Shaking the Salt Habit

Shaking the Salt Habit
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What three things can we do to lower our sodium intake? Are there any tricks for interpreting nutrition facts labeling on processed foods?

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The two most prominent dietary risks for death and disability in the world are not eating enough fruit and eating too much salt. Too little fruit kills nearly five million people every year, and too much salt kills four million.

There are three things we can do to lower our salt intake. First, don’t add salt at the table. A third of us add salt to our food before even tasting it! Number two: stop adding salt when cooking. At first, the food will taste bland. Two to four weeks later, however, the sensitivity of the salt taste receptors in the mouth will adjust to the taste of salt in the usual concentrations.  Believe it or not, but after two weeks, you may actually prefer the taste of food with less salt. Some of the flavorings you can use instead of salt include pepper, onion, garlic, tomato, sweet peppers, basil, parsley, thyme, celery, lime, chilli, nettle, rosemary, smoke flavor, curry, coriander, and lemon.

Even if you do add salt, though, it’s probably better than eating out, where even at non-fast food restaurants, they tend to pile it on. And finally, avoid processed foods that have salt added.

In most countries, only about half of sodium intake comes from processed foods;  so, there’s more personal responsibility, but in the U.S., even if we completely stopped adding salt in the kitchen and dining room, it would only bring down salt intake a small fraction. This has led public health commentators to note how challenging it is, then, for everyone to reduce their salt intake, since so much of our sodium intake is out of our control. But is it? We don’t have to buy all those processed foods. We can choose not to turn over our family’s health to food corporations that may not have our best interests at heart.

If we do buy processed foods, there are two tricks we can use. First, try to only buy foods with fewer milligrams of sodium on the label than there are grams in the serving size. So, if it’s a 100 gram serving size, it should have less than 100mg of sodium. Or, second, you can shoot for fewer milligrams of sodium than there are calories. For example, here the sodium is 720; calories are 260. 720 is greater than 260; so, this has too much sodium.

That’s a trick I learned from one of my favorite dieticians of all time, Jeff Novick. The reason it works is because most people get about 2,200 calories a day; so, if everything you ate had more calories than sodium, you’d at least get under 2,300 milligrams of sodium – the upper limit for healthy people under age 50. Of course, the healthiest foods have no labels at all. We should also try to buy as much fresh food as possible, as it is almost impossible to come up with a diet consisting of unprocessed natural foodstuffs that exceeds the strict American Heart Association guidelines for sodium reduction.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Mark Poprocki via 123RF.

The two most prominent dietary risks for death and disability in the world are not eating enough fruit and eating too much salt. Too little fruit kills nearly five million people every year, and too much salt kills four million.

There are three things we can do to lower our salt intake. First, don’t add salt at the table. A third of us add salt to our food before even tasting it! Number two: stop adding salt when cooking. At first, the food will taste bland. Two to four weeks later, however, the sensitivity of the salt taste receptors in the mouth will adjust to the taste of salt in the usual concentrations.  Believe it or not, but after two weeks, you may actually prefer the taste of food with less salt. Some of the flavorings you can use instead of salt include pepper, onion, garlic, tomato, sweet peppers, basil, parsley, thyme, celery, lime, chilli, nettle, rosemary, smoke flavor, curry, coriander, and lemon.

Even if you do add salt, though, it’s probably better than eating out, where even at non-fast food restaurants, they tend to pile it on. And finally, avoid processed foods that have salt added.

In most countries, only about half of sodium intake comes from processed foods;  so, there’s more personal responsibility, but in the U.S., even if we completely stopped adding salt in the kitchen and dining room, it would only bring down salt intake a small fraction. This has led public health commentators to note how challenging it is, then, for everyone to reduce their salt intake, since so much of our sodium intake is out of our control. But is it? We don’t have to buy all those processed foods. We can choose not to turn over our family’s health to food corporations that may not have our best interests at heart.

If we do buy processed foods, there are two tricks we can use. First, try to only buy foods with fewer milligrams of sodium on the label than there are grams in the serving size. So, if it’s a 100 gram serving size, it should have less than 100mg of sodium. Or, second, you can shoot for fewer milligrams of sodium than there are calories. For example, here the sodium is 720; calories are 260. 720 is greater than 260; so, this has too much sodium.

That’s a trick I learned from one of my favorite dieticians of all time, Jeff Novick. The reason it works is because most people get about 2,200 calories a day; so, if everything you ate had more calories than sodium, you’d at least get under 2,300 milligrams of sodium – the upper limit for healthy people under age 50. Of course, the healthiest foods have no labels at all. We should also try to buy as much fresh food as possible, as it is almost impossible to come up with a diet consisting of unprocessed natural foodstuffs that exceeds the strict American Heart Association guidelines for sodium reduction.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Mark Poprocki via 123RF.

162 responses to “Shaking the Salt Habit

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  1. Dr. Gregor, do you ever indulge in any processed foods, such as a bite of vegan whole fat chocolate bar (with sugar, cocoa butter, etc.) or are things like that completely off limits for you?




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      1. How about you? An occasional bite of vegan chocolate bar (sugar, high fat, etc.)?

        We are presented with so many organic sugar-ridden snacks in grocery stores these days.
        I have no problem finding fresh, ripe, tasty fruit, but is the idea 100 % exclusion of these
        other organic processed fun-foods, for lack of a better term?

        I love organic packaged/processed fig bars, wheat-free, “newmans own” brand, but have
        avoided them for years, as they have palm oil (organic) and white sugar.

        Thought on this sort of stuff?




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        1. We’re all human and sometimes buckle to what we know we enjoy. A “treat” is a treat because it’s sort of forbidden, but these days we seem to have forgotten that because about everything that line the shelves falls into that category! An occasional treat is just that, as long as your diet is otherwise sound. Some of us, however, (me!) need more “rules” to keep us in line because daily “treats” too easily become habitual! My strategy, because I CANNOT be moderate, is to never bring it home if I know I should avoid it. Since I rarely go out anymore, it works fine, but when you are out and about and it’s in your face…a bit harder! Though I can be pretty lazy, food prep has become very zen and what keeps me on board, so every meal becomes special. It’s all our choice, and I think the trick is not to let the “exceptions” rule!




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        2. Hi, Mitch,

          I try, (but don’t always succeed,) to avoid processed foods. One of my favorite not-as-good-as-fresh but still moderately healthy snacks is dried organic fruit. In fact, I am eating some dried green apple slices and banana slices as I type this. They’re sort of treats for me because they’re chewy and crunchy. My problem is that I’m going to a college town shortly to see my son. They have outstanding Chinese restaurants with real Chinese food, (e.g., not “Chinese American,”) and I’m a sucker for such meals. Are they few and far between for me? Sadly not because I go there once a week to re-stock my son’s larder. And do I want “steamed” veggies with rice? Not hardly. I need help because I’m about to go again….




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        3. Try artisanal chocolate like chocosoltraders.com. Look for a chocolatier who is similar to this because it works directly with the growers in the jungles




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  2. Just yesterday I indulged in a savory processed food that I normally do not. It was one of those, “just add eggs and water” deals. I wanted to see if I could use aquafaba (concentrated bean water) in place of the eggs. And I wanted to see if I could figure out how to bake it rather than fry in a skillet.
    .
    Result: My two challenges were a big success. The (salt-free) aquafaba worked great in this application and the baking (on parchment paper–so, no oil) worked like a champ also. However, the end product was inedible. It was so salty, I simply could not eat it. It was really that bad. I should have applied Jeff Novick’s trick (which I knew about before). It was 360mg sodium for each 90 calories per serving.
    .
    This was a bitter sweet moment for me. On one hand, I remember eating this product about 10 years ago, and enjoying it. So, it’s sad that I did not get to enjoy the treat again. On the plus side, it makes me happy that I have managed to make my taste buds healthier – at least in this area. Yeah me! ;-)




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  3. I was just reading that as people try to reduce salt, some are not getting enough iodine (iodized salt has been a major source). Is this a problem? Any recommendations?




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    1. Sea veggies (avoid kelp and hijiki though) or 150 mcg/day supplement. Keep in mind salt in processed garbage is usually not iodized anyway.




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    2. Hi Teresa, there are two issues with salt reduction. Salt provides two elements – sodium and chloride – both of which are essential for life. Your body cannot make these elements on its own, so you must get them from your diet. There is a risk from both too much salt and too little potassium. Recent research shows that if you have too much sodium and too little potassium, its worse than either on its own. This article sheds light on the complex factors at play with heart disease. Here’s the prescription (short cut to the ending): avoid processed foods, don’t add salt to your food, limit eating out where you don’t have control over the salt level in your prepared foods, eat plenty of fresh vegetables and fruits (potassium intake). Sound familiar?
      As for iodine, you are correct – iodized salt is one of the great nutritional breakthroughs in the 20th century since it essentially eliminated goiters, a condition caused by inadequate iodine intake. So iodized salt does provide iodine. However, eliminating processed food, the primary source of excess salt, does not lead to inadequate iodine intake.




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      1. I saw Dr. Greger at a talk and asked him about iodine intake. He told me I should be fine (I am a vegan) with 150 mcg three days a week, so that is what I do.




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      2. Last week I realized that I have once again let my sodium levels get to low (this is the fifth time in four years). The result is constant muscle pain in my shoulders and back muscles, muscle weakness in my legs, irregular heartbeat, dizziness and just a feeling of illness. I always think I’m getting enough salt from a few things like canned tomato sauce, baked bread etc. But I’m not and my blood tests confirm that I’m too low. I always swear I won’t let it happen again, but because of the fear of over consuming salt I always err on the side of less. And I end up back here. As soon as I start adding a little salt all assumptions go away.

        I get concerned when I read that we should NEVER as salt, as Dr Greger advises. Even in your post about you mention that we need sodium, but you say don’t salt your food. You might mean don’t salt food that’s already had salt added; I’m not sure. But if so, that’s not what I see. If the message is don’t add to too much, then that should nd the message, not don’t add salt. Never say never.

        I think it would be far more helpful to Sri dating “don’t” And to simply state the safe high and low range for salt/sodium and potassium too, if that’s party of it.

        I’m writing this because I think there must be others like me and I don’t want to see then messed up.
        Mark G




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        1. I take what Dr G. says about salt with several grains of salt. He is interesting and has a lot of good information. I checkout other studies and take an approach that works for me. One size does not fit all.




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        2. If you’re not getting enough sodium without adding salt to your food, it may be worth taking a second look at your food. You only need 400-500mg a day of sodium. A decent serving of spinach (250g raw) contains half that. The same size serving of swiss chard contains your whole day’s sodium requirement, as does a handful of wakame. Add more green leafies and/or sea veggies to your diet if it’s not naturally sufficient in sodium.




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          1. “You only need 400-500mg a day of sodium” That may be true for you, poop patrol, but one size does not fit all. Some people can not get enough the way you recommend.




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            1. #JJ and # mbglife… by the whole discussion I miss some little hints – like poop patrol said, “a serving spinach has half of a day portion sodium in” and you replayed “maybe for you not for me”. I think both of you are right, if we take in consider that you have to calculated also that you may steam or cook the spinach – so a part of the sodium goes into the cooking water – do you eat or drink it? Second, if you sweat a lot during the day, because whatever, you also will lose sodium – look at the T-Shirt.
              Third, consider where you buy your food, is it biology or only conventionally? Not every spinach has the same amount sodium inside – sorry, it depent also to where he was growing, how was the soil…
              I think it is absolutly right, that to much salt consume can rise the blood presure but it is not realy possible to say 1, 2 or 3 gramm Salt is enough – because we can’t be sure. Nobody makes a chemical analysis before eating his food… so calm down, relaxe and develope a sense for your need (after you weaned from salt ;-)… )




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    3. I tried to get my iodine from sea veggies and from cranberries but couldn’t find the latter without sugar (regular or apple juice) added. I finally caved and started taking a little iodine pill each day. If I have some veggie sushi with nori I won’t take my pill that day.




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  4. Too much salt kills millions? Or could it be that eating lots of salt is a marker for eating junk which is the real problem? Unless there is a study which controls for everything but salt intake you are stuck with correlation which does not equal causation.




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    1. Thank you for saying that. I found that statement about too much salt killing millions to left me with far more questions than answers.




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    2. Hypertension from excessive sodium. Google “double blind placebo controlled hypertension sodium” if you wish further study. I bet you’ll find a few things.

      Does hypertension cause other medical conditions, such as death? I’ll leave that exercise to the dear reader.




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      1. Yes some percentage of people who have hypertension are salt sensitive, many are not. And what of the people who are not hypertensive which is most of the population?




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      2. Allen: pretty much all of those studies look at variations on the standard american diet, which is such a huge confound that it makes the results kind of meaningless, unless you’ve already established independently that people who follow a low-fat whole foods plant based diet are at just as much risk for heart disease / dying from hypertension as people following the SAD diet are (and this is not the case at all). So I really don’t understand why this video was released, with this information in it.




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    3. A fair point. The study would put a high processed food diet, against a high processed food diet low in sodium. But that would be unethical. Isn’t the real solution multifaceted? If you cut out, or dramatically reduce all processed foods, you’re doing yourself a whole lotta good above and beyond just reducing sodium.

      Same is true for fiber. If you don’t get enough fiber, the solution is not to take a fiber supplement (as that in and of itself is highly processed), but to eat fiber rich foods; veggies, beans, legumes, etc. Along with now getting the fiber you should have been getting all along, you’re also getting a whole truck load of “good for you stuff” with it.

      I understand your scientific curiosity. But a good healthy diet need not be something to stress over. Far too many fall into that trap (not saying you) which has the propensity to lead to failure.




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  5. What about a person who is in intense fitness training who has to drink large quantities of water. If you don’t have enough sodium when drinking so much water you can become dehydrated. Correct? I am using sea salt on my food, but I wonder about this because I feel that my coach has me taking in quite a bit. I have noticed my blood pressure has been higher than normal lately. Wondering if it is the sea salt.




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    1. Hi Star, you can see my comment right above about intense fitness training. Over hydration can indeed be an issue with endurance athletes and sodium levels. However, this is rare – most people (unlike you, you rock star!!!) are not in intense fitness training. Did you know that the average american exercises very little? You can read more about it in this http://www.cbsnews.com/news/cdc-80-percent-of-american-adults-dont-get-recommended-exercise/. When I was endurance training (marathons) I made my own hydration beverage with a small amount of orange juice, two or three pinches of regular table salt, and H20. It worked like a charm. Depending upon your amount of training, I would likely not recommend salting your food, but instead focus on a hydration strategy WHEN you are training.




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      1. I’ve heard one can have mild hyponatremia and not realize it. Do you know if that is true? Often people who get gout attacks drink lots of H20 to help prevent attacks, and it’s occurred to me that anyone in that situation who is on a very low sodium diet might be at risk.




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  6. Be careful in telling people to avoid salt. Here in San Antonio, there have been cases of roofers passing out in the hot sun because of sweating and losing salt. At Lackland Air Force Base in the summer time the military advises young recruits to make sure they are getting enough salt because of the rigorous training in the heat. Sodium is an electrolyte that is very important in cellular metabolism. You should be careful about telling people to AVOID salt. I could give many more cases.




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    1. Hi John, I hear where you are coming from. However, there are so so many reasons to limit salt intake for health reasons. When we look at specialized groups of people who might have temporary needs for increased salt intake (military recruits in the heat, endurance athletes, roofers in the summer time) it can be important for them to have recommendations that address their specific circumstances. High blood pressure and damage due to excessive intake of salt over time (mostly from processed foods and added salt) is an epidemic problem in our country.

      If people eat a mostly processed food diet, adding salt to their diet is never necessary. Following the American Heart Association guidelines for daily sodium totals is a safe way to go. This great handout from the AHA provides some guidelines similar to what Dr. Greger is recommending in today’s video.This great handout.




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      1. Lisa —– I am not sure that a low salt diet is healthy. For example, there’s an article in the medical journal entitled “Hypertension”, 1995;25:1144-1152. This research article was written by Dr. Alderman MD. His research team took around 3000 hypertensive subjects and studied the relationship between cardiovascular death and a low sodium diet. The evidence found at the end of the study was that the group with the lowest salt intake had a 430 percent increase in heart attacks as compared to the group with the highest level of salt intake.




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        1. Question, were the hypertensives able to control their BP so that it was under 110? The point of a low-fat, low-sodium, whole-food plate-based diet (man, we have to come up with a shorter description) for folks suffering from high blood pressure is to help get BP to a truly healthy level. So perhaps only changing sodium intake without the other dietary changes necessary to reduce blood pressure isn’t a smart idea. But making the changes to bring your BP down, which does include eating an appropriate amount of sodium, definitely is.




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          1. In this study all the patients were taking anti-hypertensive medications. They were not on a vegan diet. So, what I am saying is that patients on anti hypertensive meds who were on a low salt diet were more prone to heart attacks as compare to patients on anti hypertensive drugs who were not on a low salt diet.

            But, following a vegan diet plus adding sessions of fasting will help people to control their blood pressures. Some people have even managed to go off their meds safely following this regimen. The fasting and the vegan diet helps the body to rid the arteries of plaque build up. And, if you want to speed the process up you can take a natural product called serrapeptase. You can look up serrapeptase on YouTube, or just google it. Serrapeptase is a natural enzyme that dissolves the plaque in the arteries. But, if one does not STOP eating meat, dairy products, and eggs, and to many nuts, and stop taking oils then surgery, or medicines, or serrapeptase, or fasting has a very reduced beneficial effect. The key to all of this is the vegan life style.




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      1. If you read Dr. Alderman’s study of around 3000 subjects you will get a better physiological understanding of how a low salt diet can cause you to have a heart attack. The body puts in a lot of effort to keep sodium at adequate levels. If you have low sodium levels from being on a low salt diet then your body will increase higher levels of aldosterone, rennin, angiotensin, and noradrenaline in order to assist the kidneys to RETAIN sodium. When your body has higher levels of these hormones they then can stimulate the sympathetic nervous system. Whenever the sympathetic nervous system is over stimulated it can result in a cardiac event such as an M.I. Also insulin levels are increased when the sodium level is down because of a low salt diet. It is common knowledge that elevated insulin levels can bring about diabetes, obesity, and polycystic ovaries. I refer you to the Journal of Internal Medicine , 1993;233:409-414 written by Dr. Rio MD.

        I get your point, that being a vegan you don’t have to worry about sodium levels because you get adequate sodium in your vegan diet. However, non-vegans who are put on a low sodium diet increase their risk of having a heart attack according to Dr. Alerman’s study and I can quote other MD’s with other studies to back up this point. By the way, I am a vegan and I do use Himalaya Pink Salt. Table salt is atrocious. There is a huge difference between Himalayan Pink Salt and refined table salt. We can debate that issue too, if you want to.




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        1. What is the huge difference? not nutrients content for sure, so so low especially we only eat few grams of salt at most.




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    2. The point isn’t everybody should eliminate all sodium from your diet, it is correctly manage your sodium. So if you are roofing in Texas in the summer and drinking several gallons of water a day to stay hydrated, then you are likely losing a lot of salt through perspiration and you should manage your sodium intake accordingly. But the main point to dramatically lower sodium is still that the vast majority of people eating a western diet who get 2 to 3 times more sodium than is optimal for them.




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      1. People eating the standard American diet may not have to worry about their sodium intake according to the latest research reported on by the New England Journal Of Medicine. They point out that eating 3000 to 6000 mg of sodium everyday is just fine. However a low salt diet makes one prone for a heart attack, and an aggressively high salt diet over 6000 mg also makes one prone to heart attacks. But, the way this article differs from Greger’s assessment is that Greger is talking in terms of a low salt diet of around 1000 to 2000 mg per day of sodium. Whereas the researchers reported in the New England Journal Of Medicine would say that a low sodium diet of 1000 or so mg of sodium today will put you at risk for heart problems. It is a “U” shaped curved. Too little sodium is bad for you and to much sodium is bad for you. you have to find that “sweet” spot in the middle. Here’s the link:

        http://blogs.nejm.org/now/index.php/a-salty-subject-sodium-consumption-and-cardiovascular-health/2014/08/13/




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        1. Thanks for the link but it is not like Dr G just makes this stuff up. He is reporting what expert panels have concluded after reviewing all the evidence. And the PURE study you discuss has a number of issues that mean it cannot be considered as disproving the many other studies (some with better methodology) that had .quite different findings.
          I would strongly suggest reading the comments on this article in the NEJM before getting too excited about this particular study’s findings, I would also suggest using the WHO Salt guidelines rather than basing one’s consumption on the results of a single study like this.
          http://www.nejm.org/doi/full/10.1056/NEJMoa1311889#t=letters
          http://www.who.int/nutrition/publications/guidelines/sodium_intake/en/




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          1. There are a lot of other studies showing that a low salt diet of 1000 mg to 1500 mg per day increases one’s risk of a heart attack. I don’t have the time to point them all out to you. Each person will have to decide for themselves which studies they want to believe in and which ones they want to disregard. As for me, I am not going to take the risk of a low salt diet.




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            1. Fair enough. For my part, I am not prepared to take the risk of a high salt diet. I have more confidence in the WHO and US expert reviews than any alternative claims although the US systematic review acknowledges that the evidence to date is not completely conclusive. I also think that it is important to consume adequate amounts of potassium and the evidence there is even stronger.
              http://www.nel.gov/conclusion.cfm?conclusion_statement_id=250457
              http://www.nel.gov/conclusion.cfm?conclusion_statement_id=250275&highlight=potassium&home=1




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    1. Although some will suggest that sea salt is “better” than regular table salt, there is no difference in how salt functions in the body. One difference between the two is that regular table salt is iodized, which supplies iodine, a micronutrient that our bodies need. Dr Greger talks about how to avoid iodine deficiency in his video which touches on the differences between sea salt and table salt.
      If your sodium counts are too low, that can be an indicator of a number of things – which could include hyponatremia. Other things can affect this – thyroid hormone levels and over hydrating are two contributors. Having too low Na counts is significant, and I’d recommend you visit your physician. Eating lots of salt in your foods is unlikely to resolve this in a healthy way.




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      1. Hi Lisa, it seems there is always controversy surrounding most every aspect of what we eat, and salt appears to be no exception. However, what I have heard is that there is in fact a substantial difference between sea salt and regular table salt. Regular table salt has been highly processed so it is virtually pure sodium, whereas sea salt contains dozens of other minerals. What I have understood is that these other minerals play a very important role in the way the main component in sea salt, which is still sodium, acts and interacts in the body, and hence sea salt is considered far more balanced and less deleterious than refined table salt. Your thoughts? Thanks!




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        1. Jeffrey: I know you addressed your question to Lisa. My reply is not meant to interfere in your conversation with her.
          .
          But I thought you would be interested in the following information: When the actual lab 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, those “dozens of other minerals” you speak of is like the egg industry’s claims of eye-sight nutrients in eggs. It’s a terribly misleading claim because the amounts are so miniscule. For more information, check out the following two blog posts and the bottom of the article in the third link:
          .
          http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131297498
          http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131500235
          .
          https://www.sciencebasedmedicine.org/pass-the-salt-but-not-that-pink-himalayan-stuff/
          .
          If you get a chance to review that information, I’d be curious to know if you still think there is a significant difference between table salt and sea salt.




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    2. There are some brands of sea salt that have a lower level of sodium per 1/4 teaspoon than regular salt but many have the same amount as regular salt. Read the label then decide.




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    3. Cindy Baucum: 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. For more information, check out the following two blog posts and the bottom of the following article:
      .
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131297498
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131500235
      .
      https://www.sciencebasedmedicine.org/pass-the-salt-but-not-that-pink-himalayan-stuff/




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  7. Salt is a problem when it causes high blood pressure, right? But what if I don’t have high blood pressure? My bp is always near the low end of the normal range. I assume it’s genetic because my mother is the same. Is there any reason why someone like me should worry about how much salt I consume?




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    1. Being hooked on salt is a common problem in our country. When we regularly exceed the recommended intake levels of salt, we become hooked on the taste enhancing qualities of salt. Even if you don’t have a blood pressure problem now, regularly exceeding the recommended intake of sodium tends to stiffen our arteries over time. As our arteries stiffen due to excessive intake of salt, the heart has to pump harder and harder to circulate blood. This puts a burden on our kidneys, too, since their job is to clean the body of excess compounds including salt. The kidneys have to work harder and harder, and eventually wear out. Regularly exceeding sodium intake over time by eating processed foods, adding salt to our food, and eating out (where we don’t have control over how our food is prepared, and salted) causes damage to our bodies, raising blood pressure and damaging kidneys. Far better to get off the salt habit before damage happens then gamble with a more certain future.




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    2. Once, years ago, my naturopath measured my blood pressure at 80/60 and told me I should be taking salt tablets! Instead I started salting my food – something I had stopped 20 years earlier when I had slightly high blood pressure during pregnancy. I continued having low blood pressure, though not as low as that day. Lately, now in my early 70s, I noticed it was somewhat erratic, now and then on the higher side, other times quite low. I cut way back on salt and it now seems more stable in the lower range. Perhaps we all need to learn to judge salt intake by monitoring our blood pressure.




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      1. That is really interesting, Rebecca. I too have hereditary low blood pressure – usually runs 80/60. I have never had a recommendation to take salt tablets from a physician – and have not had difficulty with hypo blood pressure, except when I get a bit dehydrated, I really feel a bit hypo (blood pressure that is!). My Mom ran very low until her 70’s, then had chronic high blood pressure which blew out her kidneys. She ate salty, processed food her whole life, and it did not affect her BP until her arteries started to wear out. This is the difficulty with added salt over time – it can be quite insidious and cumulative.




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    1. From what I know about black salt, it is still sodium chloride so I would treat it the same. I wouldn’t say you can’t cook with it…I use salt with cooking but I’ve gotten to where I just don’t need a lot of it. My recommendation would be to simply do the math and make sure you are staying well under the daily recommended intake of salt. Hope this helps.




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  8. If you supplement with iodine is it healthier to eliminate salt intake completely. Also if you do indeed need salt is sea salt healthier?




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    1. Good question. I have seen no formal recommendations to supplement with iodine here in the U.S. I also haven’t heard of Dr. Greger making a recommendation to supplement with iodine. Also, salt is salt, whether it’s regular “table salt” or sea salt. Simply do the math and add up how much sodium you’re getting and stay below the daily recommendations for salt intake. I hope this helps.




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    2. mike: 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 in either way. For more information, check out the following two blog posts and the bottom of the following article:
      .
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131297498
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131500235
      .
      https://www.sciencebasedmedicine.org/pass-the-salt-but-not-that-pink-himalayan-stuff/




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  9. What about unrefined salt from the ocean (i.e., evaporated sea water leaving behind salt that is then used directly without processing) versus the highly processed common white salt? I wish Dr. Greger could address whether there are studies showing any differences. Also, the fruit connection is likely due to fruits having a high potassium content, thus offsetting our relatively higher sodium intakes in this country.




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    1. Good connection between fruit and potassium. As you can see in other posts from today, potassium intake is vital as well.
      Salt is salt is salt . Chemically they are the same, from the sea, or by processing. Processed table salt has iodine added to it, which has eliminated the incidence of goiters in this country, which was a big problem in the last Century.

      It is a relatively recent phenomenon that salt intakes have expanded exponentially – due to high consumptions of processed foods, fast foods, and junk foods. Salt is in EVERY processed, packaged food product – as is added sugar. Two things we don’t need – added salt or added sugars.




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      1. Is the added iodine always from a natural source, or is it a lab-created chemical source of iodine being added
        to salt? Thanks.




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  10. I’m running into a raft of “new vegans” who are all touting how great (and even healthy?) the fake meats and processed vegan foods are. I tell them don’t eat or recommend that stuff. Any short term gains for “saving animals” are compensated by human health loss, higher $$$ cost and the hypocrisy of owning up to fake foods and big agribiz, which do take more oil and energy to produce, and pollute more than simple, whole plant foods.




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    1. Slim055 .: Dr. Barnard talks about the importance of “transition” foods. These are foods such as you describe, like fake meats, that help people make the transition from a meat-based diet towards one that is much healthier. I try to be very supportive of such people. These foods are marginally healthier and I would guess are healthier for the environment compared to eating the animals. Such foods are certainly more ethical for all animals (humans included) on the planet.
      .
      My thought is: A gentle approach of reminding people that they are on a path towards good health (and good for them!) rather than being at the end of the journey is likely to be more effective than deriding their accomplishment I think…




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      1. I agree Thea, some people would never make the attempt otherwise without “meaty” options. Yet observationally I also see the majority of people buying them up while still filling their carts with processed junk, a SAD vegan diet, which makes me kind of sad. Of course I am all for not eating the animals, but how about the same consideration and respect for the animal doing the purchasing? I’ve gotten into debates with “ethical vegans” about their militant views which leave out an important part of the animal welfare equation…themselves!




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    2. Processed food, no matter what it is made from, is really problematic. So are french fry vegans, and other ways people will experiment with not eating animal products. It is just so simple to get ALL of our nutritional needs met through fresh, whole, plant based foods. It is SO SIMPLE!
      The one new “product” that I’ve tried was recommended by a NF contributor a few weeks ago – Butler Soy Curls. Man, do I like these! Just dehydrated non-GMO soybeans – you rehydrate, season, and can use them in stir fries, chili, stews, etc. It is a great product!

      The over dependence on fake meats reminds me of those who choose to stop eating gluten, and then eat tons of gluten free processed poor quality poor tasting foods. Yuck. Real, whole, fresh foods – the only way to go!!!




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  11. I’m in the process of reading Dr. Joel Fuhrman’s new book, The End of Heart Disease, and so far it’s an excellent read. I have glanced at the info on salt intake, and he has the same stance as Dr. Greger. He does mention at some point that zero-salt-added Nutritarians should be supplementing B12, Vitamin D, zinc, iodine, and one or two others I can’t recall. If I didn’t want to go the seaweed route, would iodine supplementation be sufficient, and how many mcg a day?




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    1. Good question. I think you still have to consider your other plant-based sources of iodine: potatoes, navy beans, cranberries, dried prunes, canned corn, bananas (not a lot but it’s there), strawberries, green beans (again, not a lot but it’s there). I haven’t seen a recommendation from Dr. Greger (or from other in his field–I have not read Dr. Fuhurman’s new book) that promotes iodine supplementation, and I’ve never come across it in my medical career…we simply aren’t iodine deficient here in the U.S. Also, there are studies that show vegans have lower rates of hypothyroidism when compared to non-vegans. Hypothyroidism being one of the common diseases associated with iodine deficiency. Hope this helps some–there seems to never be a perfect answer when it comes to supplementation in general as both research and opinions vary widely on this topic. B12 is probably the only vitamin that has a generalized consensus when it comes to supplementation in vegan diets.




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  12. Any research available on healthfulness of potassium chloride as a sodium chloride substitute? Enjoy adding KCl it to food, and it has come to taste as good, maybe even better than NaCl.




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  13. How about the salt contained in miso, the japanese fermented soybean paste — isn’t that a healthy way to consume salt? If i recall correctly, the beans have a healthful effect which somewhat counterbalances the salt…




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    1. I think your argument does make since. It’s kind of like people who don’t want to eat fruit because it contains “too much sugar”. As Dr. Greger has pointed out in the past, the sugar in whole fruit doesn’t have the same deleterious effects that the same amount of sugar from another source might have. I still think you have to watch your salt intake…in general you’re not taking in gobs of miso in one sitting. It may be in a dish that you’ve made and that dish may have called for a tablespoon or 2. Even if it called for two tablespoons, you’re looking at 1500mg of sodium for the entire dish. Hopefully, that dish is somewhere between 4-6 servings or even more so you should still be looking at less than 300mg of sodium per serving, depending on what else you’re adding in. Usually the taste of the miso and whatever else you are adding keeps you from adding additional salt to the recipe.




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    2. silvertoad: You are correct according to pages 280 and 281 of Dr. Greger’s book, “How Not To Die”. Miso is terribly high in salt. However studies show that something about miso (presumably the interaction with the soy?) makes miso protective or at least not likely to cause harm regarding the two main reasons to avoid added table salt: stomach cancer and high blood pressure.




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      1. Good point, Thea, from Dr. G’s book. A very surprising finding about salt consumed with soy (in miso). It makes me wonder if this same effect occurs with tamari, which I use from time to time on my favorite dinner of steamed veggies over short grain brown rice with black beans. Even the “low sodium” tamari contains 710 mg/1tbsp.




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        1. JS Baker: I have wondered the same question about tamari. My guess is that there isn’t enough bean substance in the liquid to counteract the salt, but that’s just a guess. And I hope I’m wrong. ;-)




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  14. Books on Iodine, such as “Iodine, why you need it and why you can’t live without it” or “The Iodine Crisis”, state you do need to take salt, celtic sea salt, especially if you take iodine, which helps with detox symptoms. They even suggest salt loading. I take 6 mg of Iodine a day along with the supporting nutrients such as selenium, Niacin and riboflavin. You need to avoid the table salt.




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    1. It is very dangerous to take advice from such books. Anybody can publish a book, there is no quality control and you have no idea if the author has a proper understanding of the issues. Unfortunately, cranks abound and it really is a case of caveat emptor
      For example, if you are taking 6 gm of iodine daily from supplements (plus whatever iodine is contained in your food). you are taking more than five times the tolerable upper limit. This can damage your health. The recommended daily allowance for an adult iodine intake is only 150 micrograms

      The US National Institutes of Health note that
      “High intakes of iodine can cause some of the same symptoms as iodine deficiency—including goiter, elevated TSH levels, and hypothyroidism—because excess iodine in susceptible individuals inhibits thyroid hormone synthesis and thereby increases TSH stimulation, which can produce goiter [2,58]. Iodine-induced hyperthyroidism can also result from high iodine intakes, usually when iodine is administered to treat iodine deficiency. Studies have also shown that excessive iodine intakes cause thyroiditis and thyroid papillary cancer [2,58]. Cases of acute iodine poisoning are rare and are usually caused by doses of many grams. Acute poisoning symptoms include burning of the mouth, throat, and stomach; fever; abdominal pain; nausea; vomiting; diarrhea; weak pulse; and coma [2].”
      https://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/




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      1. Dr. David Brownstein has proper understanding of the issues. And I take 6 mg not 6 gms. This has helped me get off my thyroid meds that I was on for years. I also see an Iodine Literate Practitioner, who is also an M.D., that follows me closely.




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        1. Sorry for the typo but 6 mg is still more than five times the tolerable upper limit of 1.1 mg.

          However, while you and your family physician may be confident about the appropriateness of your own personal treatment, your original post implied that 6 mg daily was suitable for everyone. I do not believe that this is the case since it may produce adverse effects in some individuals. For example a 2005 study of 778 women found that
          ” Among the subjects with mildly deficient iodine intake, those with adequate intake, and those with more than adequate intake, the prevalence of clinical and subclinical hypothyroidism was 0, 1.13, and 2.84%, respectively (P = 0.014); that of thyroid goiter was 24.88, 5.65, and 11.37%, respectively (P < 0.001); that of serum thyrotropin values was1.01, 1.25, and 1.39 mIU/l, respectively; and that of serum thyrotropin/thyroglobulin ratio was 7.98, 6.84, and 5.11, respectively (P < 0.001). In conclusion, median urinary iodine 100~200 μg/l may reflect the safe range of iodine intake levels."
          http://link.springer.com/article/10.1007%2Fs12011-007-8036-0

          That said, it is apparently also the case that some people can safely consume large amounts of iodine. A review of iodine toxicity reports back in 1990 stated "It is concluded that some individuals can tolerate very high levels of iodine with no apparent side effects and that iodine intakes less than or equal to 1.000 mg/day are probably safe for the majority of the population, but may cause adverse effects in some individuals."
          http://www.ncbi.nlm.nih.gov/pubmed/2229854?dopt=Abstract

          I therefore still consider that recommending very high levels of iodine intake as your original post appeared to do, is potentially dangerous for the majority of people.




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      2. There may be some susceptible individuals but the traditional Okinawan diet had closer to 12 mg per day of iodine. It is supposed that modern pollutants as bromide and fluoride take the place of iodine in the body necessitating higher amounts of iodine.
        Mainstream medicine has been wrong before, this needs more study.




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        1. Assuming that mainstream medicine is always wrong is a risky proposition. Mainstream medicine tends to be based on the available evidence rather than the speculative reasoning and anecdotal reports employed by all too many alternative medicine advocates.

          And the traditional Okinawan Diet may well have been high in iodine because it included seaweed. But as far as I know, the actual iodine content was never measured although the content of a range other micronutrients was. So I would be very grateful if you would quote a reference for the level of 12 mg you state it contained.
          http://www.okicent.org/docs/anyas_cr_diet_2007_1114_434s.pdf
          http://www.okicent.org/docs/500s_willcox_okinawa_diet.pdf

          However, I would treat this claim of an intake of 12 mg per day with extreme caution even if you can find a legitimate reference. As a review of the literature regarding Japanese iodine intake noted:
          ” iodine content varies considerably between seaweed species, with cooking and/or processing having an influence on iodine content. Due to all these factors, researchers frequently overestimate, or underestimate, Japanese iodine intake from seaweeds, which results in misleading and potentially dangerous diet and supplementation recommendations for people aiming to achieve the same health benefits seen by the Japanese.”
          http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204293/

          As the 2005 study quoted in my response to Anne, shows, higher intakes of iodine have been observed to be associated with greater morbidity. Suggesting that an intake of 12 mg per day is healthy based on the supposed content of the traditional Okinawan Diet almost certainly falls into the category of “misleading and potentially dangerous diet and supplementation recommendations for people aiming to achieve the same health benefits seen by the Japanese.”




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          1. I have no idea how you got ” mainstream medicine is always wrong”. Here is a rebut on the mainstream view on iodine: http://iodineonmymind.com/weather
            I don’t know if the study you site takes selenium sufficiency into account. Being deficient in selenium is implicated in Hashimotos and anyone supplementing iodine needs to make sure they are getting enough.




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  15. Doc, this was almost verbatim from your chapter on high blood pressure. I just listened to the chapter yesterday, is there any new information in there that was new?




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  16. Restaurant food is the most dangerous unless they publish a nutrition list, like Panera’s, Olive Garden,Bob Evans etc. so you can pick and choose or just avoid the place. Small restaurants don’t have to have a list, so beware or just have salads with only real food.




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    1. Completely agree. Even places that you would assume are healthier turn out not to be…something like Panera’s Mediterranean Veggie Sandwich sounds like it’d be healthy. But, the whole sandwich has 1430mg of sodium. 2-1/2 times the number of calories it contains. Cook your own food is the message!




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  17. Dr. Greger, What if a person has extremely low sodium to where it is verging on dangerous levels, which I do? I also have epilepsy.




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    1. Karen, I would recommend you talk with your doctor(s). There are many factors involved when it comes to causes of low sodium–it’s usually not dietary in nature, although it can be, and it can be caused by several classes of medications. A good sit down between you and your doctor while glancing at your med list should yield some light.




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      1. Thank you DrAlex. It has been suggested that it could be one of my medications causing it but my neurologist doesn’t want to change any of them because we have only been able to get the seizures under control for about a year now. So I have had to limit my fluid intake.




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  18. Populations, salt and blood pressure
    https://courses.cit.cornell.edu/bionb1200/secure/seeley%201200.pdf
    Summary: Populations who eat less than 3 grams of salt per day do not develop high blood pressure and do not have a rise in blood pressure with age. In other populations, where salt intake is greater than 3 grams per day, the rate at which blood pressure increases with age is dependent on salt intake. Furthermore in three populations where salt intake was reduced over a prolonged period there was an associated reduction in blood pressure, and in two of these populations a reduction in stroke mortality. In Japan this fall in blood pressure occurred as it was becoming westernised.




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    1. Thanks for your comment!

      As you can see from Dr Gregers video, it is important to lower salt intake & like you state soy sauce has a lot of it! It’s probably important to be sensible about its use and for flavouring, adding lemon juice, spices and herbs can provide a tasty alternative.




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    2. If you use soy sauce go with the “low-sodium” varieties, which are by no means actually low in sodium, but simply have less obscene amounts of sodium compared to regular soy sauce. And then I would recommend only using the amount you need to get the amount of umami flavor that you want in your dish. Maybe start with half what the recipe calls for. If the soy sauce also supplies a significant amount of liquid to the dish, you can always reduce the amount of soy sauce to that required for flavor and mix with water to make up the deficit of liquid.

      And there are other sources of umami flavor that is at the root of the soy sauce flavor. A very powerful one is dried porcini mushrooms. Even just a tiny bit will add that deep, savory, “meaty” flavor that soy sauce provides but without any of the sodium. I buy porcinis by the pound since I use them frequently and they are super expensive when purchased by the little half ounce bags in the grocery. Just soak them in just enough hot water to cover them for 10 or so minutes. Then drain the soaking water through a coffee filter to get rid of any grit. Put BOTH the soaking water and minced up mushrooms in your dish. Another source of umami is tomato paste, which is increasingly available with no salt added. And of course caramelized onions are as well. In fact if you are caramelizing onions, you can stir in a tablespoon or so of tomato paste at the end of browning the onions but before adding any liquid and brown the tomato paste a little as well to bring out its umami flavor to add even more umami flavor. This is likely to not be enough paste to make the final dish “tomato-y”.

      Isa Chandra Moskowitz has a great recipe for “beef” stew in her cookbook Isa Does It where the deep meaty flavor comes from porcinis, tomato paste and caramelized onions. She uses either seitan (which can be very salty usually because of the soy sauce used in most commercial seitan) or tofu to give the meaty texture. I find that Butler Soy Curls are an even better alternative. They only have a single ingredient, steamed, dried soy beans, and no added sodium.




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        1. Usually from Amazon. Here are the ones I got the last time.

          Also you can get porcini mushroom powder that can just be stirred directly into recipes without the bother of soaking, straining and mincing. I haven’t personally tried this one yet, but I am thinking about it. My concern is whether any of the grit that is on the whole dried mushrooms is removed before they are ground to a powder or not. Some of the reviews on the one linked to above specifically mention that they couldn’t detect any grit.




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      1. Jim Felder: I know you already got some feedback on this post, but it is such a great, helpful post, I had to chime in too. What wonderful suggestions!




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  19. http://www.nejm.org/doi/full/10.1056/NEJMoa1311889

    The New England Journal Of Medicine has an article that explains how a very large study has shown that a LOW SALT diet increases one’s risk for heart disease and death. It also explains that extreme salt intake increases one’s risk of disease. The article says that the issue of salt intake is like a “U” shaped curve. In other words, to much salt is bad for you and to little salt is bad for you. You have to find the “sweet spot” in order to have a healthy sodium intake. The article went on to explain that consuming 3000 to 6000 mg of salt a day is not going to cause you any problems if you are healthy. However, people who have extreme illnesses would not be able to tolerate that much salt. In conclusion, one could conjecture that a low sodium diet of 1000 mg per day is not healthy for the majority of people on the planet.

    http://www.nejm.org/doi/full/10.1056/NEJMoa1311889




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      1. There is a study in “The Cochrane Database of Systemic Reviews. 2004 Issue 1. Art. No: CD004022DOI: 10.1002/14651858.CD0040022.pub2
        In this study 57 trials with Caucasians, and 8 trials with blacks, with a mix of normal and elevated histories of blood pressure, it was shown that a low sodium intake reduced systolic blood pressure by 6.44mm Hg and diastolic blood presure by 1.98 Hg as compared to a high sodium intake. The conclusion was that a low salt diet has very little effect on high blood pressure. The main culprit causing high blood pressure or hypertension if you want to speak “medicinese” is atherosclerosis and arteriosclerosis. A low sodium diet is not going to cure narrowing and hardening of the arteries from plaque build up. The study went on to also show that the low sodium diet caused a significant increase in cholesterol, LDL cholesterol, triglycerides, as well as rennin, aldosterone, and noradrenaline. However the high sodium diet did not elevate these hormones. So the problem is that these elevated hormones caused by the low sodium diet can increasing the risk of a cardiovascular event.

        These hormones are elevated because the body is attempting to hold onto the little salt that is left from eating a LOW SALT diet.

        The real cure for hypertension is a vegan diet, plus fasting under the care of a physician who is an expert in fasting. Plus, one can take serrapeptase, an enzyme, which will dissolve the plaque in your arteries.




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        1. Thanks. I could not find the review you referenced using those terms. There was however only one 2004 Cochrane review on salt.
          http://onlinelibrary.wiley.com/cochranelibrary/search/

          Unfortunately, it does not fully support your statements above. Importantly, it is only about ADVICE to reduce salt consumption. Even more importantly it found that “Intensive support and encouragement to reduce salt intake did lead to reduction in salt eaten.” So I do not see how this review can support your conclusions.
          http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003656.pub2/full




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        2. Thanks for this, John. Following your citations I then found a more recent 2011 Cochrane review of 167 studies which concluded, “The present meta-analysis shows that low versus high sodium diet in
          Caucasians with normal BP decreases BP less than 1%. A significant
          concomitant and persistent increase in plasma renin, plasma aldosterone
          and to a lesser degree of plasma adrenaline and plasma noradrenaline may
          contribute to the small effect of sodium reduction on blood pressure.
          Furthermore, sodium reduction resulted in a significant increase in
          plasma cholesterol and plasma triglyceride, which expressed in
          percentage, was numerically larger than the decrease in blood pressure.” http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004022.pub3/references




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          1. Thank you JS for posting this more recent review. This is the point I was trying to make which is that a low sodium diet has the potential to elevate cholesterol and triglycerides which in the long run will collect as plaque in your arteries, and then when that happens one’s blood pressure is going to go higher, which means that one is going to have to start taking anti-hypertensive drugs which are not going to cure the plaque problem. However, at the same time, they will be given statin drugs which cause side effects in some people, but not in others. But, do statin drugs prevent further build up of plaque in the arteries? I don’t think so if one is eating meat, oil, fat, and so forth. Statins just prevent the liver from making cholesterol, but if you are consuming dietary cholesterol, the plaque can still start to accumulate on the arterial walls. Correct me if I am wrong. This is why a vegan diet, fasting, exercise, and a no stress life style is mandatory to correct these problems. It certainly has helped in correcting my hypertensive history. Also, something I never hear anyone talk about is serrapeptase. This is an enzyme that will dissolve the plaque in one’s arteries. You have to take it on an empty stomach and you have to take it with a full glass of water.




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      2. The 1500 mg level is not the level you must reach each day for adequate sodium needs. As I recall from the national academy of science, sodium intake can be less than the 200’s and you would still be getting enough sodium (fluctuating with sweat). The 1500 mark is more of a mark not to exceed, even though an upper limit of 2300 already exists.




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        1. Thanks. My understanding is that it is an average requirement for most young healthy adults although 1500 mg might not be adequate for some people. You might want to debate the risk of low sodium intake with John! My understanding is that there are calls from some quarters in the US (the AHA?) to set the TUL for sodium at 1500 mg daily

          The relevant DRI document explains:

          “The AI for sodium is set for young adults at 1.5 g (65 mmol)/day
          (3.8 g of sodium chloride) to ensure that the overall diet provides
          an adequate intake of other important nutrients and to cover sodium
          sweat losses in unacclimatized individuals who are exposed
          to high temperatures or who become physically active as recommended
          in other dietary reference intakes (DRI) reports. This AI
          does not apply to individuals who lose large volumes of sodium in
          sweat, such as competitive athletes and workers exposed to extreme
          heat stress (e.g., foundry workers and fire fighters). The AI
          for sodium for older adults and the elderly is somewhat less, based
          on lower energy intakes, and is set at 1.3 g (55 mmol)/day for
          men and women 50 through 70 years of age, and at 1.2 g (50
          mmol)/day for those 71 years of age and older.”
          https://fnic.nal.usda.gov/sites/fnic.nal.usda.gov/files/uploads/269-423.pdf




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          1. Their life expectancy is 45 years.
            The Yanomami are an indigenous tribe (also called Yanamamo, Yanomam, and Sanuma) made up of four subdivisions of Indians which live in the tropical rain forest of Southern Venezuela and Northern Brazil. They live in the rain forest which is an environment that lacks salt. Interestingly, they are genetically enabled to not get hypertension even though they have chronically high levels of RAS. However, they have low longevity. The Yanomami, on their obligate low salt diet, have been used to set the guidelines. Their inability to develop high blood pressure has nothing to do with salt — it has to do with their genotype.




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  20. What about people doing a lot of exercise and sports (i.e i’m training for a marathon), is it ok to eat a salty meal after a long 15km run or more? I usually have salt on my sin after that from all the sweating so i know i’ve lost a bit!




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  21. Lack of fruit a risk factor? Does this apply to 100% WFPB eaters who are strongly biased toward vegetables? Is it fruit’s anti-oxidants that are the main deal here? (I was thinking that WFPB folks have less bad stuff to anti-oxidize, so can afford to be a little less obsessed with anti-oxidants.) Any thoughts on this, anyone?




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    1. It is the salicylate content of foods that is responsible for anti-platelet effects. Many non-fruit plant foods contain high amounts salicylates, including broccoli and a number of spices.




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    2. I suspect that is the high potassium content in many fruits that is important.
      http://www.bloodpressureuk.org/microsites/salt/Home/Howtoeatmorepotassium/Fruit

      ” Dietary potassium modulates both the pressor and hypercalciuric effects of the modern dietary excess of NaCl. A marginally deficient dietary intake of potassium amplifies both of these effects, and both effects are dose-dependently attenuated and may be abolished either with dietary potassium or supplemental KHCO3. The pathogenic effects of a dietary deficiency of potassium amplify, and are amplified by, those of a dietary excess of NaCl …….”
      http://www.ncbi.nlm.nih.gov/pubmed/16772638




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  22. Processed foods _without_ salt are only marginally better than processed foods at any other NaCl level. For every “problem” there is another “manufacturing answer”. “Low sodium” isn’t functional if you’re relying upon processed and restaurant foods to deliver it.

    Anyone eating mostly WFPB is already FAR below the SAD level of salt intake (and fats and calories as well).




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  23. Please address whether ingesting different salts can produce different results, because there is a difference between them. When I eat Himalayan salt, I can almost eat as much as I want without worrying my ankles will swell up, but if I use half as much of a comparable amount of table salt my ankles will swell.




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  24. Potassium question: I’ve been a vegan for about 6mo (so far) and have used a food tracking app religiously during this time. I rarely eat anything processed/boxed, never add sugar to things, but add stevia to my unflavored pea protein powder so it’s not gaggable. I’m trying to build muscle and drop fat at the same time by targeting 1500cals/day (30-40% pro, ~30% fat, <40% carbs), lifting weights 6days/wk for about 1hr/day and bicycling 50-100mi/wk. I drink ~96oz water daily. I noticed that my sodium levels are generally high while my potassium intake was deficient by about 1000-2000mg/day. Supps are limited (by law?) to 99mg/tablet and I don't want to take 10 expensive tablets/day to correct my deficiency, so I'm using Morton salt substitute (Potassium Chloride, 690mg of K per 1/4tsp serving) twice daily and my K numbers look better. My BP has always been decent (BP 114/61, pulse 57 this morning). Anyone have comments why using salt substitute in this way is good or bad?




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    1. I don’t know anything about your personal situation but Darryl elsewhere in this thread wrote about a trial in a Taiwanese nursing home (of potassium enriched salt) which found:

      “Conclusions:This study showed a long-term beneficial effect on CVD mortality and medical expenditure associated with a switch from regular salt to potassium-enriched salt in a group of elderly veterans. The effect was likely due to a major increase in potassium and a moderate reduction in sodium intakes.”
      http://ajcn.nutrition.org/content/83/6/1289.long

      So using the salt substitute may well be helpful from a health point of view.

      On the question of building muscle and protein supplements, you might want to read Michael Bluejay’s analysis.
      http://michaelbluejay.com/veg/protein-strength.html

      However, getting back to potassium, whole food vegetarians usually have no problem getting enough potassium because fruits and vegetables are high in it. You might want to review your diet?
      http://www.drugs.com/cg/potassium-content-of-foods-list.html




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  25. I get about 7 grams salt (3 grams sodium) per day, which is a bit too much. But it’s quite difficult to keep it this low as I eat close to 4000 Kcal per day (I exercise a lot and with my BMI of just 19 kg/m^2 I shouldn’t eat less). About 5 grams comes from just the dry bread, a few grams comes from cheese. I add no salt at all myself to anything I eat.




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    1. Thanks for your comment!

      Are you an athlete? If yes, unless sodium restriction has been recommended to you for health reasons, it’s ok to eat a bit more salt (1). Otherwise, it is advisable to try cut down salt intake from these products you consume by reducing quantity and replacing with other foods.

      On the other hand, I highly recommend you read this short summary to find out the health effects of cheese.

      Hope this answer helps!




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      1. Thanks! I’m not an athlete, but I do exercise a lot (one hour running per day), it’s not hot where I live so I don’t sweat much (almost never more than 1 liter). I’ll look into the problems with cheese. A problem here is that it’s not easy to get enough calcium from non-dairy sources alone. Even if the diet does contain enough calcium, the concentration is low which means that it may not be absorbed as well. One slice of cheese contains 300 milligrams, which is more than the 200 milligrams in the 400 grams of broccoli I ate yesterday, or the 180 milligrams in 3 liters of tap water.




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        1. The amount of calcium in food can be misleading. For example, the human body absorbs about 30% of the calcium in dairy products, but 40% of the calcium from non-dairy sources such as broccoli, kale and turnip greens. Meanwhile, with the cheese, comes a long list of health risks. With the broccoli and dark leafy greens comes a long list of known health benefits.
          .
          Similarly, there are at least two studies suggesting that our bodies absorb calcium from say soy milk as well as our bodies absorb calcium from dairy milk. And as before, with a drink of say soy milk, you get the calcium plus added benefits of the soy. From dairy milk, you get the calcium plus a whole lot of health risks, with no other added benefits.
          .
          I like to think of cheese by remembering this analogy: Water is good for me and I really should drink more. But does it make sense to drink Coke because it has a lot of water in it?




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  26. I take exception to this presentation unless the salt in question is refined salt and then I’m totally on board that refined salt is awful for good health. Dr. Greger should read Dr. David Brownstein’s SALT Your Way to Health. I’m totally on board with Dr. Brownstein that unrefined salt is absolutely necessary for good health. Another point I’d like to make is that since most Americans are deficient in magnesium, that salt will raise blood pressure. However, an individual with healthy cellular level magnesium will not get high blood pressure from unrefined salt. I know because my blood pressure is generally 115/75 with 60 beats per minute resting heart rate and I have a high unrefined salt intake.




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  27. You know how if you’re stranded at sea and you drink sea water you’ll still get dehydrated? Guess what sea salt does? It dehydrates the body. Humans crave salt because we need salt from plants. Celery, tomatoes, coconut water, watermelon all have sodium. I am a tomato addict and just eat a lot of baby tomatoes. Cherry tomatoes are my favorite. You can buy organic dulse online or you can find it in the stores to get your vegetables. If you’re craving sweet, eat fruit, if you’re craving salt, eat a giant salad with ton of tomatoes or make some celery juice or mix celery with fruits in the blender. No need to dehydrate your body. Go raw!! I wish I could eat grains and legumes but I have a bad stomach condition. The only I can eat is raw fruits and veggies and potatoes pretty much. Can’t do citrus cause of acid reflux and watermelon causes me problems.




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  28. I just read about a study in the American Journal of Medicine that a sodium intake less than 2300 mg was associated with a 37% increase in heart disease and don’t recall the % increase risk of death. What is up with that?




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  29. Can you or Dr. Greger touch upon what’s in “natural flavors” in many packaged foods? Should the public be weary of foods with this ingredient since we don’t know exactly what ingredients are in it? The same goes for when I see “vegan natural flavors”. Thanks




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  30. I have recently become a vegan and have cut all salt and oil from my diet. Im currently suffering with very high Estrogen levels, and after speaking with a nutritionist in the UKhave been told that its imperative that I consume some celtic salt in the day to help my body gain more minerals. That not having any salt at all in my diet can almost be as damaging as having table salt. Both table salt and no salt can cause high blood pressure and can prevent my body from absorbing glucose. How true is this?? I need to get my body as healthy as possible before having IVF and im getting confused with the conflicts all over the place. Scary.com! Would really appreciate a response please




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    1. Kelsterelly: I can’t tell you whether you need more salt in your diet or not. Maybe you do. But if someone thinks that adding “celtic salt” is the answer over regular table salt, that’s when my caution siren sounds. 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. For more information, check out the following two blog posts and the bottom of the article in the third link:
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131297498
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131500235
      https://www.sciencebasedmedicine.org/pass-the-salt-but-not-that-pink-himalayan-stuff/
      .
      My point is, how is any of *that* supposed to help with high estrogen levels? There may well be some dietary changes you can do that will help. I’m not sure. One thought I had for you was that you recently became vegan. Maybe you need to give it some time to see what changes the existing diet will have on your body? Dr. Greger has some videos on this site regarding fertility. You might want to look into that. Also, you clearly understand about the “no oil” ideal. But if you are not already, you might want to make sure your diet is make up largely of whole plant foods rather than processed vegan foods one finds at a store. (You probably are already doing that. I just thought I should mention it just in case.)
      .
      Good luck to you. Maybe some other people will also jump in with some ideas.




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  31. I’m a bit late to the discussion but hoping for some feedback from a moderator. If everything is functioning as it should and blood pressure is at a healthy level, is it possible that by drinking hibiscus tea or heavily eating other foods that are known to lower blood pressure that your blood pressure could go too low or does the body regulate it and it won’t go too low unless something is wrong? Mine can get low when I am dehydrated so I work on that daily. I love hibiscus tea and drink several glasses. I recently had some sort of virus and for the first time in my life I fainted. I am just wondering if I should avoid foods that lower blood pressure in case it works too well.




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  32. I am really curious about one thing. I work out (weight lifting) for more than 2 hours a day for 6-7 times a week so (almost) every day. My trainings are pretty crazy and intensive. What about my salt intake? I drink a LOT of water. Sometimes more than 5-6 litres. I don’t push it into myself but I’m thirsty. I don’t know why but if I’m thirsty and I don’t drink, I begin to feel tired and deconcentrated. So that’s why I think that it is natural. Please help me! I’m really into health and that is the only question that I don’t know.




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    1. Hello Joy, This is a “Yes and No” answer. As you are probably aware from several NutritionFacts.org videos including this one: http://nutritionfacts.org/video/the-evidence-that-salt-raises-blood-pressure/ cutting down on sodium is a healthy and salt substitutes with potassium chloride assist those who crave salt to do that while providing healthy potassium. That said, those same salt substitutes can be hazardous to some, especially those with on certain blood pressure medications, renal failure, diabetes mellitus with hyporeninaemic hypoaldosteronism, and obstructive uropathy. : See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124926/&gt;
      A safer approach would be to learn to learn to live without salt. Dr Greger has provided some encouragement on how to do this in http://nutritionfacts.org/video/changing-our-taste-buds/ By substituting spices for salts we also get the health benefits of thos espices as well.
      Joan-Nurse Educator




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      1. Thank you so much Joan for your thoughtful answer. It’s easier to choose when you know which way is better. I don’t have those conditions, but I want that to keep it that way. :)

        Thank you also for being a nurse and an educator. Just imagine how many people you’ve helped!




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  33. Hello Dr. Greger. The no added salt idea has intrigued me. I am currently using either Himalayan salt or a rock salt from Utah called REAL Salt in my house. Have you seen any research comparing the biological effects of consuming different kinds of salt including Celtic sea salt or Himalayan rock salt for example? Thanks.




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    1. Eric Salisbury: I don’t feel qualified to comment on the question of absolutely no added salt or not. But I do have some information on the concept of Himalayan salt. Below is the information I typically share when people ask this question. I hope it helps.

      ******************
      I’ll share a response that I first learned from poster Darryl some time ago: 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. Want to see the actual data? Check out these posts from Darryl:
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131297498
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131500235
      .
      Also, I can’t remember if anyone has referred to the article from Science Based Medicine yet or not. (Thank you Tom Goff for bringing this one to my attention some time ago.) The following site is not source that I generally consider to contain valid information. But no one is wrong about everything and she 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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  34. I have a question for dr Greger concerning salt. I have been researching the addition of iodine to our diet. Dr Sircus and Dr Brownstein and others recommend a protocol when supp with iodine to help with detox. It includes daily dose of unrefined sea salt such as Real Salt, magnesium, selenium, and vit c. According to them the unrefined salt helps the body to bind and get rid of bromine. They say it is the highly processed table salt that is a health problem. They recommend 1/4 tsp to 1 tsp a day of unref salt. I would love a second opinion from Dr Greger. As a nurse, we have always been taught how bad salt was and never differentiated between types. http://drsircus.com/medicine/salt/real-salt-celtic-salt-and-himalayan-salt




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    1. Tammy Travis: The following is not from Dr. Greger, but I hope it will be of help to you. Some of the sources below are very well respected and researched.
      .
      Every time there is a video on salt, people ask questions about “natural”/pink/sea/Himalayan salt. Other times, people simply assert that sea salt is healthy or perhaps different enough to invalidate studies showing salt is bad for us. I’ll share a response that I first learned from poster Darryl some time ago:
      .
      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. Want to see the actual data? Check out these posts from Darryl:
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131297498
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131500235
      .
      Also, I can’t remember if anyone has referred to the article from Science Based Medicine yet or not. (Thank you Tom Goff for bringing this one to my attention some time ago.) The following site is not source that I generally consider to contain valid information. But no one is wrong about everything and she 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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    2. Tammy Travis: I also thought I would share a recent experience I had. I had received a free sample of the Real Salt brand some time ago. I decided to try gargling with salt water like Dr. Greger recommends in one of his videos. So, I made up the salt water using “Real Salt”. I let it dissolve for a time before I went to use it. When I went to use it, the salt had fully dissolved, but there was a pile of what looked like dirt at the bottom of the cup. After seeing that, I just can’t believe on an emotional level that that stuff would be any better for someone than refined salt. Ewww. ;-)




      0
        1. Tammy Travis: No. Better none maybe? I’ve seen no evidence that contaminated/natural salt produces a
          different effect on the body (especially blood pressure) in practice/studies
          than refined salt. If I’m going to eat table salt, I’d rather get the iodine from refined salt than the contaminants from unrefined.
          .
          Have you seen the charts showing that unrefined salts are contaminated with bad things? It’s a mild contamination and unlikely to cause harm, but it’s still there and in the same amounts as the good contaminants that some people point out. In other words, those good contaminants are unlikely to help any more than the bad contaminants are likely to hurt. I can find the table that lists the contaminants found on natural salts if you are interested.




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  35. For those vegans who make all their food from scratch (not cans) how much salt do you recommend we add to avoid a sodium deficiency?




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    1. Han: Every time there is a video on salt, people ask questions about “natural”/pink/sea/Himalayan salt. I’m thinking that Celtic sea salt is no different. I’ll share a response that I first learned from poster Darryl some time ago:
      .
      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:
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131297498
      http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131500235
      .
      Also, I can’t remember if anyone has referred to the article from Science Based Medicine yet or not. (Thank you Tom Goff for bringing this one to my attention some time ago.) 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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  36. Ok, we’re convinced. My husband and I were both sort of borderline with blood pressure before starting the WFPB diet (J’s doc referred us to nutritionfacts.org ! ) . Now J is clocking 130/72 and I am around 115/68. Much better. But I travel a lot for work, and J has to eat out for work lunches pretty often, so we can never stay salt free long enough to get used to the taste. We don’t eat processed foods, they definitely taste too salty and yucky at this point. So, what to do? We love our jobs. I cook with a little bit of salt, and the salt shaker is off the table. I’ve been making a lot of miso salad dressings to feel better about salt. Should we just figure we’re doing the best we can?




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  37. First, Mary, good for you cutting the salt habit. You’ve definitely made progress and your improved BPs are proof. But still there may be some other methods you can do, such as switching to other spices for flavorings. My husband and I have found some prepared combinations that we’re finding satisfying. If you have access to a spice shop you’ll find lots of possibilities as salt substitutes. (You could check online too, but of course that involves taking a risk that you won’t like what you’re sent, whereas at the spice shops you can usually have taste samples. Eating out can be a challenge, but we eat out lots and try to make sure our waitress knows we want things prepared as salt free as possible. Of course that depends on what you order and where. For ex, if you order a baked potato that works, but a veggie burger may have salt as one of the ingredients. Finding out how much may help make the decision to order this again or not. Again, I’d encourage you both to keep cutting the salt. You’ve done well, but I bet you can even find further ways to shake the habit!




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    1. Thanks for the encouragement. Re: iodine, I’ve finally started cooking with more seaweed, I use a tiny piece of kombu in the beans when they are cooking, toasting nori, sprinkling dashi on soups. I had three or four kinds of seaweed in the cabinet for ages before I finally got going with it. Are we ok with that, or should I find ways to incorporate more iodine into our diet?




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  38. Hi, jonatec. The topic of salt has been covered extensively on NutritionFacts, as you can see here:
    https://nutritionfacts.org/?fwp_search=SALT&fwp_content_type=video
    The following video may be of particular interest to you:
    https://nutritionfacts.org/video/sodium-skeptics-try-to-shake-up-the-salt-debate/
    Yes, the body does need a certain amount of salt each day, but most people consume much more than is needed.
    I hope that helps!




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    1. We’ve been fans of Dr. G’s for almost a year now. We’ve gradually reduced salt, but still eat a little, maybe a quarter of what we used to. No processed stuff, and hitting most of the daily dozen, most days. So, our blood pressures have plummeted. I’m clocking 96/62 up to 105/65. J’s BP is just a little higher than mine. We were both borderline for high blood pressure (and vegetarians!) when we started this journey. But, at this point, I’m not worried a bit about our salt intake. And we eat out sometimes and travel for work. So, I think works fine, and its easier to reduce, but not obsess. Dr. G has also said in some interview I saw that its not possible to get salt free, etc, when traveling.




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  39. On a true whole food plant based diet it seems like getting the FDA’s RDA of 1,500mg/ a day minimum of sodium is very challenging since most fruits and vegetables contain only small amounts of sodium– perhaps some whole grains have a bit more. Does the RDA minimum of 1,500mg seem high, because it seems like in order to achieve you would have to add to one’s diet yet many plant based doctors don’t recommend adding salt to the diet in cases of severe disease– for someone who is not trying to reverse, say heart disease, should we be shooting for at least 1,500mg a day or could we be fine with much less?




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  40. Interestingly, a few years I removed ALL sodium from my diet, as much as possible, and started to feel extremely strange during the day, with what I would call small “short circuits” in my brain, along with dificulty in concentrating, it was rather horrible. Adding some sodium back in helped. Also, I was a premature baby at birth, and studes have shown premature babies tend to be hyponatremic.




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