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Why We Should Cut Down on Salt Independently of Blood Pressure

If you put people on a low-salt diet, meaning only getting twice as much sodium as they need, as opposed to a usual salt diet where they’re getting five times more, you get a significant improvement in artery function. Lower salt begets better arterial function, suggesting heart-protective effects beyond just blood pressure reduction. Now, this was after dropping people’s salt intake by about a teaspoon a day for two weeks. What if you only dropped salt intake by a half teaspoon or so a day? You still get a significant improvement in artery function, and it happens within just two days of reducing one’s salt intake—or, even after a single meal. A high-salt meal, which is to say just a “typical amount of salt consumed in a commonly eaten meal, can significantly suppress [artery function] within 30 [minutes].” In my video Sodium and Arterial Function: A-Salting Our Endothelium, I show what happens 30, 60, 90, and 120 minutes after consuming a meal with just a pinch of salt in it versus eating the same meal, but made with a quarter teaspoon of salt rather than a pinch: a significant suppression of arterial function. Now, is this in addition to the spike in blood pressure from salt or because of the spike in blood pressure?

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 the same soup with no added salt. Now, this doesn’t happen to everyone; this is just the average response. Some people are resistant to the effects of salt on their blood pressure. So what if you repeated the artery function experiment on them? You get a paper entitled (*spoiler alert*): “High dietary sodium intake impairs endothelium-dependent dilation in healthy salt-resistant humans.” Indeed, even in people whose blood pressure is unresponsive to salt intake, they still suffer significant suppression of their artery function. So, independent of any effects on blood pressure, salt hurts our arteries, and that harm begins within minutes of consumption for our major arteries and even our tiny blood vessels.

Using something called laser Doppler flowmetry, you can measure blood flow in the tiny vessels in our skin. In the video, you can see the measurement of blood flow at baseline. Now, to get the blood vessels to open up, they warmed the skin. The reason we may turn pink when we get into a hot bath is that the blood vessels in our skin are opening up, and that’s what happened: a big increase in blood flow with the warming. That was on the low-salt diet, however. A high-salt diet starts out the same, but after the same warming, there’s significantly less blood flow. The arteries just don’t seem to open up as well on a high-salt diet, unless you inject vitamin C into the skin. That seems to reverse the salt-induced suppression of blood vessel function. So if an antioxidant reverses the salt effect, then the way salt may be damaging our artery function is through oxidative stress, the formation of free radicals in our blood stream. But, how?

There’s an enzyme in our body that can detoxify a million free radicals per second (!), 24 hours a day, 7 days a week. But, compared to a low-salt diet, if we consume a normal-salt diet, we suppress the activity of this detoxifying powerhouse of an enzyme. That may help explain why our artery function is much lower on salt. With our antioxidant enzymes crippled by the salt, all the excess free radicals may be crippling our arteries. Mop up those extra free radicals by infusing vitamin C into the bloodstream, however, and artery function returns to normal. In contrast, on a low-salt diet, if you drip vitamin C into people’s veins, nothing happens because our antioxidant enzymes are already taking care of business and haven’t been shackled by the sodium of a normal-salt diet.

Whereas potassium, concentrated in fruits and vegetables, softens the cells that line our arteries and increases the release of nitric oxide that allows our arteries to relax, sodium in our blood stiffens the artery lining within minutes and reduces nitric oxide release. The more salt, the less nitric oxide is produced. Consume one salty meal, and not only does our blood pressure go up, but our arteries literally stiffen. That’s why we could figure out four thousand years ago that too much salt was bad for us. Maybe we don’t need a double-blind trial. Maybe we don’t need to follow people around for a decade. We may just have to feed someone a bag of potato chips and take their pulse.


My video Sodium and Arterial Function: A-Salting Our Endothelium is part of an extended video series on sodium, trying to set the record straight on the “controversy” manufactured by the processed food industries. Check out the other installments:

Other salt-related videos of interest include:

I touched on potassium in Preventing Strokes with Diet and Lowering our Sodium-to-Potassium Ratio to Reduce Stroke Risk, but I’m looking forward to doing a deep dive into the mineral when I get a chance.

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:

Discuss

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.


131 responses to “Why We Should Cut Down on Salt Independently of Blood Pressure

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    1. How much salt that one should take per day depends upon each individual’s need, not by a general consensus. The salt intake ranges from 3g/day up to more than 10g/day. If you take diuretic medication, then your needs for salt should be higher. Low sodium can have many health problems including infections.

    2. I’d love to know the same thing. I’m an cycling athlete and sometimes training upwards of 5-6hrs in a day. McDougall says not to worry about sodium intake and even has it on the table for quests at his retreats. McD says the sodium isn’t the problem, its the types of “food” that associated with the sodium that’s the problem. Thoughts DR.G?

      1. McDougall doesn’t recommend cooking with salt or eating processed food containing salt, but he’s happy for people to add a pinch at the table. That’s a big difference from generally not worrying about sodium intake!

      2. Bret- first congratulation on your impressive cycling. As Dr. Greger has posted salt restriction is appropriate for most individuals even those who exercise regularly. Like Dr. McDougall, he has certainly indicated that high salt foods especially those containing sugar and fat in addition to salt can have negative health consequences. As far as specifying if and exactly how much salt might be needed for endurance athletes, I will encourage you to review the information found on these links:
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445088/ and
        https://www.jssm.org/hfabst.php?id=jssm-14-172.xml/
        That’s not to say athletes don’t need salt. This article https://www.outsideonline.com/2010476/truth-about-endurance-athletes-and-salt/
        cites several studies in peer-reviewed journals, makes the point that while “there’s probably a somewhat higher need for salt in endurance athletes than in the general population… But most athletes are getting more than enough salt through their normal diets “just by virtue of eating more food to fuel their exercise.”
        I think the above quote puts your question in perspective especially considering Dr.Greger’s video on the research about need for salt: . https://nutritionfacts.org/video/sodium-skeptics-try-to-shake-up-the-salt-debate/

      1. This would explain why I perform so poorly when I reduce my sodium intake for health concerns. Thanks, Gengogakusha! Still would like to hear Dr. G’s opinion too.

          1. This seems like great info. I do often feel bloated which from the article you referred could be an indicator of too low sodium. Thx again!

      2. Excellent information, thank you. I live in a predominately very hot dry climate, in summer you will die if you don’t get enough salt. it is an essential mineral and a significant and vital part of our bodies composition so too much is bad, too little can be worse. Found that when fasting for multiple days some salt intake becomes very important, preferably with potassium also.

  1. I wonder if the study showing the impact of a MacDonalds meal on arterial function is due the salt, not the fat as implied.

  2. Very interesting. I did a study last year and noted that compliance in the radial artery had dropped completely up to five hours after injesting 150g of salted potato chips.

    At first I thought it was the oil, as that too will affect elasticity. I believe it was both negative effects on the endothelial cells.

    Boy do they get a rough time!

  3. As a suggestion, could you distinguish if you mean all salts or Morton type of salts. I was under the impression medicinal salts were good.

    1. People selling various types of salt at high prices will come up with all sorts of specious reasons why their salt is different/good for you. But where’s the actual evidence? As far as I know, there is none. It is all just marketing spin.

      In any case it appears to be the high sodium content of salt that is the issue. All kinds of high priced fancy salts contain roughly the same amount of sodium as cheap table salt. The US dietary guidelines note

      ‘ The recommendation for adults and children ages 14 years and older to limit sodium intake to less than 2,300 mg per day is based on evidence showing a linear dose-response relationship between increased sodium intake and increased blood pressure in adults. In addition, moderate evidence suggests an association between increased sodium intake and increased risk of CVD in adults. ‘

      https://health.gov/dietaryguidelines/2015/guidelines/chapter-1/a-closer-look-inside-healthy-eating-patterns/

  4. I’m one of those with historically low blood pressure, so I figured I could enjoy my salt, which I love! I don’t eat many processed foods, and don’t add it to cooking water. But does this mean that we should never salt food at the table? It’s always hard for me to understand just how much is okay – i.e. who knows how much salt actually ends up on our food with a shake or two of the salt shaker….?

    1. Carrie, you could put 1/4 or 1/2 tsp salt in a small dish as your daily ‘allotment’. It gives you an idea of what you are consuming. Canned goods are notorius for high sodium., but there’s a huge difference between brands.

      We use maybe 3 products that have a label on them…. all the rest being whole plant foods. Bouillon cubes, (approx. 1.5 per week), salad dressing, and plant milks are basically it. I understood that a wfpb diet runs approx 650 mg sodium per day with no commercial products added. Salt/sodium measures are given at this link. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/sodium-and-salt

      1. Right, that’s a great method and what I do – 1/4 tsp (590 mg sodium) for the day max, but usually I wind up using much less than half that amount, because sprinkling a pinch or two on the top of my meal is usually sufficiently salty for me these days. Combined with the sodium from other sources (low sodium beans, low sodium spaghetti sauce, maybe 1/2 — 1 tsp Tamari soy sauce), I usually stay under 800-1000 mg/d.

        Aside: I do not aim for ultra-low sodium because there are studies showing that activates the *renin–angiotensin system* (*RAS*) which can, it seems, raise BP (references no handy). I think this is another topic that perhaps has not been thoroughly vetted, and would like to see a Greger deep dive on it. Also I exercise a lot and get concerned about hyponatremia.

        1. “Also I exercise a lot and get concerned about hyponatremia.”
          – – – –

          Which I had back in the summer 2010. I’ve posted about this in several of the other Dr. G. videos regarding salt/sodium. Ain’t about to blather on about it yet again.

          1. Yeah, right. Same topics keep reappearing. Fortunately we have NWOI to thank for raising some new ones. Great to have unchartered territory.
            LMAO!

    2. It seems you got some good advice from commenters, Carrie. I’d just add that once we say NEVER it has bad connotations. Dr. Greger’s video gave good reasons why limiting salt, even if you don’t have high blood pressure and it sounds like you’re careful in trying to limit sodium intake. It’s healthier to never add salt at the table, but the very small amounts described below seem reasonable if you must have a salty taste. Again though we can change our taste buds and there are other condiments we can use, so think about experimenting and perhaps you won’t need even a small amount of salt at the table.
      Joan-Nurse Educator

      1. Before Dr. Greger, I used relatively few spices. Now I have some that don’t fit on my spice rack, which holds 40 bottles. Still a favorite of mine is to try lots of various different spices on fruits and veggies. For example trying coriander, thyme, cinnamon or oregano on cantaloupe, watermelon, tomatoes or avocado. Right there are 16 combinations! With over 200 spices available, and over 22000 fruits and vegetables, you’ll have to try over 100 different ones every day for a lifetime to come close to trying them all.
        Who needs table salt?

  5. guessing this is incorrect to dangerous advice for athletes—my lay person view point. Further guessing that if there were serious arterial stiffening or hardening or whatever u’d feel it, and I do not feel it and get zero rise in blood pressure. In fact I feel better all over after consuming a reasonable amt. of salt. Moreover, it’s hard to ignore in the Vid that the charts show relatively minor changes. So why make a big dramatic deal that salt WITHIN MINUTES is a bfd. Moreover the charts reflect high salt as opposed to normal salt instead of “any” salt. Dr. Gregor would be doing us a bigger favor by publishing exactly how much per lbs of body weight salt is necessary for optimal muscle contraction and other chemical reactions in the body involving salt, which he omits–rather disingenously imo– and that salt is one of the most important minerals and perhaps most important minerals.

    1. fb0250, an exact amount per body weight, etc…
      Can’t be done. Too many variables. Such as how strenuously you exercise, how much potassium, magnesium you get, how hot, how dry, the weather and so on.
      You can get into real trouble as an athlete, especially in a hot, dry climate if you restrict sodium.
      I think making sure you get enough potassium and magnesium is equally important as not overdoing the sodium intake.

    2. Talking about incorrect, it is incorrect and imo disingenuous to suggest that salt is essential. Sodium is essentia. Salt isn’t.

      Also, you wrote ‘Further guessing that if there were serious arterial stiffening or hardening or whatever u’d feel it’. You are likely wrong on this too since

      ‘In a study of medical information gathered on more than 6,800 people in the United States, the researchers found that 10% of those who rated themselves in excellent health had measurable evidence of cardiovascular disease without symptoms, putting them at higher risk for a heart attack or stroke.’

      and

      ‘there wasn’t any correlation between their self-rated health and their coronary artery calcium scores.’
      .
      https://www.sciencedaily.com/releases/2019/05/190515110335.htm

  6. What are the symptoms of salt deficiency? I know it’s probably rare, but I’ve seen backpackers hiking the Appalachian Trail who’ve sweated so much on hot, humid days that they had salt stains on their tee-shirt. What happens if they don’t replenish this salt?

  7. We live in Texas where it is very hot and humid and we are avid exercisers sweating a lot. My daughter and I have low blood pressure. I have to constantly remind her to salt stuff because she eats a healthy home cooked plant based diet. When she gets low on sodium, she is dizzy standing up. What is the min amount of salt an athlete should have. I get her to add olives to her salads to get some salt in her system.

    1. Hello Janet,
      I’m a family doctor who volunteers for Dr. Greger on this website. If your daughter gets dizzy when she stands up, this is most likely due to dehydration, not low sodium levels in her bloodstream. Low sodium in the blood is called “hyponatremia”, which is rare unless you have certain medical conditions (mainly heart, liver, or kidney problems) or take certain medications (e.g. diuretics), or have severe vomiting or diarrhea, or if you drink very large amounts of water. The body has lots of so-called “homeostatic” mechanisms for maintaining your sodium within a very tight range.

      So, there is no minimum amount of salt that an athlete should have. You should give your daughter a tall glass of water, maybe with a little fruit juice in it to raise her blood glucose slightly. If she were running a marathon, and sweating buckets, then it is probably wise to have some electrolytes (including sodium) in fluids used to re-hydrate.

      I hope this helps.
      Dr. Jon; PhysicianAssistedWellness.com,
      Health Support Volunteer for NutritionFacts.org

  8. Does it make a difference if you use Himalayan Pink salt or sea salt instead of plain table salt? I was under the impression that the former were actually good for you. Is that not the case?

    1. I was going to ask the same question. Thinking that the processed “table” salt and that in processed foods may be the culprit, I’d like to see test results using Himalayan instead of the other garbage.

      1. I am skeptical. Sea salt is ~95-98% NaCL. Sure, it has very minor (physiologically insignificant) amounts of many trace elements including some essential ones like calcium but also some less than desirable ones like arsenic, cadmium, lead, mercury, plutonium, strontium and uranium, but I would bet that those minor amounts of trace elements would make a difference (except in the cost to consumers to buy essentially NaCL). And I also doubt that ordinary table salt production methods would, and not the sodium (Na) content, is responsible.

    2. Himalayan salt comes from caves and has less exposure to pollutants such as occur in the sea. The “healthy” reputation of both these salts come from the fact that they will have some trace amounts of other minerals. However, it is my understanding that these amounts are so minuscule-even for trace needs-that they have little if any benefit. I use Himalayan salt because I think it has superior flavor and less pollutant exposure.

      1. Also cf.
        https://qz.com/1429207/plastic-found-in-most-table-salts-especially-ones-from-asia/

        Note that we get far more microplastic from tap water and air:
        “Based on their results, the researchers estimate that the average adult ingests about 2,000 pieces of microplastic in salt per year. But, they write, that still only represents a fraction of the microplastics a person is likely to consume.

        Previous research revealed that microplastics have also been found in tap water, mollusks, and both indoor and outdoor air. All together, those four pathways add up to an average 32,000 pieces of microplastic ingested per year per person. Inhaling microplastics in the air is by far the largest contributor—people ingest roughly 80% of the microplastics that enters their bodies through this route.

        Given those other sources of exposure, microplastics in table salt amounts to about 6% of a person’s total microplastics ingestion, the researchers write.”

        Seems like there’s bigger fish to fry.

    3. Hello Robin, and thank you for your question,

      I am a family doctor and a volunteer for Dr. Greger on this website. All salt is at least 98% sodium chloride. Because it is the sodium content of salt which results in higher blood pressure and stiffer arteries, eating sea salt or Himalayan salt will have exactly the same deleterious health effects as regular table salt. Himalayan salt has trace minerals which give it the pink color.

      One problem with eating sea salt or Himalayan salt is that it does NOT contain any added iodine, whereas table salt marked as “iodized” DOES have added iodine. I actually developed a problem with low iodine (which led to fatigue) because I have mildly high blood pressure, so I keep my salt intake very low. I now take an iodine supplement — as recommended by Dr. Greger in his “Optimum Nutrition Recommendations”: https://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/.

      I hope this helps.
      Dr. Jon
      PhysicianAssistedWellness.com
      Health Support Volunteer for NutritionFacts.org

  9. I rely on salt during the summer to keep my blood pressure up — it is very uncomfortable if it falls too low. I wonder if there is a healthier way I can do this?

      1. Deb,
        Miso has LOTS of sodium in it, FYI. Even “Mellow White” miso, which is a so-called “low sodium” type, has 310 mg per 2-Tbsp serving. Sodium is sodium, wherever it comes from.

        Dr. Jon
        PhysicianAssistedWellness.com
        Health Support Volunteer for NutritionFacts.org

              1. The thyroid is like a master control for metabolic functions isn’t it? The miso could be tinkering with the thyroid in the hours after eating and reducing the blood pressure that way.

    1. Theresa,
      I am a family doctor and also a volunteer for Dr. Greger on this website. See my reply, above, to Janet (12:12 pm on 5/28). Are you sure that the cause of your feeling uncomfortable is your blood pressure dropping? Even if it is, the reason you probably feel uncomfortable is because you get dehydrated (see above). So just drink more fluid (mainly water).

      Dr. Jon

      1. Dr. Greger has commented that the hydration industry has done a good job convincing anyone who listens that dehydration is the cause of multiple evils. But the urine color test is rarely wrong.
        I think when someone says they have low blood pressure, the response should be “Did you check it with a blood pressure monitor?” and “Did you take your blood pressure monitor to the doctors office and compare reading to the doctors professional equipment?” Dismissing a low blood pressure claim out of hand, with no knowledge, and not even touching on the urine color test makes it hard for me to value your comments.

        1. I think that Dr Jon’s knowledge is very helpful here. Your opinions aren’t on the same level.

          And what hydration industry? That’s a new one on me.

    1. bobday,

      Dr. McDougall isn’t “high salt” his guideline is to use a little bit if it helps you to eat healthier foods.

      He is more concerned about people switching from SAD to healthier foods, so he is more “palatability” oriented. He allows a pinch of sugar for the same reason.

  10. I am very sensitive to salt. It definitely raises my BP. I try to avoid it as much as possible since it’s everywhere in food except for meals I make at home. Wondering if 500mg of vitamin c with meals would counteract the arterial and BP effects of salt?

    1. Peter, I wonder the same thing every time I see soy sauce.

      I use Miso in recipes, but it comes in tubs which are way too big for me to use within the expiration time and Soy Sauce would be easier.

      I have been using the Bragg’s Amino Acids, which is made from soy and mentally, I am less worried about it because of the word, “soy” on the bottle. I don’t use the coconut amino acids because I just got burnt by gaining weight with coconut milk and I don’t know if coconut has the same mechanism for the aminos.

    2. I don’t think soy sauce works like miso. When Japan mandated lower sodium content in their soy sauce, the overall blood pressure dropped in Japan. I try to use miso instead of salt and this works pretty well for me. About 3 parts miso for 1 part salt. I like to mash it into some lemon juice. I have not found the expiration date a concern. Sort of like hard cheese.
      I have to admit that it is hard for me to completely really cut out salt. I sometimes use the Japanese Plum Vinegar, derived from fermented salted plums (which does contain salt). I am suspicious of Braggs salt content, but I don’t really know. Maybe Dr G will explore this some more! Health to everyone!

      1. Thanks, Peggy!

        I do use a low salt Soy Sauce about once a month.

        I like Miso, but I wonder if I have to freeze it or something.

        Recipes use a tablespoon or 2 tablespoons and I end up not knowing whether to throw out the container a month later.

  11. Potassium chloride is a good salt substitute. It tastes just like sodium chloride but isn’t. I asked Dr. Greger about it at the recent Michigan event and he said if I don’t have kidney issues, to go for it.

  12. What some people on here don’t seem to realize is that risk starts with blood pressure at 115/76.

    As much of this website has indicated, a whole food plant based diet is true to human requirements.
    Such a diet will provide the sodium requirements the body needs without the addition of any source of sodium chloride (mined, sea or Himalayan).

    The body regulates the sodium level within a range. Added salt to a food item does not mean the sodium will go outside this range on the high side, yet high blood pressure will ensue, now or later in life, from this abuse. And as mentioned there are those whose blood pressure does not change appreciably with added salt but the risk level stated above still applies.

    There are of course a small number who have problems with electrolyte balance, either high or low, independent of diet. They have to be treated accordingly.

    Finally one should not confuse “Athletes” with people who are healthy, nor those who are shredded or ribbed or with flat stomachs with people who are healthy. Each individual has particular performance capabilities and pushing the body to its limits has consequences which would need to be accounted for on an individual basis. This is independent of Dr Greger’s advice for the broader public. Many athletes are on a whole “cocktail” of supplements++ which is a whole other ball game, with few on a WFPB diet.

    1. D R,
      So where’d you get that 76 diastolic number from? Seems rather odd to me, although an even number. I do not believe anyone could possibly justify that specific number given the nature of BP fluctuations and the limitations of statistical studies on populations.

      1. DR is probably correct. The 76 number is probably a typo for 75 eg

        “The Prospective Studies Collaboration meta-analysis of 61 cohorts recruited between 1950 and 1990 reported log-linear associations of systolic and diastolic blood pressure with death from ischaemic heart disease and stroke, with no apparent threshold below which no further reduction in risk is observed, down to a blood pressure of 115/75 mm Hg, in participants aged 40–89 years.2 ”

        https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60685-1/fulltext

        1. FF,
          Yes, one can use that study to support the claim that a cutoff of 115/75 is overall better than 120/80. I am no expert on statistical modeling, but whenever people make categorical statements like “risk starts at 115/75”, I become skeptical because these statistical studies are quite error prone and authors strive to make find new results so they can get published and be cited. I have no trouble believing that with respect to specifically CVD, there is no evidence of a J. curve and so no evidence of **added** risk to values below 115/75. But I still question whether it’s been conclusively shown that below 115/75 is significantly different than the standard cutoff of 120/80. The study is quite complicated and there are many confounding factors, apparently few BP data points, missing data, etc.. I do not have that much faith in such studies when they try to make very fine distinctions. It is quite clear that higher BP when younger is really bad, that above 130/90 adds a lot of risk and that between 120 and 129 typically adds some risk especially when younger. Having said that, I prefer 115/75 or even 110/70 readings whenever I get them.

          1. Yes. Dr G makes a case for 100/60 being ideal or at least natural. Although I do vaguely recall another video where he suggested 110/70 might be ideal.

            https://nutritionfacts.org/2017/10/05/choosing-to-have-a-normal-blood-pressure/

            The AHA/ACC issued updated guidelines in 2017 which proposed a cut-off of 130/80 but some US professional medical associations still support the 2014 guidelines which use the 140/90 figues (even higher for people aged over 60)

            http://www.onlinejacc.org/content/early/2017/11/04/j.jacc.2017.11.006?_ga=2.22194297.316380784.1510771663-1271268032.1509237864

            https://jamanetwork.com/journals/jama/fullarticle/1791497

            I personally suspect that Dr G’s lmuch lower figures are better. Note that the 130/90 and 140/90 figures are not regarded as ideal merely the upper limits of acceptable BP figures.

        2. Help me out with this.
          What I’m reading here is that BP above 115/75 is bad, but there is no benefit to further reduction. However, they weren’t look for benefit below 115/75, only looking for death from heart disease and stroke.

          The other factoid I glean from this: It’s easy to confuse salt (NaCl) intake with sodium intake. Since I eat a Daily Dozen diet, I’m going to guess that my sodium levels are fine.
          But now I need to supplement with *salt, *because I need to *raise *my bp.
          I’m looking at these seaweed ingredients Dr. Greger recommends for iodine, as most brands are very heavy in salt. (And yes, I avoided these in the past due to their high salt content.)

          I need to reread a lot of stuff to unconfuse myself about the role of sodium (not NaCl) in BP.

          1. Hello SpaceCat, and thank you for your comment,

            I am a family doctor and also a volunteer for Dr. Greger on this website. Sodium chloride (NaCl) is what table salt is. From chemistry, 100 g of NaCl contains 39.34 g Na and 60.66 g Cl. It is the sodium in sodium chloride that causes the problems with raising blood pressure and with stiffening arteries. So, you need to minimize your intake of salt AND of sodium — it’s just that the recommended intake of sodium is LESS than the recommended intake of salt.

            The American Heart Association recommends “an ideal limit of no more than 1,500 mg (of sodium) per day for most adults.” If you do the math, that is equivalent to 3,813 mg of SALT. However, I recommend patients with hypertension to limit sodium to no more than 1,000 mg per day, and 500 mg is even better. The average sodium intake in the U.S. is 3,400 mg. On most food labels, they report the sodium content, not the salt content.

            I hope this helps.
            Dr. Jon
            PhysicianAssistedWellness.com
            Health Support Volunteer for NutritionFacts.org

  13. I have low blood pressure. Googling what to do tells me to eat more salt, cross my legs and wear compression socks. I do a pretty good job of following ALL of Dr. Greger’s advice.

    I find it more than a little disconcerting that I’m having health issues BECAUSE I am following Dr. Greger’s advice. It sure makes it difficult to be an advocate!

    One responder indicated: Miso is a way to get the sodium experience without it harming the endothelium. I can’t find the article referenced.

    One issue I see is that all the tests and studies and double blind this and thats are performed on normal or unhealthy people, NOT someone like myself who has essentially made following Dr. Greger’s advice their new religion.

    It’s not hard to believe that humans need to add salt to their food for optimum health. But how much?

    I feel like one of those vegetarians that has a B12 deficiency, or other problem because they blindly followed their diet.

    OK. So what I really need is a response on what to do for optimum health (NOT optimum athletic performance) in the case of low blood pressure induced by a plant based, no salt added diet.

      1. The video indeed says about cancer and hypertension BUT nowhere can you find a reference to damaging the endothelium.

        So, I agree, this issue should be addressed by dr. Greger.

    1. Bruce,
      I can empathize with your situation. I am not a health professional but have a few questions.

      – Was your BP normal before going no added salt WFPB?
      – How low is your BP?
      – Have you experimented with systematically adding salt to see if it brings your BP up to a low normal level?

      – By the way, where does Dr. Greger say to not add any salt under any circumstances?
      I could have missed that but would be surprised if he did, especially since there are almost always exceptions to his general recommendations (which is why no one should blindly follow anyone’s general advice given evidence that it does not work for them).

      If it were me and adding some reasonable amount of salt raised my abnormally low BP to low normal, I’d add some. No doubt about it.

      But I am not a professional health practioner. I hope one responds to your query.

      1. At my worst health, I had BP of 150/105 with meds to lower it.

        My BP has been measured as low as 85/54 recently.

        I have been adding various salt products lately to raise my BP.

        Perhaps I have cut back on salt too much. Dr. Greger, to my knowledge, only recommends that most people lower their salt intake. He has warned against iodine deficiency, which can occur in people that lower iodized salt intake. But no recommendations to my knowledge of ADDING salt to a diet.

        After my internet review, it appears I have indeed experienced the effects of “too little of a bad thing.” Estimates range from 500 to 1500mg per day of salt required.

        1. SpaceCat,
          85/54 is close to the standard cutoff point of 90/60. But measurements are not all that accurate so unless you get such low readings quite often, and assuming you do not have symptoms, it is not clear to me why you are so concerned. So I guess you must have significant symptoms….

          You must have looked into possible causes of low blood pressure and symptoms but if not cf.
          https://www.mayoclinic.org/diseases-conditions/low-blood-pressure/symptoms-causes/syc-20355465

          I assume you are off meds else there’d be no reason to think your diet is the problem. It seems to me dropping from 150/105 on meds to 85/54 without on DrG’s advice is a major victory.

          1. Definitely a major victory. A1c from 6.6 to 5.4. LDL from 180+ to 49.
            I get too light-headed during exercise going from laying down to standing.
            I hate to think I need to swap out steel cut oats for breakfast and substitute in a bag of Fritos so I can get through a yoga class.

            But maybe I can add 16 ounces of miso soup!

            Anyway–that’s my take-way. I have a great diet that is constantly modified. I’m adding miso on yoga mornings to combat low blood pressure.
            I’ll also gradually increase my salt intake (being sure to have antioxidants with the salt), making sure to keep my blood pressure well into the safe range.

            1. Fabulous improvement!

              I haven’t looked at any of my numbers this year of transition.

              My family would like me to because both of my brothers and bother of my sisters-in-law having health issues.

              I am not doing anything yet.

              They don’t understand that I am most eating salads and they are mostly eating pizza.

              Even with that, my brother got off of his blood pressure meds.

            2. ‘Lightheadedness often occurs when you move quickly from a seated to a standing position. This positional change results in decreased blood flow to the brain. This can create a drop in blood pressure that makes you feel faint. You are more likely to experience this condition if you are dehydrated due to illness or insufficient fluid intake.’
              https://www.healthline.com/health/lightheadedness

              1. Also likely to get light-headed if your blood pressure is below 90/60 and try doing a repetitive series of pushups followed by a jumping jacks, even if you drink lots of water.

                The simple test for dehydration is the urine color test: very dark for dehydrated. But the simplest test is “Do you feel thirsty?”

    2. Are you sure that you actually have low blood pressure? There is a lot of personal opinion on the net and in comments, masquerading as facts.

      Just having lower than normal/average blood pressure in Western countries doesn’t mean that you have low blood pressure.

      According to bloodpressure UK having a BP of more than 90 over 60 (90/60) and less than 120 over 80 (120/80) is ideal and healthy.
      http://www.bloodpressureuk.org/BloodPressureandyou/Thebasics/Bloodpressurechart

      1. My BP has dropped to 85/54 on a no salt added diet. This make exercise that includes laying down and standing up very difficult.

        I had incorrectly assumed I would get enough salt if I stuck to the daily dozen (and didn’t count salt as a spice.) There are numerous additions to the daily dozen–B12, iodine, and what I call “no fish” oil. Add salt to the list.

    3. Hello Bruce, and thank you for your question,

      I am a family doctor and also a volunteer for Dr. Greger on this website. You say you have low blood pressure. But is this causing you any kind of health problems? Because, basically, the lower your blood pressure, the lower your risk of heart attack or stroke. If you faint when you stand up, then maybe your blood pressure is too low. The advice you found on Google to eat more salt is bad advice, in my opinion. Of all the many thousands of patients I’ve ever seen, I’m quite sure that over 99% of them would benefit from cutting their sodium intake.

      You should be happy that your plant-based diet has caused you to have a low blood pressure. “Optimum heath” in the case of low blood pressure means, the lower the better. If you get dizzy with standing up, or after exercise, you might be dehydrated. Try drinking some fluid (e.g. water).

      See my comment above to Janet: “Low sodium in the blood … “hyponatremia” … is rare unless you have certain medical conditions (mainly heart, liver, or kidney problems) or take certain medications (e.g. diuretics), or have severe vomiting or diarrhea, or if you drink very large amounts of water. The body has lots of so-called “homeostatic” mechanisms for maintaining your sodium within a very tight range.”

      I hope this helps.
      Dr. Jon
      PhysicianAssistedWellness.com
      Health Support Volunteer for NutritionFacts.org

      1. What evidence is there that BP below 115/70 is beneficial? I know of absolutely NO studies confirming this.

        Sorry, I do NOT find you to be a reliable source of information. Your experience with the general population and patients on the SAD diet is not relevant.

    4. First, NutritionFacts.org site focuses on evidence-based research. Helping you make nutritional choices on the latest evidence-based research is the goal, not having anyone “blindly following” or treating nutritional information as a”religion” .
      I’m sorry to learn you have been dealing with hypotension. Has this occurred since you have adopted a whole food plant based diet? These two factors may or may not be related. Have you been evaluated to rule out other potential causes of hypotension?
      You asked about specific salt needs if you have diagnosed hypotension.Just taking salt may be problematic as many studies have shown. Your solution will depend on your specific symptoms and if/what else might be causing the low blood pressure. I hope you can soon have more answers so you can continue to do well eating a health-promoting diet.

    5. Bruce, do you get a lot of cardio activity in the day? I have low BP and low HR. I get a lot of cardio on the job. Heart stress test was excellent. If you do get a lot of activity it could be that you have a good cardiovascular system and dont need to raise your BP. Mine has been 90/60 with heart rate in high 30s to low forties at rest.

  14. Only true for people on a standard high carbohydrate diet. When insulin is elevated, aldosterone is also elevated signaling the kidneys store sodium and increasing total fluid volume in the circulatory system.

    Dr. Greger is a vegan hack that cherry picks all good data to support his vegan agenda.

    1. Well, thanks for enlightening us. Think I’ll dump my WFPB diet on the basis of your claim and go paleo.

    2. Would you speak so harshly if he were in front of you? I have benefited greatly by Dr. Greger’s wisdom, honesty and scientific take on many subjects. Your unkindness seems unwarranted.

    3. Ah, another low carb troll.

      ‘A colony of 26 chimpanzees given a fruit and vegetable diet of very low Na and high K intake were maintained in long-standing, socially stable small groups for three years. Half of them had salt added progressively to their diet during 20 months. This addition of salt within the human dietetic range caused a highly significant rise in systolic, mean and diastolic blood pressure. The change reversed completely by six months after cessation of salt. The effect of salt differed between chimpanzees, some having a large blood pressure rise and others small or no rise. These results in the species phylogenetically closest to humans bear directly on causation of human hypertension, ‘
      A colony of 26 chimpanzees given a fruit and vegetable diet of very low Na and high K intake were maintained in long-standing, socially stable small groups for three years. Half of them had salt added progressively to their diet during 20 months. This addition of salt within the human dietetic range caused a highly significant rise in systolic, mean and diastolic blood pressure. The change reversed completely by six months after cessation of salt. The effect of salt differed between chimpanzees, some having a large blood pressure rise and others small or no rise. These results in the species phylogenetically closest to humans bear directly on causation of human hypertension, ‘
      https://www.researchgate.net/publication/15710456_The_effect_of_increased_salt_intake_on_blood_pressure_of_chimpanzees

      Silly chimpanzees. Eating a high carb diet is clearly their problem too.

      There is lots of sodium in meat and dairy so it therefore can’t be a problem. Only carbs can be a problem. Got it.

  15. Soooo,

    I put my today’s (2x) daily dozen to cronometer and guess what: 2700 calories but only 1115mg of sodium.

    Any thoughts?

    1. As our commentator below wisely noted, there is lack of research on what is the ideal amount of sodium we should intake, which of course is usually well exceeded by our diet. Since you’re following a whole food plant based approach it’s notable your sodium intake is so much lower. Is this a cause for concern? Are you having any symptoms? Please review this link for likely symptoms:
      The American Heart Association recommends” an ideal limit of no more than 1,500 mg per day for most adults” and does not spell out any cautions on intakes lower than that. You would be wise to check out your sodium intake for several days (This one low reading may have been a rare exception) You can also monitor for any symptoms of hyponatremia intake:
      https://www.mayoclinic.org/diseases-conditions/hyponatremia/symptoms-causes/syc-20373711.You'd want these checked out as well as testing for any other causes for low sodium. Otherwise you are just eating extremely health low salt foods -so much better than the excessive amount of most Americans.

  16. From the World Health Organization (WHO) guidelines

    ‘WHO recommends a reduction in sodium intake to reduce blood pressure and
    risk of cardiovascular disease, stroke and coronary heart disease in adults (strong
    recommendation1). WHO recommends a reduction to <2 g/day sodium (5 g/day salt)
    in adults (strong recommendation)'

    https://apps.who.int/iris/bitstream/handle/10665/77985/9789241504836_eng.pdf;jsessionid=23174992619000243A7AE1BAD250B90A?sequence=1

    1. Paul,
      I don’t think the study proves anything. What I got from the overview is that the average systolic BP in all quintiles of sodium but the highest had high SBP under current guidelines i.e. over 130 mm Hg: (134.5, 132.2, 132.3, 130.3), that the highest intake quintile was pre-hypertensive (128.3 mm Hg) and that there was not much difference between the lowest and highest intake quintiles, respectively 134.5 vs 128.3. Is that a significant difference or just an artifact? Ideal SBP is more like 105-115.

      Also, I don’t get your comment about sea salt and HCl. Care to back up that comment with references to the scientific literature?

      1. I see I left out of my comment the key point that there was no indication many people in the study were on a truly low salt diet, at least less than 1500 g/d but better less than 1200g/d. In other words, it’s quite possible most of them were ingesting too much sodium to have an influence on their generally somewhat hypertensive or prehypertensive SBP.

        That’s why I don’t see that the study proved anything. But I have not seen the original study.

      2. Here is another study that was done in the year 1983 from JAMA. Just look it up there are numerous other studies. The fact is salt does not cause high blood pressure. It is a myth and it always been a myth. No one should be ingesting processed table salt

        https://jamanetwork.com/journals/jama/article-abstract/387408

        Here’s where the salt comes in. We need adequate amounts of chloride to produce hydrochloric acid. The best source of chloride is salt. There is very little available from any other foods (just a trace in celery and coconut.) People who are on salt restricted diets end up with hypochlorhydria and compromised digestion. Since there is no definitive research linking salt to high blood pressure, why deprive yourself of this vital nutrient? Also, sea salt provides vital mineral nutrients that the body requires.

        1. Ok, thanks. I’ll look into it further. Just for the record, I do recognize that various studies show that various minerals other than sodium (potassium, magnesium, calcium) and in particular potassium are key to regulating blood pressure.
          Could well be the balance of minerals is the key. Also, I’ve also read that ultra-low sodium diets trigger the RA system to conserve sodium and that this is undesirable, and can in fact, raise BP. I’ve wondered about that but have not seen it addressed by Dr. Greger or others, and it is the reason I do not follow an ultra low-sodium diet.

        2. Have to disagree with this: ” Also, sea salt provides vital mineral nutrients that the body requires.”

          Yes, sea salt does contain minerals the body requires but other than Na ~33% and Cl ~56%, the amounts are generally minuscule and so far easier to get from fruits and vegetables, which people should be eating in abundance anyway.

  17. I have high blood pressure pretty that’s well controlled on Lisinipril, but my blood sodium level is slightly low — 31 when normal is at least 35. My doctor told me to eat more salt. That seems wrong to me. Does anyone else have this problem or have a thought on t his?

    1. I am not a medical professional and hope one answers your query.

      But I was wondering how much water you drink.

      Low sodium levels indicate hyponatremia, which has various possible causes, one of which is drinking too much.

      As I said I think a medical professional should respond.

  18. I do drink quite a bit of water. I think I’ll try drinking less, but it won’t be easy because it’s a long-time habit. Thank you!

  19. Hello Susan and thank you for your question,

    I am a family doctor and a volunteer for Dr. Greger on this website. First, I’m not sure what units you’re using for your serum sodium levels. In the US we normally use mEq/l, and normal is 135-145. Some places use mg/dl, and that normal range is 310 to 330 — this is what I think you’re referring to.

    So, if your level is “31” (by which I think you mean 310), then that is at the lower edge of normal. But if your level were 350 (which you’re calling “35”), that would be certainly too high.

    Because you have hypertension, and are taking medication for it, you need to be careful not to consume excessive sodium.

    The sodium level in your blood is normally maintained within a narrow range — 310-330, by various homeostatic mechanisms, and consuming more salt will NOT normally raise your sodium level by any appreciable amount.

    Healthy people normally do not have abnormal sodium levels, and your level of 310 is not abnormal. The causes of low sodium levels (“hyponatremia” — i.e. level less than 135 mEq/l, or less than 310 mg/dl) are:
    1) certain medications, mainly diuretics
    2) heart, liver, or kidney problems (e.g. congestive heart failure)
    3) chronic severe vomiting or diarrhea, or other causes of dehydration
    4) drinking too much water — cases known to occur in long-distance runners
    5) hormone diseases, such as very low thyroid levels, or Addison’s disease (rare)
    6) the recreational drug “Ecstasy”

    I seriously doubt you have any of these conditions. The most likely one would be if you are treated with diuretics. Do you take plain lisinopril, or is it combined with a diuretic such as chlorthalidone or hydrochlorothiazide? If the latter, you should speak with your doctor.

    However, I think the advice you were given to eat more salt is probably not good advice. You might want to get a second opinion, from a cardiologist, endocrinologist, or a good internist or family doctor.

    I hope this helps.
    Dr. Jon
    PhysicianAssistedWellness.com
    Health Support Volunteer for NutritionFacts.org

  20. Yes, as there is minimal to no difference in the sodium content between Himalayan salt and regular table salt. Don’t be fooled by a little pink. Its still salt.

    1. While Salt substitutes containing potassium chloride instead of NaCL might help switch initially, you should recognize that they still contain sodium and can pose some problems for some. Check out these links
      https://www.berkeleywellness.com/healthy-eating/food/article/how-salt-substitutes-shake-out/
      (on salt substitutes) https://my.clevelandclinic.org/health/articles/17452-salt-substitutes
      and then go to these NFO videos to consider what ELSE you might use as a substitute for NaCL
      https://nutritionfacts.org/video/shaking-salt-habit/
      https://nutritionfacts.org/2018/12/25/healthier-salt-substitutes/
      Hope that helps.

  21. I’m going back into old memory here but that has been researched and it doesn’t help. Besides, have you tasted KCl? It does not taste like “table salt”.

  22. Leslie,

    Some information for you regarding K2 as this issue gets more press and we bring it to Dr. G’s attention for an article.

    Please see these studies: The (https://www.ncbi.nlm.nih.gov/pubmed/15514282)Rotterdam study looked at the vitamin K2 intake and found an inverse relationship with higher intake resulting in less aortic valve calcification and CVD.

    Keep in mind that there are multiple forms of K2, with the trans K7 being the longer duration and higher activity format, but not necessarily the best approach. For a much more in depth article on vitamin K formats etc. see: (https://omegavia.com/how-to-choose-the-right-vitamin-k2-supplement/)
    How-to-choose-the-right-vitamin-k2-supplement.

    Disclaimer I have no association with this mfg. but found the information helpful and their explanation appropriate. As a supplement formulator, in the past, it’s the “rest of the story” that may make the health difference so please read the whole story and purchase appropriately.

    And take a look at (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566462/) along with this study (https://www.ncbi.nlm.nih.gov/pubmed/25694037)Menaquinone-7 Supplementation Improves Arterial Stiffness in Healthy Postmenopausal Women: Double-Blind Randomised Clinical Trial as two examples of how a plant based diet has a direct effect.

    As a note, see this listing of where you find K2 naturally:

    1) Green Leafy Vegetables (Kale) _ c: 444 mcg (over 100% DV)
    2) Natto (fermented soy) 2 oz: 500 mcg (over 100% DV)
    3) Spring onions (Scallions) _ c: 103 mcg (over 100% DV)
    4) Brussels Sprouts. _ c: 78 mcg (98% DV)
    5)Cabbage. …
    6) Broccoli. …

    Also check out Dr. Greger’s video on best sources: https://nutritionfacts.org/questions/best-sources-of-vitamin-k/

    Dr. Alan Kadish moderator for Dr. Greger http://www.CenterofHealth.com

  23. I am a 23 yr vegan who for the last 5 years have been eating very little salt. I was recently diagnosed with hypothyroidism. I eat aLot of greens in smoothies. I have added no salt to anything. I am afraid that I may be iodine insufficient. I have taken levothyroxine which warms my hands and I think makes me think more clearly. Whats the probability that I am only iodine sufficient. Any studies on this topic. My prescription just ran out and am considering increasing my iodine. What source would you believe to be the healthiest?

  24. Hi Ray. Thanks for your comment :)

    Iodine intake will depend on your overall diet. Healthy adults need 150 micrograms a day. Iodine is also found in vegetables grown near costal areas but actual amounts of iodine are of course not listed on whole vegetables. I would not rely on coastal veggies as a complete iodine source, however, they do contain some. You are spot on with other sources of iodine coming from iodized salt, seaweed, and supplements.

    A majority of folks get their iodine from iodized salt. A 1/4 tsp of iodized salt gives about 45% of the Recommended Dietary Allowance (RDA) for iodine, however, it does have 590mg of sodium, making it not the best choice as the only source of iodine. Sea vegetables such as nori, dulse, and alaria are excellent sources of iodine and do not appear to be polluted. In fact, some research suggests sea vegetables may be beneficial for preventing breast cancer.

    Not a seaweed lover? Don’t enjoy (or cautious) of iodized salt? No problem, a supplement is just fine. You may also be interested to learn about the iodine content in beans! That’s right, Eden brand beans offers a healthy way to get iodine, adding kombu to their cans. As a note of caution: always best to consult with your doctor about supplements right for you.

    Hope it helps

  25. I cut out salt a little over 4 weeks ago. My blood pressure which has always been sorta high at 135/85-90 is now pretty consistent at 107/72. That eating a whole foods, plant based diet free of salt, oil and sugar.

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