Sodium & Autoimmune Disease: Rubbing Salt in the Wound?

Sodium & Autoimmune Disease: Rubbing Salt in the Wound?
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Two ways in which salt may drive autoimmune diseases such as multiple sclerosis, psoriasis, type I diabetes, Sjögren’s syndrome, asthma, and rheumatoid arthritis.

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

Millions suffer from asthma attacks triggered by exercise. Within five minutes of starting exercising, people can get short of breath, start coughing and wheezing, such that lung function significantly drops. But, on a high-salt diet, the attack is even worse; whereas, on a low-salt diet, there’s hardly a significant drop in function at all.

To figure out why, researchers had them all cough up sputum from their lungs, and those on the high-salt diet ended up with triple the inflammatory cells, and up to double the concentration of inflammatory mediators. But why? What does salt intake have to do with inflammation? We didn’t know, until now.

“The ‘Western diet,’ high in saturated fat and salt, has long been postulated as one potential…cause for the increasing incidence of autoimmune diseases in developed countries…” The rapidly increasing incidence of autoimmune diseases may be due to an overactivation of immune cells, called helper 17 cells. “The development of…multiple sclerosis, psoriasis, type I diabetes,…Sjögren’s syndrome, asthma, and rheumatoid arthritis” have all been “shown to involve [this] Th17-driven inflammation.” And, one trigger for the activation of those Th17 cells may be elevated levels of salt in our bloodstream. “The sodium content of processed foods and ‘fast food’…can be more than 100 times higher in comparison to similar homemade meals.”

And, sodium chloride, salt, appears to drive autoimmune disease by the induction of these disease-causing Th17 cells. Turns out there’s a salt-sensing enzyme, responsible for triggering the formation of these Th17 cells.

Organ damage caused by high-salt diets may also activate another type of inflammatory immune cell. A high-salt diet can overwork the kidneys, starving them of oxygen, triggering inflammation. The more salt they gave people, the more activation of inflammatory monocyte cells, associated with “high-salt intake induced” kidney oxygen deficiency. But, this study only lasted two weeks. What about long term?

One of the difficulties in doing sodium experiments is that it’s hard to get free-living folks to maintain a specific salt intake. You can do what are called metabolic ward studies, where you essentially lock people in a hospital ward for a few days, and control their food intake. But, you can’t do that long term—unless you can lock people in a space capsule. Mars520 was a 520-day space flight simulation to see how people might do on the way to Mars and back.

What they found was that those on a “high-salt diet displayed a markedly higher number of monocytes,” which are a type of immune cell you often see increased in settings of chronic inflammation and autoimmune disorders.

This may “reveal one of the consequences of excess salt consumption in our everyday lives,” since that so-called high-salt intake may actually just be the average-salt intake. Furthermore, there was an increase in the levels of pro-inflammatory mediators, and a decrease in the level of anti-inflammatory mediators—suggesting that a high-salt diet has the “potential to bring about [an] excessive immune response,” which may damage the immune balance, and result in “either difficulties [in] getting rid of inflammation or even an increased risk of autoimmune disease.”

What if you already have an autoimmune disease? “Sodium intake is associated with increased disease activity in multiple sclerosis.” If you follow MS patients for a few years, those eating more salt had three to four times the “exacerbation rate,” three times more likely to develop new MS lesions in their brains, and on average, had eight more brain lesions, fourteen in their brain, compared to six in the low-salt group. So, the next step is to try treating patients with salt reduction and see if they get better. But, since reducing our salt intake is a healthy thing to do anyway, I don’t see why anyone should have to wait.

Please consider volunteering to help out on the site.

Image credit: Blake Burkhart via flickr. Image has been modified.

Video credit: Julien Herman

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

Millions suffer from asthma attacks triggered by exercise. Within five minutes of starting exercising, people can get short of breath, start coughing and wheezing, such that lung function significantly drops. But, on a high-salt diet, the attack is even worse; whereas, on a low-salt diet, there’s hardly a significant drop in function at all.

To figure out why, researchers had them all cough up sputum from their lungs, and those on the high-salt diet ended up with triple the inflammatory cells, and up to double the concentration of inflammatory mediators. But why? What does salt intake have to do with inflammation? We didn’t know, until now.

“The ‘Western diet,’ high in saturated fat and salt, has long been postulated as one potential…cause for the increasing incidence of autoimmune diseases in developed countries…” The rapidly increasing incidence of autoimmune diseases may be due to an overactivation of immune cells, called helper 17 cells. “The development of…multiple sclerosis, psoriasis, type I diabetes,…Sjögren’s syndrome, asthma, and rheumatoid arthritis” have all been “shown to involve [this] Th17-driven inflammation.” And, one trigger for the activation of those Th17 cells may be elevated levels of salt in our bloodstream. “The sodium content of processed foods and ‘fast food’…can be more than 100 times higher in comparison to similar homemade meals.”

And, sodium chloride, salt, appears to drive autoimmune disease by the induction of these disease-causing Th17 cells. Turns out there’s a salt-sensing enzyme, responsible for triggering the formation of these Th17 cells.

Organ damage caused by high-salt diets may also activate another type of inflammatory immune cell. A high-salt diet can overwork the kidneys, starving them of oxygen, triggering inflammation. The more salt they gave people, the more activation of inflammatory monocyte cells, associated with “high-salt intake induced” kidney oxygen deficiency. But, this study only lasted two weeks. What about long term?

One of the difficulties in doing sodium experiments is that it’s hard to get free-living folks to maintain a specific salt intake. You can do what are called metabolic ward studies, where you essentially lock people in a hospital ward for a few days, and control their food intake. But, you can’t do that long term—unless you can lock people in a space capsule. Mars520 was a 520-day space flight simulation to see how people might do on the way to Mars and back.

What they found was that those on a “high-salt diet displayed a markedly higher number of monocytes,” which are a type of immune cell you often see increased in settings of chronic inflammation and autoimmune disorders.

This may “reveal one of the consequences of excess salt consumption in our everyday lives,” since that so-called high-salt intake may actually just be the average-salt intake. Furthermore, there was an increase in the levels of pro-inflammatory mediators, and a decrease in the level of anti-inflammatory mediators—suggesting that a high-salt diet has the “potential to bring about [an] excessive immune response,” which may damage the immune balance, and result in “either difficulties [in] getting rid of inflammation or even an increased risk of autoimmune disease.”

What if you already have an autoimmune disease? “Sodium intake is associated with increased disease activity in multiple sclerosis.” If you follow MS patients for a few years, those eating more salt had three to four times the “exacerbation rate,” three times more likely to develop new MS lesions in their brains, and on average, had eight more brain lesions, fourteen in their brain, compared to six in the low-salt group. So, the next step is to try treating patients with salt reduction and see if they get better. But, since reducing our salt intake is a healthy thing to do anyway, I don’t see why anyone should have to wait.

Please consider volunteering to help out on the site.

Image credit: Blake Burkhart via flickr. Image has been modified.

Video credit: Julien Herman

Doctor's Note

What about childhood asthma unrelated to exercise? Check our my last video, How to Treat Asthma with a Low-Salt Diet.

What are some of the most powerful dietary intervention we have for autoimmune disease? Check out videos such as:

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

89 responses to “Sodium & Autoimmune Disease: Rubbing Salt in the Wound?

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  1. Been waiting for this for a long time – a video that totally satisfies me, ie. it is surprising, stunning, important, has a lot of implications, it concerns molecular mechanisms and it concerns inflammatory diseases. I will have to do a review of literature from this video because there’s so much info to digest.

    So I love it but at the same time it’s a fun killer – especially when I discovered that I can eat salt after a long period of being unable to… and the last month I started adding salt to everything… to be precise – it’s one of these ready-to-use salt/glutamate/vegetable mixes that I am addicted to. I rationalize: glutamate enables me to eat less salt… but at the same time… it makes me use it with almost every vegetables that I eat.

    Yet another mechanism of inflammation in inflammatory diseases to consider: when you ingest salt it causes stomach/gut inflammation and this inflammation exacerbates your joint inflammation. That’s what actually happens in my case, though thanks to the treatment now getting much better despite quite high salt intake.




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    1. Hm, so there are a few questions that come to my mind.

      1) Why would evolution choose to have such a strange function for sodium ie. why would evolution allow inflammation in response to sodium? What’s the greater picture behind this?

      We’re probably not talking here about microenvironmental stimuli: take for example a body cell which dies and releases it’s contents into microenvironment. If cell contents were rich in sodium then this would increase immune system reaction locally. But cell contents are rich in potassium, not in sodium… so we probably have to think about a global supply of sodium, ie. from food and why would that be beneficial for the body.

      Or maybe it’s just a glitch in the system ie. this option was never really considered by the evolution because there was nevere too much salt around and so here we are – we’ve got problems when there’s plenty of salt everywhere.
      2) Does potassium help in this respect? There are anecdotal accounts of potassium helping to cure inflammatory diseases. Until now the explanation was that potassium increases corticosteroids (along with mineral corticosteroids) excretion which are antiinflammatory. But maybe this new mechanism is also sensitive to potassium?

      From evolutionary point of view potassium can’t hurt us in this respect (ie. drive the inflammation) because there was plenty of it and it wouldn’t be prudent of evolution to make potassium proinflammatory. So it does not hurt but can it help?




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      1. Another iteration of the thought process…

        The paper here:
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078683/
        basically has answers to almost all of my above questions…

        This paper is quite difficult (even for me but I’ll try to figure it out) but first you need to understand the concept of hyperosmolality which means that a solution is denser than a model solution. In our case this simply means that in hyperosmolar solution there is more sodium ions than in model solution (and beware: osmolaLity doesn’t exactly equal osmolaRity but for our purposes it does (https://en.wikipedia.org/wiki/Plasma_osmolality#Osmolality_versus_osmolarity) – that’s one of the catches that this article contains).
        Looks like within the body there can be regions of varied osmolarity.
        Sodium ion hyperosmolarity can be sensed and some actions can be taken by the body (paragraph “PATHOLOGIES ASSOCIATED WITH HYPEROSMOLALITY AND INFLAMMATION”, but again it’s quite difficult to understand). This mechanism is responsible for hypertension (“Role of NFAT5 in Blood Pressure Regulation and Sodium-Sensitive Hypertension”) and it might have been quite incidental that it causes inflammation too (from the evolutionary point of view – at first it caused hypertenstion, only after some time it also caused inflammation). The paper describes such cases of local inflammation caused by sodium ion hyperosmolarity.

        My thought (but it’s a long shot): evolutionarily we are descendants of marine organisms. Such organisms might have had a mechanism causing inflammation in response to sodium – it’s simple: you got bitten, salty water is pouring inside your body, so you need to have an immediate inflammatory reaction in response to increased sodium ion concentration. And it will be a whole body response which is better because the whole body will fight for just this one bite.

        So what are likely conclusions for all the inflammatory diseases sufferers?
        1) Limit your sodium intake but don’t overdo it – overdoing will also cause osmolar stress.
        2) There are ways to increase cell resistance to osmolar stress, namely supplements: betaine (or TMG as they call it, most important of them all in this respect, there is even funny research in pigs:
        http://www.nationalhogfarmer.com/animal-health/research-finds-betaine-reduces-heat-stress-impact-sows
        ), creatine (in muscles), carnosine (actually it’s best to take beta-alanine and carnosine will be produced) and L-carnitine. Any other, anyone?
        3) It’s also probably wise to drink your water and take your potassium.

        Ok, I got agitated by this quite amazing topic (and it’s a problem with my ADHD and all), I’ll try to get calm now…




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      1. Ashwin, are you aware of the Sources Cited button above? It is located just above the Doctor’s Note. You will find many more articles referenced, including at least one that you listed in your comment. Thanks for adding these other resources. They look quite interesting.




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    2. Sounds like this is a good time to share and remind everyone that Benson’s Table Tasty is a sodium and potassium chloride free salt substitute:
      http://www.bensonsgourmetseasonings.com/saltsubstitute.html
      I, too, find salt very difficult to give up mostly because I love it! So I cook without salt and load up on the spices and vinegars, limes, lemons to create flavor. Then salt my portion just before eating. This method with Table Tasty I find to be helpful. Helps me to use a minimal amount of NaCl but still have flavor.
      Best –




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      1. Hmm, too bad I’m allergic to paprika and lemon (ie. my joint react with inflammation so it’s not really an allergy but rather sensitivity).

        However maybe such small quantities would not hurt me…

        For now I bought potassium chloride (“pure for analysis” grade), I had to crash it (unfortuantely it has large crystals) and I tried to add some spices and dried vegetables and crash this mixture to a fine powder. Unfortunately when it comes to taste it is not the same as in the case of a ready-to-use product.
        And even worse – I feel that potassium chloride burns inside my gut even more than sodium chloride (it’s just its chemical property, it’s more reactive). And burning inside gut is inflammation which translates to joint inflammation. It’s quite incredible that I always have the same kind of reaction… so I can be sure that my arthritis is caused by gut problems…

        But I keep looking for spice mixtures that would be better… perhaps fried (and dried) onions would be tasty (though not healthy but what can you do) but there is always addition of wheat flour so it’s gluten so it’s something I’m sensitive to…




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    3. Mick, you seem to be really into the science… I know this is off-topic, but I welcome you (or ANYONE in the community) to troubleshoot this one, because as a vegan, I’ve been challenged on this before without any valid response:

      We know that L-Arginine increases vasodilation. So animal-eaters should be in their glory since arginine levels in animal foods far outweigh those in the Plant Kingdom. I understand that there’s a whole list of things wrong with animal foods. However, wouldn’t high levels of arginine be a positive thing among all the other bad things?

      We plant eaters cannot boast about the positive effects on arteries led by plant foods’ arginine content.
      We can, however, look to other reasons that plant foods act as vasodilators , and repair endothelial cell damage.




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      1. Caspergomez, There are some very good plant based ways of opening up your arteries and veins and capillaries. One of them is beets or beet juice. They are very good NOx creators and some have postulated beet juice will open up vessels in the brain so that previously dormant brain cells are awakened (the theory is that the brain cells go dormant if they do not receive enough oxygen to function, but re-awaken once oxygen is restored.)

        Another good one is dark chocolate. After seeing one of Dr. Greger’s videos showing how salt can stiffen our blood vessels, I have since begun taking vitamin C, astaxanthan, a drink of beet juice and a small chunk of unsweetened dark chocolate before eating a few spoonfuls of my natural peanut butter. Reason is, the peanut butter does contain salt… probably to act as a preservative.

        As suggested, keeping potassium levels up to somewhat counterbalance the salt probably means we can deal with salt as a nutrient rather than a nuisance… if follow good practices concerning intake.




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        1. Thanks, Lonie!
          I do understand the wonderful effects plant foods have on our endothelium.
          However, it doesn’t address the L-arginine and meat connection, or provide a response to meat-eaters who challenge me with that.




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          1. Meat eaters think that arginine is a problem for plant based eaters?

            Watermelon is high in citrulline that gets converted to arginine. There are others to.

            Maybe you should ask these meat eaters about the negative effects of their consumption of saturated fat, cholesterol, heme iron, igf-1 raising animal produce etc, and how whole food plant based eaters don’t have to deal with these deleterious effects.




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            1. We’re on the same page, Scott. I agree with all that, but I’m really more interested in the arginine paradox. In other words, how much do the high levels of arginine (as a vasodilator) negate the deleterious effects you mentioned.




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      2. Many people try to defend bad diets or, for example, high cholesterol or saturated fat consumption by referring to highly technical aspects of a single nutrient or biological process. Aspects which neither they nor the websites they get these arguments from understand fully but which they think imply some benefit which would validate their dietary choices. However, foods are package deals and they initiate or affect many thousands of biological processes and contain many micronutrients. In reality, these sorts of arguments are just attempts to distract attention away from the hard endpoint consequences of eating say meat. Pretty much every credible organisation from the WHO downwards accepts that red meat (ie meat from mammals) consumption appears to increase cancer risk but people and the meat industry will still attempt to justify it using it arguments like its arginine or zinc content despite a complete lack of evidence regarding mortality and morbidity benefits.
        In this case though the argument is even more silly because some plant foods are high in arginine content, especially seeds, nuts and lentils. Peanuts and peanut butter for example have significantly more arginine per pound than beef. The arginine content of foods can be checked by going to the USDA nutrient database
        https://ndb.nal.usda.gov/ndb/nutrients/report?nutrient1=511&nutrient2=&nutrient3=&&max=25&subset=0&offset=0&sort=c&totCount=5029&measureby=g




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        1. Tom… I love this argument you made, about single nutrients and package-deals. So true! Thanks!

          This arginine challenge also reminds me of how meat-eaters throw the B12 thing at us. That is, animal foods that contain adequate to high levels of B12 would have a POSITIVE effect on homocysteine levels. So wouldn’t THAT be a good thing? However (I think) we see that meat-eaters end up with higher levels homocysteine… so again, how do we explain this paradox?




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      3. Oh, I should add one further point that illustrates just how silly this particular arginine justification for eating meat is:

        “In healthy adults, endogenous synthesis provides sufficient arginine that it is not required in the diet, but it cannot provide enough arginine to meet metabolic requirements in certain conditions, including inflammation, dysfunction of small bowel or kidney, or in neonates and premature infants. Thus, arginine is classified as a semi-essential or conditionally essential amino acid”
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737650/
        and
        “In principle, there are three conditions that could result in arginine deficiency: dietary deficiency of arginine either by starvation or by ingesting a diet severely deficient in arginine (although the latter has not been found to result in arginine deficiency in healthy adults),”
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268370/#R2

        In other words,unless they have certain specific conditions, healthy adult humans will not be arginine deficient even if they consume zero dietary arginine. However, if people want to safely boost their arginine levels, they should eat eat nuts, seeds and lentils.




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        1. Totally agree. Great points again, Tom!!

          The whole thing is silly really… as you guys mentioned and many of us know, plant foods are the only foods that have a positive effect on the Endothelium. So what’s the point of worrying about Arginine when you’re eat animal foods that are paralyzing and destroying endothelial cells. lol

          Sometimes, it’s better not to argue with friends and family who argue as if they’re working with the Weston Foundation.




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        2. Well, so my reply to the question asked by caspergomez was supposed to be along the lines you defined…
          But you wrote it up so much better than I would have…

          I also wanted to say that this question is silly (though no question is silly, probably just difficult to answer in a simple way, to answer it you have disect it, blah) because it makes you assume that arginine is needed or necessary or the only factor required to get you better.
          And none of these assumptions is quite true, as for example nobody said that arginine itself will in the end be beneficial for your health. This would have to be studied in a interventional study. Otherwise such statements are only wishful thinking. Take me for example – a long time ago I also used to think that arginine might help me. This was because I was very cold, my hands and feet were cold, and I thought that improving circulation might help me. So I started taking arginine supplement (obviously, as this is the way I do). Small dose. After a few days I only got a terrible headache which lasted for about a month…

          The assumption that any single nutrient is helpful usually is wrong… You say it’s a switch of a function, I say it’s a mere disturbance in a very complicated system which was designed by the nature to deal exactly with such disturbances. So the body always tries to achieve homeostatis.
          For example metabolic rate of pathways breaking down/utilizing the ingested nutrient might be increased.
          In order to really make a difference you might want to attack the problem from many angles, and in this respect healthy foods are best – because they contain many nutrients working synergically. You might also aim for two (or more) foods (supplements) that work synergistically.

          The sad exception to all of the above is when there is a deficiency (even subclinical) of one nutrient. In such a case one nutrient might make you feel better fast. It’s sad because it probably happens more often than we could suspect. Me? After so many years (I am aware of vit. D “problem” since 2006) I am still unable to achieve a correct level of vitamin D (now around 20 ng/dl, should be at least 40). It gets even worse – I am probably very sensitive to such deficiency (this conclusion is the only logical and includes also genetic tests results, however misinforming they may be).

          BTW: A very good list of deficient nutrients can be found here:
          https://selfhacked.com/2016/08/12/16-nutrients-vegans-arent-getting/
          Dr Greger has already talked about deficiencies of certain nutrients from this list and recommended supplementation but there are many more and all of them important. And for example: you won’t get carnosine (in other words beta-alanine) from a WFPB diet – you have to supplement.

          And speaking of vitamin B12 – adenosycobalamin (also called dibencozyde) is a very important nutrient too. It’s present in meat and it’s not the same as methylcobalamin or cyanocobalamin. So it also requires supplementation… dibencozyde helped me a lot…

          There are many other details like this… too many to dwell on them here…




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          1. That selfhacked site to me comes across as a very biased one based on the authors/owners personal beliefs and thus he finds studies and information to support his beliefs. Only a few of those nutrients are needed in supplemental form, such as B12 and D3 that consumers of animals also need. Dr Greger has this far shown that this to be the case with his site.




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    4. As an MS patient, I found this video very interesting. As long as folks make note that remission must be done with a multi-prong attack over a long period of time to retrain and bring the good bacteria and enzymes back into dominance. I have when all natural in my attack on the MS. NO MORE DRUGS!. Stop the inflammation and stop the disease. But this does not work over night. The notion that “Take-Two Asprin n call me in the morning” That is gone with the wind. Diet, enzymes, alkaline ionized water plus less stress should all be used to help.
      As my friend Shan Stratton says, “If you do the same things today that you did yesterday, you will have the same problems tomorrow that you have today. The time for change is now.” I guess we should drop the salt shaker in the trash can…………… or at least cut way down on the salt! Wouldn’t you agree?




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  2. I never knew about the autoimmune-salt connection until today. I would like to thank Dr Greger and team for this video as a psoriasis patient in recovery/remission. I was a model for the western diet 9 months ago. Yall convinced me to go whole food plant based to save my life. I look forward to more Autoimmune disease/Psoriasis videos in the pipeline. So many Psoriasis commercials these days!




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      1. Table salt and Himalayan salt are not the same. Table salt is sodium and chloride only while the latter is a full range of minerals. That’s like saying a vitamin supplement is the same as a whole food. i personally have an autoimmune disease and was salt free for 3.5 years. I was still in pain. Now I take Celtic salt, eat potassium rich foods and take Magnesium. I finally found what works for me. I’m no longer swollen even though I use salt. Something wasn’t right for me when I was salt-free.




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    1. Stef: That’s a good question and one that lots of people share. 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. ​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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  3. Can you or someone else elaborate on how exactly eosinophiles are elevated post exercise? The interest comes from a recent eosinophilia (17%) I’ve had to deal with.




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  4. “The National Heart Lung and Blood Association reports that 500 mg is a safe daily minimum intake of sodium. This amount will be enough to maintain the bodily functions that require sodium. In an average temperate climate, a normal adult may be able to thrive with as little as 115 mg of sodium each day. Because most foods contain at least a small amount of natural sodium, it is difficult to drop below the minimum recommendation even on an extremely low-sodium diet.” – http://healthyeating.sfgate.com/much-sodium-adults-need-daily-5362.html

    I would tell you to through away your salt shaker, but I do keep one in my spice cupboard for guests. I get the majority of my sodium intake from greens and potatoes.




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    1. What about various claims that very low salt diets are not beneficial e.g. they have been associated with increased insulin resistance in http://www.metabolismjournal.com/article/S0026-0495(10)00329-X/pdf

      Cf, also
      http://jamanetwork.com/journals/jama/fullarticle/1105553

      I’d be interested in studies or articles that refute these sorts of claims because there’s a big difference between a diet not high in salt/sodium vs an ultra-low salt diet (no added salt), and it could well be that the optimal intake is in the “middle”.

      Given that the terms “low salt”, “high salt” seem not well defined, I find this a confusing topic.




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  5. It’s nice to finally learn why it’s important to eat low sodium. All I knew before watching this video was the connection between salt and hypertension. The fact that salt increases inflammation and affects the immune system is new to me. Love these more complex videos packed with new information!




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  6. Auto Immune Disease runs in my family. As far as genetics how does all this work? I have exrsize induced asthma, My mom sister brother grandfather aunt and cousin all have had different Disease and at least as far as my immediate family is very healthy. Can genetics actually play a huge role in this? And can salt reduction help with Lupous Pots and fibromyalgia to name a few! also my husband suffers from light form of porsis and would love to help him out! We are about 90% plant based. Only when we are out will we dabble in something that has cheese or something else not plant based.




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    1. SarahBradford022: You asked about whether genetics could play a role in autoimmune diseases. I’m not an expert in this topic, but here are some things to consider that generally applies to some conditions: Often times families have the same behaviors/eating patterns. So, even if there wasn’t a genetic component, one would expect to see environmentally influenced diseases to run in families.

      Also consider that what often enough seems to happen is that genetics and environment both play a role. Genetics can make some people more susceptible to getting certain diseases, but do not necessarily mean that the disease will happen. The environment and our behavior can be the factor which makes the disease actually happen. So, genetics can make that disease more likely compared to someone who has the same behavior, but doesn’t have the “special” genetics. I can’t remember who says this, but one of the plant based doctors likes to say something like: Genetics loads the gun. Diet pulls the trigger.

      This situation can be very empowering for people who have certain diseases in their family. It means that they are not necessarily doomed/destined to get that disease. By eating a healthy diet and doing whatever else is needed in the environment, they lower their chances of getting that disease. This is not a guarantee. A person may never smoke in her life and still get lung cancer. Surely it makes sense, however, to abstain from smoking to dramatically lower ones chance of getting lung cancer.

      Just some thoughts for you.




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  7. Fascinating video, as always. I’m wondering if there are studies done on Japanese populations re salt and autoimmune disorders, given their traditional high sodium intake? Also, I’m curious what constitutes a “low sodium” diet in these studies. Is it the 500mg that Joe Caner notes from the National Heart Lung and Blood Association?




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    1. Hi, Carol. I am not sure where you are getting your information regarding high sodium intakes in traditional Japanese diets. I believe that typical Western diets are higher in sodium than traditional Japanese diets. Much of the sodium in a traditional Japanese diet comes from miso. You can find out more about that here:
      https://nutritionfacts.org/video/is-miso-healthy/
      The low sodium levels in at least one of the studies was 5-6 g/d, as compared to a more typical 12 g/d. I hope that helps!




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    1. The magical thing is that it will taste flat for only two or three weeks. If you can tough it out for that long, you’ll find that you will again be able to taste all the flavour in the food; it will all taste fine again. And then if you do happen to eat something salted, it will taste awful. But for this to work, you really do have to go cold turkey and suffer through those two or three weeks. Try lemon juice instead of salt (that’s a flavour enhancer that works and is good for you), and use spices and herbs (also very good for you). Guarateed—the flatness doesn’t last.




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    2. Saltless and low salt are not the same. (Of course every study defines it’s terms.)

      The Western diet and the majority of processed foods are hyper-salted.

      A little on top can be quite enough.




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  8. Great to see a video on autoimmune illnesses. Doctor Greger, please post more info regarding autoimmune diseases.
    As except recommendations according to functional medicine(which recommend healthy meat, no nightshades, no legumes, no soy, no grains, and even no nuts which drives me to a wall because i do not know what can i even eat anymore), there is little info on healing foods or diet that we can follow to help.




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    1. Hi Juliet. As a former and present sufferer from auto immune diseases I can indicate a bit that is important. First Wade Patterson gave an excellent lineup of credible sources to look at so go there first.

      My own experience began with plaque psoriasis about 5 decades ago. Then at age 21 I developed T1 diabetes. Then in my late 50s I developed psoriatic arthritis. “Functional medicine” talk about the negatives of harsh drugs to suppress the auto immune reaction. After that I tend to part ways with them completely.

      The list you gave of foods to avoid is very instructive. Indeed, some of those can be an issue for individual persons with a particular allergy. But the blanket removal from the diet of overwhelmingly healthy foods when you do not know the particular allergy is more than a bit unnecessary. e.g. peanuts are very healthy unless they put you into anaphylactic shock. Then by all means avoid them and eat other legumes. They are way to healthy to give up. Amy Myers claims to have found the answer with avoiding the list of foods you gave. I will grant that she may have found a solution to a particular auto immune disease by eliminating a particular allergen in that large group of otherwise healthy foods she mentions.

      The fact is that wheat can be an issue for some people but that is not the issue for most people and certainly not all grains. To put that in perspective. I have a mild wheat sensitivity which was implicated in my arthritis. However only about 15 % of all people with psoriatic arthritis have such a sensitivity. But to put that into context, in one clinical study of auto immune sufferers put on a whole food plant based diet with no animal products, 50% had complete remission. 90% of the rest showed significant improvement.

      In my own case, eliminating gluten from my diet did give me remission from my arthritis. But any contamination caused an outbreak with great pain. Then as I read more and more about the pro inflammatory factors in dead animal, I decided to eliminate those as potential culprits. The outcome is that it turns out that I now have no problem with gluten, and even the plaque psoriasis is slowly but surely improving. I have been more than 5 years without arthritis so I no longer say that I am in remission. I am cured.

      Again, the links that Wade provided are outstanding and will help you tremendously. I just wanted to put it into an overall perspective that the more we attack our bodies with pro inflammatory factors the more we will suffer. The individual elements of that suffering will of course vary from individual to individual.

      The best of luck to you.




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  9. Fascinating article. Thank you once again. And from the special effects perspective, I have been a fan of the old style. They have had too much movement that distracted and made reading harder. But this one was much better. It was not distracting. I think I even like it better than the old style presentations.




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  10. Are excitotoxins in processed salt the culprit, and not the salt itself? I’ve had personal experiences with highly processed salt spiking my blood pressure and unprocessed salt having no ill effect whatsoever. Salt is salt is salt? Not true. Try it for yourselves and see. And Dr. Gregor – it seems this video makes my point. To me, everything points to the chemicals causing the problems, NOT the salt. Give (pure / unprocessed) salt a break. We’ve been eating it forever. How is it possible to believe so many of our bodies just all of a sudden mutated into a state of salt sensitivity? Doesn’t it make more sense that the salt has mutated by having the presence of chemicals (such as anti-caking agents) in it now?




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  11. I found the presentation tolerable, albeit a bit too busy I expect for older, less_graphics_obsessed people.

    Also, this sort of information on NaCl seems much more applicable to myself than the old standard anti-salt routine.

    But then my consumption is relatively low as 85% of my foods are scratch-made by me.




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  12. It is said that our immune systems are attacking and hopefully defeating cancer cells all the time.If so,wouldn`t it be a good thing to keep up a generous salt intake to help fight cancer.And I recollect reading somewhere (dont remember where) that people with asthma (i.e. hyped up immune system)get less cancer. Comment ?




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  13. The text animations look georgeous and the video quality is generally amazing.
    However I would suggest not using the “page turning”-effect. I think it would look better and even more professional with a fast cut.
    I love your videos and however they are visually presented, I sincerely thank you for the valuable information. :)




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  14. Is this ONLY true of refined processed salt, or does this include Himalayan and Celtic unprocessed salts with microminerals?




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    1. NaCl is NaCl and contaminants and or “extras” or “organic_ness” have nothing to do with most issues regarding NaCl and human nutrition.

      They are only selling points for those who have fancy salt to sell.




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  15. The graphics are beautiful but this graphics designer has eliminated the journal reference at the top left of the page. It is much more convenient for me to be able to see the reference immediately as you speak.

    Great new findings – thanks for keeping us informed as the research unfolds.




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  16. Fascinating video on the autoimmune-salt connection, giving us yet another reason to ditch the salt shaker (if we haven’t already). And this video is so beautifully presented! It looks as if you’ve struck a good balance on movement in the videos. I love the gentle flow & rhythm.




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  17. Wow, there may be a connection here for me. I have had new and chronic bouts with “random swelling” (urticaria / angioedema) (tongue, hands, feet) for several months now (starting Oct-30-2016). One episode put me in the ER with swelling throat. My lifestyle and diet leading up to this was a high salt intake and working out at the gym more than I have ever before in my life, six days a week for several months. I went through the whole allergic doctor workup, blood tests, skin scratch tests, etc., etc., etc. only to find out that I am not allergic to any foods. But I have had sinus allergies all my life. Thank you Dr. Greger for this information!!




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  18. What about long sustained exercise in the heat where you sweat a lot? It is true that I would require more salt and not enough salt could effect heart function? My shirt is frequently sweat soaked?




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    1. You only lose excess salts when sweating. Your body knows how important sodium and potassium are and it recycles them when they are running low. If it releases them in sweat, then you have excesses. Sodium and potassium must be kept in balance or our circuitry fails. The brain knows this. Physical Education of the 1950’s did not.




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  19. Unlike other posters, I did not like todays video graphics at all. Opening to a shot of mid-page of a journal makes NO sense to me at all. The “page splitting ” (not sure what its called) apart to separate the quote was a major distraction , and annoyance, for me; way over-done. Videos of recent years had it right !

    The topic is terrific though, and I thank the NF team for working so hard to bring us up to date info on matters important to us all.




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    1. Susan: I agree with you regarding the graphics. This video format was as distracting as any of the new ones. Really hard to focus on the message with all the unnecessary movement.

      We also need to be able to see which journal the quotes and graphs come from at all times while that study is being discussed. It is extremely rare that someone would know that we would want to look up a particular study the second Dr. Greger starts talking about it. So, by the time we realize we want to look at the source, we have go backward in the video. It is a real pain to have to back in time and try to find those few seconds where the study information is displayed.

      I said it before, but I’ll say it is again: It is vital that these videos focus on function over aesthetics.




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      1. Though I found these graphics less annoying than some others, I think your observation is important in judging the worth of visuals. Do they interfere with patterns of thought or of research, while looking pretty, much like kinds of salt? So far, consensus seems to favor older ways, though it would be nice to separate longer-term from newer viewers; or older from younger, assuming a cultural change in viewing preferences.




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  20. Of all the recent styles of presentation that you’ve been sampling, this one was the best for me. I really liked it.
    The content was great too of course!
    Very timely for a family diagnosis that I needed additional info to convey the importance of salt reduction.




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  21. Isn’t it funny when evidence shows a link to something that is added to our diet that people start trying hard to find reasons to keep on adding. If you look at the animal kingdom whether they be herbivores, omnivores or carnivores none of them add anything to their foods as we humans do. Therefore as these animals in the wild seem to avoid the chronic diseases their companion animal and farmed animals suffer from as well as humans we can make an educated guess that adding anything to natural diet will have some effect and that predominately it is a negative result. The only reasons reports recommend adding ingredients for health comes from the sponsors of the report and the link to the industry behind the report can be very hard to find.
    I have recently cut out all added salt in my cooking and don’t add at the table and now notice how much is added to foods when I eat out, so hard to find no added salt foods at a restaurant. Salt, sugar and fat is addictive I know as my favourite snack was salted potato chips and boy do I miss them.




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    1. Your reference to animals in the wild reminded me that Wild Elk, Deer, congregate to a natural salt lick. But as much as some like to compare us to animals, we are in fact quite different.

      For instance, red-meated animals have a molecule in them that we humans do not have. When we eat red meat we build up anti-bodies against that foreign molecule and that causes inflammation. Predators are not affected when they eat another red meat animal since they also have that same molecule… and if they eat prey (fowl for instance) that doesn’t have the molecule, there is no reaction either.




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  22. While this is not related to sodium intake,
    I don’t see a place on your website to ask you nutritional questions in general, so here goes. I’ve never seen any information on your website about low thyroid function, with which I have been recently diagnosed and that I since have learned is quite common for women in their fifties and beyond. Even though I am symptom-free, my doctor has now prescribed a low dose Synthroid – 25 mcg of Levothyroxine Sodium, daily. This is my first prescription drug in 32 years, and only the second in my life, as I have been very healthy my whole life. I would much rather treat my low thyroid nutritionally. I am 58 years old, totally vegan for about a year, 5’8″ and 123 lbs. and have taken zinc and selenium, along with a large number of supplements for many years and have now added
    a few iodine drops to my daily supplements. What’s your advice on how to treat the low functioning thyroid with food rather than with the thyroid medication? Please publish or record something on low thyroid as I have seen next to nothing in your books or website on this even though it is a very common problem, especially for older women. Thanks, Dr. Greger! I LOVE your books and website – my husband and I have changed our diets considerably because of you and your research team’s diligent work! Keep up the fantastic work! It is indeed life-changing!




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    1. Hi Marlene
      Have you been having symptoms like fatigue, dry skin, etc? Or you just tested low? Also are you still taking all those supplements? You mentioned you read How Not To Die. I believe it is recommended to take B 12 for sure. Maybe Vit D depending on how much you go outside and maybe algae?




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  23. Can you suggest how much we should limit our salt? how many milligrams? and would you suggest different numbers for folks already dealing with autoimmune or inflammatory diseases?




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  24. The more time passes, more science confirms the old natural hygiene(Herbet Shelton, Arnold Ehret and more)diet recommandations, thats fascinating~




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  25. Dana,

    The number seem to be indicating ~ 1 tsp/day total or less…. however this can be very deceptive as what salt are we discussing ? The differences between the granulation can make a difference. http://www.answers.com/Q/How_much_sodium_in_one_teaspoon_salt and have you looked at all your intakes ?

    Is there an ideal amount….. probably less is more beneficial within reason. By that I mean are you sweating significantly be that with exercise or ….. so there is no ideal number not unlike most medicine, it’s personal. The majority of my patients never realize the overt amounts of salt present in their processed foods and eating out coupled with the salt shaker….vs the herb shaker should be a consideration. Make a transition from your salting of foods to many more herbal products is a good way to change the sodium intake. And yes you can consider the “no-salt” idea as a transition as it substitutes potassium for the sodium…..

    Dr. Alan Kadish moderator for Dr. Greger




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  26. Marlene,

    A couple of comments on thyroid….. first make certain that you have all the details regarding your thyroid tests. This means at the minimum: TSH/FT3/FT4/RT4/TA/TPO. This is a basic evaluation panel to get adequate intake to make certain that some disorders are not present and to properly monitor your use of supplemental thyroid, etc. I would be curious if you’re getting adequate conversion of the synthroid to T3, the most active form of thyroid. Don’t under any circumstances use the TSH as your sole indication of thyroid issues……(see more below)

    A word of caution, your intake of iodine daily many not be a good move. It can suppress the thyroid function. Some intake via the diet is totally in order however. One of the best sites and with easy to understand info can be found at:http://sick2death.com/facts-about-thyroid-disease/

    You may find it interesting and helpful to some easy testing on yourself…..using the basal body temperature checking. (see above site) and also have a conversation, when you review your labs about using whole thyroid vs the synthroid…. if you’re indeed low in FT3 and or showing signs of hypothyroidism from an autoimmune disorder called Hashimoto’s. And don’t forget to review your sodium intake if that’s indeed the case.

    Dr. Alan Kadish moderator for Dr. Greger




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    1. Dr Kadish I very much appreciate your comment and the link. I do have an additional question. My wife had most of her thyroid removed about 20 years ago and for the most part is functioning well. At 67 she teaches 8-10 aerobic fitness classes per week and does at least two 5 mile runs per week to make sure she gets enough exercise. She is taking levothyroxine to make up for the thyroid deficiency.

      Now except for a about 1/2 cup of skim milk two times per week she is completely vegan with mostly whole plant food. She consumes only small amounts of plant sourced saturated fats but she continues to have elevated total cholesterol. Her HDL is pretty good at, I believe, about 75 and her triglycerides are about 60 but the total cholesterol is still above 230. Is it possible that this is thyroid related? Any suggestions would be appreciated.




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  27. What about people with low blood pressure? I used to get headaches, was tired often and out of energy. Since I eat more salt I don’t have these problems anymore. Is there another way to keep your blood pressure normal?




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  28. Thought bubble. So salt raises blood pressure. What about acids? Blood pressure is affected by arterial function but what about the kidneys? Salt and acid are used in cooking all the time and they might be straining the kidneys. I’d like to see research on acid load from diet and its effect on the kidneys. What about diuretics and blood pressure? What about water intake?




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  29. Dear Dr Michael Greger,

    My family member has Trigeminal Neuralgia & Atypical Trigeminal Neuralgia Symptoms, He is 58 years old & currently in hospital with quite a lot pain in face & jaw, he is also on morphine.

    Is there anything he can take to solve this problem.

    Kind regards
    Faisal Kashmiri

    M. +44 7802627252
    E. fmk@stratasports.co.uk




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  30. Question – I’ve been consuming a Whole Foods plant based diet for about a week now and noticed my salt intake is basically zero! Everything I consume pretty much lists 0mg sodium. Is this something to worry about? I’ve been striving for the “daily dozen,” but it basically gets me zero sodium as far as I can see. I also enjoy regular exercise. Am I going too low?




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  31. Is there an ideal amount….. probably less is more beneficial within reason. By that I mean are you sweating significantly be that with exercise or ….. so there is no ideal number not unlike most medicine, it’s personal. The majority of my patients never realize the overt amounts of salt present in their processed foods and eating out coupled with the salt shaker….vs the herb shaker should be a consideration. Make a transition from your salting of foods to many more herbal products is a good way to change the sodium intake. And yes you can consider the “no-salt” idea as a transition as it substitutes potassium for the sodium…..

    Dr. Alan Kadish moderator for Dr. Greger




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  32. I just watched What the Health featuring Dr. Greger: thank you!

    His statement about a plant-based diet for Crohn’s stuck a chord. My son was vegan from age 19-22, when he was diagnosed with celiac disease (which his sister also has).
    Switched to vegetarian for more diet options, until age 33
    At 33 he was diagnosed this year with Crohn’s and Primary Schlerosing Colangitis.

    In trying to find food to reduce symptoms, he’s been on an elimination diet for about 4 mo, starting w bone broth. Eats very few, very plain items, like plain meat, fish, some nuts, eggs, carrots, olive oil. That’s about it. Little success so far in terms of reduced symptoms like fatigue, diarrhea, pain.

    He lives in San Francisco, where UCSF will be a great center for eventual liver need. But amazingly, nutrition and dietician help is not forthcoming.

    Suggestions?

    concerned mom




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  33. Hi Karen and thanks for your question. I am glad that you have discovered the wealth of evidence-based nutritional information available here at nutritionfacts.org as it can be very difficult to obtain this information from doctors and health systems. It seems as though your son has been on an elimination diet for quite some time so hopefully he has been able to identify some potential triggers in order to permanently remove these foods from his diet. Again, a whole food plant based diet can be very beneficial in many autoimmune processes and this video highlights the power of even a semi-vegetarian diet on relapse of Crohn’s symptoms: https://nutritionfacts.org/video/achieving-remission-of-crohns-disease/. Many times however, the diets of patient with Crohn’s needs to be customized based on the response to certain foods and they way in which they are consumed – namely, raw vs cooked vs blended. Dr. Fuhrman is another great resource for evidence based nutritional treatments and you may find this link helpful: https://www.drfuhrman.com/learn/health-concerns/62/crohns-disease. I hope this helps and that your son can achieve a lasting relapse from his symptoms.




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