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.

64 responses to “Salt Is Put to the Test

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  1. This all reminds me of how in the US the Republicans have done an AMAZING job convincing the public that all regulations are bad and impinge on our freedoms. “Rabble rabble rabble, the government should leave me alone, rabble rabble, the free market can do everything better, rabble rabble rabble” little realizing that it used to be completely legal to sell rotting meat loaded with parasites before regulations. Restaurants used to be able to operate while cockroaches and rats skittered through the kitchen and pantry. It was par for the course for companies to falsely advertise and sell dangerous products (heavy metal poisoning anyone?) Hell, even the much exalted stock market only exists and functions at the scale that it does because it’s so heavily regulated. No one likes red tape but it takes all of a minute to figure out ways that regulations help keep the public safe from corporate profit-seeking and indifference. /end rant

    1. One of the landmark supreme court decision was the slaughterhouse decision.
      That decision appealed all the way, was of the right of slaughterhouses up stream from New Orleanes if they had the right to dump offal, discards from slaughtering, in the river.
      The river went through NO and it was thought it was leading to the outbreaks of cholera in the area.

      It set prescedent (now likely to be overruled) on the rights of local municipalities and state governments to set laws as opposed to federal laws or view. The basic principal allowed the setting of gun control laws in local places and statewide.

      But think of it….no government a slaughterhouse sets up shop upstream from your city….nothing you can do about it….puts a end to jobs at the plant if you disallow that.
      This place is so sad at times. I wish it were civilized..;(

      1. James I agree with you 100% and while we’re at it we might as well pass laws that outlaws cell phones, doctors, internet,TV and many more commonly used luxuries and practices in society.
        For everything I mention here is in some way causes death and disability.

        Or better yet why not have less government regulation and prosecute organizations within the government that are catering to big business thus the FDA would be telling us things not unlike this site on how to eat healthy with the most up to date scientific evidence. Then an informed public can put as much crap into there body as they damn well please.

        Mike Stilinovich

  2. I have not noticed a problem with salt and BP but then I rarely add salt ( unless I use a low sodium boullion cube LOL) . What I have noticed is that blood pressure changes more or less constantly and by a wide measure. Also I have noticed that it’s SUGAR, not salt, that puts my blood pressure up to worrisome levels. Anyone else notice this ?

    1. I think that you have nade this comment at least twice before?

      “Both dietary salt and sugar are related to blood pressure (BP). The evidence for salt is much stronger, and various types of studies have consistently shown that salt is a major cause of raised BP, and a reduction from the current intake of ≈ 9-12 g/day in most countries of the world to the recommended level of 5-6 g/day lowers BP in both hypertensive and normotensive individuals, in men and women, in all age groups and in all ethnic groups. Countries such as Finland and the UK that have successfully reduced salt intake have demonstrated a reduction in population BP and cardiovascular mortality, with major cost savings to the health service.”

      Your comment about BP variability was very interesting. I have never really considered this although it is apparently a risk factor. It’s probably important though to measure BP in exactly the same way every time. Do yu do that?

      1. hi TG, thank you for your comments. I don’t recall mentioning sugar or BP before, but it’s possible. I mention it because I came across this page the other day I have taken the opportunity during various circumstances in the hospital to notice the numbers up ‘on the board’ as they fluctuate over time – hours and days sometimes. BP seems as if to ride a slow wave.

        Re your quote mentioning 5 to 6 grams per day.. isn’t that a lot? I recall people tracking their sodium intake on a wfpb diet saying it comes in at approx 600 mg / day but perhaps on a whole food diet there is huge variance with use of canned goods, nut butters etc. I have not tracked my intake, but generally my bp is close to 106/ 65 to 112/70. Thank you for the links!

  3. Thanks Sandy.

    The 5-6 grams per day figure is salt not sodium. 5 grams of salt contains approx 1.94 grams of sodium.

    Your BP figures look pretty good. They will though vary with activity levels, posture and time of day. Even eating/drinking/digestion will affect BP.

    Thanks for the Mercola link. However, the low carb/paleo etc crowd tend to be heavily invested in playing down the adverse effects of saturated fat and salt because meat and dairy are relatively high in both saturated fat and sodium.

    While sugar does have a role in hypertension, the evidence for salt’s role is incontrovertible – no matter how inconvenient that is for eg Mercola or Lustig whom Mercola quotes approvingly. Lustig is another unabashed apologist for saturated fat, see eg

    Neither added sugar nor added salt have a place in a WFPB diet but arguing that, because sugar plays a role in these things, sodium must therefore be innocuous is illogical. Both are harmful.

    1. Interesting links.

      This is a topic, where I have heard things from so many different perspectives, that it is challenging for me to figure out the truth.

      Luckily, I have always had lower BP.

      Also, lucky, that I am eating things like rice and beans more than anything and don’t need salt on those to enjoy them.

      Thank you, Dr. Greger, because I had just listened to Dr. McDougall’s logic of salt being a scape goat and, for the first time in ages, I salted a dish I had made, because of his sentences. It was a pasta salad, which I don’t eat very often, but I tasted it and had the thought, “It needs salt” and Dr. McDougall’s sentences about having foods be palatable came to mind, so I pulled out my lower sodium salt substitute. It is supposed to be lower sodium, but I am not sure if artificial salts are any better than artificial sweeteners.

      1. In Dr. McDougall’s book “The Starch Solution”, he cites studies that show that reduced salt intake lowers BP but increases cardio death and raises cholesterol and triglycerides. I am a great fan of both Dr. McDougall and Dr. Greger but agree with the former that salt is just a scapegoat for the real culprits, animal products and vegetable oils.

        1. Thank you Blair and Tom.

          This is the debate.

          Studies contradict each other so often that it is challenging to know how to interpret the data and which data is right.

          When I was having the worst Alzheimer’s night terrors and cognitive problems, that confusion terrified me. Almost a paranoia in every direction.

          Now, I have gotten rid of so many health issues that it feels less traumatic.

          If it wasn’t my elderly dog who had Cancer right now…. if it was someone seriously close to me, this process still would be traumatizing.

          My dog looked pretty good tonight. Even that probably goes back and forth. A few days ago, I felt like I was going to fail. Tonight, it felt like I am going to succeed.

          My finger nails keep getting filled with Amla and Mushroom powder.

          I upped his Amla dosage and upped his Beta Glucan from multiple sources (based on the dog studies with his type of cancer) and upped the Bromelain (based on mice studies) and I am giving him milk thistle. The lab tested Triphala and Dandelion haven’t arrived yet,

          I have the Trypsin and Chromotrypsin and Amylase high dose pills, but I am frustrated by the Dr. Gonzalez study not succeeding. The Bromelain study with mice increased the survival index significantly with every type of tumor, except melanoma. Plus, they gave an easy dosage to figure out.

          I still haven’t figured out what to do with the micrograms / ml – I don’t understand the measures enough to translate it into dog dosages. Plus, I am doing powders into capsules and don’t understand how to know how many milligrams I put into the capsules. I guess I need a scale.

        2. I agree with you on this Blair, but to add I think McDougall overstates the protein negative as it applies to plant protein.

          Salt…… the studies that show gross bad findings as in the UK Finland or if it was done on my brothers close family or anyplace in the US …they all are based on less than healthy non WFPB’s diets.
          A comparative study of certified WFPB low salt WFPN medium salt and WFPB high salt would be necessary to make a absolute determinate of specificity.
          WE do know if you have a poor diet non WFPB it is probably bad for you

          1. McDougal’s protein opinion I think is based on a optimal to keep alive base, not a optimal to perform base as in physical exertion.

  4. Great explanations TG, ty. I do read labels on beans, tomatoes, soup stock or other whole food item I might buy checking for salt or added ingredients. I am occasionally surprised by how much sodium is added to even organic brands.. it’s worth checking.

    I have seen a couple of Lustig’s presentations and will stick with wfpb eating style. Univ of Calif tv does have some interesting videos though for those that might be interested

  5. Mercola comes up often in my Google searches. Never heard of Lustig.

    I can’t do saturated fats, because when I stopped them, I started losing weight, finally.

    I am happy that I had already lowered my carbs and didn’t lose weight. When I was in my early twenties, I lowered my carbs and lost a ton of weight. This time, cutting thing after thing out, nothing happened at all, until I lowered my saturated fats. Won’t go back. Not worth it.

    Still losing weight.

    I am going to say that adding the starches in, decreased my other fruit and vegetable intake considerably. It always does.

    Turns out that it doesn’t matter whether it is pasta, potatoes, rice or beans, they are all filling and satisfying and once I reach for them, the produce in my refrigerator starts going bad.

  6. I was curious, so looked up what the AHA recommends. 1,500 mg of sodium per day or less is easy if you eat WFPB–it’s the processed food that gets you. We even add salt to recipes, but I’ve tallied up our daily average sodium intake and it is always below 1,500.

    “The American Heart Association recommends no more
    than 2,300 milligrams (mgs) a day and an ideal limit of
    less than 1,500 mg per day for most adults, especially
    for those with high blood pressure”

  7. Back in 2010 I had to go to the ER with what they eventually diagnosed as hyponatremia I posted about this in one or two of Dr. G’s prior videos about salt/sodium. I said I’d been avoiding salt and guzzling a lot of water at that time.

    I was mostly concerned with my electrolyte numbers. So, after four years I had another blood test taken (a few weeks ago).. After not hearing from the med office about the test results, I called and was told the test was “normal.” I know how to read those charts, and I wanted a paper copy of my own. Anyway, I found, my sodium level is/was still below the norm. The test showed 133, when it’s “supposed” to be between 135 – 145.

    So now I’ll have to eat a lot of celery and buy salted peanut butter instead of the unsalted version. I guess life could be worse.

    1. I almost bought some Gatorade at the supermarket this morning, but then I looked at the ingredients. Maybe I’ll try another electrolyte beverage of some kind. (?)

      1. Laughing at the Gatorade.

        I look at the color of some of those drinks and wonder what they use to get neon colors.

      2. It is pure junk Gatorade.

        Are you looking at the other side..the how much are you drinking water side?

        1. Yes, ron-with-the-much-longer name. I’ve been measuring my water intake ever since the ER incident summer of 2010.

          And, yes, I was told I could have more salt in my diet — sauerkraut, kimchi, and the like. Could be I’m one of those folks who need more than others. I don’t eat processed, high-sodium foods from boxes or cans and do keep a mostly WFPB diet. So there’s that.

          1. YearRight, climate matters also. I live in the mountains of the desert Southwest US. I am also a runner. In the summer, I definitely need quite a bit of salt to keep going. I also consume an lot of potassium (fruits and veggies), to balance the sodium. Like you I do not eat processed foods.
            I have to remember to use salt in the summer or my blood sugar gets way too low and I feel awful.
            Seems to me most of these studies are done on people in cities who eat tons of processed foods and don’t sweat much.

      3. Soy sauce (I think probably the organic well done stuff is best) seems to not have as a negative affect as other salts to my dim recollection. If I had that problem I would do that, add some to things.
        Sport drinks pretty much suck even the healthy called ones.

        1. Well YR…I remain with my unqualified non medically authorized position of recommendation….soy sauce, a good organic one.
          The single most thing with salt in it , found in the common diet, is usually a pickle,
          They sell organic ones.

          One size fits all often works, but not always, as regards diet as you well know.
          My lifestyle is just so different I think it rarely fits me.
          . You are by my read a pretty close example on how we may not use study, always, as sole determinant in things .Even good ones.

          I have decided I am mostly vegan, as time wise I was once not, but time strictly considered I mostly am. I hope the vegan society and certain posters do not claim exception on such a personal thing..:)

          Especially if they chime in on that, it is so discouraging when they do so, but they do tend to do so . ;) .

        2. Yup, I do the soy sauce too — should have mentioned it. I never tried one of those sport drinks. Anything with a slew of ingredients in it, some of which I’ve never heard of, I stay away from.

          Hmm…maybe I’ll get me a bag of potato chips and feast out. Kidding, of course. :-)

          (People do like their labels….vegan, pescatarian, vegetarian, WFPB, etc.. But how important is it in the Higher Scheme of Things?)

          1. Well that is a leading question, you and I both know the answer to….labels mean nothing.

            But to closely defining veganism is why we see to my opinion, it little advocated for, prior to around 2010. PETA and them vegan society and them, pretty much functionally defined it and they are a rare esoteric groupings of folks.
            With you tube and such, we have now a real large group of peoples of all sorts under the sun who favor it and apply it in different ways. So it is becoming wildly popular.
            Environmental concern in the UK is especially a important consideration. Vegan society them back in their day it never really much occurred. Their thing is all personal morality.

            Environmentalism is morality but not of a personal sort like stopping animal pain.

            So labeling is important to this thing in that it has to be widely opened up, as to application to become and remain popular.Better it is that we should all try to be this thing and not always be this thing, than to not try at all and give it all up as hopeless. The vegan societies rating of who qualifies and who does not, is clearly arbitrary and actually laughable….they disallow a leather belt quite conspicuously, but a cosmetic made of a animal product….that allows you to still be vegan but to work at considering other options.

            I personally think the WFPB crowd don’t give mostly a fig about the environment, as their response to the microwave oven thread a bit ago attested. One helps conserve greatly by cooking the thing not the surroundings in a microwave. But all here was…how about me?
            So maybe it is desired to paint this thing as impossible. But honestly that is only conjecture.

            I have considered the vegan society most in peta and the like, are all a bunch of nitwits that drive peoples away from being vegan with a pitchfork, but that is also labeling and it is a personal opinion.

            1. We draw circles to keep people out based on the small stuff.

              The reality is once you are focused there, you always will find reasons to keep people out.

              Think about vegan doctors and see if your mind doesn’t immediately start singing, “You say potato, I say potato, let’s call the whole thing off.”

              The lyrics would have to be more like “Dr. McDougall says potato, Dr. Fuhrman says stay away from potatoes, let’s call the whole thing off.”

              1. But oh! If we call the whole thing off,
                Then we must part.
                And oh! If we ever part,
                Then that might break seven billion people’s hearts.

                1. I became vegan years ago completely on my own. I had no exposure to the type of people who were vegan thought about it or were even vegetarian.
                  I thought them all actually a bunch of no nothings with chips on their shoulders. Weak peoples who were satisfied by a sprig of parsley and a slice of tofu for lunch, peoples who could do nothing physically…not me.

                  But I knew I had a angst a spiritual lack, and figured It out, the why to that.
                  Now these fools who I never liked in the first place are telling me how they define veganism……geeze louise go try that on someone about 40 years or so younger.
                  I’ve been under that sort of pressure, a form of peer pressure by pros in professional training and pros in formal spiritual training. No vegan group is going to define a thing for me. It is compassion and all compassion for me. Others I am glad to add them to the list of those who like it and add to the numbers, It can only help. I will not tell them they need to follow my way or reason. Do it for your reason any reason is good enough for me. And you do it part way…better than no way by my book.

                  My dog just had a problem presenting as excess flem I was thinking almost like rabies even tough a shot was had. But a week or so ago I gave her a herbal flea type thing. Noticing on application her nose getting wet I thought well just maybe…

                  So I gave her a good shower..most symptoms abated. Another all abated….lucked out I guess. Wonder why it took a week to present?
                  Hope you have the same success with your dog.

                  And as for me….I call myself whatever I want whenever I want. I advise all to do the same.

                  1. That’s right Ron

                    “When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean—neither more nor less.”


                    1. Excepting that the person who started this whole thing named vegan clearly identified it as diet in 1944 and then expanded it to include lifestyle as veganism….

                      And though I think the vegan society archaic and totally out of touch, prescribing OK’s for animal content in cosmetics, but not in belts, by some arbitrary and capricious means…they do maintain a good history and state this as fact which it is…

                      ” November 1944, Donald Watson (right and below) called a meeting with five other non-dairy vegetarians, including Elsie Shrigley, to discuss non-dairy vegetarian diets and lifestyles. Though many held similar views at the time, these six pioneers were the first to actively found a new movement – despite opposition. The group felt a new word was required to describe them; something more concise than ‘non-dairy vegetarians’. Rejected words included ‘dairyban’, ‘vitan’, and ‘benevore’. They settled on ‘vegan’, a word that Donald Watson later described as containing the first three and last two letters of ‘vegetarian’. In the words of Donald Watson, it marked “the beginning and end of vegetarian.” The word vegan was coined by Donald Watson from a suggestion by early members Mr G, A Henderson and his wife Fay K. Henderson that the society should be called Allvega and the magazine Allvegan.
                      Although the vegan diet was defined early on it was as late as 1949 before Leslie J Cross pointed out that the society lacked a definition of veganism and he suggested “[t]he principle of the emancipation of animals from exploitation by man”.

                      Yes I believe there it is….. right above staring out at us, last sentence of the last paragraph from the vegan society themselves….”vegan diet”….

                      Who others, some of us that are not even vegan, and a very select few who are, state this thing…”vegan diet” can not, does not, exist….when we all who have eyes to see and ears to hear …..know quite well it does….see it there…”vegan diet”.
                      And this all despite the known fac,t every person and their brother if one does exist, knows of people espousing adherence to a vegan diet on any facebook you tube blog radio or visual media discussion in not only America but the entire English speaking world…..

                      Really not knowing what to say at this point in time, this discussion edging into the far reaches of illogical.

                    2. Well Ron, when people refer to a vegan diet they just mean a truly vegetarian diet. The tem ‘vegan diet’ is a useless and unnecessarily confusing neologism.

                    3. Funny thing Tom
                      That link you gave to YR it interchanges the terms vegetarian and vegan. The nuns do indeed eat no dairy meat nor eggs and are by diet vegan.

                      But their order was established in Taiwan generally around 1949 and is following a lineage way way prior to the creation of veganism derived from mainland China.
                      And they are assuredly not vegan by the vegan societies standard.
                      From Master Sheng Yen a notable Taiwan Budhist monastic now passed…

                      “There are no rules in Buddhism that forbid the use of leather, but it’s best to try to avoid it unless it’s something we need. For example, in the bhikshu and bhikshuni precepts, there is a rule that monastics are allowed to wear straw sandals with leather soles for walking on mountain paths or long distances. Hopefully we can use less leather, but if we use leather when we need to we shouldn’t feel guilty. ”

                      The monastics themselves…. a bell is used to call the monks nuns to meditation practice in Taiwan, is made of leather customarily.
                      But your link interchanges vegan nuns and vegetarianism.
                      So one has to assume they mean diet, and as this is a nutritional study not a lifestyle study……

                      Thanks for providing a proof of my point. A vegan diet does exist, you have provided link attesting to that.

                    4. Here Is part of it, the terms are interchanged…
                      ” although the diastolic blood pressure of vegetarians was higher compared to the omnivores (77.0±10.0 vs 73.3±10.1, p=0.01), indicating a narrow range between systolic blood pressure and diastolic blood pressure in the vegans. The BUN, BUN/creatinine ratio, total cholesterol, and fasting plasma glucose levels were all significantly lower (p<0.05) in the vegetarian group."

                      Again thanks for providing that ;)

                    5. Sorry Ron.

                      All you have done is note that the term vegan diet widely used to denote a completey vegetarian diet. That’s not the point nor is it something I would dispute. According to that logic, if frequent references to a vegan diet prove that it is a real thing frequent references to Santa Clause would prove that he is actually real

                      All I am saying is that it is a completely redundant term since it simply refers to a vegetarian diet. It is a neologism that has become popular since most people now falsely believe that a vegetarian diet is a diet that omits meat. That of course makes about as much sense as defining a fruitarian diet as a diet that omits fish.

                      People are weird ……. ‘save thee and me, and even thou art a little’.

                    6. Is a vegan diet a subset of a vegetarian diet…..not really.
                      In conventional terms a vegetarian diet is thought of as less restrictive than a vegan diet.
                      In a more to less restrictive scale.

                      Is a vegan diet as well vegetarian..yes always. The inverse not being the case a defining term is appropriate which is the term, vegan, vegan in dietary choice.

                      Tom you have gone from a shaky stand to a stand build upon quicksand…your argument makes no sense. I have in multiple ways from multiple references shown how that is so.
                      You basically at this point in time are presenting a argument based upon solely denial. Nothing logically proves your view nor is their any evidence in common use that the term vegan does not and cannot be applied to simply is always…

                      I think you may need to get out more…this thing is all the rage in the UK.

    2. Possibly. I suppose it depends if ‘normal’ in those tests means ‘average’ or ‘optimal’

      Normal is one of those irritatingly ambiguous words. Also we don’t really know what would be optimal/normal for someone on a completely vegetarian diet – that might be different from the normal level for someone on an omnivorous diet for example. It appears that average sodium levels in vegetarians are lower than in omnivores though eg

      My understanding is that physicians aren’t really concerned about lower sodium levels until they reach about 120 mEq/L

      Your 133 level might even have just been the result of drinking of a lot of water before your blood test. Certain mediactions also lower sodium levels.

      1. Good link, TG….I bookmarked it.

        It was an overnight fasting blood test, and even though water is allowed, I made sure to drink very little nevertheless. I take no meds whatsoever. And, Goddess/God willing, I’ll get through life sans the damn things.

        Well, I won’t worry too much about the sodium issue then. Maybe I could put a little more miso on my morning slop (hot cereal). As it is, I’ve been adding about 1/8 teas. Miso is high in sodium, but as we know, is one of the good guys.

          1. JaysusMary&Joseph (as even former Catholics are prone to say). It seems we’re damned if we do, and damned if we don’t! First we hear we should never eat soy other than the “healthy” fermented types. (I never cottoned to the taste of tempeh.)

            Now I hear I should maybe junk my miso — even though the tiny 1/8 – 1/4 teaspoon I’ve been adding daily could hardly be called “high consumption.” :-(

            And then many nutrition pundits say to just avoid soy foods entirely. Alas.

  8. I think a part of the difficulty is in the observational studies, separating the low salt from the healthy diet anyway, grouping.

    If one group is eating low salt likely they are also WFPB…so is the read on BP a read on low salt or on WFPB? Would a same result occur in part with a WFPB normal salt consumptive group.
    If we add salt to a poor diet group or remove salt from a poor diet group we know salt is very bad.
    But how about a WFPB diet group control and other?

    Agreeing overall that high salt is very bad and productive of High BP. But with athletes and those of high heat intensity endeavors, construction workers doing roofing in the hot south west ultra marathoners… much really is bad?

    1. Good point Ron – for example armies have traditionally issued salt tablets to troops engaing in intense physical activity in such climates. The World Health Organization though comments

      ‘Even in hot, humid climates, there are only minimal loses through faeces and sweat. Acclimation to heat occurs rapidly; thus, within a few days of exposure to hot and humid conditions, individuals lose only small amounts of sodium through sweat (19, 20). Under conditions of extreme heat and intense physical activity that result in high sweat production, sodium losses in sweat are increased and appreciable; nonetheless, most individuals can replace the necessary sodium through food consumption, without dietary alterations, supplements or specially formulated products (19-21).’

      1. Hyponatremia is a less than rare thing in distance running. In fact in the time of the over attention to hydration(mid 80’s) leading to overhydration it did produce deaths amongst most commonly marathoners.

        The cause of that is invariably drinking to much water without addition of electrolyte. That may be exasperated by entering a event in a state of overhydration. Which once was a common practice as well as making sure to take a drink at each and every rest stop.

        Salt tablets are little advised nor is there much to recommend them. Ultramarathoners are probably the most studied group as per hydration and continued ability to perform in relation to events such as the death valley run and dietary inclusions of salty items are always engaged. They are in fact specifically recommended in literature related to the runs.
        Salt tablets never.

        There is little doubt in the field of sports long duration endurance events in heat require a salty diet to be pursued.
        Ones sweat does reduce sodium content with training but that does not infer no salt is lost with sweat. With time more salt is lost. Water itself requires electrolyte the body provides for assimilation if it is not found in foods or drinks. One does continue to sweat in any event and salt is in part a assist in that translation from stomach to other bodily fluids.
        Ones sweat is in any event never pure water no matter how well trained to heat one is .

        1. The link you provide by WHO is all concerned with reduction of salt as stated in their introduction…
          “The reduction of sodium intake in the population is a cost-effective public health intervention for preventing NCDs and is one of the nine global targets selected by Member States for the prevention and control of NCDs.”

          Which is a lofty and well thought goal, but little is its application concerned with endurance athletes of others engaged in like activities. Salt consumption is way overboard in many societies and WHO speaks in these type things for 6 Billion or so peoples.

          Their guidelines cannot be considered specific in this regard to each and every individual nor to each and every individual involved in each and every sport or occupation. Generally they fit and are good things of advice, specifically there may be exception and considered the target base to be about 6 billion there are as well quite a few in the way of exception.

          1. All range animals crave it.
            I want to bring deer to my area all I need to do is put out a salt block..they will show up.

            They then all keel over with strokes from high blood pressure, and I get to eat their rotting flesh…….no….. I am joking it is good for them. Horses elk, same thing they seem to benefit from it.

  9. Many different kind of salts are available on the shelves of a grocery store. There is the regular table salt, sea salt, rock salt, kosher salt, pink or black himalayan salt, red or black Hawaiian salt, smoked salt……
    I understand that it is the sodium content of salt that contributes to the BP problem.

    What I would like to know is, of all these salts which would likely have less sodium content per gram?

  10. Here is an article from Jeff Novick which hits the question from a slightly different angle, but comes to the same conclusion: “My recommendations, which are inline with the IOM, recommend a limit on total sodium, regardless of the source. If you choose to use sea salt as the source of your sodium (as some people prefer the flavor of these “gourmet” salts), that is up to you, but it is not any healthier, safer,and/or more toxic than table salt.”

    1. Hi Hoan-Nurse Educator. I’m still skeptical of complete salt restriction, especially for athletes that sweat often and have higher requirements. Please review the following studies:

      Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. 133,118 individuals in 49 countries studied over 4.2 years. This study concluded that low sodium and high sodium intake associated with adverse outcomes, but not moderate intake. Moderate = ~3-7g or ~1 teaspoon.

      Natural sea salt consumption confers protection against hypertension and kidney damage in Dahl salt-sensitive rats. This study concluded that sea salt may be less detrimental than refined table salt.

      Low-salt diet increases insulin resistance in healthy subjects. This study concluded that a low salt diet increased insulin resistance and other stress hormones.

      Effect of Low Salt Diet on Insulin Resistance in Salt Sensitive versus Salt Resistant Hypertension. This study concluded that a low salt diet increased insulin resistance.

      So, if one is going to use salt, is it best to stick to lower amounts (e.g. 1/16th tsp to oatmeal, etc) and only use sea salt with other protective trace minerals? From what I understand, restricting salt completely (very low salt diets) can cause the kidneys to overwork (trying to retain as much sodium as possible) and become fatigued, much like iodine deficiency causing the thyroid to overwork and become very large (goiter). What is your take on this research and reasoning? Thank you.

      1. You’re cherry picking research papers. The totality of the evidence clearly demonstrates that adding excess sodium to ones diet increases the risk for disease and premature death. If you eat a varied WFPB diet, then you’ll get all the sodium you need which is about 200 to 400 mg/day. It is likely that sprinkling a little more on your food (not cooking with it) will not increase the risk substantially. Processed food, even vegan processed food, often has massive amounts of sodium (and minimal amounts of potassium) so should be avoided at all times.

    1. Hello Tania, many thanks for your comments.

      The 2015-2020 Dietary Guidelines for Americans recommend that Americans consume less than 2,300 milligrams of sodium per day as part of a healthy eating pattern. 2,300 mg of sodium will be equivalent to about 5 gr of salt per day.

      Take into account that the main source of sodium in our diet is salt, although it can come from sodium glutamate, used as a condiment in many parts of the world. So, you need to pay attention not only to the salt you add to your meals, but also the one that comes from processed foods, such as ready meals, processed meats like bacon, ham and salami, cheese, salty snack foods, and instant noodles, among others.

  11. I got a book called The Salt Fix: Why the experts got it all wrong. It mentions most of all the salt test done are on processed salts which rob minerals from our bodies and not regular salts. That if you get blood pressure to drop from extremely low salt that heart rate goes up. And that is also a factor in the stress of the heart.

    One of the things the book mentioned was how much salt use to be consumed and how the salt intake has went down but heart issues go up. (I’m not saying it is or isn’t the salt but maybe it isn’t all the salt).

    Are there any studies done on salts which retain all their minerals? It would be like studying white bread then saying all bread is evil (such as Ezekiel) because the white bread? Not sure if Ezekiel is healthy but it look good.. at least better than white.

    1. Just would like to add I am at the part of the How Not To Die book and I am still really curious about this topic. He is saying that the enzyme is stopped from salt intake which detoxes free radicals. I am still wondering if this is all salt or maybe could it be due to some anti caking agent in processed salts?

      According to the book mentioned above he was saying romans averaged 10grams salt daily, 16th century europeans averaged 40grams salt daily. 70 grams daily in the 17th century. super high numbers without the modern disease.

  12. Frop,

    When we consider the different cultures and salt use it’s not surprising that they had that high an intake. Consider their need to preserve food products. Highly salted foods retard bacterial growth, etc.

    On the issue of salt and modern diseases……they succumbed much sooner to a host of disorders and overall no comparisons are appropriate.

    Typical anti-caking products can be a host of items form organic minerals, such as silicon dioxide to tricalcium phosphate or synthetics such as green ferric ammonium citrate or others. As a note processed salt can also contain conditioners and free flowing agents.

    Stick to the low salt intake approach and if your concerned with the salt clumping put some brown rice in the shaker.

    Dr. Alan Kadish moderator for Dr. Greger

    1. I kind of put this salt thing to test. Unintentionally came across a video from a different doctor saying low salt is bad (I was searching starch..) He sighted a study of 100 million Americans showing higher salt was better to reduce the risk of cardiovascular mortality. The study he called it The NHANES III study. Can comment if that is true? I just want to know if salt is good or bad. I see two camps and neither agree or have given valid reasons on how each may be true or false.

    2. I believe I see the link now. If salt is good it could be shown to be bad because salt is often paired in processed foods, meat, and cheese. So essentially salt is like the ashtray to a smoker. Or fiber to a plant eater. It is just a marker (well more than that) to a animal product or diet void of nutrients. No wonder the studies give it a bad wrap.

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