doesn’t provide any (I’ll be surprised to be wrong), I guess it must come from food and water. :)

        • Wade Patton

          Nit-picking but Sodium is a highly-active soft metal, not NaCl. I don’t get the common reference to “sodium” as if it were table salt. Curious as to why. thanks.

          • Israel Navas Duran

            It refers to sodium ion. It’s more accurate to talk about sodium since sodium is the ion with known effects on osmoregulation and the amount of sodium present in table salt may vary since not all the salt in table salt is sodium chloride, there are other salts as well, some water, and even talcum powder.
            In addition there are a few other food sources of sodium (mostly as additives) with comparable effects on the body homeostasis such as sodium bicarbonate (baking soda, not present in table salt), monosodium glutamate, sodium nitrite, sodium saccharin, and sodium benzoate.

          • Wade Patton

            Thanks.

    • Eating a WFPB diet will give you the amount of sodium you need barring certain unusual medical conditions. I’m not a fan of “optimal” health. It’s usage is often used to imply that if you eat a certain amount of a particular substance you can optimize your health. As we have gained an understanding of complex or adaptive systems we need to eat according to our biological system… in our case hind gut fermenting herbivores and trust our bodies to make the adjustment. You might read “Whole” by Dr. Campbell which is a nice introduction to the limitations of reductionistic science. That doesn’t mean there aren’t minimum requirements. You can develop scurvy with inadequate vitamin C intake… that doesn’t mean more is necessarily better. There also is variation in the population so what works for one person doesn’t work for another. I do write prescriptions but I have found that patients who follow the correct lifestyle approaches seldom require medication. As always if you are having symptoms you should be evaluated by a knowledgeable health professional. I do believe it is important to keep up with the latest science especially as it relates to lifestyles nutrition and fitness. The goal is to delay death and avoid disability and minimize medications, supplements and procedures. There is alot of information out there but the best to keep up with latest in science is NutritionFacts.org.

      • HaltheVegan

        Dr. Forrester, your name reminds me of an engineer from MIT by the name of Jay Forrester, who, back in the 1970’s/80’s did a lot of research in making mathematical and computer simulation models of dynamical systems. He called the field of research “System Dynamics”. The models contained “feedback loops” and were very useful in modeling complex adaptive systems. In fact, I would consider his work as pioneering the current field of adaptive systems theory. His early work showed that even simplistic systems with just a few variables can have unexpected behavior when feedback loops are incorporated. So it’s mind boggling to think about how complex the interactions are between nutrition and the systems of the human body. Just curious if you have heard of his work especially since you both have the same last name :-) ?

        • I agree. No relation but am a fan. I especially like the work of Donella Meadows who studied under Jay Forrester. She wrote Limits to Growth and Beyond the Limits plus her notes were published in an excellent paperback, Thinking in Systems. I saw her do a presentation at the U of Michigan describing the demise of the cod fishery. Interesting the profits for the companies were highest right before the ecosystem collapsed…. growth, technology, market and gov’t didn’t save the fish. Dr. Campbells more recent book Whole is a nice introduction to complex systems in nutrition and discusses the limitations of reductionistic thinking.

          • HaltheVegan

            I haven’t read Dr. Campbell’s book Whole yet but will do so. Thanks for the reference. I will probably agree with most of what he has to say because I’ve spent most of my career doing “systems” thinking and agree that with complex systems, reductionist thinking has severe limitations!

  • MikeOnRaw

    Can salt affect people differently, i.e. for some not affect blood pressure? My blood pressure is fine and has been my entire life. 5 months into being WFPB my blood pressure was no better or worse than before changing my lifestyle. I don’t eat much salt now and I’m sure before ate a bunch of salt in prepackaged and processed foods. Just curious as I have found various dietary foods that affect most people one way don’t seem to affect me at all.

    • Joseph Gonzales R.D.

      Darryl mentions heritability of blood pressure below. I am sure there is some variability, but it’s fairly clear that the lower our salt intake the better.

    • Wade Patton

      I’m with you on the condition-if my BP goes much lower, I pass out. That is even when eating SAD (high salt, sugar, fat, processed, critters). Now that I’m WFPB, I know it hasn’t changed much because it can’t. But I am sure that my cholesterol and all those important blood profile thingies have improved markedly as well as reduction in inflammation and better health all over otherwise. I can’t give blood and then “walk out”-tried it once. Takes too long to recover so I don’t. Required an extra unit of fluid in order to leave the hospital the last time I was stitched up. Not everybody has this tendency to hypertension. Most of my 49 years I ate the same junk as “everybody” else. No more.

    • guest

      Could it be the sodium to potassium ratio? I’ve seen arguments that the problem is not so much that we consume too much sodium but we consume too little potassium.

      • Fred

        That’s my thinking. Apparently sodium is interstitial…between cells…potassium tends to be IN the cells? A plant based diet results in higher pott?

  • Adrien

    Is there any study who demonstrate that the real and absolute cause of High Blood Pressure is a high salt intake, and a high salt intake only (not caused by animal product) ? Meaning either demonstrating that non vegetarian with HBP can be cured if they cut back on salt only, or that strict plant based eater with high salt intake will develop HBP over time ? Darryl where are you ? I’m sure you have the answer :)

    • The Vegan

      Well I have been a vegan over 20 years. My blood pressure has always been good but about a year ago I found my blood pressure to be high(130/90). I didn’t give a thought, then months later I checked and it was still high. Then I bought a machine to check it regularly and it was very high. On average I would say, 128/95. The 95 is the one that scared me. Well I did an extreme diet change so as not to intake so much sodium.. I never added salt to my food but I do eat a lot of packaged foods which can very high in sodium. So I made the change and got my average down to 116/84 after about 6 weeks. I then slipped back and now my bp is through the roof. Even higher then before. So I am going to try again. Personally I think my overall stress and anxiety level is what makes me so susceptible to high bp these days. At the moment I can’t control that but my diet I can so I will bring down my bp that way.

      So my point here is I am a vegan who had great bp for all of my life but then developed high bp. I got dramatic results from cutting out most of my sodium, went back to high sodium and the bp went through the roof. So the point is even plant based diet can suddenly develop high bp but cutting out sodium can bring it down dramatically rather quickly.

      • lgking

        “Well I have been a vegan over 20 years. I do eat a lot of packaged foods”

        I to have been a ‘vegan’ for about the same amount of time. But my definition of a ‘vegan’ is to consume nothing that comes in a box, package, bag, wrapper, jar, can, bottle, or container of any kind. WFPD diet is just what it says it is. To me that’s ‘fresh’ fruit and ‘fresh’ vegetables…daily. Live food is where it’s at.

        Prior to my journey in this direction blood pressure was 155/90. Since addapting the new lifestyle…110/68.

        • The Vegan

          Your definition of vegan is off, because veganism is about an ethical stance but I wholeheartedly agree about live food being where it is at. There is nothing healthier than a diet of raw, organic, fruits, vegetables, nuts and seeds.

  • Wade Patton

    Thanks Doc. I’m one of those who needed MORE info on NaCl. Still don’t have any BP issue (at 49 with lifelong “low normal” BP so far.), but am going to get a cuff and ‘scope and start monitoring mine, maybe others.

    Recently I started looking at the salt content of the processed foods I eat. Found most to be low, then one day I thought I’d have a little veggie juice. I bought a 12-ounce bottle of the big famous brand and sucked it down without looking at the label. Thought I’d get the quart next time. A day or two later I bought the quart (litre) bottle of the stuff. This time I looked at the sodium content: 27% USRDA, for one “serving”!

    Four servings in the bottle. So drinking that whole bottle put me 8% over RDA without consuming anything else-which was okay for me as the rest of the food and drinks I had for the day were made by me, and very low in salt content. My body dumped that extra salt via sweat that day-and it still didn’t get to the level of “the old days” when I ate anything and everything and was never shy about eating salt-cured meats.

    Lesson learned on the processed juice-make your own and then it’s smoothie-style and little or no salt.

    Question: Why do so many walk around talking about “sodium” this and “sodium” that making reference to table salt, when Sodium is only half of the chemical compound? It’s like speaking of water and calling it “Hydrogen”, or bleach-which could also be called “sodium”. I realize there are lots of chemical compounds that are “salts” and that NaCl is only one. But why not call sodium chloride, “salt” when having a nutritional conversation? Yes I did notice you, Dr. G are indeed doing so, Thanks.

    on a related note: So my friends where I used to work are all on BP medications “and others” and feel it’s okay to dump the KCl (the table-salt substitute) all over their _processed_ foods. How is this “better” or less problematic that NaCl? I read around enough to try to let them know (sharing a video from here IIRC) that that stuff shouldn’t be thought of as completely benign. I’m sure there was no change.

    So sad to see folks eating themselves into sickness and death every day.

    • Matthew Smith

      Even bread has a great deal of Sodium added. Upon hearing that blood pressure is high, I imagine I would use even less table salt, which I barely touch. I sadly have been neglecting table salt, and as such I had no source of Iodine for many years, and I think became very Iodine deficient. This could be part of a whole host of deficiencies in me. Calcium, Magnesium, and Potassium deficiencies also play a role in hypertension. I hope that if people eliminate table salt they have an alternate source of Iodine, as Iodine deficiency is once again a health problem for our country.

      • Wade Patton

        Make nearly all my own bread, too much sugar and sweeteners in ready-made bread. Now I’m making tortillas. Nixtamalization rules.

        • Matthew Smith

          There’s a Scientific American article which doesn’t site the indigenous people. http://www.scientificamerican.com/article/its-time-to-end-the-war-on-salt/ I think America had tabulated how much Iodine we need before all our foods came to us loaded with salt. Reducing salt does not seem to be an effective way to lower blood pressure in people with high blood pressure. I wish they would recommend Dr. Greger’s advice to eat less animal products. The Vegan diet and losing weight are a very effective way to lower blood pressure. Flax seeds seem to be very effective at lowering blood pressure. I think somewhere in there is the breakdown in doctor’s office that is part of what is sickening America. I personally think many kinds of chronic pain could be related to an Iodine deficiency. Are seaweed and cranberry juice good for pain? In China they are adding Selenium to salt to help reduce cancer rates. Good for you for sticking to Iodized table salt. Even now more people are switching to sea salt.

          • Matthew Smith

            In this article in the sources cited, MR Law, CD Frost, NJ Wald. By how much does dietary salt reduction lower blood pressure? III–Analysis of data from trials of salt reduction. BMJ. 1991 Apr 6;302(6780):819-24. They say a 3 gram reduction in salt intake would lead to a 5mm reduction in blood pressure and a 7 mm reduction in blood pressure in those with values over 170 mm. This is hardly a cure, compared to the offered alternatives like flax seeds, hibiscus tea, and a vegan diet. Only vegans meet targets for weight, blood pressure, and cholesterol, according to Dr. Greger.

          • Wade Patton

            Just found out that potatoes and strawberries and navy beans are good sources of iodine. Won’t need the iodized salt now.

          • Chris Gumb

            Can you provide a source for this information? If this is indeed the case then why would Dr. Greger recommend sea vegetables for iodine rather than these other foods which are much more common and much cheaper? Basically, I’m calling baloney on this.

          • Wade Patton

            IIRC it was from a “non-controversial” food information source. I’d have to look again. I’m not inclined to defend the statement at this time so “baloney” works for me, just a bit busy. I do respect your right to “challenge my testimony”. Just nothing in the defense fund timewise. Cheers.

        • How do you go about nixtamalizing?

          • Wade Patton

            I buy hominy and corn flour which have been nixed already. Not doing it myself yet, but will probably use KOH and corn to make hominy and then go from there. Didn’t get my corn crop in this year.

    • I think food labels use sodium because it makes for a smaller number in the list. Sodium weighs 23 daltons, so 23 mg of sodium = 23+35 = 58 mg salt. ….because that other half is chlorine weighing in at 35 Daltons.

      Smoke and mirrors…..great question!

      • Lawrence

        Thanks Gregor. That explains this food label for table salt that lists 6g (1tsp) having 2325 mg sodium. There’s some rounding error somewhere, but it’s close enough. So, about 1/2 tsp table salt/day is my new rule of thumb (which isn’t very much at all…)
        http://nutritiondata.self.com/facts/spices-and-herbs/216/2

  • Will

    If a low enough salt intake is all that it takes to significantly lower the chances of essential hypertension, then why all the focus on getting enough potassium? If I reduce sodium, don’t I require less potassium or is there a relationship that I’m missing. Anybody know what the levels of sodium and potassium intake were on Kempner?

    • Will

      Also, was just reading about about the role of fat and high BP

      Diet: high sodium, high fat, and high cholesterol in the diet generally increase blood pressure while high fiber, high calcium, high magnesium and high potassium in the diet lower blood pressure.

      https://www.gbhealthwatch.com/Science-Behind-Blood-Pressure-Control.php

      This got me to thinking about diets centered around APOE genotype. I’m a 3/4 and I read that I should eat low fat to gain most benefit whereas those with a 2/3 or 2/4 can have a more liberal amount of fat in their diets. I don’t mean to get too far off topic but has the good Doctor done any vids on APOE types, I can’t recall seeing any? Thx in advance

    • Darryl

      Potassium intake appears to have a stronger influence on all-cause mortality. This meta-analysis found considerable benefits for more potassium in stroke and cardiovascular disease in nearly all studies. NHANES III found those consuming 4+ g potassium had 40% fewer deaths than those consuming around 2 g. And in this study, using more reliable 24-h urine samples, while the cardiovascular risk was minimized with just 2 g potassium excretion, all-cause mortality kept improving up through 4+ g.

      • Will

        Thx for the feedback!

      • Lawrence

        Tubers are great choices. And for those of us looking to up our potassium intake with less calorie-dense foods, there are beet greens, Swiss chard and spinach.
        http://www.whfoods.com/genpage.php?tname=nutrient&dbid=90

        Honestly, I don’t see how we can get the RDA of potassium unless we eat WFPB. Which, as Dr. Greger has said, 98% of Americans don’t get enough K (I’m sure I am included, but at least I am trying!) P.S. Thx for excellent postings. These last few days (K, brown fat discussions) have been extraordinary.

        • Lawrence

          I forgot to mention tomato paste as a rich source of potassium. (It’s even got vitamin E, for which my go-to source is sunflower seeds). I buy tomato paste in huge cans and transfer into smaller containers and put them in the freeze to be used as needed.. Very handy stuff; I use it in everything including as a spread on toast/sandwiches.
          http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2689/2

      • dorange

        That’s a lot of potatoes. I always have difficulty reaching the recommended mg of K, even eating bananas, tomatoes, 1 potato, beans and coconut water daily… As per Nutrition Data, 100g baked potatoes with skin have 575mg K, and 100g boiled potatoes with skin have 379mg K. I wonder if steaming potatoes you don’t lose so much potassium?

        • Darryl

          I’d expect no loss of potassium with steaming. I bake batches of 4-6 large potatoes (350°F/175°C for ~ 1 hr), refrigerate, and warm for meals, as this is quick and increases resistant starch to around 10%.

  • karen

    What about the Himalayan Pink Salt with all the necessary nutrients? I changed to it & have better BP than before.

    • Joseph Gonzales R.D.

      Hi Karen. Good question! People often hear claims about “natural” sea salt or pink Himalayan salt being more nutritious due to mineral content, but the truth is the research is lacking and these minerals can be found elsewhere without sodium. Himalayan salt doesn’t appear any safer or more beneficial than regular table salt. At any rate it’s great you have better BP now!

      Best,
      Joseph

      • guest

        And Himalayan salt is so much more expensive than regular salt.

        • Joseph Gonzales R.D.

          Right. And does not have any iodine, a nutrient often overlooked in the diet.

          • Wilma Laura Wiggins

            Is that for sure because I thought it did, naturally from the sea? Second question, what about the effect on blood pressure from various medications such as Lisinopril?

          • dorange

            It doesn’t? I thought it did…

          • Joseph Gonzales R.D.

            Double check the label, but to my knowledge natural sea salt does not contain much, if any, iodine.

          • dorange

            I meant Himalayan… as per Wikipedia “The chemical composition of Himalayan salt includes 95–96% sodium chloride, contaminated with 2–3% polyhalite and small amounts of ten other minerals. The pink color is due to iron oxide.” Here is an spectral analysis where it says it has Iodine <0.1 g/kg: http://themeadow.com/pages/minerals-in-himalayan-pink-salt-spectral-analysis
            Also, according to wikipedia, "Fleur de sel,the best part of sea salt or gray salt, contains "Sodium chloride: 94.3 – 97.6%, Calcium: 0.19 – 0.20%, Magnesium: 0.42 – 0.79%, Potassium: 0.22 – 0.67%, Iron: 8.0 – 11.1 mg/kg and Iodine: 0.5 – <3 mg/kg"

          • Joseph Gonzales R.D.

            Oh okay thanks for clarifying! So what would that equate to if you had a dash of Himalayan sea salt in terms of iodine? I would think the value would still be super low. We need about 150 micrograms per day.

          • dorange

            I see your point… I suppose we won’t get that from any salt – maybe the iodized one?

          • Joseph Gonzales R.D.

            Yep. Just the iodized one.

    • Darryl

      Himalayan Pink Salt may be thought of as slightly contaminated table salt. with negligible amounts of either essential trace minerals or toxic ones.

  • albert

    Weeks of heated news discussions about one person dead (I don’t mean any particular case). Nobody blinks about 1000 deaths per day. Welcome to our “normal” reality. Or Matrix rather?..
    There are also lots of studies linking traditionally heavily salted foods and GIT cancers. Salt adds to irritation-inflammation which can lead to more serious issues when given enough time.
    I’m really cutting on salt, thank you Dr. Greger, once again.. :))

    • Wade Patton

      Cut the “news” out of your daily intake (as i have). Does wonders in allowing one to focus on his/her own life and how to improve it rather than the irrelevant distractions brought to us by the companies.

      • albert

        I did just that a while ago, with effects exactly as you described :) As author-economist Nassim Taleb says, if the news is serious enough it will reach you anyway. I still feel sorry for my elderly (and not so) family members whom I visit and just get absolutely gutted by how much negative noise is poured on people daily.
        But back to our health! Today I’m rediscovering pearl barley and hoping I have finally found my “holy” low GI grain! looks like its also really good for mindful eating – takes a bit of time to enjoy it’s springy texture :)

        • Lawrence

          Hi albert. Ditto on the barley. A great source for buying in bulk http://shop.honeyville.com/products/grains/barley/pearled-barley.html
          (They used to have hulled barley, but I don’t see it today.)

          I just recently purchased 50lbs Whole Oat Groats. For reference, one 5 gal food-grade bucket holds 25lbs (approx.) I like having my own ‘bulk foods’ section at home.
          http://shop.honeyville.com/whole-oat-groats.html#.UN0sHW88CSo

          I’m not a shill for Honeyville; have purchased their 9-grain cracked cereal, 6-grain cereal, hulled barley and now I am enjoying the oats. The quality has always been top-notch and the shipping is fast. The grains store for at least a couple years in food-grade buckets at reasonable temp/humid conditions. Enjoy in great health!

          P.S. ditto on ‘news.’ just awful stuff. 15 seconds channel surfing is all I can take at one time.

          • albert

            Thank you for the tip Lawrence! I’m not exactly on the Honeyville side of Atlantic :) but I’m sure people will find this valuable!
            Ok, here is a quick story about barley. Once I spoke to a woman from a family of hard workers with rather modest income. One day they run out of all money and were left with only pearl barley to eat for a number of days, not sure how many. After a couple of days of this forced barley diet they noticed that their, well, excreted metabolism residuals become rather odorous and dark toned (we are talking medicine here right?). This went on for a few days and then they found themselves feeling extremely well, with baby soft skin and clear bright eyes, great energy etc. End of story. I’m still curious what kind of the process it might have been…
            Still waiting for my literally gut reaction from barley since I’m not quite sure what my relationships with gluten are. I get easily inflamed very often and still in process of separating good grains from bad chaff so to speak (nightshades are already out, long live Mark Hyman for his book Ultramind, helped me very much with spotting my food allergies that were always there but we’re never noticed, just like the real concerns for the news).

          • Rhombopterix

            check out FODMAP diets. Fixed my wife’s “IBS” in 3 days flat. she is still WFPB and now low FODMAP. Never looked back

          • albert

            Thanks! Ironically I’ve been trying to increase my prebiotic intake, but I can see how solution may be in limiting flora overgrowth if one is overreactive and/or has somewhat improper flora. Interesting. Thanks again.

          • Rhombopterix

            I kept pushing her to eat more legume, more good foods to establish good micro-flora. Nope. Just wont work for her. I dont understand why, Just that it changed her very much for the better. Good luck…let me know if you see a result please.

          • Rhombopterix

            Have tried millet? Mmmmm

      • gp65

        I have cut out cable news. In fact I do not have a cable connection. I get my news through Internet without drama. Plus I do not have the same information drilled into my head repeatedly. I try to get online news from 2 different perspectives (Fox snd MSNBC) and between them I get both sides of arguments which allows me to reach a sane conclusion.

        • Wilma Laura Wiggins

          Once in a while I watch BBC or PBS news but mostly I avoid all news. I think its obvious, when you use your remote to check all the news stations and find the same stories, in the same words, in the same order, that the “news” isn’t what it used to be or should be.

          • Charzie

            They are all supposedly owned by the same people, so makes sense. In any event, seems to me it’s all created to be whatever depressing or confusing crap they want us to hear, and little of it has any true value, or often even truth! I don’t think it’s coincidence either that they refuse to touch certain “controversial” topics as if they don’t exist, or at the very most, disparage anyone who asks legitimate questions about certain topics, I’ve seen it again and again. We would all probably be considered “conspiracy theorists” against the meat and dairy industries! LOL!

  • Salt of the Earth

    Interesting video by Dr. Guthrie on Dr. McDougall’s YouTube channel, suggesting that salt isn’t the bogey man we might like to make it out to be: https://youtu.be/rVK5fLtPQKI?t=4m58s

    • Lawrence

      Hi SOTE, Thanks for posting this link. Dr. McDougall isn’t too concerned with salt at the table provided we are eating whole plant foods; without any paper in front of me I think it is safe to assume most sodium in SAD is from processed foods; the more processed, the more sodium.

      As Dr. Guthrie points out, one problem is not getting enough potassium; sodium/potassium balance being crucial to every cell in our body. Dr. Greger has previously mentioned that we do not get enough potassium http://nutritionfacts.org/video/98-of-american-diets-potassium-deficient/

      That said, I think it is good to be mindful of sodium intake. I use a little iodized salt in cooking whole plant foods, and a little at the table. And, I thank Dr. Greger for initiating this series of videos on salt and look forward to taking in what the science has to say about this subject.

  • John

    Very helpful and interesting. At 77, wfpb, I’ve taken my BP from 140/95 down to 117/77 avg. But, if hypertension kills 400,000 Americans per year, why is it not listed by the CDC or the NutritionFacts.org as the 3rd leading cause of death? Or, what is its interrelationship with heart disease and stroke? Is it a marker, correlation , or the cause of death? Thank you (for everything)!

    • largelytrue

      It may help to think of a pipeline model for disease. Upstream, we have things that certainly cause death, like hyperlipidemia and hypertension and systemic inflammation and other general risk factors. Death can be ascribed to these factors in a proportionate manner, but when we go to tally ‘the’ cause of death in official reports, we rely on a classification of proximate causes that mostly describes what happened downstream: heart attack, stroke, kidney failure, accidents, infections, and so on.

  • I would like to have more details on a sample Kempner diet. How many servings of rice? How many servings of fruit? How many servings of vegetables? How much sugar? How much salt? The reasons for my query is that 45 years ago my blood pressure was 110/70 mm Hg in my doctors office without medication. The problem started 20 years ago when I began taking medication to control my BP. My systolic pressure always is higher in my doctor’s office than at home. I am sold on the Kempner diet and for the last month I have been eating more fruits and vegetables, but salt consumption from bread has been a problem, sauces, salad dressings, etc.
    I know what the DASH diet is because there is enough details about it. But, not so for the Kempner diet. For instance, what do I eat for breakfast, lunch and dinner. So tell me precisely how does this patient control his high blood pressure with the Kempner diet; I am on a daily dose of 10 mg of a beta blocker (Nadolol), 20 mg of and ACE inhibitor (Lisinopril.)
    Thank you.

    • Jim Felder

      To really control sodium in this society whose taste buds are comatose due to the continuous salt bath they receive, the only way to control sodium is to make nearly all of your own condiments and sauces from scratch.

      • Wilma Laura Wiggins

        I think if I have to give up another thing, I am going to get discouraged and just quit. I already gave up animals and animal products, almost all processed foods, heavy sugar use, gmo’s, non organic food, heavy salt use. I think looking for perfection is just too much.

        • Jim Felder

          Agreed! I only reduced my salt consumption significantly two years after going plant based. In many ways it was harder slashing salt consumption than it was giving up the meat and only rivaled by the difficulty of giving up cheese. I probably couldn’t have sustained eating this way if I tried to switch everything in one great whack!

          Still several large discreet steps was easier for me than trying to ever so slowly slide into it. So rather than go with Meatless Mondays and gradually add Tuesdays and so forth, it was easier to just make that leap in one step.

          But however it works for you, the important thing is to have a goal and work towards it in however big a steps that are doable for you.

    • george

      I wonder how people on Kempner diet meet their daily protein requirement. Fruits have little protein. Rice has some protein but compared to protein-rich vegan foods, such as beans, lentils, and nuts, or even compared to other common grains only small amounts. And rice protein is not a complete protein, lacking sufficient lysine and tryptophan.

      • Julot

        Rice and several types of fruits combined together give you completes proteins, no problems~

    • Kitsy Hahn

      Not here to reply to your Kempner diet question, as I haven’t the foggiest. However, regarding Lisinopril…..:

      http://www.askapatient.com/viewrating.asp?drug=76180&name=LISINOPRIL

    • Thea

      ronalwgumbs: I remember reading an article from Dr. McDougall which I hope I will accurately repeat the gist of: That Kempner’s diet is for the dying. McDougall’s diet is for the living.

      What Dr. McDougall meant by that is that he will prescribe Kempner’s diet when a person is so very sick that they need an extremely limited diet ASAP to get on track or they face death. McDougall’s diet is also for sick people, but sick people who are not on death’s door. Importantly, note that same McDougall diet is also a diet that is optimal for healthy people long-term. Where as it does not appear to me that Kempner’s diet would be good long term/year after year. (Missing some key nutrients for true long term health…)

      I’m not a doctor and don’t know your situation, but I would suggest that you take a look at McDougall’s starch based diet (whole plant foods with no added salt). McDougall’s diet is going to taste better, have more options, AND educate!!! you on eating in a way that would be balanced and good to continue for the rest of your life.
      http://www.amazon.com/Starch-Solution-Regain-Health-Weight/dp/1623360277/ref=sr_1_1_twi_1_pap?s=books&ie=UTF8&qid=1439238845&sr=1-1&keywords=starch+based+diet
      There are recipes in the back of the book!

      Another similar program in the free PCRM 21 Day Kickstart program. They will hold your hand for 21 days, including meal plans, recipes, videos, inspirational messages, and a forum (moderated by a very respected RD) where you can ask questions.

      http://www.pcrm.org/kickstartHome/
      (Click the green “Register Now” button.)

      Good luck.

  • Plantstrongdoc M.D.

    Again modern medicine gives insufficient advice to patients. MD`s advice hypertensive patients to reduce their salt intake – not to avoid salt altogether

    • Jim Felder

      Or worse give the “all things in moderation” suggestion to people in our hyper consumption food culture who no real idea what moderate anything is with regard to diet.

      • Plantstrongdoc M.D.

        Exactly.
        Moderation kills! (I think that was dr. Esselstyn).

    • mike at the river

      Does chronic kidney disease (stage 3) make it hard for salt restriction to lower blood pressure? My Nephrologist suggest that rennin and many other factors from CKD also raise blood pressure. In spite of low salt, low fat, WFPB diet and meds, hard to maintain low blood pressure. Modern medicine says that nephrons in the kidney don’t regenerate when they die in kidney disease, but Kempner seems to have had good results.

  • Panchito

    On the other hand, two variables that affect dietary salt intake are physical activity and fluid intake. The higher those two, the higher the salt intake should be in order to avoid hyponatremia.

  • RicardoRichard

    Sorry, but what sort of salt are we talking about? Salt full of minerals or that refined pure white table salt? I heard that recent studies point to the contrary to what has been said here. Use Himalayan salt or Celtic sea salt or even normal sea salt and you will see good result unless you eat a kg or more every month.

    • Jim Felder

      Trouble is that most studies make big claims for the health aspects of something if it moves the health needle any amount at all. So if Hymalayan salt brings with it trace amounts of other mineral, then it is touted as being healthy, despite the fact that it has very nearly the same amount of sodium as table salt with all the same negative health impacts of any salt. The only truly healthy thing is to reduce salt intake, designer or not.

      The worst aspect of “health-washing” item like designer salts is that it confuses people into thinking that they are health promoting items and so they add more than they would without the health claims in a quest to improve their health, when in fact the health benifits are only in comparison to things that are even worse. Olive oil is probably one of the worst with its claim of being “heart-healthy”. As a result people add extra amounts of olive oil to their diets thinking that it will improve their health, when in fact it is only healthy in comparison to fats like lard that are very high in saturated fat. Never mentioned is that removing all refined fats from your diet is even healthier.

      • Plantstrongdoc M.D.

        Yes – the mediterranean diet is healthy despite the olive oil – that’s what the media and people in general dont get. The only healthy fat, is the fat that you dont eat :-)

      • RicardoRichard

        I see you are still in the world of horrible and pernicious cholesterol, so you eat 1 egg a week – I eat 20 and I am still alive and kicking. The same with lard as saturated fat that will push you to early grave, etc, etc. I am so fed up with listening to the same music. Carry on like that. I won’t.

        • largelytrue

          What an impressive accomplishment! At this time you eat a diet that is supposed to induce the progression of chronic disease over a long period of time and presently you are still alive! Golly, that’s all I need to know! None of these things can be harmful at all, then!

          • RicardoRichard

            Nothing impressive. I have been doing that for 12 years now. Read or watch Carolyn Dean, Lair Ribeiro, David Perlmutter and Jerzy Zieba. That last one eats 30-40 eggs per week. Lair Ribeiro cannot start the day without having 4-5 eggs. He calls them the second best food after human milk. Unfortunately, I don’t think they are translated into English. You will need a couple of different languages. Remember English is not the only language in the world. There are very impressive researchers but they use Swedish, German or Russian not to mention Spanish or Portuguese. Oh, and I don’t forget about grounding/earthing, sunshine, lots of veggies and fruits even though I am not a vegetarian. Besides I must be a lucky dog because when I read things about gluten – the creeps go down my spine, because I have been devouring grains for over 55 years now (I have limited them considerrably recently but I have not stopped them) and I have been slim all my life.

          • largelytrue

            If they are great researchers then they’ve argued in terms of studies, and if you are a careful person you just haven’t been convinced by a story, but have actually read some primary research from actual researchers and can vouch for some of it. Wouldn’t it have been better to lead with that than a comment that simply encloses your own bias?

            By the way, I view Perlmutter as someone who has been trying to make a living selling supplements on a thin evidenciary basis for a long time. He’s been searching for a marketing niche and found one, no? Carolyn Dean peddles supplements too. Jerzy Zieba’s “ukryte terapie” encloses a strong conspiracy-minded narrative, does it not? It’s more or less enough for me to see him endorsing the pseudoscience of Uffe Ravnskoff.

          • RicardoRichard

            Yes, indeed, you are right – Carilyn Dean, Perlmutter, Zieba and others are a bunch of idiots, peddlers,
            conspiratory theorists, etc, etc. I am biased but you are the only one of a righteous mind together with a super-unbiased Michael Greger. So keep on stewing in your unbiased juice and be happy eating only veggies and defend your position tooth and nail.

            You did not mention Jack Kruse and Lair Ribeiro who I also resorted to.

            And that Swede whom nobody wanted to help, because he dared to rise against the corrupted Establishment in
            1990s. Why are you so dishonest? And Prof Voll and his remarkable invention for diagnostics was also a fool, because he he could not agree with conventional medicine?

            Read or listen to others – Chris Kresser, or the late Gonzales or Mark Hyman and others – maybe they will sway you – they are not peddlers, or perhaps they are because they do not sing your song in unison. It is better to wear blinkers and to watch/listen to only those who you want to.

            Everything that does not agree with you belong to pseudoscience. Rupert Sheldrake or Deepak Chopra will
            explain better what it is all about because it is not only healthcare and nutrition that are at stake. The whole so-called scientific paradigm started to shake and it will fall to pieces not in a very distant future for it is unsustainable any longer. Dip into quantum physics and you will be amazed thinking that what you call science
            should have been dead and buried at least 60 years ago at the latest.

            Have a look at Kruse, already mentioned. The fact that you saw Paleo diet on his site, which acted on you like a rag acts on a bull stopped you from delving into his articles more deeply, didn’t it?

            Read the latest 2 books of ”a peddler” called Perlmutter. Obviously he has invented everything just to sell his products…

            Only those who lack counter-arguments resort to attack the so-called conspiratory theorists. Curiously
            enough those ”theories” after some years become truth (Reichstag, Pearl Harbour, Liberty, Landing on the Moon in 1969, and in health vitamin C, ozone, H2O2, cholesterol, statins. Now it is time for 9/11 and healthy fats.

            It seems to me you are a person of a closed mind so any further serious discussion is pointless.

          • Charzie

            Hate to bust your bubble, but you sound like the one with a strong agenda and biased opinions! Dr Greger just reports the actual research, for free, he has nothing to gain. He follows the findings himself, and is not pandering his opinion…or products. What is…IS, like it or not. I think it would benefit you a whole lot more to go meditate or chill out somewhere else that says what you obviously want to hear, than to come here and get all riled up because it doesn’t suit your personal beliefs. It’s your life, you can believe whatever and whomever you want, just don’t waste energy trying to cram it down the throats of those who know better.
            Since you seem to think the good Dr is biased and instead of worshiping your idols, maybe you should truly use some critical thinking and get information from others that doesn’t just echo your personal preferences, but instead is the best science:
            http://nymag.com/scienceofus/2015/06/problem-with-the-grain-brain-doctor.html
            http://www.forksoverknives.com/embracing-fat-for-a-healthy-heart-is-a-notion-based-on-flawed-science/
            https://www.drmcdougall.com/misc/2014nl/jan/smoke.htm
            http://plantpositive.com/
            http://doctorklaper.com/answers/answers22/
            http://www.pcrm.org/
            http://www.scribd.com/doc/94656/The-Comparative-Anatomy-of-Eating
            http://www.dresselstyn.com/site/studhttp://engine2diet.com/y05/
            http://engine2diet.com/
            http://nutritionstudies.org/articles/

    • Julot

      Several grams of the best salt will still give you a ridiculous amount of minerals~

      • RicardoRichard

        But I did not mean to find in Himalayan salt a substitute for all the minerals. I simply stopped consuming the so-called table salt. But there must be something to it if specialists in the matter advise us to. It has been confirmed that such salt does not cause HBP if consumed “rationally”.

        • Julot

          No salt raises BP if consumed in small amount~

  • gp65

    Hmmm a thousand unnecessary deaths everyday means one 9/11 like episode every 3 days. If even 1/10th of the time, passion and resources that were expended on war on terror were spent on war on hypertension…

    One question though in an earlier video about 4 years back you had indicated that protein needs had been underestimated in the past and actually should be 0.4 grams per pound of ideal weight. Now that would be a lot more protein than what someone could get on Dr. Kempner’s diet. You had also indicated earlier that though one might expect his rice diet to increase diabetes, in fact it had improved blood sugar control. So the only challenge with that diet was compliance because it was not very palatable.

    How then do you square the circle on the high stated protein need for a healrhy body with Dr. Walter’s diet which apparently had excellent health outcomes despite being low on proteins?

    I am very interested in this answer because currently being overweight I eat a calorie restricted diet if 1300 calories which is plant based whole food and I struggle to get the 60 grams of protein that the calculation above would have me eat. I either need to continue a PBWF diet and reconcile to eating fewer proteins than recommended or eat animal proteins to meet the protein goal. The option of eating more calories is one I am unwilling to consider at this stage since weightloss is important and necessary. So I need to understand which goal if compromised will have fewer adverse health outcomes.

    I am 5 ft 5 and at BMI. 25 my weight would be 150 (clearly I weigh much more than that).

    • Charzie

      The whole point of eating a WFPB diet is that plant foods are not calorie dense so you can eat all you want of them and NOT restrict calories and have optimal health benefits, since isn’t that what weight loss is about? Restricting calories is why dieting is notorious for failure, it doesn’t work over time. After a lifetime of “dieting”, I finally lost 150 pounds and kept it off eating all I wanted of a whole foods plant based diet, nothing processed including no fats, and no animal products. Calorie restriction for weight loss is very counter productive as it just seems to make your body cling to the calories you ingest as it would in a famine situation. As for protein, ALL plant foods contain more than enough protein, you never have to resort to eating animal products. In fact, excess protein is far more of a concern than not enough, as it has been shown to accelerate cancer and kidney disease.

      http://nutritionfacts.org/video/do-vegetarians-get-enough-protein/
      http://nutritionfacts.org/video/caloric-restriction-vs-animal-protein-restriction/

  • Jon Spallino

    As a big fan and NF.org supporter – I’m very glad to see more ‘salt’ videos are in the que. Also interested in more videos on the relationship of alcohol to HBP. Thanks for the excellent work you do!

  • baby_grand

    I can give up salting my food, and I don’t eat processed food, but where do I get a reliable convenient source of iodine? I usually buy Hain Iodized Sea Salt. ?

    • Leonid Kalichkin

      Seafood or iodine supplements. I find calcium, zinc, selenium and iodine are worth supplementing, while B12 is crucial.

      • largelytrue

        Bearing in mind that aquatic vegetation is ‘seafood’, I agree. Whatever you do you may want to try to assess your iodine status first, since excessive intake of iodine is not a good idea either. European vegans seem to have a much more difficult problem with iodine than North American vegans, due to differences in the soils in which food is grown. The historical US goiter belt doesn’t actually extend far enough south to interfere much with the main produce-cultivating states, for example.

        • Leonid Kalichkin

          Oops, I intended to write ‘seaweed’. I’m an ‘European vegan’, and I’m consuming less and less iodized salt, so I can’t rely on it anymore. I won’t overdose supplementing with 100% of RDI, I think.

    • Wilma Laura Wiggins

      There is a Japanese noodle made from seaweed that I enjoy now and then. I am pretty sure it has a fair amount of iodine. Any seaweed would also help.

    • guest

      Baby Grand: Of course, getting iodine from iodized salt is better than not getting iodine at all, but the problem with iodized salt as the source of dietary iodine is that you don’t know exactly how much iodine you get on a given day, unless you know exactly how much salt you consume everyday, which for most people is impractical. So somedays you wouldn’t get enough iodine and on others too much of it. Multivitamins have iodine. I take a kelp supplement standardized to iodine so I know the exact amount of iodine I get a day.

      • largelytrue

        Actually you might not know even if you measured the intake of added salt. Iodine will sublime directly from the salt crystals, and under the right conditions this will be nutritionally significant.

        • guest

          largelytrue: I thought iodized salt contains potassium iodide, not elemental iodine. But he iodide ion oxidizes readily giving iodine, which is especially likely if the salt is added to food before cooking. High temperature, oxygen, other oxidizing agents in the food would facilitate the process. Your point is well taken. Thanks.

          • largelytrue

            Right, and potassium iodide is explicitly mentioned as less stable in that reference. Iodate is a complex anion, while the iodide in potassium iodide is an elemental anion.

            Part of what I’m highlighting here is that losses during storage are a concern, since people on a low-salt diet may buy a container that would take a long time to use up. The data are evidently not that robust for iodate, but even there, losses could be as large as 66% after 12 months, with more loss expected for longer time frames and for hotter, more humid environments.

          • guest

            In which case, it’d be a good idea to keep the iodized-salt canister in the fridge. (At my place, one canister lasts about six months.)

  • Kal

    In my hot and dry town, when people do follow salt reduction advice and then go out in the heat they develop hyponatremia from sweating and get instructed to take salt pills (which cant be good for the stomach lining).
    If potassium intake is sufficiently high, will potassium take sodiums place in sweat?
    Any time I’ve developed hyponatremia symptoms my sweat still tasted like salt, no bitter potassium tang, despite getting like 4 grams of potassium per day.

    Some tropical cultures, like the yanomamo, just dont sweat in heat.

  • gtrdoc911

    I truly feel Dr.Greger’s pain. We know what causes most of society’s medical ailments but the majority of people chose to ignore the facts. I’m a dentist and an analogy is sugar. Who doesn’t know that sugar causes cavities? Yet many people still consume way
    too much of it and suffer the consequences.

    • Plantstrongdoc M.D.

      I agree with you, but have to say that Dr Greger is not in pain – he is a man on a mission, and my impression is that he thrives with this mission, and it must be very rewarding for Dr Greger to experience NF grow, the message is getting out, and in the end Dr Greger is a pioneer in a movement that will save millions of lives in the future – thats more than most doctors will ever experience.

      • gtrdoc911

        Of course when I say “pain” I mean frustration. Like when I see him (and others) lobby so hard at that govt panel to take dairy off the USDA recommended food groups backed by reams of data. And no results! Most of the world still believes “milk does the body good”.

  • baby_grand

    The atomic weight of sodium is about 23, sodium chloride (salt) is about 58! I wish people would specify whether it is ‘sodium’ or ‘salt’ when talking about this, as the difference is huge. 1500 mg of salt is only 40 percent sodium, or 600 mg of sodium. So which is it, salt, or sodium?

  • deepocean

    I often soak my beans in salt water overnight to soften them and reduce the bloating.
    The next day I rinse and wash the beans thoroughly again before cooking them
    with a pinch of baking soda. After that I make Indian dal along with some Hing.

    I wonder whether the rinsing and washing of the beans will wash away the salt
    or whether the salt is soaked up and retained by the beans. Thank you!

  • T

    What is the formula if you exercise and sweat a lot, don’t you loose salt, and other minerals?

  • Heidi

    So should you eat more salt for low blood pressure? I am a 55-year-old woman in excellent physical health/condition. Normal for me has always been mid to high 90s/60s, occasionally 50s. Sometimes the blood pressure cuff has to run twice to get a reading. I very rarely get lightheaded but have never passed out.

    • Wade Patton

      Mine is low too. Eating high levels of salt has never affected my pressures, so I don’t expect it to change yours. Going to get a cuff and start checking mine for fun and insight as to what, if any dietary factors affect me personally.

    • Jen Drost, PA-C, NF Volunteer

      Hi Heidi, BP chronically running 90/60 is PERFECT! You are protected, as Dr. G. says in today’s video, from all of the “normal” :( diseases that come with “normal” BP. As for the dizziness, there can be many reasons for it. Before you go “fixing” it with salt, would recommend keeping track of the dizzy symptoms (do they happen if you stand up quickly, do they happen if you’re exercising, etc.) and discuss first with your doc. Hope this helps and congrats on all of your healthy choices! :)

  • Lawrence

    OFF TOPIC: More on food waste. It is good to see positive steps in addressing this ongoing problem.
    http://www.c-span.org/video/?324925-2/discussion-recovering-wasted-food

  • Panchito

    I can see a huge contrast between Dr Greger’s approach to medicine and the US product driven approach. It is about the mentality and the difference in perspective. US politicians want more expensive products (drugs, etc.) to fix the health of individuals. They don’t see any other solution. They demand more government investment and more relaxed favorable laws towards drug companies. In contrast, Dr Greger seeks into look into the causes and avoid them (prevention), which potentially translates into saving money long term, and avoiding drug interventions (saving money).

    I am not sure if the following video is part of the one I watched the other day. Politicians try to sell the idea that we need more investments in medical products (new drugs, etc.) to get new jobs at the same time. I would like to see Dr Greger gain some short of representation there, so that we break away from a model of self perpetuating companies running the show through products and sucking up all the money. How could we get Dr Greger to those talks?

    Investments in Science and Innovation: http://www.c-span.org/video/?327348-1/forum-middle-class-investment

  • charles grashow

    http://www.ncbi.nlm.nih.gov/pubmed/25119607
    CONCLUSIONS:
    In this study in which sodium intake was estimated on the basis of measured urinary excretion, an estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake. As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a lower risk of death and cardiovascular events

    http://www.nejm.org/doi/full/10.1056/NEJMoa1311889#t=articleBackground

    http://eathropology.com/2013/05/21/the-nacl-debacle-part-2-we-dont-need-no-stinkin-science-2/

    • Joseph Gonzales R.D.

      These U-shaped curve studies have been refuted by the American Heart Association and low sodium intake < 1500 mg / day is still considered the gold standard.

  • Rhombopterix

    “Now the diet wasn’t just extremely low salt, but strictly plant-based, extremely low fat, protein, and calories, but there is no doubt that Kempner’s rice diet achieved remarkable results, and Kempner is now remembered as the person who demonstrated, beyond any shadow of doubt, that high blood pressure can often be lowered by a low enough salt diet.”

    Ahh, whaaaaa? Am I the only one who finds this statement illogical? Spock out.

    • Adrien

      I do ! It’s seems that all the people who benefit from a low salt diet are also strict vegetarian or pretty close to.
      I did post something similar here: http://nutritionfacts.org/video/high-blood-pressure-may-be-a-choice/#comment-2184453930

      I have the feeling that this will be answered in the upcoming video. So stay tuned !

    • Rhombopterix

      It does sound better in the video…i had copied that from the transcript (which i really appreciate so thanks for those).

      I guess its salt causing my 160/85 (down from 180/90 every AM) even after 20 mg Ace inhibitor, 90 Beta block, 5 calcium channel block. I’m 61, 190 lb,5’9″, strictly WFPB, 2 drink max, NO SALT ADDED for 3+ years now. Lost some 40+ lbs but still cant get the BP right.

      • S Slavin

        Just curious, have you included exercise as part of your regimen as well? Losing 40 pounds sounds impressive, I would think that for sure has a positive affect on BP even though 190lbs at 5’9″ is still officially “overweight”

        • Rhombopterix

          My BP has dropped from well over 200/120 type range. They used to look at me like I was going to blow out my eyeballs at any second. They told me I had familial hypertension and there wasnt much I could do about it. Then i heard Pam Popper say “I wasnt going to be a helpless victim of my genes” No turning back from WFPB for me.

          Exercise eh? Yeah, I’m kind of a slug I guess. I hate team sports. Hate machines. love reading and computers. Screen time…ok ok enough already…get off my back. I’ll go walk up that dam hill again. you sound like my wife, RaptorJane : ) *just kidding

          • S Slavin

            It went from 200/120+ to 160/85+ while the medications remained the same? Or you were on more more/less medication before?

            Ya walking up hills is a pretty good workout. Find a staircase somewhere and line it with magazines :).

          • Rhombopterix

            Actually my BP was in that 200 range since my early 20’s. As I remember they said stuff like it is “the high side of normal” and “your mother has high BP too”.

            I started on meds at about age 45 and they kept upping my doses until I literally started fainting flat out when I stood up. My BP looked great but I could not function in any sense of the word. Then about mid 50’s, some 10 years after burying my mother (62) I LISTENED to a person who regained her health after going WFPB. 3 months later I was down to 190 and I cut my meds to those I listed. The quack still thinks I’m taking all the crap they prescribe. Now i self-medicate using a fraction of the meds they keep trying to pump into me.

            We have no stairs…lots of mags tho. I’ll try stacking them up ;)
            I do record my bp, lets see what happens when I try tackling “Cardiac Ridge” for a while.

            thanks for asking…great fun talking about …. me

    • I think you are splitting hairs. The main point is important. People should take away from this the importance of Kempner’s pioneering work. I see you have BP issues. I suggest that you look at the labels and tote up the salt that sneaks into your recipes. same for high fructose corn syrup. Processed food is not good for people.

      Now get back to your sensors, you pointy earred galute

  • Tikiri

    Thank you. An excellent piece of advice indeed.

  • Aaron Fader

    “Salt” is used generically in this video. Refined salt is always looked at as the bad apple. But what if you never use refined salt, but Himilayan salts………… does it matter?

    • Adrien

      I suggest that you read Darryl’s older post on NutritionFacts and Jeff Novick’s answer on Dr McDougall’s Forums:
      nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131297498
      https://www.drmcdougall.com/forums/viewtopic.php?t=5966

    • Joseph Gonzales R.D.

      Agreed! From Adrien’s link you can see a chart by Darryl on pink salt. It looks like sodium is sodium in this case.

    • Julot

      No, it is still NaCl, sodium chloride

  • Guest

    Oh please studies long ago dispel myth about sodium and hbp/

    • largelytrue

      You sound biased, with a tendency toward rigid black-and-white thinking. What old, authoritative study on the proposed non-relation between sodium and hypertension do you have in mind?

      • Guest

        There are plenty epidemiological studies open google and search nation with high salt intake (except US) and check statistic, second Currently Im not in home(dont have my disc with studies) but you can for example take studies cited by http://www.scientificamerican.com/article/its-time-to-end-the-war-on-salt/ (I mean studies not article)

        • largelytrue

          I can wait quite some time until you are prepared to present what you take to be authoritative and have actually taken the time to vet for yourself. I’m of course aware that there are studies whose conclusions are nominally pro and that there are studies whose conclusions are nominally con, but this has little to do with the best interpretation of all currently available evidence. That’s part of why your appeal to “long ago” seemed strange to me.

          • Rhombopterix

            I wish I could clic the thumbs up more than once…thanks for supporting evidence-based science

          • Guest

            Ok then I will reply you on friday/saturday because then I will be at home.

          • Guest

            Sorry but currently I dont know when I will be in home but I have few reference you ask about older science about salt

            http://ajcn.nutrition.org/content/71/5/1013.full

            http://www.ncbi.nlm.nih.gov/pubmed/9928744

            http://www.ncbi.nlm.nih.gov/pubmed/10482976

            http://www.ncbi.nlm.nih.gov/pubmed/3231692

            http://www.ncbi.nlm.nih.gov/pubmed/6847013

            http://www.sciencemag.org/content/281/5379/898.summary

            The currently evidence is that any scientist who actually study salt tell you that this is myth, only people who only drawn conclusion from epidemiological studies tell you otherwise, but if you have knowledge in this field you know what a problem we must faced with epidemiological studies (correlation dont imply causation, there is so many co-factors that cannot drawn conclusion on the other hand in vivo studies dont find any correlation). Regards

          • largelytrue

            Be sure to clarify exactly what myth about sodium and high blood pressure you think that these studies dispel, too. Thanks.

          • Guest

            I dont understand your question, reference I provide you describe what salt and hypertension correlation is, I dont know honestly how can better explain you this than them. Sorry for such delayed responds but in this month I cannot post comments faster.

            Ross like always you show your incompetence and lack of knowledge. For people like you the word QUACK was developed. On your site your called sources are very poor without any true scientific meaning.

          • largelytrue

            Are you resorting to name-calling? You are replying to me, but who is Ross? Should I even try to clarify my question?

            There are a number of claims that could connect salt and hypertension, and I want to know which myth you have in mind. There are multiple correlations depending on the timescale and variation in salt intake that you are considering. Salt consumption has been correlated with changes in blood pressure over the short term and it has been correlated with age-related increases in salt sensitivity and blood pressure over longer periods of time (decades, roughly).

          • Guest

            About Ross dont read this I simply wrote in other page this comment and copy with wrong fragment. “There are a number of claims that could connect salt and hypertension, and I want to know which myth you have in mind. There are multiple correlations depending on the timescale and variation in salt intake that you are considering. ” yes but when scientist look at mechanism not one can provide proof, “Salt consumption has been correlated with changes in blood pressure over the short term and it has been correlated with age-related increases in salt sensitivity and blood pressure over longer periods of time (decades, roughly).” Over short period term exercise also increase BP this mean they are bad? Over long period we have only some information from epidemiological studies but we know that correlation dont imply causation and any study which looks at mechanism cant find such assocation that is why all mechanism about how salt cause hypertension show to be false and that is why I wrote science disprove that P.S Next time pls provide some reference to support your claims.

          • largelytrue

            …but when scientist look at mechanism not one can provide proof…
            …any study which looks at mechanism cant find such assocation that is why all mechanism about how salt cause hypertension show to be false and that is why I wrote science disprove that…

            This are additional instances of claims that sweep way beyond your likely intellectual competence. Do you seriously claim that you have examined all the literature on these topics, or that you have followed an authority that did?

            Bear in mind, again, that I am just trying to clarify your position first. It’s part of your responsibility if you seriously claim to know what you are talking about. It should be easy to say
            a) what your claim is, precisely, and

            b) what your argument is, in brief

            Have we gotten to the point where you have done that? Is your claim now that because there are no long term (presumably epidemiological) studies examining some putative mechanistic intermediary between salt consumption and age-related rises in blood pressure, the hypothesis that salt causally explains a substantial fraction of age-related rises in blood pressure, is “disproven” long ago? I don’t really see any focus on disconfirming or null, long term mechanistic study in the references that you have supplied me (some of which are simple comments that haven’t passed peer review), so your claim here seems to me to likely be based on nonexistence of such studies, rather than the existence of disproving studies.

          • Guest

            I thinkg you dont quite understand studies.

            ” you seriously claim to know what you are talking about. It should be easy to say

            a) what your claim is, precisely, and

            b) what your argument is, in brief”

            a) check my first comment.

            b)check my rest comments.

            “Is your claim now that because there are no long term (presumably epidemiological) studies examining some putative mechanistic intermediary between salt consumption and age-related rises in blood pressure, the hypothesis that salt causally explains a substantial fraction of age-related rises in blood pressure, is “disproven” long ago?” check from when they start study salt hypertension link( 1940s, Walter Kempner, MD). The facts we know is that large-scale scientific reviews have determined there’s no reason for people with normal blood pressure to restrict their sodium intake.

            ” Do you seriously claim that you have examined all the literature on these topics, or that you have followed an authority that did?” no, no I but revies you called

            “some of which are simple comments that haven’t passed peer review” they dont passed peer reviev because they ar review of scientific literature.

          • largelytrue

            they dont passed peer reviev because they ar review of scientific literature.

            Okay then, you simply don’t understand scientific process on this or pretty much any topic. Review articles and other forms of secondary research get through peer review all the time.

            I’m looking for a yes or no response about whether you are willing to defend the claim that I have focused on and presented to you. Simply repeating vaguely that your list of citations shows your position is no good, nor is a generic claim that “large-scale studies” show “no reason” to restrict sodium intake, with no qualifiers or specificity about the limitations of the large-scale studies that you have in mind, except for the addition of the qualifier that this is only true for “normotensives”. Again, I really doubt that you have large-scale trials over several decades showing no benefit from salt restriction, and if you are going to extend your claim to the long term then I will challenge you.

          • Guest

            Sorry for delays but really its hot period so dont have so much time i’d like to have to wrotes comments

            “Okay then, you simply don’t understand scientific process on this or pretty much any topic. Review articles and other forms of secondary research get through peer review all the time.” I really sorry but I think you dont understand process articles which sumarize other research dont need pass peer review(altouth they can) I know that because I published few(of course in other field)

            “I’m looking for a yes or no response about whether you are willing to defend the claim that I have focused on and presented to you.” maybe read one more time your own comments because I think you dont know what you wrote, you looking for reference from which I claim about sodium.

            “Again, I really doubt that you have large-scale trials over several decades showing no benefit from salt restriction, and if you are going to extend your claim to the long term then I will challenge you.” Im sorry but from this I can for 100% claim that you dont have no idea how science work, What you must need we dont always do studies about some question, some answer apear as a negative result in other studies like this which focusing on salt intake and dont finding such assocation,

            You wroting abou challenging me yet you dont provide any reference to support your claims(which about I ask you).

            So yes using your words “I challenge you” if you wrote about somehing support your claims with studies because you dont provide even single reference.

            “, I really doubt that you have large-scale”Then maybe check epidemiological studies looking at people diet and activities you can find plenty studies which also included salt intakes

            P.S If you have basic knowledge in science from reference I provide you, you can find reference to many studies supporing my claims, As you say you have some knowledge in this field I was thinking that was obvious.

          • largelytrue

            I asked immediately for studies because studies were the first thing that used as justification in your first comment. That doesn’t mean that bare citations are all I expect from you if you are competent to debate.

            Taking a position on my question should be simple if you have actually processed the evidence you present. Remember that you weren’t just claiming that something was uncertain on either side, but that the positive proposition was disproven, that evidence came to light which invalidated it more or less totally. That’s why you need to present strong evidence and take a stance that at least minimally reflects a competent reading of the citations that you are pushing toward me and an understanding of the positions that you are arguing against. If you’ve merely been collecting ‘con’ references like a magpie while ignoring the ‘pro’ then your opinion can merely be dismissed, because you have too much bias and too little expertise.

            I’m not responding to your other comments in this post until you get to the point and respond by clarifying your position about the “myth about sodium and hbp” that you claim was disproven: “Yes”, “no”, or “I don’t really know, I guess I wasn’t really thinking clearly about that issue when I blasted out my comment”. You basically have three choices about how to respond, if indeed you are ever going to respond at all.

          • Guest

            Hello sorry for delay.
            I dont understand your question, reference I provide you describe what salt and hypertension correlation is, I dont know honestly how can better explain you this than them. Sorry for such delayed responds but in this month I cannot post comments faster.

            Ross like always you show your incompetence and lack of knowledge. For people like you the word QUACK was developed. On your site your called sources are very poor without any true scientific meaning.

  • S Slavin

    Wouldn’t it depend on WHY a person has HBP? If it’s because of too much liquid (i.e. too much salt – not even sure why that would cause HBP), then perhaps salt would help, but if someone has HBP due to some completely different reason (out of shape, stiff arteries, etc), wouldn’t salt have no effect at all?

    Isn’t that the reason HBP medication in general is a ‘needle in a haystack’ sort of thing, where they guess the cause and just prescribe different drugs until one seems to work?

    • jj

      Of course it depends on the cause of HBP. I know people on the WFPB lifestyle that have cut out salt and only get the sodium from the food. They ended up with too low of a sodium blood level. And it did not lower the BP.

  • joe

    thank you as i pointed out before the entire success of kempners diet was due to the extreme salt restriction , not the rice or the fruit

    • Rhombopterix

      How do you know that?

  • Not Always

    “Kempner is now remembered as the person who demonstrated, beyond any shadow of doubt, that high blood pressure CAN OFTEN BE lowered by a low enough salt diet.” May Be and Can Often Be does not mean it always will. Sodium is not the only culprit. That is reductionist science which is not healthy science.

  • Robert Haile

    I have not had NaCl for years. Since we make our foods and meals from scratch and almost all our main meals contain tumeric, ginger, garlic, onions, beans, and most of our diet is vegetable. I even make Hibiscus tea. I exercise moderate to hard about 2 hours/ day and meditate 1 hour daily but still need maximum doses of 3 drugs with no history of kidney disease. My mom was the same. My BMI is usually 25-26 with years of developed muscle. My brother eats terribly but has no health issues.

  • Rita

    Thanks for all the information Doc that you, your staff and volunteers provide. I have been looking for the definitive minimum amount of sodium required and it is finally answered here – 500 mg per day. Thank you Doctor Joseph. I would also like to comment on the illustrations that are displayed at the beginning of the videos. I’ve been enjoying someone’s creativity. I particularly like the skull and crossbones drawn in salt on this one.

  • m_a_bloom@yahoo.com

    What about iodine? Don’t most table salt brands include iodine? I have read that many vegans are iodine deficient.

    • I think this is a good question. You can get your iodine status checked and if low are not some seaweeds able to restore. Maybe you could find out and post for those with a concern about it?

      Also, is the iodine in salt of the form NaI? if so can we buy sodium iodide, carefully dilute it to the right proportion and consume in our food…why must it tag along with salt?

    • Joseph Gonzales R.D.

      Perhaps that’s one advantage of using iodized salt. I have a post about iodine, including sources and supplement considerations. Throughout the post I have many links to other videos on iodine deficiency. Note that iodine overload is just as bad! Let me know if any of the resources help?

      Thanks,
      Joseph

  • Bj Reed

    My BP has been trending down, seemed like a good thing (around 105/65), occasionally dropped to 80/45 then I would get lightheaded and weak. After awhile this low BP was occurring twice a week or so, causing me to curtail daily activities. I went to my plant-based PCP but she could not diagnose a problem so referred me to a cardio consultation this week, I’ve never been before. I have been diagnosed with MVP years ago, last echo was 7 years ago. I don’t want to take unnecessary tests, I’m a minimalist as is my PCP. On the other hand, I’d like to determine whether it’s a heart issue or not. Any thoughts?

    • jj

      I don’t like tests either but when it is the only way to know what is going on in the body the test is then necessary. Can’t fix it if you don’t know what is wrong.

      • Bj Reed

        My PCP said that echo, stress test nor EKG would show anything, not sure I understand that? When I suggested upping my sodium, doc said no, they were looking at my blood work…all was good. I see some people here have low BP, where you checked out for heart issues?

        • Hi Bj, I’m guessing that MVP stands for Mitral valve problem? If so doesnt that suggest that your heart not efficiently moving blood through the pipes? That would be consistent with low BP.
          I’m certainly no expert so take a grain of salt with this.

          The one place that modern medicine is good is doing surgical repairs and there is often a good surgical fix for failing valves. just dont wait too long to get a good pro involved!

          • Bj Reed

            Mitral valve prolapse…was diagnosed in my early 20s but I understand many people have murmurs. Had an echo probably over 7 years ago, my PCP said she couldn’t hear it these last few years so she never recommended another test. I’m going to see a cardio this Thursday.

        • jj

          An echocardiogram is a type of ultrasound and it shows how much the heart is pumping, the valves working and much important information on the workings/health of the heart. It is an easy test. If you had valve problems in the past I would have it rechecked. Very important. Don’t delay.

          • Bj Reed

            I know, I don’t know why they said it wouldn’t help them to diagnose my situation, hopefully it would at least eliminate some type of major issue, etc.

        • Joseph Gonzales R.D.

          Hi BJ. I would side with jj and Gregor and revisit your doctor. There is probably a very good reason why they think just boosting salt won’t do the trick. Do not add salt till everything else has been ruled out. Best of luck and warm wishes! Joseph

          • Bj Reed

            Thanks. They were looking at my blood work when they said I don’t need to increase my salt, so guess they saw it was ok.

        • dorange

          I have MVP, too, echo with doppler is OK and non-invasive, no drugs or anything, just an ultrasound of the heart and blood flow. I have low BP, too, and sometimes a real drop after a meal – never understood why… My “remedy” is coconut water, good source of both sodium and potassium. Symptoms of low blood sugar are similar, so check it out. In any case, coconut water is what I have when I feel something is not right.

          • Bj Reed

            Thanks for sharing dorange. I did go to plant-based (well not entirely anymore) cardio, had EKG (was OK), scheduled Holter monitor and echo in a few weeks. He said he is “vexed”. I asked if it could be less stress in my life (I was my Mother’s caretaker, passed last Nov), he said could be as the body produces hormones to compensate with less stress, hormones readjust…so? He mentioned Gatorade when exercising, I thought ugh… have you ever looked at ingredient lists. I’ll certainly check out coconut water, hopefully not a lot of additives and sugars? My BP is always low after I’ve relaxed in the evening, as well as other times.

          • Veganrunner

            Hi Bj-I am with you on the Gatorade. Pure junk. I like coconut water on my long runs. Or pure water and a date or too if going long.

          • Bj Reed

            Sounds like something to look into, thanks.

  • john bruneau

    The Yonomami have a life expectancy of 45 years. Does moderate salt intake = longer life expectancy ?

    • John, are you really asking a question or are you trying to stir something up? Can you think of a reason why those folks live such a short time? Maybe several reasons? yes you can.

  • Thule

    Well. what about this?

    https://www.youtube.com/watch?v=nbxooeQttKw

    https://www.youtube.com/watch?v=cT133MAEjzo

    https://www.youtube.com/watch?v=yZ3hS9jpmm0

    Then there is also the fact that people following Dr. Fuhrman’s diet found themselves hospitalised because lack of sodium. Severe electrolyte imbalance.

    Also I consume normal amounts of salt, all my life kept low/average blood pressure, In fact when I take foods that lowers that pressure, many times I get dizzy.. sudden drop. Not nice at all.

    Some individuals are hypersensitive to sodium, but that cannot be extrapolated to the rest of the population. People gets high blood pressure from arteriosclerosis, salt as Dr. McDougall says, is a scapegoat.

    • Yeah, I also lean toward McDougall on this one. There’s no doubt that eating salt raises a person’s blood pressure, but I’m not convinced that this high blood pressure is a causative agent in terms of heart disease. Correlation does not equal causation. I think if a person is eating a zero cholesterol diet, their blood pressure doesn’t matter all that much. I’d like to see some research that weeds this out, but I haven’t been able to find any. The evidence in the Dr. Popper video you linked seems to support my assertion.

      • Why do you think that…zero cholesterol diet , then BP not important. How did you arrive at that?

        • Because high blood pressure doesn’t do anything on its own. For example, high blood pressure doesn’t cause narrowing of the arteries, it’s a symptom of narrowed arteries. High blood pressure doesn’t cause aneurysms. Aneurysms are related to atherosclerosis, and atherosclerosis obviously raises blood pressure because the blood has to pass through narrower arteries. So here we have correlation but no causation.

          When salt raises blood pressure, it does so in a way that is completely unrelated to atherosclerosis. Salt raises blood pressure through water retention, and I’m not convinced this is inherently harmful. Having high blood pressure due to atherosclerosis is obviously bad, but having high blood pressure due to water retention… I don’t think there’s any evidence to show this is dangerous.

          • I can see you’ve thought a lot about this. thinking is good…in a lot of cases.

          • largelytrue

            Do you have evidence for your claim that raised blood pressure is completely unrelated to atherosclerosis? It seems obvious that hemodynamic stresses promote aspects of the process, and if you are following the reasoning behind the scientific consensus closely I don’t see how you could have missed that.

            Do you have evidence that aneurysms can’t be caused by high blood pressure in the context of high dietary sodium? Bear in mind that this doesn’t rule out the fact that atherosclerotic processes seem to be a cause of aneurysms as well, since aneurysms can be caused in multiple ways.

          • My argument isn’t that high blood pressure doesn’t matter. My argument is that high blood pressure caused purely by water retention due to sodium intake, in the complete absence of atherosclerosis or other diet based damage to blood vessels, doesn’t matter. And that’s because I can’t see how water retention alone could cause BP to rise into danger zone levels if a person’s blood vessels are totally clear and functioning normally on a vegan diet.

            I mean they would literally have to be eating tablespoons of salt out of a salt shaker for that to matter.

          • largelytrue

            I know that’s your argument, but I isolated two claims that you made in support of it and asked for evidence.

            You are also veering toward an argument from ignorance. Just because you don’t see how something could be true doesn’t mean it’s false. It can just mean that you haven’t investigated enough.

            You are also fixating on “water retention alone” in a strange way. There are other possible mechanisms by which high consumption of salt might weaken the arteries, right? That could just be a way in which the arteries respond to excessive exposure to sodium in the serum over time.

          • largelytrue

            Which studies in particular do you want to use in support of which of the two claims?

          • Randomized control trial meta analysis: http://ajh.oxfordjournals.org/content/24/8/843

            No increased morbidity from hypertension related disease.

            Meta analysis, no evident linkage between salt intake and hypertension: http://www.jrnjournal.org/article/S1051-2276(08)00439-1/abstract

            So here we can see, according to these studies, that salt raises blood pressure but does not in itself lead to hypertension, which supports my argument that salt acting on its own is not problematic. And we can also see that high salt intake on its own does not lead to increased morbidity from hypertension, which also supports my argument. And that first study is from randomized control trials, not population studies like Greger is citing.

          • largelytrue

            The latter study isn’t even a meta-analysis in the ordinary sense of the word. Dumler presents no careful statistical aggregation of the results of studies that he discusses, but is instead referring to this meta-analysis, which doesn’t even report on the development of hypertension per se. Nor do I think they can necessarily find it given the relatively short duration of 7 years at most and the poor control for other variables. As the statistics show in the error bars on the meta-regression coefficient for sodium excretion and as the authors themselves say, the number of studies is small and the effort to relate sodium excretion with blood pressure in their analysis is statistically weak. Large changes in blood pressure, such as would be required to shift a typical nonhypertensive participant into hypertension at a particular point in time, are likely explained by other effects of the interventions beside the achieved salt restriction of 25% intake at most, though the authors do remark that in the included trials, salt restriction does seem to allow hypertensives to go off their medication. That isn’t the truly long term and cumulative effect of salt consumption that may underly the development of salt sensitivity as a result of salt consumption, but it confirms the idea that salt restriction can change the rates of hypertension in hypertensive groups to something substantially less.

            The Cochrane review has been updated, but if you’ve read the 2011 paper then you’ve surely noticed the conclusion, which also remarks on statistical power:

            “Despite collating more event data than previous systematic reviews of RCTs (665 deaths in some 6,250 participants) there is still insufficient power to exclude clinically important effects of reduced dietary salt on mortality or CVD morbidity. Our estimates of benefits from dietary salt restriction are consistent with the predicted small effects on clinical events attributable to the small BP reduction achieved.”

            As for the update, they report similar problems with statistical power and the like, but the outcome effect for morbidity (number of events) is nearly significant at the 95% confidence level for both hypertensives at both end of trial and longest followup, while the pooled result of studies for hypertensives and normotensives showed a statistically significant benefit for the intervention at longest followup, with no heterogeneity. In fact if you look at Comparison 1, all estimated effects on disease favor the intervention, though they don’t always reach statistical significance due to relatively low statistical power. Taking the meta-analysis at face value as indicating what sodium restriction does for risk over the long term (and not merely the effect of attempts to get free-living patients to reduce sodium), it actually suggests that sodium restriction is more likely to be beneficial than not.

            I hope for your sake that you understand the value of cross-cultural comparisons in understanding chronic disease. While we will never have in hand an RCT measuring how smoking or salt consumption affect health from cradle to grave, stable, homogeneous cultures can show you exactly the sort of blood pressure trajectories that are produced by that particular gene pool and lifestyle. It’s hard to control for confounding variables, meaning that it’s important to look careful for other information about pathogenic mechanisms, but provided that the relevant differences between populations are properly accounted for and controlled appropriately at the statistical level, you can make useful inferences about very long term effects that an analogous RCT might never get to explore for reasons of cost or ethics. And absent RCTs on the exact question about chronic disease that you are interested in, you may simply have to do the best you can in interpreting the best available evidence at this time in order to be prudent about your health.

          • Hey, I agree. Not eating a pile of salt with every meal probably has some small benefits associated with. That said, we can clearly see that the effects of salt are so small as to be incredibly difficult to tease out in scientific studies. In my opinion, sites like NutritionFacts should not be focusing on getting people to reduce their sodium intake since the benefits of this are largely undetermined, if they exist at all. And the downside of this is that it makes the diet being recommended EXTREMELY unpalatable.

          • largelytrue

            The effects on blood pressure are not necessarily that small. In the Cochrane review, sodium excretion was only estimated to go down by 27.81mmol = 639mg per day in pooled results, and only 20.48 = 471mg per day in hypertensives. I think the difference is likely explained by the hedonic barriers that you allude to, which reduce compliance especially in hypertensives, who are more likely to be the ones attached to excessive salt consumption in the first place.

            The benefits of salt restriction are better determined than you may think. As I’ve pointed out, thviere is no long term RCT on smoking, but we still recognize long term harms and avoid the practice based on other lines of evidence, including “population studies”.

            As for a low-salt being “EXTREMELY” unpalatable, I think you need to qualify your claim. Tastes do seem to adapt to a systematically reduced level of salt in the diet in important ways that help the palatability of a salt-reduced diet, even if unsalty foods are less palatable to those accustomed to heavily salted food. See for instance references 50 and 51 in this general review on the effects of dietary sodium reduction on flavor. The section on sodium reduction strategies is also probably worth reading.

          • To me, if the effects were substantial, they would have shown up as being significant in the studies. Humans have salt receptive taste buds for a reason. Sodium plays a role in a huge number of biological processes. We are adapted to eat salt in the same way we are adapted to eat carbohydrates. Adding a reasonable amount of salt for flavor to a whole food diet, in the absence of disease, isn’t likely to cause any problems. That’s what the science says. Again, I’m not advocating people go pound McDonalds french fries here. Also, iodine added to table salt is a necessary nutrient that isn’t readily found in whole foods.

          • largelytrue

            Simply saying that if the effects in a statistical study were substantial, then they would be statistically significant is fallacious, no?

            Serum cholesterol also plays a role in a large number of biological processes. This includes disease processes when levels are excessive. The science recommends sodium restriction for the general population of the US according to the CDC, NIH, AHA, American Stroke Foundation, American Kidney Association, and many other organizations. What is a “reasonable” amount of salt according to the science in your book? What is the approximate amount separating “reasonable” from “unreasonable” additions?

          • The significant difference between salt and cholesterol is that humans make their own cholesterol and we don’t have taste receptors for cholesterol. As for the recommendations, clearly people who are eating the standard american diet should reduce their sodium intake. However, this discussion isn’t about them. To me, reasonable is around 2300 mg daily intake, which translates into about a teaspoon of added salt and that also falls within the Dietary Guidelines for Americans recommendations. Although I doubt doubling that would have any consequences for someone eating a whole food plant based diet.

          • largelytrue

            So you aren’t actually confident that arbitrary amounts of salt are safe on this diet, correct? And do you think the safest limit for the general population on this diet, no matter the presence of common genetic polymorphisms in e.g. American blacks that predispose to hypertension, is probably around 2300mg? Do you still insist that salt loading won’t introduce people on this diet to greater risk of hemorrhagic stroke as caused by bleeds from a cerebral aneurism, or are you allowing at least that this has a meaningful chance of being true?

          • I’m confident that in the absence of other medical issues, and if a person is eating a low fat vegan diet, the amount of salt they consume has a negligible impact on their long term health – for any race. Consider that if a person is hypertensive, they have a medical issue and should not consume additional sodium.

            Of the 30,000 people in the US who have strokes every year, how many of them do you think had BMIs in the normal range, were non-hypertensive, exercised regularly, ate a low fat vegan diet, were drug/alcohol free and had no known medical conditions – yet still had a stroke because they ate too much salt. I’d wager that number is around 0.

          • largelytrue

            But you also wager that nothing about long-term salt consumption can cause hypertension in the context of this diet, and that nothing about salt can weaken vessels? And again you are veering toward an argument from ignorance. It’s rare to be able to confirm the status all the lifestyle factors you mention in a stroke victim, and the particular lifestyle you mention is quite rare, particularly if we are talking about one that is maintained over the bulk of life. You don’t want to insist that it can’t happen because it hasn’t come to your attention, because our capacity to observe and confirm this sliver of the population is quite limited. Meanwhile there are forms of indirect evidence, including controlled trials, that suggest that salt can cause hypertension in some individuals even in the context of a whole food plant based diet.

            Can you consistently reject studies on salt-loading in chimps as suggestive of salt loading in human physiology, yet accept unspecified data on “no ill effects” in Korean soldiers under feeding conditions that prevailed for a short period of time as strongly suggestive that high salt consumption over the entire lifetime has no “ill effects”? I mean, you’ve said that anything but a controlled clinical trial is meaningless to you on the question of healthy salt consumption, but based on other things that you’ve said it doesn’t seem like this is actually so.

          • I’d wager that a person could not become hypertensive based on salt intake alone. Of course, the nice thing about blood pressure is that we can monitor it, so that if a person does through some random act of God become hypertensive due to sodium consumption alone, they could then take steps to reduce their sodium intake.

            “Meanwhile there are forms of indirect evidence, including controlled trials, that suggest that salt can cause hypertension in some individuals even in the context of a whole food plant based diet.” – that’s just not true. Show me the study and I’ll shut up about it.

          • largelytrue

            We were looking at some them, Michael. Controlled trials in the general population are in general suggestive of what would happen in the context of a whole food plant based diet, especially where we would expect the relevant biological mechanisms to be similar, as is the case in many non-ischemic diseases. No, it is not an ironclad observation, but it is indirect evidence. For crying out loud, we are in the discussion section of a video that refers to the INTERSALT study in thinking about how salt may affect blood pressure trajectories in whole-food plant-based diets. The AHA presidential advisory that you were referred to cites scores of trials, and DASH-sodium by name (DASH is fairly close to WFPB, all of observable modernity considered). I was asking you about chimps in part because I want to show you a study that also helps to structure thinking about the effect of salt loading in plant-based diets, but it’s pointless to do this if you are just going to declare an entire method of research as having no validity on the topic, despite its obvious importance in other areas of scientific consensus in medicine.

            I’m willing to show you some of the sources that I find to be useful, but if you are now willing to accept a broader base of evidence on the ‘con’ side in order to be consistent about how you evaluate the ‘pro’, part of what you are going to have to do is take the time to reconsider those arguments that you before rejected out of hand because of the type of study that they examined and the stance that they took on the issue.

            Lastly, I want to point out that your acceptance of the idea that salt raises blood pressure on a whole food plant based diet is a tacit admission that it probably causes cases of hypertension. I’ve said this before, but let me reiterate more clearly. You seem insistent that there’s no risk from elevated blood pressure in prehypertensive categories (another can of worms…), so you probably presently accept that on a whole-food plant-based diet, blood pressure can naturally vary within the sub-hypertensive range. Indeed, the reduced but still substantial odds ratios for hypertension in the vegan arm of Adventist 2 are suggestive that a whole food plant based diet by itself does not preclude hypertension. If there are people in the prehypertensive category and salt loading can increase blood pressure in some of these people, it pretty much follows that salt loading can push people on this diet from the prehypertensive category into the hypertensive category. In other words, salt is a cause of hypertension on a whole food plant based diet.

          • jj

            “the vegan arm of Adventist 2” does not equate to a whole food plant based diet. I’ve been to their cooking classes. Just to name a few things that really surprised me is cooking with and using oil is fine. It also does not equate to no junk food or processed foods. They use vegan butter and mayo.

          • largelytrue

            So you think that oil causes high blood pressure? As far as I recall it doesn’t except insofar as it promotes obesity (and they adjust for BMI), but I’d be interested if you have credible information that says otherwise.

          • jj

            “So you think that oil causes high blood pressure?” – No just their not always so healthy vegan diet. HBP is not caused by just consumption of salt. Some people are salt sensitive but to many/most its consumption does not equate to HBP.

          • largelytrue

            Of course there are other causes. I wasn’t claiming that salt is the sole cause, just pointing out a particular piece of evidence that in lifestyles that likely have a lot of the pressure-raising factors ruled out but are not explicitly prohibitive of salt, hypertension still exists.

          • Yeah, but your typical vegan consumes a boat load of fat in their diet, so just being vegan doesn’t mean much. You can subsist on a diet of french fries and potato chips and still be called a vegan, and obviously still put yourself at risk for a myriad of diseases by doing so.

            I do agree with the vast majority of what you’re saying – that salt can raise blood pressure and lead to hypertension for some people. And what your saying is true and of immediate concern for the vast majority of the American population. However, I’m making a very nuanced point here. My point is basically that since a whole food diet is naturally so incredibly low in sodium, that adding back in some sodium to improve taste isn’t going to do much as long as its kept to reasonable levels and the person doesn’t have other risk factors at play.

            I looked up those chimp studies you mentioned. Found a 2007 study that’s probably what you’re talking about. circ.ahajournals.org/content/116/14/1563.full

            Interesting research.

            “Over the 2 phases of the study, blood pressure fell for the control group (standard diet), but the intervention group (reduced sodium) experienced a larger fall. Without adjustment, the differences in falls between the 2 groups (intervention minus control) were −10.9 mm Hg (95% CI, −18.9 to −2.9) systolic, −9.4 mm Hg (95% CI, −16.1 to −2.8) diastolic, and −9.3 mm Hg (95% CI, −15.9 to −2.6) MAP for a sodium reduction of 122 mmol/d (P=0.007, P=0.005, and P=0.006, respectively). Adjusted for age, sex, and baseline weight (Figure 2), the analogous numbers were −5.7 mm Hg (95% CI, −12.2 to 0.7) systolic, −4.4 mm Hg (95% CI, −9.6 to 0.8) diastolic, and −4.8 mm Hg (95% CI, −10.2 to 0.7) MAP (P=0.08 to 0.10).”

            To me, the impact is pretty minimal for such large decrease. 5.7 points adjusted? A 122 mmol reduction in sodium is over a teaspoon of table salt. So yeah if you dump an entire teaspoon of salt on your veggies, I could see how a person could end up with a 6 point higher BP because of that, but who does that?

          • largelytrue

            There is an established tradition of sodium research in chimps but I was referring to an earlier study where they weren’t on a biscuit diet. At peak feeding most chimps got up to about 8g NaCl a day (levels reminiscent of average intake in the US and low intake in contemporary Japan) because they typically consumed about half of their salt supplement. You ask:

            A 122 mmol reduction in sodium is over a teaspoon of table salt. So yeah if you dump an entire teaspoon of salt on your veggies, I could see how a person could end up with a 6 point higher BP because of that, but who does that?

            People who’d do that would be people who are holding dogmatically to the sat-fat and cholesterol connection and thinking that they are absolutely protected from any hint of cardiovascular disease by their current dietary choice, or who are otherwise inclined to hold to the idea that the issue of dietary salt is generally irrelevant to health. You yourself were somewhere in that general region, I thought:

            My argument isn’t that high blood pressure doesn’t matter. My argument is that high blood pressure caused purely by water retention due to sodium intake, in the complete absence of atherosclerosis or other diet based damage to blood vessels, doesn’t matter. And that’s because I can’t see how water retention alone could cause BP to rise into danger zone levels if a person’s blood vessels are totally clear and functioning normally on a vegan diet.

            There are also the people who just kind of don’t care or are unaware/uninterested in investigating the recommendations of public health authorities. At 3 meals a day, I know people who get more than a teaspoon of salt from the shaker quite easily, before considering what’s in their meat, bread, soup and cheese, and what they may regularly add to popcorn that they eat while enjoying a DVD. Then there are people who are making healthy changes in their diet, but in losing out on the powerful tastes of sugar and fat, wind up leaning heavily on salt.

            Salt denialism (of varying shades of reasonableness) is apparent to me both in popular magazines like Scientific American and Forbes, and main news outlets such as the New York Times — between the issue of salt and the issue of dietary cholesterol, and a man named Gary Taubes who connects them, the NYT has been swinging hard and batting empty on nutritional credibility in my opinion. You can also get friendly info from a VP of the Salt Institute here.

            Part of what I think that human civilization shows when set beside the behavior of many animals, including chimps and gorillas, is that we are inclined to overconsume salt because we are adapted to an environment where salt resources were scarce. Plants in general have pretty mixed feelings about concentrating salt from the soil into their bodies, while land animals are pretty much stuck with inherited dependencies on having a bodily ocean of oceanic salinity, and require sodium to grow and reproduce these oceans. Just as with refined oil and refined sugar, we have a latent preference for consuming hyperpalatable foods 24/7, which drive our intake to unhealthy levels, and we must stand guard against it with some measure of care.

            Since you have mentioned McDougall in this discussion, let me say that I tend to agree with him (or only slightly disagree) on a lot of practical things, including his apparent position that the relatively low BP of around 110/70 is a desirable target if pursued the right way, a position which is largely congruent with that of the AHA’s claim of progressively increasing risk from around 115/75. I prefer to bias my consumption in the direction of discipline and physiologic levels, but I also tend to agree that some amount of salt and sugar on the surface of food is a relatively cheap nutritional strategy for making a change to a much healthier diet, particularly when diet-induced sickness is becoming acute and you really feel you need to change now, which is a relatively normal situation in his program. I don’t think that his 2008 figure of about 1600mg/day on the McDougall diet over the long term is especially unreasonable, either. So it isn’t my intention here to demand that people avoid salting their food at the table, just to have people recognize that oversalting is a real danger that likely carries some real risks, both in connection with BP and not. A gradient of health still exists with respect to salt, and we should be careful about how we think about it, since a gradient of pleasure also exists with respect to salt, and has already influenced discourse in society at large.

          • largelytrue

            And to clarify about the Cochrane review, the review is most specifically focused on the question
            of whether salt reduction interventions are effective in primary care and whether the effect can be attributed to the change in blood pressure.
            They break down the results into two groups to identify whether the quality of the evidence and the estimated relative risk reduction from intervention should be judged differently for normotensives vs hypertensives. However, they do not explicitly make a statistical comparison of the relative risk of morbidity between normotensives and hypertensives in either the control or intervention arms, not even in the 2011 review. I do not see how you are drawing that particular conclusion from the text of the meta-analysis.

      • Joseph Gonzales R.D.

        When I watched the video it seems Dr. McDougall says the only reason why simple sugar and salt were added was to get folks to eat the food! He even says 1,000 mg was the norm in his clinic, if I heard correctly? I still think salt can be an issue. Of course it depends on the totality of the diet and individual response but it’s pretty clear a lower sodium diet is preferred and maintaining a normal BP is important.

        • At his clinic, he does use a low sodium diet, but he also said that Korean soldiers were studied eating a diet of 11,000 mg with no ill effects. I didn’t hear him say one bad thing about eating a normal salt load of 3-4000 mg a day. And why don’t you provide me with some research links that support your claims. I just want to read the research for myself. And by that I mean I want to see research that shows negative effects from high blood pressure alone, caused by purely salt based water retention, where cholesterol and saturated fat are controlled for. As far as I know, such studies don’t exist.

          • Joseph Gonzales R.D.

            Click on my hyperlinks I usually put them in my comments. Can you not see the one above? (sometimes they hide).

            I’m not sure the AHA study I linked addresses exactly what you desire, but it lays out enough information to suggest a lower salt diet.

          • That doesn’t tell me anything other than saying a meta analysis was done on observational studies which found that people should reduce their sodium intake. To me this is worthless information. I want to see medical ward studies or controlled trials that show high blood pressure from sodium alone, where the effects of cholesterol and saturated fat in a diet are controlled for, are responsible for heart disease. I’m not seeing that anywhere.

            Salt will not give you a heart attack or do anything bad to you, saturated fat and cholesterol will.

          • largelytrue

            So have you jumped from the claim that salt-mediated rises in blood pressure are due to fluid retention and not harmful, to the position that no, salt doesn’t affect BP at all? What is your position?

        • Thule

          I am in the impression that Dr. Greger (as happens with Dr Fuhrman) is against adding any salt to food.

          Frankly I am 100% with Dr. Greger in everything else, but I don’t see the evidence for this. And in fact, it is know that can be dangerous. (I was no kidding when I commented that folks found themselves hospitalised with electrolyte imbalance following that recommendation from Dr. Fuhrman)

          I don’t see that the case is settled for recommending 0 added salt.

          (Of course folks who are dying of hypertension, are another matter, but salt isn’t the guilty one there, is their arteriosclerosis. Salt acts there more like the canary in the mine.

    • Salt is required for life to continue. So if you dont eat any salt you will die. If you loose more salt than you take in you will die. Like the very first Star Trek when that woman thing with suction cup fingers almost sucked out all of Bone’s sodium. Close one.

      Fuhrman’s diet really made people sick? He always seemed a bit shaddy to me. And Macdougall! MacDougal bugs me with his hard edge and redefinition of starch. Hes got that same slow burn going that his haggis stabbing bro’s barely keep a lid on. ~Aye, its nay a starch if i see tis nay a starch laddie. Be that clare nuff fer ye Jimmy? arrrrrr

      • Lawrence

        Close, indeed! Thanks for the memories…

      • Mike Quinoa

        Your post gave me a good laugh, but Dr. McDougall’s ethnicity is actually fighting Irish.

        • Irish Haggis
          1 sheep, shaved and eviscerated
          90 pints of Guinness
          30 pounds of oatmeal
          1 sack of onions, chopped

          Soak a shaved sheep in 80 pints of the Guinness. Roll the sheep in a mixture of oatmeal and onion. Dig a pit in the back yard and build a fire. Roast the sheep for 8 to 10 hours and drink the remaining ten pints of Guinness. Discard any hairy, bony, or hoofy parts of the sheep, and serve with boiled potatoes, cabbage, and plenty of Guinness.

          Collected by Bert Christensen
          Toronto, Ontariohttp://bertc.com/subfive/recipes/irish.htm”A good haggis Flynn but tat Cheviot twas a bit starchy and stuck in me troat!”

          • Mike Quinoa

            Ha-ha. Seems like a waste of 80 pints, but sounds like it would feed the multitudes.

    • Joseph Gonzales R.D.

      Hi Thule. Thanks for posting the video links of some recognizable doctors. If I was not mistaken didn’t Dr. McDougall say “our clinic uses about 1,000 mg?” That is pretty low, no? Here is a great explanation why 1500 mg per day is a good norm.

    • Lawrence

      Good posting, Thule. In addition to Dr. Popper’s advice on sodium, her other takeaway is the collusion between Big Pharma and the FDA (its wholly-owned subsidiary) as detailed in this book:
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046551/

  • 129 comments in less than 15 hours. People seem to be interested in salt and BP. I wish I could be at a high level food conference and hear what all the professors have to say about Dr. Greger’s work. Harrumph!

    BTW/ I know about Big Sugar…but there is no Big Salt? What drives food processors to add so much salt? We really can’t eat a lot of restaurant food now because of the overwhelming salt load.

    • Lawrence

      Ah, but there is Big Salt. If you’re a glutton for punishment, you can sit through a few hours of the 2015 Dietary Guidelines public comments. Big Salt is in there and-as expected-pushing to increase salt intake guidelines. This meeting is actually quite interesting, a real ‘mash-up’ of black-hat special interests with sharp elbows looking to keep their snouts in the trough. Lots of WFPB foodies as well, including Dr. G, PCRM, celebrities, et.al. Worth a view; once is probably enough!
      http://videocast.nih.gov/summary.asp?Live=13448&bhcp=1

  • Susan C

    After exercise and sweating my body is covered in salt and my assumption has always been that I need to replace this loss of salt to, among other things, ensure that I don’t get leg cramps. I use pink Himalayan salt. Should I not be doing that? Is the sweating of salt perhaps an indication of too much salt? But then how do I prevent cramps? I have a “normal” blood pressure and a plant based diet.

    • My father used to work in a glass factory near the big melt tanks. I visited there, it was like 120 degrees. The company handed out salt tablets like candy. I remember vividly the thick encrustation of salt on the brim of his hat when he came home.

      All living things, including plants, try to maintain a narrow range of salt concentration. So if you eat plants you are getting the right amount of salt UNLESS your lifestyle tends to move your salt concentration outside of the optimal range.

      If you sweat out a lot of salt then you need to replace it. Some people experience actual salt “hunger”. If you can listen to that you may find it to be an effective way to stay in balance and minimize the cramping.

      I would add that leg/calf cramping during exercise is a symptom of atherosclerosis. How old are you? Maybe you should post a picture of yourself after you’ve been exercising quite a lot? For science.

    • Wade Patton

      Your body will conserve salt and you sweat will not be salty when you consume less NaCl. My sweat isn’t salty enough to burn my eyes and I sweat a lot. I drink water and tea all day long while working outside in this heat (surveying).

      Yes, salt tablets were given out-in the recent dark ages when smoking was likewise promoted.

      • jj

        When I lived in Georgia wasn’t used to heat plus humidity. Rather than salt tablets I found that dill pickles worked just fine and tasted so much better.

  • Danilo

    What if you have too low blood pressure, how can you raise it?

    • Good question, especially considering recent study reports about higher mortality with low salt diets.

  • Rodrigo Cardoso
  • Noe Marcial

    How salt increase the blood pressure in long tem? Witch is the mechanism? I undertund the short increase in blod pressure in short time. Thank you!

  • Sebastian Tristan

    I have been wondering this question for ages. My girlfriend is a big proponent of a no-salt diet. I agreed to it but I always thought we humans always needed at least a bit. So from now on, back to no salt. The good thing is that thanks to spices and (in my case but not my girlfriend’s) dulse, our meals can taste good even without salt.

  • MysticCowboy

    Okay we have an extremely low calorie vegan diet that lowers blood pressure. It also happens to have low sodium, and low fat, and low protein. I’d hardly call that a controlled study. I seem to remember vids that mention that Kenyans eating traditional diets had no heart disease. Then there’s the China Study. All the whole food very low or no animal product diets seem to have the same outcomes. The Okinawans are about the longest living people on earth and regularly eat seaweed, which is high in salt. This video doesn’t convince, as too many other populations are free of cardiovascular disease, or nearly so. Were they tested for low salt intake?

  • K

    My BP is great (100/60!), but my partner has isolated systolic hypertension. It’s improved after removing most salt and adding exercise, and we already eat a whole foods, plant-based diet. He used to be closer to 150/80, and now he’s in the 130s, over 60. He’s happy his diastolic is now ideal, but wonders/worries about his systolic. Anything else we can do? Not interested in taking meds.

  • The Detonator

    This makes me so sad. I really, REALLY love salt. Keep your sweets, I have a salt tooth.

  • Jeff

    When Dr. Gregor talks about people like the Yanomamo who eat close to an ideal diet and get lots of exercise, I often wonder what their life expectancy is and more importantly what their major causes of death are (aside from environmental hazards that must exist in a rainforest). If they dramatically reduce the presence of the major killers in the West then what gets them in the end???

  • Lisa in NC

    Braggs vinegar and a combination of kyolic garlic 109 keeps mine at around 120/70. Drinking lots of water. Keep in mind salt is a necessary ingredient for proper digestion. Yes salt is hidden but a proper food intake is essential. Today the standard American diet is predominately a culprit to many. I also keep in check with Dr Bob Marshall with qnlabs. All of the help both here and elsewhere is great. I am on no prescriptions and will be 52 next weekend.

  • Rebecca Cody

    I had slightly elevated blood pressure during my second pregnancy, almost 50 years ago, so I cut way back on salt. Fast forward to the late 1980s. My naturopath measured my blood pressure at 80/60 and said I should be on salt pills! Yikes! Instead of that I added salt back to my foods. I’m now 72 and continue with low blood pressure while eating unrefined sea salt. There must be something genetic there. My mom had high blood pressure as she got older and eventually died of strokes at 95, but my dad’s blood pressure was always low.

    I read somewhere in the last year that having blood pressure that is too low is associated with having many small, undetectable strokes. Does anybody know anything about that? How low were they talking about?

  • Wade Patton

    Got my hands on a BP cuff today. Right after supper it was 95/46 got that reading or thereabouts twice. Was messing around on the other two readings (like standing on my head). Told you it was low.

  • dorange

    Does dietary intake of salt influence plasma sodium? I am in my 60s, have low blood pressure since birth, consume salt to taste – and my plasma sodium, although within the normal range, is always in the higher end. Changing to a WFPB diet didn’t change that, although ALL other parameters improved from normal range to ideal range.

  • Will

    Any thoughts on this study?

    CONCLUSIONS:

    Adults consuming more dietary protein from either plant or animal sources had lower long-term risks of HBP.

    http://www.ncbi.nlm.nih.gov/pubmed/25194158

  • John Aycoth

    Dr. Walter Kempner’s World Famous “Rice Diet” is now located at the Rice House Healthcare Program http://www.ricehouse.org in Durham, NC…..email is info@ricehouse.org or call to discuss how we can help you reverse and control Type-2 Diabetes, Hypertension, Heart, Kidney and Obesity…….

  • nitestar95

    Only 25% of the population is subject to high blood pressure just from sodium intake. The other 75% can eat as much of it as they want. However, if other factors have contributed to high blood pressure, restricting sodium can help reduce it. These concepts are virtually never told to the masses.

  • Kim

    Is there any risk of not getting enough sodium? For instance, plugging my diet into Cron-o-Meter, it’s not uncommon for me to get about 200 mg a day. I know the amounts listed on the site aren’t always accurate, but assuming it is here, is that a problem? It’s hard to find information on this – everyone talks about how not to get too much! Thanks.

  • Harvey Mitchell

    Here is an ayurvedic cure for high BP, joint inflammation, auto immune issues which I used as a night cap for the last two nights dropping the BP from !71 / 93 to 145 / 88 first night in about two hrs. Last night was 133 /80 to 111 / 74 in 3 hrs rest rate 61 per min . In a glass of warm milk add 1 level teaspoon of tumeric powder and a teaspoon of honey stir well and drink. 3 nights maximum as it’s a strong protocol. Cheap but effective. HT licence afterall :-} Joints are better too.

  • Harvey Mitchell

    PS I used 1/3 milk and hot water to minimise dairy damage haha !

  • ptrjnf

    how about the Na+ / K+ ratio ? is that a valid way of dealing with high sodium intake, with normal kidney function? i have been adding KCl to my food instead of NaCl . i still eat some salty foods, and sometimes seem to crave the salty food. does the Cl – have any effect on BP ? i generally do try to follow the WPBF diet.

  • Graham

    Robert Heaney, of vitamin D repute, argues that you need 3200 mg/day of salt intake to prevent renin etc rise. See his article http://blogs.creighton.edu/heaney/2013/06/10/the-sodium-story/

  • Judy55

    What about salt substitutes, like the product No-Salt? Thank you.

  • If we knew this 40 years ago why didn’t it make it into the mainstream? Industry pressure like today?

  • Modus Operandi

    So if we do not add any table salt to our diet, where can we get iodine from?

  • Susan

    When my blood pressure was taken by physical therapists, they made no concern whether or not it was taken on my right or left wrist. But, I noticed that my right wrist was higher (though still in the normal range) than my left.

    The nurse at my local physicians’ office also took it on both sides and I discovered it was higher on one side, although still in the normal range. Neither party was concerned because I was “good” no matter which side the blood pressure was taken.

    I do not salt food when I cook, although I’m told I should use ionized salt. I have become used to no salt as both parents had problems with blood pressure. And while I still have a weight problem, my pressure is in the “normal” range.

    My husband, whose blood pressure is really low, will pass out if he doesn’t pour on the salt.

  • The Poetry Lady

    Does it sometimes take months for a low fat plant based diet to bring blood pressure numbers in a normal range? And is much of this primarily due to the weight loss that occurs?

  • veggiecamilla

    My grandma has a BP of 150. Not sure what the diastolic number is. She is fed by my mother who feeds her a majority plant based diet but still includes some oil and meat occasionally. I’ve asked her to try taking the animal products 100% off the menu and minimise oil and salt. I’m just wondering…how harmful are the effects of even just a little bit of meat?

  • The Poetry Lady

    After reading about what your colleague, Dr. McDougall prescribes for high blood pressure, I began taking Chlorthalidone with the 40mg Lisinopril that I have already been taking to no avail. The nurse practitioner I see would only let me try 12.5mg per day of the Chlorthalidone. While also knocking out the salt in my diet and drinking up to 10 glasses of water a day, my blood pressure rarely goes above 140/90, which a huge improvement. What we hypertensive people need to realize is fast food is loaded with all sorts of toxic chemicals, salt being a huge contender. After fighting high blood pressure and trying all sorts of dangerous and ineffective medications, the simplicity of cutting out salt and adding a much cheaper, safer med made a huge difference.

    Just in my opinion, genetics may may make us susceptible to certain diseases and not to others, but eating at restaurants rather than cooking our own food, not exercising and taking a pain reliever for every small discomfort has contributed to a host of our problems, some perhaps irreversibly. Ibuprofen had a huge impact on my blood pressure. What is worse is we also have energy drinks and Starbucks coffee that everyone quaffs down without thought to what it does to our blood vessels and heart rhythms. Back in 80’s, I imbibes my share of alcohol which was also a large ingredient for my hypertension. I think one of the best things about the Forks over Knives/plant based regimen is the requirement for cooking what we eat in our own kitchens and forgoing many of the harmful additions we Americans like to use. The pathway to wellness is much easier than we think. We can blame our ancestors but the real responsibility does indeed lie within our own choices. Logic wins it hands down.

  • Sohail Ahmed

    Himalayan Crystal Salt is the most beneficial, cleanest salt available on the planet. It was formed about 230 million years ago where the energy of sun has dried up the original, primal sea. This crystal salt is absolutely pristine and natural, identical in composition to the ancient primal ocean. Himalayan salt is most commonly found as coarse grains, fine grains, or large blocks in Pink Dark pink and in white colors. Himalayan Pink Salt is used by holistic chefs, spas, health professionals, and individuals for its range of nutritional and therapeutic properties.Himalayan Rock Salt envelopes in its beauty secret to the healthy living and is also source of therapies such as light therapy and salt therapy in different ailments. Himalayan Crystals are nature’s most natural medicine available with 84 essential minerals and its attributed to be immaculately pure. Pink salt may be used in the same manner as table salt for culinary dishes and baking, but it is purer and higher in mineral content. Pink salt can be used to stimulate circulation, relax the body, lower blood pressure, sooth sore muscles, and remove toxins from the body. Mehran corporation exports all kind of salts

  • lamorrill

    I am 71 and having one year ago my second open heart surgery , this time was the aortic replacement, finding out what is causing all this for years I now am on a WFPB diet and have lost 66 lbs down from 300, walking daily and eating plenty of ground flax seeds and greens in smoothies etc, and recently checking my BP it is 140 plus over 90 plus morning and night, very discouraging to say the least after eliminating all my meds and the cardiologist telling me I am a poster child. What can I now do to eliminate this high BP ?

    • Thea

      lamorrill: Congratulations on the changes you have made so far. Regarding high blood pressure, have you seen the videos on this site regarding salt? Removing most of the salt from your diet may be the trick. Also, check out the topic page for blood pressure for other ideas on ways to tweak your diet: http://nutritionfacts.org/topics/blood-pressure/

  • Cindy in Mnl

    Hello, i’m in my 60’s and have a bp of less than 90/60. Should i still worry about salt intake? Tnx!

  • Sanjay Sharma

    Can anyone suggest any best, reliable bp measuring macine to measure at home?

  • Ori

    Any thoughts about this new study that seem to suggest that ” low-salt diets may not be beneficial and may actually increase the risk of cardiovascular disease and death compared to average salt consumption”?

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30467-6/abstract

  • Miroslav Kovar

    Should people with symptoms of electrolyte imbalance (hypoglycemia, low blood pressure) increase their intake of salt?