Is Miso Healthy?

Is Miso Healthy?
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Miso is packed with sodium, which is linked to both stomach cancer and high blood pressure, so is miso safe to consume?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Salt is considered “a probable cause of stomach cancer,” one of the world’s leading cancer killers. If the estimate from the Second World Cancer Research Fund / American Institute for Cancer Research expert report, of an 8% increase in risk for every extra gram of salt a day, is correct, then, in a country like the UK, nearly 1,700 cases of stomach cancer happen every year just because of excess salt intake. And, in a country like the U.S., it would be thousands more every year.

The risk of stomach cancer associated with salt intake appears on par with smoking, or heavy alcohol use, but may only be half as bad as opium use, or increased total meat consumption, based on this study of more than a half-million people, which may explain why those eating meatless diets appear to have nearly two-thirds lower risk.

We know “[d]ietary salt intake [is] directly associated with [the] risk of [stomach] cancer.” And, the higher the intake, the higher the risks. But, this meta-analysis went further, looking at specific salt-rich foods: pickled foods, salted fish, processed meat, and miso soup. Habitual “consumption of pickled foods, salted fish and processed meat were [each] associated with” about a 25% greater risk of stomach cancer. The pickled foods may explain why Korea appears to have the highest stomach cancer rates in the world.

But, there was no significant association with the consumption of miso soup. This may be because the carcinogenic effects of the salt are counteracted by the anti-carcinogenic effects of the soy, effectively canceling out the risk. And, if we made garlicky soup with some scallions thrown in, it may drop our cancer risk even lower.

But, cancer isn’t the primary reason people are told to avoid salt. What about miso soup and high blood pressure? Well, it may be the same kind of thing. The salt in miso is squeezing our blood pressures up, but the soy protein in miso may be relaxing our blood pressures down. So, for example, if you compare the effects of soy milk to cow’s milk—and, to make it fairer, compare soy milk to skim milk, to avoid the saturated butterfat—soy milk can much more dramatically improve blood pressure among women with hypertension. But, would the effect be dramatic enough to counter all the salt in miso? Japanese researchers decided to put it to the test.

They followed men and women in their 60s who started out with normal blood pressure, and followed them for four years to see who was more likely to be diagnosed with hypertension in that time—those who had two or more bowls of miso soup a day, or those that had one or less. Two bowls a day would be like adding a half-teaspoon of salt to one’s daily diet, yet those who ate two bowls or more appeared to have five times lower risk of becoming hypertensive. So, maybe the anti-hypertensive effects of the soy in the miso exceed the hypertensive effects of the salt.

Please consider volunteering to help out on the site.

Image credit: Kristina DeMuth. Image has been modified.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Salt is considered “a probable cause of stomach cancer,” one of the world’s leading cancer killers. If the estimate from the Second World Cancer Research Fund / American Institute for Cancer Research expert report, of an 8% increase in risk for every extra gram of salt a day, is correct, then, in a country like the UK, nearly 1,700 cases of stomach cancer happen every year just because of excess salt intake. And, in a country like the U.S., it would be thousands more every year.

The risk of stomach cancer associated with salt intake appears on par with smoking, or heavy alcohol use, but may only be half as bad as opium use, or increased total meat consumption, based on this study of more than a half-million people, which may explain why those eating meatless diets appear to have nearly two-thirds lower risk.

We know “[d]ietary salt intake [is] directly associated with [the] risk of [stomach] cancer.” And, the higher the intake, the higher the risks. But, this meta-analysis went further, looking at specific salt-rich foods: pickled foods, salted fish, processed meat, and miso soup. Habitual “consumption of pickled foods, salted fish and processed meat were [each] associated with” about a 25% greater risk of stomach cancer. The pickled foods may explain why Korea appears to have the highest stomach cancer rates in the world.

But, there was no significant association with the consumption of miso soup. This may be because the carcinogenic effects of the salt are counteracted by the anti-carcinogenic effects of the soy, effectively canceling out the risk. And, if we made garlicky soup with some scallions thrown in, it may drop our cancer risk even lower.

But, cancer isn’t the primary reason people are told to avoid salt. What about miso soup and high blood pressure? Well, it may be the same kind of thing. The salt in miso is squeezing our blood pressures up, but the soy protein in miso may be relaxing our blood pressures down. So, for example, if you compare the effects of soy milk to cow’s milk—and, to make it fairer, compare soy milk to skim milk, to avoid the saturated butterfat—soy milk can much more dramatically improve blood pressure among women with hypertension. But, would the effect be dramatic enough to counter all the salt in miso? Japanese researchers decided to put it to the test.

They followed men and women in their 60s who started out with normal blood pressure, and followed them for four years to see who was more likely to be diagnosed with hypertension in that time—those who had two or more bowls of miso soup a day, or those that had one or less. Two bowls a day would be like adding a half-teaspoon of salt to one’s daily diet, yet those who ate two bowls or more appeared to have five times lower risk of becoming hypertensive. So, maybe the anti-hypertensive effects of the soy in the miso exceed the hypertensive effects of the salt.

Please consider volunteering to help out on the site.

Image credit: Kristina DeMuth. Image has been modified.

Doctor's Note

So miso paste, a whole soy food, can be used as a “green light” source of saltiness when you cook. That’s why I used it in my pesto recipe in How Not to Die. It can help you in Shaking the Salt Habit.

Not convinced that salt is bad for you? Check out videos like:

Not convinced that soy is good for you? Check out videos like:

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

105 responses to “Is Miso Healthy?

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  1. Great to know! I love miso and always just assumed it was healthy due to the probiotics. Miso soup is so easy to make at home, and add your own organic tofu, mushrooms, seaweed and veggies – all great stuff of course. It’s easy to find organic miso paste nowadays. It’s also great for making a salad dressing (I mix with crushed ginger, a bit of vinegar and a bit of olive oil).




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    1. Even though the soy in miso may counteract the salt it does not have anything to do with how healthy tofu is. Tofu is a processed food and much of it is made with isolated soy protein which is likely not healthy.

      Better than miso is natto which is the highest K2 in any food on the planet, tempeh or the soy beans whether in a pod or cooked at home like other beans.




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      1. Richard: I looked up how tofu was made some years ago. It’s made by congealing soy milk, much the same way that dairy cheese is made by congealing dairy. In essence, tofu is soy cheese. It does not have any isolated soy protein to my knowledge. While the whole bean (say edamame or tempeh) is healthier, as Dr. Greger says, beans have so much nutrition in them, you can take out half the nutrition and it is still healthy. Bottom Line: There’s nothing inherently unhealthy about tofu.




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  2. I have a question about sodium vs. salt: I seem to recall from chemistry class that the sodium atom is much smaller than the chloride atom in sodium chloride, salt. So, if I eat 200 mg of “sodium” in a serving of taco chips, does that really translate to a much larger quantity of actual salt? IOW, when I read the sodium content on a nutrition panel am I reading the weight (mass) of the sodium atoms or the weight (mass) of the salt added? If the former, it would seem that each gram of “sodium” I consume would imply many more grams of actual salt, since most of the weight is in the chloride atom.




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    1. You are right, drcobalt. If you multiply the amount of sodium by 2.5, you get the actual salt content. If the package reads sodium, it only gives you that amount. The RDA for sodium is 2 g/day, equal to 5 g of salt/day. At least that’s the RDA in Europe and should be considered an upper limit rather than a recommended amount. Unsalted food usually provides all the sodium we need, as it does all other minerals. Keep in mind that we add sodium for the sole purpose of flavour. That’s why you don’t see a pizza spiced with magnesium, calcium and potassium.




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    2. Honestly, I would make not so much thoughts about the size of atoms, then the quality of salt. There is a big differene between, and I don’t mean the price, because salt is more then NaCl… here in Germany we can buy stone salt, ocean salt with seaweed (for iodine intake) and without, we can get so called Himalaya salt and of course the normal NaCl with industrial iodine and huge help (mostly aluminium)… it is the cheapest for the buyer and the best for the pharma industry and the medicine profit. Be aware in junk food always they use the cheapest salt with no good quality. Miso mostly has ocean salt inside, this is a good thing. Let me say one word to the article of master Greger at the Japanese study… I haven’t read the study in original yet but I suppose they made no statement to the food consumption generally. It’s only a quess of me but I think older Japanese people eat not so much junk food like ordinary Germans or Americans and may be they have no barbecue party every weekend during the summertime , they are eating not so much cheese and sausages but more rice and vegetables… what I mean is – don’t look only at one study, look at the hole diet, the hole circumstance – every study is nothing alone but is a pice of a big, big puzzle. Master Greger shows us every day a other pice of this puzzle but everyone has to make the puzzle by him self. ;-)




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  3. When I first when vegan, I started used miso quite liberally as a flavoring. The pungent flavor of miso actually makes a fair cheese substitute for pasta dishes, but after a after a while, I noticed my increased sodium intake didn’t make me feel all that great so I gave away or threw away all of my salt containing foods, and suffered through about a month of tasteless meals until my body found a new set point and my taste acclimated to flavor of un-salted foods. During this time I, I ate a lot of fruit and raw vegetables because they taste great without salt.
    Since then, I never looked back. I remembered being shocked by how “salty” un-salted cooked Swiss Chard and spinach could taste after going on a “no added salt diet,” or how much better I felt by omitting added salt from my diet. I can tolerate eating out every now and then, but I now prefer my meal un-salted. It’s a good way to go. My recommendation is to give it a try.
    As far as miso soup goes, it probably safe enough to have every now and then, but one is probably better off getting the wonderful benefits of soy foods by eating them un-salted.




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    1. So true, Joe. I remember waking up with puffy eyes with bags under them whenever I consumed a high sodium meal the night before. Now it only happens once in a while when I have to eat out. It’s pretty systematic: high sodium dinner = bags under my eyes the next morning. I can only imagine what it’s doing to the rest of my body.




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      1. Nancy, I haven’t any regrets eliminating added sodium from my diet. If one listen to one’s body, it will tell you when it likes what you are doing, and my body is very happy that I’ve given it up.




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    2. Hi Joe, I use miso regularly as a condiment. I mix with rice vinegar and a touch of mustard for a dressing, or add a little H20 and make a quick sauce for veggies. Good stuff!




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      1. Miso is very tasty stuff. I can see how it would be a great ingredient for sauces. I just went overboard with its usage when I initially went WFP based which had the net effect of putting me off added sodium altogether. Enjoy it sensibly.




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    1. vgnchk: I’m not sure we know for sure on way or another, but I remember an older NutritionFacts video where the gist was something like: Yes, soy is great, but so are other beans. It’s possible that soy is special in some way that chickpeas are not, but I would *guess* that chickpea miso would be a lot more like soy based miso than say like salted pickles. What do you think?




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      1. Thea,

        Has Dr. G done any research on siberian ginseng? I can’t seem to find any videos or topics on it and
        am surprised. Wondering your thoughts. Thanks.




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      2. Thea, I posted this earlier today but it looks like it got replied to another person, so maybe I made mistake.
        It was meant for you.

        Has Dr. G done any research on siberian ginseng? I can’t seem to find any videos or topics on it and
        am surprised. Wondering your thoughts. Thanks.




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        1. Shea: I did a search for ‘ginseng’ and came up with a video that didn’t mention ‘ginseng’ at all. Then I read the doctor’s note: “And I’ve yet to do a video on ginseng, but I will!” That was in 2012. :-)

          I don’t know anything about ginseng myself. I looked it up on Wikipedia and found this interesting statement: “Siberian ginseng (Eleutherococcus senticosus) is in the same family, but not genus, as true ginseng.”

          I will forward your comment onto staff to make sure the topic is on Dr. Greger’s topic list. Maybe he will cover it in the future. I just don’t know enough about the topic to have any opinions.

          How about yourself? Have you found it to be helpful?




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          1. I don’t use the ginseng, but have considered. I’d first like to find out the science, and if it gets a green light or not from Dr. G for safe use.




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            1. Shea: I think that’s a wise approach. I’ve been assured that this topic has been added to Dr. Greger’s official list of topics. Just a word of warning, however: That is a long list. There’s no guarantee if/when any one topic will be addressed.




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              1. Hi Thea, Hi Shea,
                sibirian ginseng is very commen at the TCM, on the German page of PharmaWiki you can read, that this root content mostly so called Eleutheroside (mostly Triterpensaponine and Phenylpropanoide). The roots are antiviral, immuno stimulating and adaptogen and we use it agains fatigue and weakness also you can try to use it agains lack of concentration – may be you have to be a little bit careful if you suffer on high blood pressure.
                Because it is a natural plant I quess master Greger would put it in the green light area but it is like all natural drugs use it with understanding and not every day if you are not sick. some natural plants are good for every day, like the most hherbs and spices but some plants are made only for a short time use if you have some health problems… ;-)




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            2. I drink a cold-brewed ginseng/green tea mix during the summer….wonderful stuff. 6 teabags in 1 gallon water in the fridge….no sugar. Good hydration…slight pick me up.




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  4. If the cancer fighting compounds in soy counteracts the cancer promotion of salt in Miso, I don’t understand why not the cancer fighting compounds in cabbage also counteract the cancer promotion of salt in Kimchi. Does not make sense to me. Maybe it’s not the Kimchi that promotes the high stomach cancers in Korea. Maybe its the Bulgogi.




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    1. Their kimchi is generally fishy so maybe that makes a dfference? Also, high intake of kimchi replaces fresh veg especially over winter.
      Garnish-size doses without added sesame oil, I’ll put down as beneficial until I hear otherwise.




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    2. I don’t have specific knowledge to contribute, but I don’t see how we can know anything about kimchi without knowledge specific to kimchi. I don’t think it was mentioned in this video.
      It’s possible (again, I don’t know, I’m not saying it is) that the anti-cancer activity of cabbage is destroyed by the pickling process, or it’s possible that the pickling process changes a chemical in cabbage to make it unhealthy.




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    3. Hello! There are 2 main reasons why kimchi is not comparable to miso.
      1. Kimchi is pickled, pickled foods are really bad because they are extremely acidic (literally preserved IN acid AKA Vinegar). This is why pickled vegetables are associated with such a large increase in cancer risk. Meanwhile, Miso is fermented by salt and a type of fungus, not vinegar (Basically, the preservative is the salt itself.
      2. Soy foods are much higher in antioxidants than cabbage. Especially non-red cabbage. To see this in a hypothetical situation in number form:
      Soy bean can be assigned anticancer value of 12. Cabbage anticancer value of 3. If the salt content was exactly the same, in addition to ignoring the acid from vinegar added to the cabbage – salt is given a carcinogenic value of 10.

      Soy + Salt = 2 –> Protective.
      Cabbage + Salt = -7 –> Carcinogenic.

      Hope that helps!




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      1. I think the health bennies of naturally fermented foods greatly overcomes any possible risk from sodium intake. Salt is required to create a safe environment in most ferments, miso even much more as it is a specific fungi, inoculated into a relatively sterile growth medium. In our products we only use pink Himalayan, as the “Day Glow Fukishima” and “Plastic Sea Island” flavoured sea salts are questionable to me. Our krauts & kimchi ingredients are grown in soil specifically created for most healthy microbial content. This transfers directly into the veggies natural acidification process and in a way, is like “plugging into the Earth”. Soil Based Probiotics work. The salt content I feel is is irrelevant. a couple potato chips have way more sodium than a few mouthfuls of kraut, or kimchi. If anyone has any data that shows sodium/salt changes during a two month fermentation, please let us know.




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    1. Frank: I have sound and another poster kindly let us know that he has the sound also. Can you check and make sure your sound is not muted? If muting is not the issue, you might do some tests to problem solve before reporting to the Help Center. For example, does the sound work in another browser? Does sound work for other videos on this site? Once you have some parameters figured out, you can report the problem by clicking the Help Center link at the bottom of the page and then clicking the link in the upper right side of the screen. Good luck.




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    2. I have sound.

      Great talk today. I love Miso and buy the low sodium type though still wary of the salt content. I do love soy but not the processed varieties except for the organic tofu I buy often along with original, with out sweetener, added soy milk.
      I really enjoyed Dr. Greger’s timely talk today.




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  5. This is great news!! I make a white salad dressing/veg dressing using cauliflower, raw cashews,tumeric,pepper,a bit of sea veg and miso.. I’m sensitive to salt as it raises my BP. I was curious about the salt in miso and this timely vid answers my question… Thanks!!!

    No problem with sound on my end…
    m




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      1. It’s really simple.. I read about it as a ersatz alfredo sauce and just messed around with it.. 10 to 12 oz fresh,frozen or cooked cauliflower florets that I throw into a Blentec/Vitamix type blender.. A bit of almond milk, veg broth or just plain water… Start to wiz it up and gradually put in the cashews.. Then a good dollop of miso paste.. Stop and taste it… ? lemon juice or zest maybe? Then put in spices to taste like turmeric and pepper, garlic powder (or fresh). I sometimes put in Nutritional yeast also. Maybe sea veg’s.. They never come out the same twice but always delish… The cashews give it the mouth feel/unctuousness of oil in a dressing without that much oil and the cashews are the whole nut, not just the nut oil… It lasts about a week in the fridge.. but I usually eat it up first… Great on salad’s and steamed veg….
        Here are some web sites that I got my inspiration from…

        http://heartbeetkitchen.com/2015/recipes/type/vegetables/creamy-vegan-cauliflower-sauce/

        http://www.staceyhomemaker.com/roasted-cauliflower-cashew-cream-alfredo-sauce/

        Enjoy!! mitch




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  6. I tried to leave the following comment, but forgot to put in my email address so it gave me an error page and told me to fill in the missing info. I did an his submit, and I got a different error page telling me that the comment was already posted, which it’s not. Perhaps the feedback form needs a little tweaking.

    I use an organic non-pasteurized miso, but it’s made from chickpeas, not soy. Now I’m wondering where that leaves me. : /




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  7. I love NutritionFacts.org and I am crazy about Dr. Gregor. With that said, I would like to say I think the title might be better phrased “Is Miso Healthful?” if we mean “for humans”. Just sayin’.




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  8. Wonderful!! I’ve been begging for this topic to be covered for years & finally….clarity! If miso confers health benefits that other salted fermented (pickled) vegetables do not, presumably it is due to the protective nutrients in soy, not the fermenting microbes. Is there any data that evaluates other fermented Asian soy-based condiments like fermented soy sauces/tamari, douchi (fermented Chinese black soy beans ), etc?




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  9. Rather than go for a product where the ‘good’ cancels out the ‘bad’, think i will opt for something with just the ‘good’.. soy milk (the brand i currently use) has 110 mg sodium / cup.. 2 cups per day is fine in the context of wfpb eating. Oddly, since starting wfpb, I have been struggling with higher bp so I read labels in the rare event i use any food that bears a label.




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    1. This is an impossible endeavour. Every thing you metabolise breaks you down a little, to word it differently is that everything is bad for you even the cleanest water and air. This is part of the reason, combined with environmental influences, we age and die. Unfortunately we also require these things to live.




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    2. What is so great about a processed product like soy milk???? Have you really checked the ingredients? I prefer unprocessed soy products like natto, tempeh and soy beans which do not have cane sugar,salt or Carrageenan as many soy milks do…




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      1. Richard: The ingredients in my soy milk are “soy, water”. What’s great about soy milk is that I can make some delicious, creamy sauces and (on occasion) rich cakes while still getting the benefits of some soy and avoiding the dangers of dairy milk.




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  10. Interesting. I’m curious about the pickle comments. Does that mean vinegar pickles or fermented. Does the salt outweigh the microbiome benefits of fermented foods? Also is it possible Korean’s high rates of stomach cancer are related to their high rates of alcoholism vs the kimchi?




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    1. I have noticed a wide range of salt content when I buy sauerkraut, up to a 3x difference. I choose the ones with lowest sodium, as they taste better, and are no doubt healthier. So, I wonder if there is any standardization on the sodium content when these studies are done, cause I am sure it would make a difference in the results. How the kimchi is prepared would probably make a big difference.




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  11. There is a mistake in the german translation at 2:50. The Translation says „Forscher der Harvard Universität“, but Michael Greger says „Japanese Researchers“ witch is actually right, the study is from Showa University, Tokyo.




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  12. Could it be the benefits of the healthy bacteria in miso rather than the soy that canceled the salt effects? I still very much doubt that the soy is a health food given its toxicity, phytic acid and phytoesstrogene impacts, except when its fermented like miso.




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    1. Well, the science says that you’re wrong. Internet propaganda and misinformation no doubt. Watch the NF videos on soy. It’s an excellent food. You should try to incorporate it into your diet.




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  13. I’m new here, but a 21 year cancer survivor who used macrobiotics for a very deadly (considered ‘terminal’ by 5 doctors at Sloane-Kettering, NYC. * I guess it’s only terminal cancer if you die from it!) head and neck cancer. Please don’t forget the vitamin B12 benefits of naturally (salt/brine) pickeled products like miso, sauerkraut, pickeled daikon, pickeled ginger, etc. For those of us who rarely eat any animal flesh products, B12 is near impossible to get any other way. Go Pickles!!




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    1. A cheap and small vit B12 tablet is easy to take as appropriate in a week. I take 2-3 vegan 1000mcg cyanocobalamin tablets on a week (Veganicity brand… I’m not affiliated to them).




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  14. Might it be better just to eat the soy and leave off the salt that comes with miso? Or is it the interaction between the ingredients which keeps BP from rising?




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    1. The salt is not necessary for soy benefits, but it is necessary for the benefits of the pickling process. Also, there are many people who are allergic to unpickled soy products but can eat pickled soy products like miso and shoyu (in small amounts) my wife being one of them.




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      1. Michael, I am also allergic to soy but have recently found that I can consume small amounts of fermented soy. BTW, congratulations on your 21 years as a cancer survivor, and may you have many, many more!




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        1. Thanks Nancy. Macrobiotics is powerful medicine when you need it. BTW many allergies are caused by high levels of yeast (candidiasis) in your body. Also, IMHO, some food allergies and addictions can be caused by overconsumption of a particular type of food. I know I became ‘allergic’ or highly sensitive to soy after 5-6 years of eating soy products at practically every meal: miso, shoyu, tofu, soymilk, tempeh, shoyu pickled foods, etc. I laid off soy for about a year and slowly re-introduced it into my diet recently. Now I keep soy as a small part of my diet, mostly as miso and shoyu, and no problems. If you are eating ‘healthy’ American processed foods, soy has now become a ubiquitous part of ingredients. Check package labels. If you are interested, check out macrobiotics online. I had considerable personal counselling at the Kushi institute in Becket MA. I am in no way affiliated with them, but as far as I am concerned, I credit my counselling and food prep lessons at the above mentioned institute with curing my cancer and saving my life. ‘Food is very powerful’ was what my counselor used to say.

          Good luck, And thanks for your kind words.




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  15. Miso is a bit generic Iam curious other than Soy miso any study has been done

    I also want to say pickling and fermenting can be defined differently

    One more question.
    During proper pickling, doesn’t salt ionize and combine with other minerals creating a new molecule and minimizing any deleterious side effects? And, if added during cooking and not as a table condiment, doesn’t it do the same?




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  16. I fine grate uncooked red cabbage and raw beet and immerse in cyder vinegar with the addition of kelp powder. This mix ferments and is great savoury food dressing preferable I think to saurekraut.




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  17. Is there a mechanism for salt to cause cancer? The closest I could find was a study that found salt increased cancer in animals with h. pylori and another study with animals dosed with two carcinogens.




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    1. Hi, I am one of the volunteers at NF site. I hope this information helps to answer your question about salt and how it could damage the Stomach. Scientists believe the increased stomach cancer risk from salt-preserved foods is because it infuses the foods during the preservation process. Experimental research has shown that salt damages the stomach lining and causes lesions, which, if left to develop, can become stomach cancer.

      Importantly, infection with Helicobacter pylori bacteria also damages the stomach lining, and is made worse in the presence of salt.
      Salt: Shaking up the link with stomach cancer




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  18. Hmmm This would seem to imply that we should be consuming soy with ANY meal that is high in sodium. And since eating out is alway a challenge where salt is concerned, I think I’ll start packing a soy snack with me and call it a little after dinner treat.




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  19. What about soy sauce? I have a vegan Pad Thai recipe that requires soy sauce. I’m hoping that there is something healthy counteracting all that sodium. Even reduced sodium soy sauce is high in sodium.




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    1. Thanks for your question Tami.

      You are right, replacing regular soy sauce for a lower sodium soy sauce option may be helpful but not very effective. According to this study, after giving low sodium soy sauce to one group and regular soy sauce to another group for 6 weeks, the results indicated that :

      “There were no significant differences in age, sex, body mass index, BP or hypertension between the 2 groups before intervention. After the 6-week intervention, no significant change in BP was observed in the entire cohort. However, in those aged 40 years and older, 6.4 mmHg net reduction in diastolic BP with no significant change in systolic BP was noted in the low-sodium group.”

      PCRM advises people to limit their soy sauce intake to reduce blood pressure. Interestingly, in animal studies, one review states that:

      “Kajimoto reported that soy sauce decreases blood pressure. When 25 to 30 ml of soy sauce was administered to dogs, whose body weights were 6–10 kg, their blood pressures decreased 1 min after the administra- tion and returned to the baseline level within 1 h. Kajimoto suggested that soy sauce contains a substance that promotes histamine absorption as the causative agent of the blood pressure decrease effect.
      Kinoshita et al. found an inhibitory compound of the angiotensin I-converting enzyme (ACE) in soy sauce. ACE catalyzes the hydrolysis of angiotensin I resulting in the generation of the potent vasoconstrictor angiotensin II, which regulates arterial blood pressure. ACE inhibitory activity in soy sauce was fractionated into two major fractions of high molecular weight (Hw) and low molecular weight (Lw) by gel filtration chromatography after treating with ethanol. The Hw fraction decreased blood pressure in hypertensive rats after oral administration, while the Lw fraction did not (Table 1). Blood pressure decreased 1–8 h after the administration of the Hw fraction and returned to the baseline level within 24 h in spontaneously hypertensive rats (SHR) and two-kidney Goldblantt hypertensive rats (2KGH rats). The Lw fraction had no effect on blood pressure in either type of rat. The main ACE inhibitor in the Hw frac- tion was purified by high-performance liquid chromatography and was identified as nicotianamine (N-[N-(3-amino- 3-carboxypropyl)-3-amino-3-carboxypropyl]-azetidine-2-carboxylic acid) (Fig. 1). The IC50 of nicotianamine for ACE was 0.26 μM. It was one-tenth of that of the widely used antihypertensive drug Captopril.
      Blood pressure decreased to 24, 20 and 19 mmHg at 1 h, 4 h and 8 h respectively, after a single administration of 20 mg/kg body weight of the purified inhibitor (nicotianamine) to SHR. Kinoshita et al. (7) found that soybeans contain a large quantity of nicotianamine”

      Hope this answer helps.




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    1. Hello, I am a volunteer moderator helping Dr. Greger answer questions posted to NutritionFacts. You raise a great question. Miso soup is actually made from miso paste – as are some vegan cheeses. Miso paste is the active “soy” ingredient that appears to have the beneficial anti cancer effects. Vegan cheese has way too many variants, so as such, I am unable to comment without reading nutrition labels. There may be compounds in some vegan cheeses (like the dreaded and environmentally terrible PALM OIL) that have the opposite effects.




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  20. If this is true, why wouldn’t having a glass of soy milk with a salty meal also prevent blood pressure from going up? Or have edamame before having fast food? I would love to see this study re-done in America with a thousand people or more, with various soy foods consumed with salty meals. By the way, I too love this website and am constantly answering questions on Quora.com by directing people to this site.




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  21. Someone can certainly correct me if I got the wrong impression, but todays video does not give me the idea that soy in of itself can mitigate the negatives of consuming a salt laden meal… on the contrary, I thought Dr Greger is suggesting that we continue to avoid salt use where possible, and is putting forth the idea that we can use a bit of miso paste IN PLACE OF SALT in our recipes without incurring the negative effects (elevated risk of cancer and higher blood pressure for example)

    Thanks Dr Greger !




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    1. Thanks for your comment susan.

      You may be right, according to the study mentioned by Dr Greger:

      “One plausible hypothesis is that dietary protein supplementation may result in a higher concentration of proteins rich in specific amino acids in regions of the brain or blood vessel wall, triggering a vasodilatory response. Soybean protein contains high levels of arginine, the metabolic precursor of the potent vasodilator nitric oxide. Intravenous injection of arginine in humans substantially de- creases blood pressure and total peripheral resistance. In addition, protein intake leads to increased sodium, water, and urinary-free dopamine excretion levels in humans. The dopamine-mediated, protein-induced natriuresis may play a role in the blood pressure–lowering effect of protein. Compared with normotensive patients, patients with hypertension were found to have a decreased urinary-free dopamine response in the post- absorptive state after protein ingestion. Furthermore, animal experiments suggest that soybean protein may improve insulin sensitivity and glucose tolerance. Lavigne and colleagues found that soybean protein–fed rats had lower fasting plasma glucose and insulin concentrations and higher glucose disposal rates than casein-fed animals. Dietary soybean protein may increase insulin-receptor gene expression in Wistar fatty rats and reduce insulin resistance due to a defect of insulin-receptor gene expression. Insulin resistance and the concomitant compensatory hyperinsulinemia may be a major underlying pathogenetic mechanism of hypertension”

      One review does point out that the potential beneficial effect legume intake in hypertension may be due to protein and fibre.

      Hope this answer helps.




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  22. Also, in looking through the sources listed (check out the positive trials for soy milk ) and other resources, I saw with this page on incidence of stomach cancer , world wide. http://globocan.iarc.fr/old/FactSheets/cancers/stomach-new.asp Its really interesting to me that Japan seemed to have topped even korea, but yet do they not have a strong tradition of miso soup consumption ? Plus, it would seem that incidence is decreasing sharply in some countries.




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  23. This is off topic but worrisome. Medscape Family Medicine sent out an email with a link to an article: “Obesity: when diet is a treatment, not just a diet.” Good subject, but in it they promoted low carb-high protein diets. When that advice is coming from Medscape, people listen. Dang.




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    1. Thanks for sharing Steve.

      I am not aware of the article but recently I just came across a 2011 publication that concludes that low carbohydrate, high protein diets during weight loss programes are likely to be detrimental to colonic health, which is one more reason to avoid such dietary patterns in obesity related issues.




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  24. Please tell me if the same benefits with respect to high bp that is associated with soy miso would apply to chickpea miso.
    Thank you.
    John Cinciarelli




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    1. Thanks for your question John.

      I am going to give you the same answer as mentioned below and I hope this can help.

      When it comes to gastric cancer and according to this prospective study, “the benefits of soybean intake could be due to isoflavones such as genistein and daidzein, which have anti-inflammatory and anti- oxidative effects mediated by inhibition of protein-tyrosine kinases, DNA topoisomerases, and ribosomal S6 kinase”.

      Despite this, a 2016 World Cancer Research Fund report has stated that the evidence for the protective effect of pulse (legume) intake in regards to stomach cancer for example is limited (i.e. no conclusion can be drawn due to limited data), however, in the same report they do recommend the consumption of legumes as part of a cancer prevention diet.

      On the other hand, when it comes to hypertension, according to this publication mentioned by Dr Greger, it seems that the benefits of soy protein may be related to:

      “One plausible hypothesis is that dietary protein supplementa- tion may result in a higher concentration of proteins rich in specific amino acids in regions of the brain or blood vessel wall, triggering a vasodilatory response (29). Soybean protein contains high levels of arginine, the metabolic pre- cursor of the potent vasodilator nitric oxide (30). Intrave- nous injection of arginine in humans substantially de- creases blood pressure and total peripheral resistance (31, 32). In addition, protein intake leads to increased sodium, water, and urinary-free dopamine excretion levels in hu- mans (33, 34). The dopamine-mediated, protein-induced natriuresis may play a role in the blood pressure–lowering effect of protein (34). Compared with normotensive pa- tients, patients with hypertension were found to have a decreased urinary-free dopamine response in the post- absorptive state after protein ingestion (35). Furthermore, animal experiments suggest that soybean protein may im- prove insulin sensitivity and glucose tolerance (36, 37). Lavigne and colleagues (36) found that soybean pro- tein–fed rats had lower fasting plasma glucose and insu- lin concentrations and higher glucose disposal rates than casein-fed animals. Dietary soybean protein may in- crease insulin-receptor gene expression in Wistar fatty rats and reduce insulin resistance due to a defect of insulin-receptor gene expression (37). Insulin resistance and the concomitant compensatory hyperinsulinemia may be a major underlying pathogenetic mechanism of hypertension (38).”

      As such, other reviews have also found a potential benefit of consuming legumes:

      “An increase in legume protein and fibre of 15 and 10 g/day, respectively, could increase average protein intake from 17% to 20% and dietary fibre intake from 24 to 34 g/day. They portend a promising food source of both protein and fibre intake and further clinical trials of their influence on levels of blood pressure and overall cardiovascular disease risk are clearly warranted.”

      All in all, while there is no data to whether chickpea miso would have a neutral effect on hypertension, it seems like consuming chickpeas (or other legumes) is very beneficial for health and should be a part every meal.




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    1. Thanks for your question.

      When it comes to gastric cancer and according to this prospective study, “the benefits of soybean intake could be due to isoflavones such as genistein and daidzein, which have anti-inflammatory and anti- oxidative effects mediated by inhibition of protein-tyrosine kinases, DNA topoisomerases, and ribosomal S6 kinase”.

      Despite this, a 2016 World Cancer Research Fund report has stated that the evidence for the protective effect of pulse (legume) intake in regards to stomach cancer for example is limited (i.e. no conclusion can be drawn due to limited data), however, in the same report they do recommend the consumption of legumes as part of a cancer prevention diet.

      On the other hand, when it comes to hypertension, according to this publication mentioned by Dr Greger, it seems that the benefits of soy protein may be related to:

      “One plausible hypothesis is that dietary protein supplementa- tion may result in a higher concentration of proteins rich in specific amino acids in regions of the brain or blood vessel wall, triggering a vasodilatory response (29). Soybean protein contains high levels of arginine, the metabolic pre- cursor of the potent vasodilator nitric oxide (30). Intrave- nous injection of arginine in humans substantially de- creases blood pressure and total peripheral resistance (31, 32). In addition, protein intake leads to increased sodium, water, and urinary-free dopamine excretion levels in hu- mans (33, 34). The dopamine-mediated, protein-induced natriuresis may play a role in the blood pressure–lowering effect of protein (34). Compared with normotensive pa- tients, patients with hypertension were found to have a decreased urinary-free dopamine response in the post- absorptive state after protein ingestion (35). Furthermore, animal experiments suggest that soybean protein may im- prove insulin sensitivity and glucose tolerance (36, 37). Lavigne and colleagues (36) found that soybean pro- tein–fed rats had lower fasting plasma glucose and insu- lin concentrations and higher glucose disposal rates than casein-fed animals. Dietary soybean protein may in- crease insulin-receptor gene expression in Wistar fatty rats and reduce insulin resistance due to a defect of insulin-receptor gene expression (37). Insulin resistance and the concomitant compensatory hyperinsulinemia may be a major underlying pathogenetic mechanism of hypertension (38).”

      As such, other reviews have also found a potential benefit of consuming legumes:

      “An increase in legume protein and fibre of 15 and 10 g/day, respectively, could increase average protein intake from 17% to 20% and dietary fibre intake from 24 to 34 g/day. They portend a promising food source of both protein and fibre intake and further clinical trials of their influence on levels of blood pressure and overall cardiovascular disease risk are clearly warranted.”

      All in all, while there is no data to whether chickpea miso would have a neutral effect, it seems like consuming chickpeas (or other legumes) is very beneficial for health and should be a part every meal.

      Hope this answer helps.




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  25. This video says that pickled foods were asocciated with about 25% greater risk of stomach cancer.
    What’s about sauerkraut ? It is safe to consume?

    Thanks




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    1. Thanks for your comment Carlos.

      In the study you are referring to, there is no mention of sauerkraut. According to this review:

      “Salt also inhibits spoilage microbes while allowing growth of lactic acid bacteria in fermentations producing sauerkraut and pickles.

      (…) Salt is added to a concentration of 2% to 2.25% to cabbage in making sauerkraut to suppress the growth of spoilage bacteria and select for growth of fermentative lactic acid bacteria. Addition of a starter culture of Leuconostoc mesenteroides to cabbage consistently produced sauerkraut with a firm texture and good flavor with salt concentrations of 0.5% or 1%”

      While similar studies have not been conducted on the effect of salt in sauerkraut to health (& therefore I am unaware whether the impact is neutral or negative), this product has been associated with a few health benefits as explained in an article written by Dr. Michelle Schoffro Cook, PhD, DNM in Care2 (a website for which Dr Greger also frequently writes).

      Hope this answer helps.




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  26. I´ve been eating mostly plant based for a year and a half or so, and I only eat animal products when I go out or in social meetings. The only thing I can’t stop using is salt, food is kind of tasteless to me without it, so I always sprinkle a little bit. I try to eat whole foods, with the exception of some veggie burgers that I buy. This video seems to be about salt in processed food, but what about the added table salt in WF? Does it cause cancer as well? Sorry for my english




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    1. Hi Frederickk! Congrats on your growing commitment to plant based eating! I’m a dietitian and volunteer moderator who helps Dr. G answer questions. Studies show that the average person gets about 77% of sodium in their diet from processed foods (this includes bread and other foods like frozen dinners); 11% is naturally occurring in foods, 6% is added at the table and 5% is added in cooking. For someone eating whole unprocessed foods with only the occasional indulgence as you indicated above, I think you’re likely within the guidelines of under 2300 mg of sodium per day (ideally total daily intake should be more like 1500 mg). To get closer to 1500 mg/d level, then the less salt used in cooking or at the table, the better. Our taste buds do adjust if we give them a chance. In just 2 weeks, if you can persist with less salt, you will find your taste sensitivity increases and a lower salt food or meal will suddenly start to taste salty again. To help you out even more, load on the herbs and spices, lemon juice, pepper etc to bring out flavours in foods. The goal is to reduce salt from all sources in our diet when it comes to cancer prevention, lowering blood pressure etc. I hope this answer helps!




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  27. Just my luck! I’m the exception to the rule. I adore miso but my blood pressure goes up everything and anytime I eat miso even in small amounts. I don’t suffer the same effect from eating sauerkraut though. I wonder why miso gives me hypertension?




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  28. I’ve heard that Bragg Liquid Aminos is a good alternative to soy sauce, due to no added salt. But the nutrition label does report a sodium content. Does anyone know if Liquid Aminos would have the same negative effects as adding salt?




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    1. Carina Hall: It’s my understanding that Braggs has just as much sodium as soy sauce once you account for serving size. Braggs has a really great marketing program, but I would treat it just like soy sauce.




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  29. We’ve vegan. If it has a face or a mother, we don’t eat it.

    We use Celtic Sea Salt to flavor meals. We don’t buy any other type of salt.

    I have no idea what our daily salt intake is, but I’m sure it’s really low.

    When I watched this video I got the feeling that all salt is bad – Celtic or otherwise. But then when I looked over the Celtic page, it’s what’s added to salt that’s bad.

    We’ve always trusted that Celtic is better than processed salt. No reason to believe otherwise, until now. So I thought I’d post to get some feedback on Celtic Sea Salt versus processed salt.

    Thanks,




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    1. spinbackwards: I’m glad your daily intake of added salt is low. What’s bad about salt is the sodium in the salt. All salt, regardless of whether if it Celtic or sea or Himmalayan etc has the sodium. Hence, it’s good to limit how much you consume. How do I know?

      When the analysis is done, it looks like sea/Himalayan salt is nothing more than slightly contaminated salt – contaminated with some good things *and* contaminated with some very harmful things. But none of the contaminated substances are there in such quantities as to likely affect health either way. ​In other words, there may be a say small amount of iodine, but not enough to make a difference and not enough consistency to be something you will want to rely on. ​Want to see the actual data? Check out these posts from Darryl: (Sadly, these links only work on the disqus site. I couldn’t get wordpress to find the comments in order to link to them throug wordpress.)
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131297498
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131500235
      .
      Also, the following site is not ​a ​source that I generally consider to contain valid information. But no one is wrong about everything and ​the author seems to get this one right. She explains the point Darryl raises so well, I’m going to quote it for you:
      .
      “They claim that two double-blind studies were done, but no such studies are listed in PubMed. There is no evidence published in peer-reviewed journals that replacing white salt with pink salt makes a shred of difference or leads to any improvement in health.
      .
      If you read down the list of minerals, you will notice that it includes a number of radioactive substances like radium, uranium, and polonium. It also includes substances that act as poisons, like thallium. I wouldn’t be worried, since the amounts are so small; but if anyone believes the trace amounts of “good” minerals in Himalayan sea salt are good for you, why not believe the trace amounts of poisons and radioactive elements are bad for you?
      .
      The claim that pink Himalayan salt contains 84 trace minerals may be true, but the claim that it “promotes health and wellness” is false until proven otherwise by legitimate clinical studies. While waiting for evidence, I’d just as soon my salt didn’t contain uranium.” https://www.sciencebasedmedicine.org/pass-the-salt-but-not-that-pink-himalayan-stuff/
      .
      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.” http://www.jeffnovick.com/RD/Blog/Entries/2012/3/29_Test_2.html
      .
      Makes sense to me!




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      1. Wow, many thanks.
        I’m going to forward your comments along to Celtic. I’ll post back what they say.
        Based on your comment, though, it appears to me that Celtic Sea Salt is akin to promoting “Cane Sugar”.
        Definitely more in tune with sodium now, we’ll be watching it.
        Dr. G’s site rocks.




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  30. Interesting the effect of soy on HTN. What about those individuals who don’t tolerate soy and purchase rice or chickpea miso? Any benefits to those? Is there any effect of the probiotics in the miso that seem to counter effect the high sodium content?




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  31. If miso/soy can counteract the carciogenic and blood pressure effects of salt, is there other food that could potentially behave similarly? It would seem very odd to me that soy and only soy possess such a quality as some kind of miracle food. I think it would be really valuable to test which ingredients can exist “in harmony” with salt (for the lack of a better expression) because apparently it is possible.

    For example, Dr. Greger suggested that adding garlic and scallions might make miso soup even more protective to cancer. That makes me wonder, if I add salt and scallions & garlic (as I normally do – and as I love those ingerdients I’d also have no problem to go over board with them…) but no miso, could the carciogenic effects be neutralised as well? (No idea if scallions and garlics also do something against BP if there are other ingredients to counter that I could just add both.)

    I know that people can get adjusted to salt-less food. Personally I don’t eat any salt on my regular days, except for some tofu or miso now and then and I have grown very fond of it (I honestly enjoy it and I my taste is MUCH more sensitive now which allows me to enjoy food much more intensely. I hardly crave salt but I would also be lying if I said I don’t like its taste anymore).
    However, I know that salt-less food is a high barrier for many others who want to switch to healthy eating. I believe instead of just telling people to drop salt without any alternative whatsoever (except miso like Dr. Greger suggests), some research into neutralising salt-combinations could be very beneficial for spreading the message (and keep sodium as an occasional ingredient for cooking enthusiasts like me for some versatility).

    (I’m not a dietitian but I read that the effects of salt can also be in part due to a lack of potassiom and calcium as those are minerals that interact with sodium? No idea if it is true. I read it on a German wikipedia page once but don’t find it anymore.)




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  32. Thank you for this video on miso and sodium. Our question is…if the soy in miso counteracts the effects of sodium, does the soy in soy sauce/tamari counteract the sodium in it the same way?




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    1. Hello! I am a plant based dietitian in Scottsdale, Arizona and a volunteer medical moderator. I help Dr. Greger with answering questions posted to the website. It is tough to answer your question without more information, specific to you. For example: is your blood pressure normal? Are you a whole foods plant based vegan? Are you on any medications for hypertension? For anything else?

      In general, if your blood pressure is normal and you consume no or little processed foods (which all have added sodium) you can use things like soy sauce and tamari as condiments. Note that healthy adults who are not hypertensive have a daily sodium recommendation from ALL SOURCES of 2,500 mg. per day. A tablespoon (which isn’t a lot) of soy sauce runs 920 mg (for Kikomann) and tamari runs 1,001. That is almost 1/2 the daily recommendation for sodium. If you are concerned about your sodium intake, you can purchase “low sodium” versions of both and save about 1/2 the sodium. Finally, if you are hypertensive or on medication for HBP, your daily sodium recommendation is 1,500 mg per day. Nearly impossible to adhere to unless – you eat only fresh, whole foods, eliminate eating out and processed foods, and eat widely from all food groups.

      I hope this helps, and thank you for your question!




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      1. That doesn’t answer the question posed: Does the soy in soy sauce counter the effects of the salt in soy sauce, like Greger reported appears to happen with miso in humans?

        Anybody know of any human studies that address this question?




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  33. Now it’s a tough call and this particular study is dated February 2016:

    http://i.imgur.com/GkdFhsV.png

    Age- and sex-adjusted and multivariable-adjusted hazard ratios of gastric cancer according to frequency of miso soup intake
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728120/table/tbl05/

    Maybe the jury is still out? Shiro (white) miso should have less than 20% of calories from fat and much lower sodium content when compared to other varieties. There’s no way to tell what kinda miso they’re consuming since it wouldn’t be all that practical to ask such questions, it ain’t exactly easy to remember what we’ve been eating and sometimes we don’t necessarily know what miso it is unless we buy/make that ourselves.

    Oh well, maybe it’s one of those “better be safe than sorry” situations then.




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  34. What about the effects of salt substitute (potassium chloride) on your body (blood pressure or otherwise)? Is it safe to consume in the 1 to 3 g range like most people do with salt? I am trying to limit my salt and I add almost no salt to any of my foods, but switching to items made form scratch like beans and rice, mean that the taste is different than processed foods due to the much lower salt content. Rather than add back the salt I am saving, I am trying to use salt substitute (or other spices like paprika, turmeric, chili, etc.). But, I worry that there may be an adverse health risk with too much potassium chloride.




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  35. Hi Disney House Dad, I’m Dr Renae Thomas, one of the medical moderators :) I would highly recommend letting your tastebuds readapt to the lower salt (it doesn’t take long!) and using other flavourings like you mentioned such as paprika, turmeric, chilli, and ones such as vinegars, veggie broths (homemade), fruit juices etc… for flavour. Potassium can be risky in excess and most people can’t accurately measure their intake…




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