Image Credit: Jason Tuinstra / Unsplash. This image has been modified.

Salt Is Put to the Test

From a medical journal editor:

“Like any group with vested interests, the food industry resists regulation. Faced with a growing scientific consensus that salt increases blood pressure…major food manufacturers have adopted desperate measures to try to stop governments from recommending salt reduction. Rather than reformulate their products, manufacturers have lobbied governments, refused to cooperate with expert working parties, encouraged misinformation campaigns, and tried to discredit the evidence.”

After all, salt is the main source of flavor in processed foods. Of course, they could improve flavor by adding real ingredients, but making a pop-tart with actual strawberries would be more expensive and cut into profits.

The evidence they’re trying to discredit includes double-blind, randomized trials dating back decades. When you take people with high blood pressure and put them on a sodium-restricted diet, their blood pressure drops. Then, if you keep them on the low-salt diet and add a placebo, nothing happens. But, if you instead secretly give them salt in the form of a time-release sodium pill, their blood pressure goes back up. And, the more sodium you secretly give them, the higher their blood pressure climbs. You can see these trials in my video The Evidence That Salt Raises Blood Pressure.

Even just a single meal can do it. If you take people with normal blood pressure and give them a bowl of soup containing the amount of salt a regular meal might contain, their blood pressure goes up over the next three hours compared to those who had the same soup with no added salt. Why, though? High blood pressure appears to be our body’s way to push the excess salt out of our system.

Dozens of such studies have been done, showing that if we reduce our salt intake, we can reduce our blood pressure, and the greater the reduction, the greater the benefit. The so-called DASH diet, which I covered in my video How to Treat High Blood Pressure with Diet, is commonly used to capture the blood pressure benefits of a more plant-based diet, but how do we know the benefits have anything to do with eating less salt instead of just from eating more fruits and vegetables? Because it was put to the test. Sure, eating more healthfully lowers blood pressure no matter how much salt we eat, but, even if we stick to the same diet, lowering salt helps independently of other dietary improvements.

You can do this on a community level with two matched villages that both start out about the same. In one such study, on average, blood pressures in the control village went up or stayed the same. But, in the village where they were able to cut down on salt intake, blood pressures went down.

If we don’t cut down chronic high salt intake can lead to a gradual increase in blood pressure throughout life, as shown in the famous Intersalt study. Fifty-two centers from 32 countries participated, with hundreds of participants each, and four of those centers were in populations that ate so little salt they actually complied with the American Heart Association guidelines for salt reduction, something less than 1 percent of Americans achieve. In a population where everyone made the cut off, not a single case of high blood pressure was found. What’s more, the older folks had the same blood pressure as the teenagers.

This is why including such populations is so important. If you just look at the 48 centers in the industrialized Western world, there does not appear to be any relationship between rising blood pressure with age and how much sodium people are getting every day. Now, the salt industry looks at this and says, “Aha! I told you so! There isn’t any relationship between salt and increasing blood pressures as you get older.” But maybe that’s because they’re all getting too much salt.

In the Intersalt study, they were all way over the American Heart Association recommendation for salt intake. You can imagine a similar result if this was instead lung cancer rates versus packs of cigarettes smoked every year. Whether you smoked 150 packs a year or 200 packs a year, it might not make much of a difference. To see a relationship between smoking and cancer, you’d have to compare smokers to those who rarely light up. And, indeed, if you add in those low-salt populations who get little or no high blood pressure as they get older, you end up with a highly statistically significant relationship between increasing sodium and increasing blood pressure—but only if you include people that actually comply with the salt guidelines.

As with so many lifestyle interventions, they only work if you actually do it.

This is part of my extended dive into the manufactured controversy about the health effects of sodium. Check out:

Will cutting back on salt make everything tastes like cardboard? Don’t worry! Check out Changing Our Taste Buds.

For more on the DASH diet, check out How to Treat High Blood Pressure with Diet.

Interested in more on the blood pressures of those on plant-based, salt-shaker-free diets? See:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

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