Doctor's Note

This is the final video in a six-part video series on the Mediterranean diet. Here are the first five in case you missed them:

  1. Why Was Heart Disease Rare in the Mediterranean?
  2. The Mediterranean Diet or a Whole Food Plant-Based Diet?
  3. PREDIMED: Does Eating Nuts Prevent Strokes?
  4. Which Parts of the Mediterranean Diet Extended Life?
  5. Do Flexitarians Live Longer?

I was happy to have an opportunity to plug Julieanna’s new book. Learn more about her work at http://plantbaseddietitian.com/

I touch more on whole grains in How Many Meet the Simple Seven? and Whole Grains May Work As Well As Drugs.

More on breast cancer and alcohol in Breast Cancer and Alcohol: How Much Is Safe? and Breast Cancer Risk: Red Wine v. White Wine

I’ve touched on olive oil in the other videos in this Mediterranean diet series, but also have an older video Extra Virgin Olive Oil vs. Nuts.

More on sodium in Dietary Guidelines: With a Grain of Big Salt and Can Diet Protect Against Kidney Cancer? But what if without salt everything tastes like cardboard? Not to worry! See Changing Our Taste Buds.

If you haven't yet, you can subscribe to my videos for free by clicking here.

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  • Michael Thompson

    Good stuff! oh oh on the salt intake though. I just have to have some salt on my grains and veggies to bring out the flavor, or I won’t be able to stick with it…

    • Veganrunner

      Maybe you aren’t getting as much salt as you fear. The majority of the salt in the SAD is from processed foods.

      • Michael Thompson

        true. I did lose a ton of sodium when i quit eating bacon and other processed meats, and pizza, I can only wonder how much salt is in one, and I ate whole ones in a meal lol

        • b00mer

          Hi Michael, have you tried cronometer.com yet? If you enter only whole plant foods without any added salt or sodium containing preservatives it will still list some sodium content, averaging approximately 500 mg for a full day’s calories. If you’re concerned about getting enough you can try logging your intake for a day or two and see where you stand prior to adding any additional table salt, soy sauce, hot sauce, etc. Just my two cents, personally I limit the salt when cooking, though I do use bouillon and soy sauce fairly often, add limited table salt on the surface of food, and I’m usually around 1500-2000 mg sodium total. I don’t feel as though I’m restricting at all. I don’t currently have any issues like blood pressure but if things ever come up I’ll reevaluate my intake then, but for the time being not really worried about it, especially in light of more recent studies mentioned by Daryl and Tobias.

          • If you eat a whole food plant based diet and don’t cook with salt you will have a very low intake of sodium in the order of 500 mg as b00mer points out. That gives some leeway to add some sodium at the table if desired. Dr. McDougall and Jeff Novick RD two gentlemen whose opinions I value differ a bit on their recommendations but they both are on the low side. One researcher I heard speak at a McDougall ASW mentioned it may not be the sodium(Na) as much at the Na/K(potassium) ratio that is important. One epidemiological study showed that persons eating a plant based diet for 20 years had on average lower BP’s (20(sys)/10(diast)). The mechanism is not clear… more K, less Na, more Mg(magnesium), more phytonutrients, more soy… have all been suggested. See videos on K… http://nutritionfacts.org/video/98-of-american-diets-potassium-deficient/ and Mg… http://nutritionfacts.org/video/mineral-of-the-year-magnesium/. I’m not sure we will ever sort it all out not only because it is complex but because the funding and design of such a study would be difficult. My recommendations for most of my patients are to only add a bit of salt… although there are some other alternatives at the table as desired and then you should be fine. I think you will find that your taste will adjust to a low salt diet.

          • Zuppkko

            I think a healthy body sorts things out for us.

            I know that adrenal glands excrete hormone which helps reabsorb sodium, which is usually low on a whole food plant based diet. On the ohter side there is usually enough potassium in plant foods which is easily eliminated through kidneys.

            The obvious problems with the salt are irritation and stimulation of our tissues. Also dehydration. Best option to avoid those problems is to minimize salt intake (as you stated) and to dissolve it in water (slightly helps).

            A great way to decrease salt cravings and intake is to eat “salty plants”, e. g. celery or tomatoes. Those contain higher levels of sodium.

    • If you’re eating a whole foods diet, don’t sweat it. Get a little iodine in the deal while you’re at it.

      • GeorgeBMac

        Yes! I worry that I do not get enough iodine on WFPB diet w/o added salt

        • Scot Michael Semer

          Hope this helps.

          BANANAS
          – 1 medium banana = 3 micrograms of iodine (2% DV)

          GREEN BEANS
          – 1/2 cup = 3 micrograms of iodine (2% DV)

          STRAWBERRIES
          – 1 cup = 13 micrograms of iodine (9% DV)

          DRIED PRUNES
          – 5 prunes = 13 micrograms of iodine (9% DV)

          NAVY BEANS
          – 1/2 cup = 32 micrograms of iodine (21% DV)

          STEAMED/BAKED POATOES
          – 1 medium potato = 60 micrograms of iodine (40% DV)

          CRANBERRIES
          – 4 ounces = 400 micrograms of iodine (267% DV)

          DRIED SEAWEED
          (be careful with seaweeds, too much iodine can be as bad as too little, and really mess with thyroid function)

          – A quarter-ounce serving (0.25oz) contains 4,500 micrograms of iodine. That’s way more than enough iodine for the body to absorb in a day (3000% of the daily value) Consume smaller portions over time in order to gain the health benefits.

          • GeorgeBMac

            Thanks! Yes, that does help!

          • Wilma Laura Wiggins

            Wow I did not know that. Are you sure ha ha? I had no idea, thought you could only get iodine in sea plants.

          • Kim Churchman

            Dr. Greger has a vid on using the right types of sea vegetables (sea-‘weed’). Don’t eat nori too often, it has much too much. Just search iodine at his homepage.

          • Chris Gumb

            Nori is fine; it’s kelp that has too much iodine. As for the other fruits and vegetables that Scot listed above as sources of iodine, it is my understanding that iodine levels in these foods are entirely dependant on the soil in which they were grown and so _cannot_ be considered reliable sources of iodine like sea vegetables can.

          • Kim Churchman

            I got the idea that nori is kelp when I saw the above-mentioned vid. Guess I got confused. I played with kelp on ocean beaches growing up here in Washington State, gotta admit they’re not similar. Thanks.

    • Doug Overman

      I took 3/4 teaspoon of table salt (1500 mg sodium) and put it in a small dish for my day’s cooking. When I season vegetables I just take a pinch and season the dish. I usually have plenty left over by the end of the day and plenty of tasty vegetables.

      • Kim Churchman

        Nice idea, thanks! Btw, if 1/2 tsp is 500 mg, then how much is 3/4, again?

        • Doug Overman

          From the American Heart Association:
          Salt vs. Sodium Equivalents
          Sodium chloride or table salt is approximately 40% sodium. Understand just how much sodium is in salt so you can take measures to control your intake. These amounts are approximate.

          1/4 teaspoon salt = 575 mg sodium
          1/2 teaspoon salt = 1,150 mg sodium
          3/4 teaspoon salt = 1,725 mg sodium
          1 teaspoon salt = 2,300 mg sodium

          My point is that you can get a lot of flavor with just a little salt sprinkled on the top of your vegetables.

    • Jim Felder

      Your taste adjust to sodium like your eyes adjust to light. If you have been in the full sun, walking into an adequately lit room will seem terribly dark until your eyes adjust. The same with your taste buds. If you can say cut the salt you add by say 2/3 and stick with it for just a couple of weeks, you will gradually notice all the flavors coming back out as your taste buds come out of their salt coma.

      Oh, and I would do it all at one time to get the period of blah food over with at one time rather than try to gradually reduce the salt which just means you have to go through the adjustment period over and over again. Plus it is very hard to exactly meter salt, so it is really hard to know if you are actually hitting your target if the step size is too small. A bigger single step is much easier to know that you have actually made the desired a change.

      I also follow Dr. McDougall’s advice and never cook with salt and only add it on top of my food at the table. There I can taste it more distinctly since it hasn’t completely incorporated into the food. Of course this means that I have to make an extra effort to try to find salt free canned beans and tomatoes and the like. One down side is that now when my wife, who doesn’t even add salt at the table, and I go out to eat it tastes like the chef misread the amount of salt to add as being in tablespoons rather than in teaspoons! :-p

    • Darryl
      • b00mer

        Hi Darryl, apologies for not reading through it myself, but in what you’ve quoted have those effects been seen directly or are they being stated as a possible explanation for the health risks observed at low intakes? That is, is a sort of reverse causation resulting from CVD patient-specific recommendations off the table in your opinion?

        • Darryl

          Reverse causation in hypertensive patients would cause serious issues with these studies, which is why the large-scale prospective studies often exclude individuals with CVD at baseline. In the recent PURE study, for example the increased risk at low intakes was robust when all participants with a history CVD, cancer, diabetes, or smoking were excluded.

          I anticipate that salt intake will remain controversial – no randomized controlled trials to date only altered sodium intake, so intervention studies all have some confounding (even partial replacement with KCl markedly alters potassium intake). Despite this limitation, low-sodium intervention studies in hypertensives do show some benefit, while risk increases in congestive heart failure and chronic kidney disease. Ie, its complicated.

          The average blood pressure response to sodium is small (2 mm Hg / 2.3 g sodium), compared to other dietary factors like added sugars 1, 2, and hugely variable between individuals – BP actually rises in some with sodium restriction. I think this is a place where perhaps the perfect shouldn’t be the enemy of the good, and while consuming salt in moderation we can perhaps focus on other factors with more consistent results like reducing added sugars and increasing potassium intake with a WPBD.

          • Mike Quinoa

            Thanks Darryl for all the links on your salt posts. I’ve pretty much weaned myself off of salt (for better or worse), but I do love soy sauce.

    • Fruiteddragon

      Not hating or trolling but could you please explain what this means? I hear it a lot and I don’t get it. When I put some salt on something, it makes it taste like salt.

      • Michael Thompson

        if it tastes just like salt, you are putting too much on, if you can barely taste the salt, then the other flavors seem to stand out more, maybe a contrast kind of thing…

      • b00mer

        Hi Fruiteddragon, have you heard of the concept of super-tasters, non-tasters, etc? I recall hearing about in regards to bitter and sweet (some people love or hate broccoli, or super sweet candies like smarties) but perhaps it’s an issue with salt as well?

  • Tobias Brown

    While I’m fully in your camp, the statement on salt goes against my most recent impression on the issue. See Pam Popper’s video on salt intake. She cites scientific studies (begins at 4:00). I can dig out other references if requested. This is one major one if I recall correctly.

  • Alex

    Is high dietary sodium intake risky in and of itself or is it just out of balance, with for example, potassium?

    • Joseph Gonzales R.D.

      Yes, diets high in sodium are risky in and of itself. I know potassium and sodium work together, but to the extent of raising potassium to negate high doses of sodium I am uncertain? Also, 2% of Americans obtain the potassium needed.

      *Note* Salt is a well-known contributor to high blood pressure; even if our blood pressure is normal, it might be wise to keep sodium intake under 1,500 mg per day and watch out for high-salt foods such as chicken. Other possible contributors to hypertension include certain banned pesticides, advanced glycation end-products, and viruses present in chicken and turkey.See hypertension for more details.

      Thanks, Alex!
      Joseph

      • Alex

        Thanks Joseph for the response and links. I think my Na and K levels are good, although I don’t measure. My rest pulse is <60. I don't confidently remember my BP, but is BP 103/53 dangerously low?

  • smith

    there is a component of olive oil fat that is for building brain fibers.

  • Arjan den Hollander.

    http://www.nytimes.com/2014/08/26/upshot/dash-of-salt-does-no-harm-extremes-are-the-enemy.html?_r=1&abt=0002&abg=1
    Studies are linked in the article.

    A similar article plus overall systematic collapsing blood pressures and a very likely Takotsubo cardiomyopathy event (I thought it was a mild heart attack at the time) made me start using salt in moderation again. At that time I did quite some cronometer calculations which pointed to 500 – 750 mg a day intake of salt. I haven’t had similar incidents again since I’m back on the salt. 3-6 gr/day

    • Joseph Gonzales R.D.

      Thanks for sharing that article! Interesting about salt and cause mortality. I think it’s important to take into consideration all the negative associations with high sodium diets beyond hypertension. For example, we know that salt can wreak havoc on our arteries. There may be variations of how much you should consume based on your experience and the specific testing that you are conducting? I can’t speak to the calculations or medications, but I am glad to hear you’ve figured out what works! To me that is most important.

      • Arjan den Hollander.

        Would you care to elaborate havoc? Because he doesn’t :)

  • smith

    After an average follow-up of 7.3 years, there were 380 cases of colon cancer and 110 cases of rectal cancer. Overall, compared to regular meat eaters, the vegetarians were 22 percent less likely to have colorectal malignancies, the study found.

    Pescovegetarians, which the researchers defined as people who ate fish at least once a month and meat less than once a month, had the biggest risk reduction – 43 percent.

    For lacto-ovo vegetarians, who consumed eggs and dairy while limiting fish and meat to less than once a month, the risk reduction was 18 percent. Vegans, who ate eggs, dairy, fish, and meat less than once a month, had a 16 percent risk reduction.

    Even limiting fish and meat to once a week had some benefit; semi-vegetarians had an 8 percent risk reduction.

  • Kitsy Hahn

    Nearly five hot summers ago (in early July, around noontime) I’m told a friend called me on the phone. I supposedly didn’t know who she was and sounded confused. She then rushed over and took me to the ER…or so she told me later. While in the ER they checked to see if I had a stroke (I hadn’t), and performed a slew of other tests. They said I was able to babble back and forth — and even flirt — with the docs, and give them my SS number, etc. And yet, where was “I” during the 3-plus hours in the ER?

    Later in the afternoon I found myself sitting on a hospital bed wearing a little nightie thing, with a tube stuck in my arm. It seems that, because I’d always heard we should drink a lot of water and restrict our salt intake in order to control our BP, my sodium level had plunged to around 122. It should be between 135 – 145. I spent two nights in the hospital hooked up to a saline solution until my sodium levels got higher. And now I have to ration my water intake and not worry too much about table salt. A couple of years ago a blood test showed my sodium level to be (only?) 132. So maybe I should eat more sauerkraut and celery. :-)

    http://www.nytimes.com/2012/06/03/opinion/sunday/we-only-think-we-know-the-truth-about-salt.html?pagewanted=all

    • Joseph Gonzales R.D.

      Hi, Kisty. Thanks for sharing your story! My goodness, sounds like a scary experience to encounter! You and Arjan are certainly right about the sodium buzz. One thing I forgot (the most important) to address below is Dr. Greger’s take on low sodium diets and heart disease: Could a low-salt diet be bad for your heart?. I asked Dr. Greger about your situation and his response was that 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.

      • Kitsy Hahn

        Right, Dr. G. (I deleted my “story,” as you can see — dunno why, actually, and it’s probably too late to retrieve it.) I didn’t know anything about keeping the electrolytes in good order at that time. I’d squeeze lemon juice on stuff instead of using the salt shaker, and etc. Well, some of us have to learn the hard way.

        I’ll check the other Dr. G’s “low-salt diet” video now. :-)

        • JV

          Dear Kisty, according to Joseph, you seem to have a similar story to mine, hyponatremia? He referred me to your comment and his response but you seem to have deleted it? Would you be willing to share your story with me? I really think it could be helpful, we can learn from others experiences too! I shared my hyponatremia episode in one of my comments on the video “Salt Ok if blood pressure OK?” On the site as well if you want to read it. How did you find yourself in the hyponatremia situation and how did you recover from it? Did you change your salt habits as a consequence? Do you eat salt nowadays? Thank you so much in advance!
          Sincerely,
          JV

          • Kitsy Hahn

            Okay, JV, will do. :-) Back in the summer of 2010 (July 3, to be precise) I found myself in a little hospital nightie, sitting on a bed and hooked up to a saline solution. It seems that a few hours earlier a friend had called me at home about something or other, and I supposedly didn’t know who she was. She urged me to call 911, but probably knew I wouldn’t do this, so drove over as fast as she could. Yes, I was told I was “with it” enough to open the door and let her in…where we (supposedly!!!!) grabbed my phone book with next of kin information, and she drove me to the ER.

            I remember none of this. Nor do I remember flirting with the ER docs (“you look like a movie star!”), or telling them my date of birth, SS number, etc. Yes, part of me was able to do this, but where was the real “Me”? (Or is it “I”?) Where had I gone? Anyway, they gave me a slew of tests to see if I’d had a stroke. Nope, that wasn’t the problem. Ah, then a blood test showed that my electrolytes were off kilter. My sodium level, which should have been between 135-145 was hovering around 120. After two nights, I was discharged….with instructions on how much water to take each day. Yes, I always read (weren’t we taught this at one point?) that we should drink plenty of liquids, especially during hot weather, and — to control our blood pressure — go very easy on the salt. I never ate junk/processed foods, and most of the time used lemon juice instead of salt, thinking I was doing the right thing. Not in my case!

            I still don’t eat any processed (high sodium) foods, but am no longer intimidated by the salt shaker. Maybe I’m one of those people who “needs” more than others? Yes, I sort of ration my liquid intake, but not compulsively so. Hope this helps. Let me know if you have any other questions. Good luck to YOU!

  • Plantstrongdoc M.D.

    Redwine without alcohol………man……

  • Roman

    What is the healthiest whole grain?

    • Joseph Gonzales R.D.

      Roman. Whole grains vary in nutrient value. They are all amazing! Often researchers do not look at specific whole grains, but rather lump them together to see what groups eat the most. What are your favorite kinds? That could be more important. Quinoa, oats, wheat berries, are all excellent choices. Sometimes I like to cook kamut, it tastes kind of like buttered-popcorn.

      • Roman

        Thank you for your response! I enjoy eating buckwheat groats, oats, and whole wheat pasta. I was just wondering if any one whole grain trumps the others in a specific category such as antioxidants.

        • Kitsy Hahn

          I too like buckwheat groats (kasha). What I do is cook a wholegrain cereal every morning — yeah, I’m addicted to my gruel/porridge. :-) I’ll add, say,1/4 cup kasha to 1/4 cup steel-cut oats on a Mon/Wed/Friday and the other days of the week, 1/4 cup millet to 1/4 cup organic brown rice (yeah, I’m baaaad…arsenic ‘n all). On Saturdays and Sundays I’ll make it 1/4 cup barley (gluten doesn’t bother me) to 1/4 cup one of the others, even something called “freekeh.”: Quinoa is a seed, but I always think of it as a grain. It’s considered one of the very best, antioxidant-wise (complete protein and all that).

      • Dommy

        Raw Buckwheat is especially high in rutin, a nutrient helpful to the integrity of the CV system and especially as a safe anti-coagulant/anti-thrombotic.

  • Dylan

    Good stuff! Although, I’m not sure about the estimate that some Men/Women are getting an estimated 7-10g of salt per day…
    Even with eating processed food, that’s like the equivalent of 20 hot dog’s worth of salt.

    • Joseph Gonzales R.D.

      I know, right, Dylan? Doesn’t seem like we could even come close to meeting those amounts. According to the study Dr. Greger cites, the numbers don’t lie. Somehow we are eating tons of sodium! If you happen to come across other estimates let us know. It would be super helpful. I hope these numbers go down.

      Thanks,
      Joseph

      • Dylan

        Will do Joseph. Great to see a well trained RD on the message boards with NF!

    • b00mer

      Hi Dylan, keep in mind salt (sodium chloride) is only 39% sodium by mass, so 7 g salt contains about 2750 mg sodium. To go from the lower recommendations of 1500 mg sodium per day to 2750 mg would only require about an additional 1/2 tsp salt.

  • Mike Quinoa

    What is the relationship between sodium and potassium? My last blood work my sodium was fine (even though I consume very little salt), but my potassium level was below the reference range (and I eat lots of fruit and veg).

    • Joseph Gonzales R.D.

      Hi, Mike. There are many relationships between sodium and potassium. They are both electrolytes working at the cellular level, to balance fluids, and help control blood pressure. Did your doctor comment on the low potassium levels? It’s important to know how they interpreted your lab results, as obviously I cannot. Perhaps more pottassium-rich foods may help? What kind of fruits and veggies do you eat? Potassium levels in food are easy to look-up. ON top of fruits and veggies, think sweet potatoes, red, blue, and gold potatoes and their skin, as they provide a large dose of potassium. Squash, too. The good news is your blood work on sodium is fine. Let me know if this helps. Thanks, Joseph

      • Mike Quinoa

        Thanks so much, Joseph. I’ll try to focus a bit more on the potassium superstars and see if that does the trick.

  • JakeN

    Is it possible to get too much fibre? Could too much fibre effect digestive & gut health?

    Thanks !

    • Joseph Gonzales R.D.

      Hey JakeN. Welcome. Perhaps it could. Your body should be able to tell you when enough is enough. It does seem however that lack of fiber in the diet is more of a concern.

  • Mary Zdrojewski

    A question about salt – is there a recommended daily limit?

    I eat very few processed foods due to allergies, and while I try to season food with herbs and spices, I do add kosher salt or liquid aminos for some flavor. Is there an amount that is considered safe (like a teaspoon a day)? It’s hard to judge milligrams when you’re cooking from scratch. I have never worried too much about salt because my blood pressure is on the low end of the healthy range, but your video says that everyone should limit salt, no matter what your blood pressure?

    Thanks!

    • Julot Julott
    • Chuck

      According to Cron O Meter, 0.55 grams or just a hair over half a teaspoon of salt is what you should aim for. Because I eat only unprocessed foods and didn’t add salt to my cooking or food, I generally came in at zero grams of sodium a day. That makes me wonder if I wasn’t deficient in sodium or chlorine, both necessary minerals to maintain life. My Physiology instructor said that salt content is closely regulated by the kidneys so that it is kept at appropriate levels. So I asked him about all this teaching among health professionals that we should “halt the salt.” He indicated that this was older thinking and that adding salt to food wouldn’t be a problem. So I tentatively started using a little salt to my food and my electronic scale showed the difference: percentage water content went up as did muscle mass, percentage fat went down although actual weight went up perhaps due to more water retention. I also felt better. Seems to me that I was sodium deficient before.

      • b00mer

        Hi Chuck, when I enter only whole plant foods into cronometer it lists the sodium in those foods. For example I just plugged in about 1600 Calories of plain fruits, veggies, and rice as a test and it listed about 600 mg sodium as my intake.

      • peseta11

        Chuck and Mary, the CronoMeter reading, .55t, comes to 1279mg sodium, a shade over my 1200mg limit, so I’m comfortable with their suggestion. The best sources (and here I quote the good doctor as well as DASH2 and those impressed by it) say “under 1500 milligrams” of sodium is best. Not terribly much disagreement there for the upside.
        For the downside, I’ve read guesstimates of 50-200mg sodium, and the comfortable low, taking account of personal differences, has been 500mg for a long time.
        So 500-1500/1200 is the range, and those arguing you can get ‘too little’ sodium have to offer some big evidence if their new low is outside that range, down or (more likely, given corporate preferences) up.

    • Joseph Gonzales R.D.

      Hi, Mary. 1500mg/d is the recommended range. The upper limit is set at 2,300mg/day. Dr. Greger does mention that less sodium is better for everyone regardless of salt-sensitivities (or hypertension). I would be cautious of not measuring salt. Actually, 1 teaspoon is 2,400mg of sodium – a whole day’s worth. Please don’t kill the messenger we are only relating what the research says ;) I too enjoy cooking with salt. I have learned to use less, and add more herbs and spices like you. We need to compare recipes or generate some buzz for an optimal recipes on nutrition facts.org! No? Ok, sorry for the rant. I also commented about this below. Here is the sits of my response with a link to more information, if interested.

      *Note* Salt is a well-known contributor to high blood pressure; even if our blood pressure is normal, it might be wise to keep sodium intake under 1,500 mg per day and watch out for high-salt foods such as chicken. Other possible contributors to hypertension include certain banned pesticides, advanced glycation end-products, and viruses present in chicken and turkey.See hypertension for more details.

      Best to you,
      Joseph

      • Mary Zdrojewski

        Thanks Joseph! So if I use 1/2 tsp in a recipe that makes 4 servings, I’m still fine. Good to know!

  • UCBAlum

    Unsolicited advice:

    If you want to reduce salt intake, don’t ever cook with it. Instead, add it to your food after. It makes all the difference in the world. I can see cutting salt intake 50% to 80% easily by doing this.

    I just weighed 1 gram of salt and I never come close to adding that much to my food in a day, and forget about 2.3 grams…or 10 grams.

    I figure I’m between 50 and 250 mg per day, and I use all the salt I want.

  • AA

    Is whole wheat really that healthy when we consider this recent study? Any comments?

    http://www.mdpi.com/2072-6643/7/3/1565/htm

    • Billy

      The subjects of this study, from its title, were “celiac disease patients and patients with non-celiac gluten sensitivity.” For the 1-3 percent of the population that have adverse reactions to gluten, its always a good idea to avoid wheat-if not mandatory! For the rest of us however, it’s unlikely that we’ll develop future problems with wheat. Note however, that in Asian countries where wheat consumption is less frequent, so is gluten sensitivity. Whether this is due to less detection of the diseases or due to less exposure to wheat, I can’t say.

      Celiac
      Disease Patients and Patients with Non-Celiac Gluten Sensitivity – See
      more at: http://www.mdpi.com/2072-6643/7/3/1565/htm#sthash.cA8LY2DH.dpuf
      Celiac
      Disease Patients and Patients with Non-Celiac Gluten Sensitivity – See
      more at: http://www.mdpi.com/2072-6643/7/3/1565/htm#sthash.cA8LY2DH.dpuf
      Celiac
      Disease Patients and Patients with Non-Celiac Gluten Sensitivity – See
      more at: http://www.mdpi.com/2072-6643/7/3/1565/htm#sthash.cA8LY2DH.dpuf

      • JohnG

        From the conclusions of the above cited study:

        “This study demonstrates that gliadin exposure induces an increase in
        intestinal permeability in all individuals, regardless of whether or not
        they have celiac disease.”

  • vegank

    Is there any truth in the theory that the older generation died from stomach cancer more than people do now because they ate more preserved/pickled & smoked food ?

    • Jerry

      It’s certainly interesting that all other cancer rates are going up while stomach cancer has declined. There must be a reason for this. I’d also read that the Japaneses get more stomach cancer because they like their rice very white and so they add talcum to it.

      • vegank

        Hi I did a little search and in Japan people who ate pickled/preserved fish or shell fish and fish eggs (the kind you get on Sushi) products daily had a higher rate of stomach cancer (1 in 500)than those who only consumed them occasionally (1 in 1000). When steamed rice is the staple pickled vegetables and other salty food is consumed on a daily basis with it. I also read somewhere that because the older generation had to preserve food since the fridge hadn’t been invented yet this resulted in higher rates of stomach cancer both in Japan as well as some western countries. I’m not into fatty or sugary food but enjoy savory.salty food , and was just thinking
        I might need to be careful with my salt intake. Here is a research (reviewed in 2014) from the UK about overuse of salt and stomach cancer. They too seem to say that consumption of pickled/preserved seafood is linked with higher rates of stomach cancer. http://www.cancerresearchuk.org/cancer-info/cancerstats/types/stomach/riskfactors/stomach-cancer-risk-factors

  • Tim Miller

    After watching multiple NutritionFacts.org videos on salt and reading through all the comments on this page, I am still confused about the recent studies claiming to show that people who consume the least amount of sodium are asking for health troubles. I did a 12-day fast at True North last June hoping to cure mildly high blood pressure. And it worked. At True North they counseled me to add no salt to what I cooked and none at the table, forever more. Plus to not eat commercial foods with salt added. I have stuck to that religiously, and my blood pressure is doing great. I also found that my taste buds quickly adjusted and I don’t miss the salt at all, not one bit. I greatly enjoy my whole foods no-junk vegan diet. But here’s my confusion with recent sodium studies. I am getting no added sodium in my diet. All the sodium I get comes from the foods themselves. I eat lots of veggies, whole grains, fruits, beans, and a small amount of nuts, seeds, and avocados. I supplement with B12, D, and iodine but nothing else. I strive for variety, meaning I eat lots of different types of food in all the categories I listed. And I experience no symptoms that lead me to think low sodium levels might be a problem for me…so far. But hearing about all those studies worries me a little. Do I need to add a little sodium to my diet, perhaps by using very small amounts of sea salt or some supposedly good salt like that? Or am I doing the right thing, given my blood pressure history, by avoiding added salt entirely?

    • Orthorexic

      I can’t blame you for being somewhat confused, Tim. I feel more or less the same way. I’m going to track my food for a day or so to see what it’s sodium content is and if it’s too low, I’ll add a little salt, using the guidelines mentioned below in Joseph Gonzales’ response to Mary Zdromewski where he seems to say that five-eights of a teaspoon of salt minus what you get in your food is the right amount.

      • Joseph Gonzales R.D.

        That was just a guess :) The idea is to have a total intake around or less than 1,500mg. If not using table salt I’d imagine your intake would be much less than 1500mg. Is 5/8th the calculation? At any rate — better than 1 teaspoon @ 2400mg!

      • Joseph Gonzales R.D.

        Just posted a comment above, maybe this new study by the American Heart Association can clear up some confusion?

    • Joseph Gonzales R.D.

      Great post, Tim. Thanks for adding this here. Dr. Goldhamer does great work from what I hear at True North. I am confident if the advice was to omit table salt than sticking to that advice is of value. Hard to say how much you obtain from natural foods, but I know it is very low. I can’t speak to the studies showing low salt users had more risk of death. Let me investigate and get back to the group.

    • Arjan den Hollander.

      Stress is the game changer that leads to wasting and with it imbalances.

      Tim if your values are still say 20 over you might want to give 50 grams of natto through a green smoothy daily a try, you might just see those 20 BP points drop off within just a few weeks. A few peanuts and a few strawberries or raisins blended in with it masks the nastyness pretty good, for me it turns it into something tasteful actually. A bit of ground flax for nicer texture, mmm.

      Real heroes eat the natto whole food instead of these way to expensive pills for pussies :)
      https://www.youtube.com/watch?v=ZumCN9qbIpk

    • Joseph Gonzales R.D.

      OK, Tim. I found a better answer. The American Heart Association found issues with the low-salt intake and increased mortality research. Did you see the NYT article posted below? It discusses the NEJM research that many members brought to my attention. I think this is an awesome debate. Even the researchers are scratching there heads asking the same questions you all are. At any rate, take a look here: http://circ.ahajournals.org/content/early/2014/01/10/CIRCULATIONAHA.113.006032.abstract

      “Conclusions—Results from the TOHP studies, which overcome the major methodological challenges of prior studies, are consistent with overall health benefits of reducing sodium intake to the 1500 to 2300 mg/day range in the majority of the population, in agreement with current dietary guidelines”

      Also a great article about the two study’s findings, here(make sure to read all three pages, as they interview the researchers)

      Still think you are doing the right thing keeping sodium low. No difference in all the fancy salts out there, sodium is sodium.

      • Tim Miller

        Thanks much. Excellent information. I look forward to seeing what Dr. Greger’s take on this material will be.

      • Tim Miller

        I just read through the whole study at the link you provided Joseph (http://www.ncbi.nlm.nih.gov/pubmed/23124030). I understood most of it (my eyes glazed over at some of the stats) and it does address my worries very effectively. Thanks again!

        • Joseph Gonzales R.D.

          Most important is what the abstract says, as I post it above. Quick funny story, I went back to old comments and here is a link to Dr Greger’s comment talking about the SAME THING 3 years ago! I had no idea salt was such a hot topic. Again, stay posted for more information.

      • Ⓥince Green

        Thanks for linking to this reply over on the “High Blood Pressure May Be a Choice” page.
        Recording my sodium intake on cronometer.com I found I was getting ~1200mg of sodium eating only whole foods (so no added salt), which seemed high to me. Glad to see that this is a somewhat acceptable amount.

  • vegank

    “Salt that kills, salt that heals ” by Dr D Mayfield

    an interesting comparison between sea salt consumption and Himalayan salt as well.

    https://www.youtube.com/watch?v=O6V1QKx6JLQ

    • Joseph Gonzales R.D.

      Heym VeganK. Thanks for posting this. I cannot get it to play. Do you mind retrying to post? I would appreciate that! Also, I have not found Himalayan sea salt to be better than regular, according to the research. If you have any new stuff I am unaware of (I’ll be honest I haven’t searched very far so perhaps you can enlighten me) please post some studies! That is probably even better than the video anyway. Thanks! Joseph

      • vegank

        Thanks for your reply Joseph, I seem to be technically challenged this week !

        I will try posting the link again below. If it still does not work you may like to search for the video “Salt that kills, salt that heals-March 17, 2013” , on YouTube by Dr D Mayfield. Dr Mayfield is talking from a chemists point of view if I remember correctly. His recommendation was to use Himalayan salt from the high Himalayas, and also said that because of the minerals you get with the Himalayan salt it is better for you, and without the contaminants from the sea. I would be interested to hear what you think. I am sure I don’t have newer info than you have: ), but I find it interesting to look at a topic from different angles and consider what different specialists in their field have to say.

        https://www.youtube.com/watch?v=O6V1QKx6JLQ

        • jj

          Enjoyed the video. Just google this title — Salt that kills, salt that heals-.

          The next video up on you tube was “Discovering Good Health: Importance of Water and Salt” by Barbara O’Neill. I’ve heard her before and really enjoy the detail that she puts in her videos. Thanks.

          • vegank

            Great !
            I’ll watch the Water and salt video which you recommended.

        • largelytrue

          I’d ask you to link directly to the exact time which relates some specific insight related to his specialty with a claim about nutrition and health. For me the effort to appeal to Chinese Medicine and the principle of “As Above, So Below” is enough to show me that he is not strong at thinking on nutrition scientifically: https://www.youtube.com/watch?feature=player_detailpage&v=O6V1QKx6JLQ#t=471

          • vegank

            I understand what you mean , don’t have any interest in Chinese medicine or “alternative medicine” either. However I thought that the idea of using Himalayan salt in place of other salts because of the contamination of the ocean might be plausible, for example in places like Japan where there is concerns about the latest leakage which they haven’t been informed about for the last 18 month or so.

  • Give peas a chance

    I love your attention to Mediterranean diet from Crete, emphasizing it is a 90% plant-based with room for improvement. There seems to be a disconnect; however, even with physicians, as to what a 90% plant-based diet really looks like.

    In my experience, many Americans underestimate the glass of milk with breakfast, chicken breast and cheese on their lunch salad and a piece of fish with butter for dinner easily makes a 70%+ animal-based diet (<40% plants). This is far from the 90% plant-based diets they think they are achieving, or nearly achieving. People, who never really compute the numbers of their diet, tend to look at the volume of their food rather than calories when making estimations. It may seem like they are eating more plant foods, but in fact many more of their daily calories are coming from animal foods. An example: fruit and oatmeal at breakfast (with milk), salad greens and chopped veggies (with chopped chicken breast and cheese) for lunch and a side of mashed potatoes (with butter) and large serving(1/2 plate) of vegetables with a small serving of salmon for dinner. Many times people are unaware of the calorie contribution of their non-plant foods because of their extremely high energy density in comparison to their plant choices. Sometimes these animal-based calories are almost invisible: think melted cheese, cream, butter or bacon drippings added to your veggies or veggie soup at your restaurant meal! Some people misunderstand a 90% plant-based does not mean replacing your usual meal meat serving with a plant protein 9 out of very 10 meals. They do not register that dairy and eggs also factor in as an animal-based foods and even one serving of meat daily (without zero eggs and dairy) puts you over the 90%.

  • Soeleejmen

    I have a question, i don’t know if anybody knows something about it or not but. I hade an MRI scan today, does any 1 know if this is harmfull or not ?? My feet and my hands feel like ice after the scan. Don’t think that’s a good sing. CAN ONY 1 HELP ???

    • Charzie

      I’m no doctor, but I’ve had a few and not had any effects, it is magnetic imaging. Were you nervous going in? It could just be a stress induced reaction possibly?

      • Soeleejmen

        Yeah verry nervous, i thought i would go in and out. But when they told me that i have to sit still for 25 minutes. I felt like being told i have to swim with crocodiles. I actually hade 2 knie’s that were going to be examined, but after the first 25 minutes i told them to stop. I was verry scared, and made a new appointment for this coming Tuesday. Thanks allot for your answer

        • Charzie

          Medical procedures can be very scary, and even panic inducing in some people! I think it’s only fair we are told just what to expect in advance, to take away that element of vulnerability so many of us feel when we aren’t sure what is in store for us.

  • Derrek

    Why is Mercola’s work not credible? What are his conflicts of interest? Is he associated with the Winston A Price Foundation? People always say The China Study cherry picked information and use Mercola’s data. Any advice Joseph?

    • largelytrue

      Is peddling everything from personally-branded whey protein to personally-branded tanning beds not enough for you to diminish the credibility of a doctor?

      http://shop.mercola.com/catalog/miracle-whey-protein-powder,135,0,0.htm
      http://shop.mercola.com/product/mercola-vitality-elite-32-lamp-tanning-bed,1157,145,0.htm

      This is before we actually dive into the quality of his claims and reasoning, mind you, but this in itself represents a pretty big conflict of interest to me.

    • jj

      One thing that Mercola believes in is there is a way to eat according your blood type. I don’t go for that. And whether or not he is associated with the Winston A Price Foundation he touts their science.

    • Joseph Gonzales R.D.

      I am not familiar with Dr. Mercola’s work entirely. From what I gather he sells many supplements. Does he cite sources on his website? That is all you need, references, kind of like here at NutritionFacts and then you can decide what the mounting research suggests. As a dietitian I always recommend whole foods over pills and powders.

  • raz

    I really want to applaud the emphasis of other healthy habits and not just plant based. Namely reducing oils, refined grains, and over-consumption of salt, which has been sadly missing for the most part from your advice up to this point. Thank you!

  • Guest

    Scientists at the University of Delaware find that “…even in the absence of an increase in blood pressure, excess dietary
    sodium can adversely affect target organs, including the blood vessels,
    heart, kidneys and brain.”

    http://www.sciencedaily.com/releases/2015/03/150310160033.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily+%28Latest+Science+News+–+ScienceDaily%29

  • Dr Paul Stevens

    I recommend the recent TV series Ottonlenghi’s Mediterranean Island Feast, where he meets and cooks with locals who still do things the traditional way. Fantastic Mediterranean food inspiration. The vegetarian cookbooks are also wonderful.

  • Wade Patton

    If reducing salt reduced my blood pressure, i’d pass out. I have always had a low-normal BP. I’m not shy with the seasoning salt, but tend to use much less when eating plant-based diets. I was never one to salt fresh tomatoes or watermelon, but that’s how many folks do it. eww.

  • Ellie

    About salt: I suspect that most studies look at salt as the industrially processed sodium chloride with added iodide. Would the results have been different if people had eaten sea salt or rock salt with a lower sodium content and loads of other minerals? Also sea salt and rock salt tastes saltier so you automatically use less. Science is wonderful but often the answer depends on the question.

  • Octavision Vigo

    About alcohol consumption, what if i don’t drink during the week, follow a whole plant diet and do some exercise, but saturday night i have more than moderate consumption of alcohol (though high quality alcohol, organic or good brands), let’s say for instance: 2 liters of beer OR 1 liter of wine AND 2 oz of another drink, like whisky, vodka or gin? Is it too bad for liver, brain, pancreas and esophagus? Or doing this only once a week is not harmful?

  • lee

    love your videos ..however some information is out dated Alcohol for one is not heart healthy alcohol offers No health benefits what so ever according to the newest health research