Sodium Skeptics Try to Shake Up the Salt Debate

Sodium Skeptics Try to Shake Up the Salt Debate
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What about the studies that show a “u-shaped curve,” where too much sodium is bad, but too little may be bad too?

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High blood pressure is not the only harmful effect of too much salt—it’s also been tied to stomach cancer, kidney stones, bone loss, obesity even, and direct damage to our kidneys, arteries, and heart. But as I reviewed before, there is a consensus that dietary sodium plays a significant role in raising people’s blood pressure, a dispute that has now finally been resolved.

So, there’s this unequivocal evidence that increased sodium intake is associated with increased blood pressure, and we know that increased blood pressure leads to increased risk of vascular diseases like strokes, aneurisms, and atherosclerosis.  So, to quote the long time editor-in-chief of the American Journal of Cardiology, “We all must decrease our salt intake!”; as other authorities have echoed. So, how is the food industry going to keep the salt controversy alive? If salt leads to high blood pressure and high blood pressure to disease—if A to B, and B to C, then A to C—the logic seems sound. Blood pressure is one of the best validated surrogate markers for cardiovascular disease, and when countries have tried cutting down on salt, it seems to have worked.

 Campaigns in England were able to successfully bring down salt consumption. Blood pressures dropped, and so did rates of heart disease and stroke. Now, they also successfully brought down cholesterol levels and smoking, and improved fruit and vegetable consumption, but in Japan they dropped salt intake while eating a worse diet and smoking more, and still saw a large reduction in stroke mortality. Based on what they were able to achieve in Finland, one daily teaspoon of salt may mean between 25 to 50% more deaths from heart attacks and strokes.

 But are there randomized controlled trials to show that? They’ve never randomized people into two groups, one low-sodium, one not and followed them out for 20 years to see if the differences in blood pressure translated into the expected consequences. But for that matter, such a study has never been done on smoking either. Imagine randomizing a group of smokers to quit smoking or stay smoking for ten years to see who gets lung cancer.

First of all, it’s hard to get people to quit, just like it’s hard to keep people on a low-salt diet, and would it be ethical to force people to smoke for a decade knowing from the totality of evidence that it’s likely to hurt them? That’s like the Tuskegee experiment. We can’t let the perfect be the enemy of the good; we’re never going to get a decade-long randomized trial, but in 2007 we got this. There have been randomized trials of sodium reduction, but they haven’t lasted long enough to provide enough data on clinical outcomes. For example, the famous TOHP trials, which randomized thousands into at least 18 months of salt reduction. What if you followed up with them 10 to 15 years after the study was over figuring maybe some in the low-salt stuck with it, and indeed, cut sodium intake by 25 to 35%, and we may end up with 25% lower risk of heart attacks,  strokes, and other cardiovascular events.

 This was considered the final nail in the coffin for salt, addressing the one remaining objection to universal salt reduction, the first study to show not only a reduction in blood pressure, but a reduction in hard end points—morbidity and mortality—by reducing dietary sodium intake. Case closed, 2007.

But with billions of dollars at stake the case is never closed. One can just follow the press releases of the Salt Institute. For example, what about the Institute of Medicine report saying that sodium reduction may cause harm in certain patients with decompensated congestive heart failure? But an analysis of those studies has since been retracted out of concern that the data may have been falsified. But it’s certainly possible that those with serious heart failure, already severely salt depleted by high dose salt-wasting drugs, may not benefit from further sodium restriction. But for the great majority of the population, the message remains unchanged.

 What about the new study published in the American Journal of Hypertension that found the amount of salt we are eating is just fine, suggesting a kind of u-shaped curve where too much sodium is bad, but too little could be bad too?

Those biased less towards Big Salt and more towards Big Heart have noted that these studies have been widely misinterpreted, stirring unnecessary controversy and confusion. It basically comes down to three issues: measurement error, confounding, and reverse causality. All these data came from studies that were not designed to assess this relationship, and so, tended to use invalid sodium estimates, just because it’s hard to do the multiple 24-hr urine collections necessary to get a good measurement. And, in the U.S., many of those eating less salt are simply eating less food, maybe because they’re so sick. So, no wonder they’d have higher mortality rates. So, compiling these studies together is viewed as kind of like garbage in garbage out. But why would they do that—they claim to have no conflicts of interest? When confronted with evidence showing at least one of the co-authors received thousands of dollars from the Salt Institute,  they replied that well, “they didn’t get more than $5,000 from them in the last 12 months,” so, no conflict of interest. 

 If you instead look only at the trials in which they did the gold-standard 24-hour collections in healthy people to avoid the reverse causation and controlled for confounders, the curve instead looks like this: a continuous decrease of cardiovascular disease (CVD) events like heart attacks and strokes as sodium levels get lower and lower, a 17% increase in risk of CVD for every gram of sodium a day. And, this is for people without high blood pressure, for which we’d expect the benefit to be even greater. Unfortunately, the media has widely misreported the findings and a false sense of controversy has been broadcast, confusing the public. But it’s not just the media. When editorials are published on the subject in some of the most prestigious medical journals in the world, you don’t expect them to be written by those who got paid personal fees by Big Salt.  And before accepting money from the Salt Institute, she was accepting money from the Tobacco Institute, and was a frequent expert witness in defense of Philip Morris and other tobacco companies. So, if that’s who the New England Journal of Medicine chooses to editorialize about salt, you can see the extent of industry influence. The editor-in-chief of the American Journal of Hypertension himself worked for many years as a consultant to the Salt Institute.

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 JD Hancock via Flickr.

High blood pressure is not the only harmful effect of too much salt—it’s also been tied to stomach cancer, kidney stones, bone loss, obesity even, and direct damage to our kidneys, arteries, and heart. But as I reviewed before, there is a consensus that dietary sodium plays a significant role in raising people’s blood pressure, a dispute that has now finally been resolved.

So, there’s this unequivocal evidence that increased sodium intake is associated with increased blood pressure, and we know that increased blood pressure leads to increased risk of vascular diseases like strokes, aneurisms, and atherosclerosis.  So, to quote the long time editor-in-chief of the American Journal of Cardiology, “We all must decrease our salt intake!”; as other authorities have echoed. So, how is the food industry going to keep the salt controversy alive? If salt leads to high blood pressure and high blood pressure to disease—if A to B, and B to C, then A to C—the logic seems sound. Blood pressure is one of the best validated surrogate markers for cardiovascular disease, and when countries have tried cutting down on salt, it seems to have worked.

 Campaigns in England were able to successfully bring down salt consumption. Blood pressures dropped, and so did rates of heart disease and stroke. Now, they also successfully brought down cholesterol levels and smoking, and improved fruit and vegetable consumption, but in Japan they dropped salt intake while eating a worse diet and smoking more, and still saw a large reduction in stroke mortality. Based on what they were able to achieve in Finland, one daily teaspoon of salt may mean between 25 to 50% more deaths from heart attacks and strokes.

 But are there randomized controlled trials to show that? They’ve never randomized people into two groups, one low-sodium, one not and followed them out for 20 years to see if the differences in blood pressure translated into the expected consequences. But for that matter, such a study has never been done on smoking either. Imagine randomizing a group of smokers to quit smoking or stay smoking for ten years to see who gets lung cancer.

First of all, it’s hard to get people to quit, just like it’s hard to keep people on a low-salt diet, and would it be ethical to force people to smoke for a decade knowing from the totality of evidence that it’s likely to hurt them? That’s like the Tuskegee experiment. We can’t let the perfect be the enemy of the good; we’re never going to get a decade-long randomized trial, but in 2007 we got this. There have been randomized trials of sodium reduction, but they haven’t lasted long enough to provide enough data on clinical outcomes. For example, the famous TOHP trials, which randomized thousands into at least 18 months of salt reduction. What if you followed up with them 10 to 15 years after the study was over figuring maybe some in the low-salt stuck with it, and indeed, cut sodium intake by 25 to 35%, and we may end up with 25% lower risk of heart attacks,  strokes, and other cardiovascular events.

 This was considered the final nail in the coffin for salt, addressing the one remaining objection to universal salt reduction, the first study to show not only a reduction in blood pressure, but a reduction in hard end points—morbidity and mortality—by reducing dietary sodium intake. Case closed, 2007.

But with billions of dollars at stake the case is never closed. One can just follow the press releases of the Salt Institute. For example, what about the Institute of Medicine report saying that sodium reduction may cause harm in certain patients with decompensated congestive heart failure? But an analysis of those studies has since been retracted out of concern that the data may have been falsified. But it’s certainly possible that those with serious heart failure, already severely salt depleted by high dose salt-wasting drugs, may not benefit from further sodium restriction. But for the great majority of the population, the message remains unchanged.

 What about the new study published in the American Journal of Hypertension that found the amount of salt we are eating is just fine, suggesting a kind of u-shaped curve where too much sodium is bad, but too little could be bad too?

Those biased less towards Big Salt and more towards Big Heart have noted that these studies have been widely misinterpreted, stirring unnecessary controversy and confusion. It basically comes down to three issues: measurement error, confounding, and reverse causality. All these data came from studies that were not designed to assess this relationship, and so, tended to use invalid sodium estimates, just because it’s hard to do the multiple 24-hr urine collections necessary to get a good measurement. And, in the U.S., many of those eating less salt are simply eating less food, maybe because they’re so sick. So, no wonder they’d have higher mortality rates. So, compiling these studies together is viewed as kind of like garbage in garbage out. But why would they do that—they claim to have no conflicts of interest? When confronted with evidence showing at least one of the co-authors received thousands of dollars from the Salt Institute,  they replied that well, “they didn’t get more than $5,000 from them in the last 12 months,” so, no conflict of interest. 

 If you instead look only at the trials in which they did the gold-standard 24-hour collections in healthy people to avoid the reverse causation and controlled for confounders, the curve instead looks like this: a continuous decrease of cardiovascular disease (CVD) events like heart attacks and strokes as sodium levels get lower and lower, a 17% increase in risk of CVD for every gram of sodium a day. And, this is for people without high blood pressure, for which we’d expect the benefit to be even greater. Unfortunately, the media has widely misreported the findings and a false sense of controversy has been broadcast, confusing the public. But it’s not just the media. When editorials are published on the subject in some of the most prestigious medical journals in the world, you don’t expect them to be written by those who got paid personal fees by Big Salt.  And before accepting money from the Salt Institute, she was accepting money from the Tobacco Institute, and was a frequent expert witness in defense of Philip Morris and other tobacco companies. So, if that’s who the New England Journal of Medicine chooses to editorialize about salt, you can see the extent of industry influence. The editor-in-chief of the American Journal of Hypertension himself worked for many years as a consultant to the Salt Institute.

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 JD Hancock via Flickr.

Doctor's Note

This video is part of my extended deep-dive series on sodium, with lots more to come. Here are the ones I put up so far:

Salt restriction is also important for kidney stones, How to Treat Kidney Stones with Diet, but aren’t low-salt diets tasteless? Only for a little while. See Changing Our Taste Buds

For more on how industry influence can distort nutritional science, see:

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

244 responses to “Sodium Skeptics Try to Shake Up the Salt Debate

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  1. Mine doesn’t fluctuate. Absolute statements will always find exceptions. I won’t re-retell it all. I’m sure we’re all tired of my odd salty tale.

    But I’m all for the good of the general population, and sure they need big and clear rules to follow. To that end I’ll hush now.

    Of course the core of THIS (WFPB-oriented) group doesn’t need to be told to reduce anything.

    1. I also have constant low blood pressure regardless of diet..always loved salty food. I eat mostly vegan now but do not purposefully avoid salt. I guess I’m one of the lucky ones but often wonder if I would pass out from even lower bp if I really worked hard at a low sodium diet?

      1. Thankfully no. Not sure how it works but I’ve intentionally (and now just naturally) reduced my NaCl intake such that my sweat wouldn’t leave a salt ring on a black t-shirt after repeated sweat soakings. There was no problem with my BP.

        OTOH, let me take sinus medications like I had to when I was consuming dairy, and I would often get postural hypotension, without regard to salt intake. Postural hypotension is when one becomes light-headed (pre-faint) when he stands too quickly.

        Maybe there are more of us who have no hypertensive response than they have ever accurately measured.

        @alainaberger:disqus I do not think that NaCl intake variation has any affect on mine and your blood pressures. I do know that I’m very sensitive to blood loss. Giving blood is out of the question. I did once. Took too many days to recover and I spent too much time in the floor at the Red Cross…

        It’s fine by me if salt affects everyone else and not me and you. But I remain a bit confused as well. Maybe we’ll learn the facts that apply to us one day.

      2. My blood pressure drops without salt and I get fainting spells. I suspect I am a rarity and it may have something to do with hormones or adrenals as my potassium and magnesium levels are all over the place as well. I wish I had more scientific research to divulge but this has been an undiagnosed problem that I have only done self tinkering with. If you do try lowering your salt, stay near soft chairs for the day ;)

    2. No more than 1500 mg of salt is recommended per day. Is this added salt to food or the total including natural salts within food? So is this 1500 mg just what we add? Can someone have too little? What is your recommendation for longevity? Add no salt at all?

      1. Hi I’m a RN and Health Support Volunteer. This recommendation is total sodium intake. There is of course sodium in most foods. But you will find small amounts in whole, plant based foods and large amounts in processed foods.

        If you are eating a healthy diet, you should not have a problem with too low sodium. Our kidneys will typically retain the sodium in our body if our intake is low. You only need a small amount of sodium intake to prevent too low of sodium and you should get that just fine from a healthy diet.
        Generally the only times we recommend increasing your salt intake is when your blood pressure is too low- this is symptomatic low blood pressure, not just based on the numbers. We see this in patients who are prone to fainting after prolonged standing or get very dizzy when they first stand up. The only other time might be during endurance exercise, like a marathon runner who loses a lot of sodium in their sweat. They may need to replace it at the time with something like gatorade. Low sodium levels tend to cause severe symptoms such as confusion, vomiting, and muscle cramps
        https://www.mayoclinic.org/diseases-conditions/hyponatremia/symptoms-causes/syc-20373711

        We would recommend adding no salt or as little as possible to your food. Here is more information from American Heart Association
        https://sodiumbreakup.heart.org/how_much_sodium_should_i_eat

        Here are a few more videos of Dr. Greger’s you might like:
        https://nutritionfacts.org/video/salt-of-the-earth-sodium-and-plant-based-diets/

        Thanks for your great question.
        NurseKelly

    1. If anybody out there has any doubts of your statement above, they will be shocked at the extensive problems, and informed about how very pervasive this unethical behavior is, by reading T Colin Campbell’s book, Whole. He articulates and brings together the enormity of government and business involvement in creating our health problems today. He has seen it and been affected by it along with the rest of us, over a lifetime as a distinguished and honored nutrition researcher and he tells it like it is, as we all used to say in the ’70s.

        1. As the old saying goes, be careful what you wish for. Doesn’t corruption exist in any economic system, not just capitalism? Just look at the history of the last 100 years where socialist systems were tried and failed. They all seem to go bankrupt. Maybe what we need to do is revamp our system of ‘checks and balances’, and go back to true ‘free-market’ capitalism as opposed to the ‘crony’ capitalism we now have.

            1. But why have we become bankrupt? Could it be because we’ve recently adopted so many socialist policies.

              And looking at socialism (collective ownership) and capitalism (individual ownership), from a more direct perspective, let’s consider a simple example. I believe that the people who regularly visit this website, are people who are being responsible for their own health and trying to learn about nutrition to help themselves do so. Now suppose the people who visit this website were forced to pay the medical bills of the vast majority of Americans who eat the SAD diet, laugh at vegans, and don’t bother to educate themselves about nutrition. Would that sound fair? Socialism is just a broader form of this simple example.

              1. Capitalism with rules so that billions of animal/kids are not raised in concentration torture factories & butchered in total secrecy for Profit. Rules that prevent lawmakers from receiving bribe (lobbying funds) from big business & wall street. If you love capitalism, why not legalized child porn, child prostitution, rape, crack-cocaine, terrorism, etc….These will all be going on if it was not for some “anti-capitalism” rules.

          1. Historically, socialist systems were under attack from their very inception by capitalist states. Since the end of WWII the prime directive of the USA with regard to foreign policy was to force the Soviet Union into an arms race of such proportions that their economy would be bankrupted. This and the strategy of manipulating oil prices finally accomplished this goal. The USA is now lowering oil prices to damage the Russian economy. When the end goal is world domination, every last significant obstacle must be removed.

            1. In my recollection of the history, Karl Marx wrote the Communist Manifesto in the mid 1800’s. Then Vladimir Lenin imposed communist rule on the Russian people around the time of WWI. This was way before the ‘cold war’ started after WWII. It was only when the USSR started their efforts to forcefully implement World Communism, that the U.S. got involved to stop them. I don’t know where you’re getting your history and ideas from, but I lived through the cold war so I know what really happened. And if you like socialism so much, there is no one stopping you from moving to a socialist country. I’m sure Cuba or Venezuela would love to have you. And if the U.S. is so evil, why do we have an illegal immigration problem and long waiting lines to move here? Seems like a lot of people must like the U.S.

              1. The United States, along with Canada, Great Britain, France, and Japan invaded Russia at the end of World War I after the Soviet government had negotiated a peace treaty with Germany removing them from the war. America and its allies joined with the White Russians to fight the Red Army.

                An allied force under British command invaded Russia on August 3, 1918. They took control of the city of Archangel and drove the Red Army (Bolshevik troops) south. At the request of the British, the United States sent a regiment to join the campaign. This was the first attempt to crush the socialist state in its infancy and the intimidation in the form of nuclear blackmail continued till the SU fell.
                I am getting my history ideas from books, which I suggest you begin reading. Like most Americans your world view is narrow and parochial, as evidenced by your naïve comment concerning immigration. Can’t blame you personally, as you are a victim of the propaganda machine from cradle to grave.
                As far as who likes the US – most people of the world like the US people, but despise the US government, which is seen as the Bully of the planet, illegally invading sovereign nations to suit its interests, the most recent being Afghanistan and Iraq. It’s just the way capitalism works, war and threats of war are its primary driving forces when it acquires the means to do so.

            2. Regarding ‘the U.S. manipulating oil prices’, by doing some research, I think you’ll find that OPEC has been setting the price of oil since the 1960’s! And the U.S. is not a member of OPEC. In the last few years the U.S. has been trying gain oil independence by using ‘fracking’ technology. OPEC has now started over-producing oil to lower the price. Unfortunately, this now makes fracking non-cost-effective, so the U.S. must remain dependent on OPEC oil. This lower price also hurts both Russia and Brazil. Check it out:
              https://en.wikipedia.org/wiki/OPEC

              1. To think that the US has historically had no influence on oil prices is fanciful. To buy oil one must exclusively use US dollars, which has allowed the US significant economic and political power internationally. When this currency is threatened, steps at removal of the threat are initiated. One good example of this is why Saddam Hussein had to be eliminated- he planned to challenge the hegemony of the US dollar as the international currency for oil.

            1. They have negative interest rates. The U.S. Federal Reserve is paying people to not buy bonds. The U.S. Constitution reads to many people that a bond is 50 cents on the dollar. The Federal Reserve’s bizarre and outlandish spending is causing a bond to cost 99 cents on the dollar. They are reducing the interest rate to record lows causing extremely large rates of bankruptcy. A bond is 99 cents on the dollar and has a much latter date of maturity. The U.S. constitution, as proposed by James Madison, suggest 6 percent as a minimum interest rate. It’s in the Bill of Rights he proposed to the U.S. Congress, if you read the text in situ. The Federal Reserve has removed compound interest, cut simple interest, and eliminated any interest. It is in Deuteronomy that people cannot be charged for their interest, and yet, here, the Federal Reserve Bank is charging people for their interest. It is disasterous policy. They are buying bonds, at the cost of $7 trillion, instead of selling a single one. They should sell bonds, not buy them. The dollar index is $99. It should be $1. A dollar is worth $99 to the military and $1 to you. It should be the other way around. Is this backwards economy any sense at all? If you do it backwards, you could live to see a rich future. We must be paying down the debt from the cold war. The actual employment of the nation is perhaps less than 50 percent of the population. Very few people can find work. There is great demand. Anyone selling anything of quality could profit. This is a very imperfect market. I hope this backwards plan works well for the future. There is little else to believe in.

              1. They are democratic socialist countries, where if the corporations try to put poison in the food, the government won’t let them. Here, the government protects the corporation that is putting carcinogens in your food, then makes you pay top dollar for semi-organic food. There, they have another name for organic food. It’s called food. Here the government destroys anyone trying to create a better way to fight cancer, because it would threaten the profits of Big Pharma, which is why we have the most expensive and least effective health care of modern countries. We also pay way more for pharmaceuticals than anywhere else on Earth. There, health care and higher education are free. They like health care and education for the people. We like corporate care here. Sometimes I wish I was an American corporation instead of a human being. That’s what our system is designed to help

                1. As should be clear, Scandinavian countries have some socialist strategies such as high taxes and extensive welfare systems, yet these countries have relatively capitalistic markets. Scandinavian businesses are for the most part free from regulation, nationalization and protectionism. If those countries were truly socialist, you can be sure that the U.S. government would have subverted and/or engineered their overthrow a long time ago.

                  Scandinavian nations have some of the highest wealth inequality in Europe, according to Credit Suisse’s weighty Global Wealth Report 2014. The top 10% of wealth holders in three Nordic countries (Norway, Sweden and Denmark) hold between 65 and 69 per cent of those nations’ wealth. Hardly the earmark of socialism!

                  1. Norway ranks 5th out of 36 industrialized countries in terms of equality. They are one of the most equal. Also these countries do have regulations so companies can’t just pollute the land and poison the people and make the government pay for it. The idea on the high taxes is that you don’t let the rich have all the power, something we have yet to learn.
                    http://www.oecdbetterlifeindex.org/countries/norway/

    2. I would also add Big Government and Big Media. They seem to be working very closely together these days to the detriment of the average person!

  2. My guiding star regarding diet is how it makes me feel. When one listens to and becomes attuned to one’s body, one can get nearly immediately feedback as to how food is affecting one’s health.

    Abstaining from added salts gives me an immediate feeling of wellbeing, and eating foods with added salts give me a correspondingly quick feeling of dis-ease.

    1. ExactaMundo Joe… If I take in too much salt my heart starts to pound like a pile driver.. Happened last week… After a few mouthfuls of a “healthy” home made snack I could tell I was in trouble… Went to my “go to” of Niacin and magnesium for palpitations and all was well..

      Is there a gizmo that measures sodium in food??? a “salt-0-meter”? Like a thermometer but measures sodium content…

    2. > My guiding star regarding diet is how it makes me feel.

      If I were to stop drinking coffee, I would feel awful.

      I believe than a radical change to a person’s diet can make that person feel awful, even if the change was towards a healthier diet. At least, that can be the immediate effect.

      1. I have a lovely expresso machine. I use it most every day. When I do, I prepare a double shot espresso, and on exceptional days two. I don’t feel bad on those day when I drink coffee, nor on those days when I do not.

        If I were to ever get to the point where I felt that I had to have that cup of coffee, I would suspect that I was too dependent on it, and I would set it aside. YMMV

  3. What’s the minimum salt intake the body needs? And is there some kind of regression line that says dropping from 3000mg to say, 1500mg will result in a range of S/D BP ranges? And how fast does BP drop in a reduction to sodium restriction? Thx.

    1. Will: I can’t remember off the top of my head how much sodium a person needs. But I think it is important to include the term *sodium* somewhere when talking about RDAs, because when people only talk about salt, the talk seems to me to ignore that plant foods naturally have sodium in them and the human need is for sodium not table salt. In other words, salt has (at lot of) sodium in it. But plants have some sodium too.

      So, the key questions in my opinion are: do we need *any* added salt at all in the context a truly healthy diet (ie, whole plant foods)? And even if added sodium is not needed, is there a small amount of salt that people could eat for enjoyment which is at least not harmful to health?

      The gist I have gotten from all of Dr. Greger’s videos on salt is that we don’t need any added salt in the context of a healthy person on a healthy diet. And that any amount of added salt, even for healthy people, progressively adds to health risks (though maybe lower risks for healthy people who only use a little?). However, I’m not sure if either of these statements are true. And I know that other posters have claimed to experience health problems without some added salt to their diet. (Ie, some people say that their plant food diet alone was not sufficient sodium intake.) So, I’m not clear on this issue. I’m just sharing my perspective.

    2. There’s a 56-page publication from the World Health Organization available online named Sodium Intake for Adults and Children and it says, “Although the minimum intake level necessary for proper bodily function is not well defined, it is estimated to be as little as 200–500 mg/day.”

  4. The problem with salt reduction is the reduction of iodine, which I believe has caused thyroid issues with a couple people I know.
    One needs to suggest iodine supplementation if you are to suggest less salt, especially to a vegan who eats no fish.

    1. When I went whole food, plant-based (WFPB), I made a point of including a good serving of seaweed (either kelp or wakame) once a day. For a while I went completely without adding any salt to meals. But then I got worried that I was consuming too little sodium when I sat down and tried to figure out how much total sodium I was consuming per day – turned out to be 200-400 mg/day, mostly from the seaweed. I’ve since added either a pinch of sea salt or a splash of soy sauce each day to get my sodium intake closer to 1 g/day.

      Problem is, as others have pointed out, there’s no real guideline for an ‘ideal’ intake level. Here in Canada, there are a couple of Health Canada docs that suggest an RDI. One suggests 2400 mg/day, the other suggests between 1200 and 1500 mg/day based on age.

      I imagine the requirement may be influenced by diet as well. Do those consuming a purely WFPB diet require more sodium to balance out the relatively higher intake of potassium, magnesium, etc, or less because of the relatively higher carbohydrate intake which naturally causes greater water retention?

      Some more specific information other than “too much salt bad” would be helpful.

        1. Hi. I was wondering the same thing. Why do we want salt? Is it the body telling us something or is it just a bad habit that the body has gotten used to?

          1. I think it is a bad habit that our body has gotten used to. I eat a lot of white potatoes and would put salt on them every time or i thought they were bland. I still eat a lot of potatoes and never put salt on them and after just a little time with no salt i got used to it and now i think the potatoes are better now than when i used salt. I really enjoy them. I also eat a lot of Sweet potatoes. Never did put salt on them and see no reason to start. They are a very good and tasty food.

        2. We crave it because we do need some. The same reasons we crave sugar, and fat.

          The problem is getting too much.

          I also think there is a problem with getting acclimated to certain level, then we need more to get the same “fix.”

        3. It is the first spice! Medicine, in saying salt and Iron are bad for you, seems to be the root cause of all sickness! Salt, Sunlight, and Iron are very good for you!

      1. Well said, poop patrol. Sodium is a necessary nutrient, but it must be balanced with potassium. People eating huge amounts of veggies at each meal (as I do) will have no problem if they are salting their food to taste, not eating salty processed foods and junk, and using naturally derived salt. Most of these studies are conducted on people eating the Standard American diet that is so devoid of veggies. and high in processed foods (full of salt) and refined carbohydrates.

        I put a lot of salt on my veggies but also put an equal amount of potassium chloride substitute because I am in a class of patients who continually pee to excess (won’t get into the biochemical reasons why yet again) and lose their electrolytes. My BP is usually 110/80 (or 75) but if I don’t add salt to my food, my BP will plummet into the shock range.

        1. I am very concerned about my blood pressure that has been over 200/90 for several days in a row. I eat a lot of vegetables, no animal products, no oil. I try not to eat excess sugar. But last night I had 3 hard candies (I won a jar at Christmas time :( yeah I know, no excuse but I did give some away) Today it was 202/96 an improvement over yesterday of 209/103. I don’t eat processed foods. I cook from scratch. I try to keep the salt down and use Himalayan pink salt sprinkled sparingly on after it is cooked. I don’t want to take blood pressure pills (I quit taking them 2 weeks ago because they weren’t doing that much good) but I also don’t want to have a stroke or heart attack. I only have one kidney and the doctor has not flagged any kidney problems but a doctor once replied to my question about taking potassium “If you want to die”. I should have queried her about that but didn’t. Anyone have any ideas? By the way, my cholesterol was high also. I have COPD, oxygen 24/7, and have 3 meds for that: Spririva, Symbicort and Proair HFA.

          1. Wilma: In the 1970s it was shown clinically that stress can cause high blood pressure. It’s known that a large amount of potassium within a short time could trigger a heart attack. Have you read the chapter on “How Not to Die” in Dr. Gregor’s book?

              1. Wilma: the book has an excellent discussion on high blood pressure, including some simple things one could do to lower it, like eating flax seeds and drinking hibiscus tea and beet juice (and other nitrate-containing foods.)

          2. Hello. You should try Selenium, Magnesium, and MSM for high blood pressure. Great job. Do you eat Brazil Nuts? Thank you for your reports.

          3. At 200/90 BP your risk for stroke/MI is massive.
            Forget the table salt (opt for Half&Half) and sugar until you go down to *at least* 140/80.
            I suspect you have some form of CVD with this level of BP which indicates a Cholesterol problem too.
            Your most natural interventions there are:FIBERS and beta-sitosterol i.e. avocadoes, glucomannan :)
            1g of Niacin (nicotinic acid) is also an idea but given your other medical conditions you may want to run this by your doctor to rule out any negative interactions with your medications.

        2. Hey, Linda. Glad to see I’m not the only one with this question. As mentioned, I added some salt back into my diet, but have no idea how much is ideal for someone on a WFPB diet who consumes a fair bit of greens (0.5-1.0 kg/day). I’m not sure if BP alone is a great indicator; mine fluctuates, mostly sysolic (ranges from 65/110 tp 70/130).

          To those eating unpeeled potatoes for iodine, please reconsider, especially if you consume them daily (as I do). Unlike most fruits and veggies where on balance one is better off eating the peel, that’s not the case with potatoe skins, which can have quite high concentrations of a natural neurotoxin.

          http://www.hc-sc.gc.ca/fn-an/pubs/securit/2010-glycoalkaloids-glycoalcaloides/index-eng.php

        1. I did not know they were high in Iodine. Good to here. I eat a lot of unpeeled white potatoes steamed in a small amount of water. Good food !!!

        1. If on WFPB diet, there are a lot of cruciferous vegetables that impede the iodine absorption. You may want to consider increasing the frequency of the kelp pill intake to avoid any potential goiter complications.

    2. Interesting if I remember correctly most of the added salt to processed food is the non-iodized sodium chloride. Also many people now use sea salt and the pink Himalayan salt which has very low levels of Iodine in the salt mixture and apparently not enough to maintain healthy thyroid function.
      I’m reposting a question to Dr. Greger and Joe Gonzalez, RD here for review:

      Should we take Iodine Supplements?
      “I’ve had a question regarding iodine for some time. As far as I know there are few options:

      – iodised salt
      – seaweeds
      – supplement

      I believe sodium-intake should be minimized, so that’s a no. I’ve also read about many pollutants in seaweeds these days. Is supplementing currently the best way to go?

      VinceGreen/Originally Posted in Introducing Joseph Gonzales, R.D.

      Answer:

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

      A majority of folks get their iodine from iodized salt. A 1/4 tsp of iodized salt gives about 45% of the Recommended Dietary Allowance (RDA) for iodine, however, it does have 590mg of sodium, making it not the best choice as the only source of iodine. Sea vegetables such as nori, dulse, and alaria are excellent sources of iodine and do not appear to be polluted. In fact, some research suggests sea vegetables may be beneficial for preventing breast cancer. It is also worthy to note that too MUCH iodine may be as bad as too little. Not a seaweed lover? Don’t enjoy (or cautious) of iodized salt? No problem, a supplement is just fine. You may also be interested to learn about the iodine content in beans! That’s right, Eden brand beans offers a healthy way to get iodine, adding kombu to their cans.

      Vegans, especially pregnant vegans, are at risk for iodine deficiency and should consider taking supplements or including iodine rich foods in their diets. Lastly, overconsumption of raw cruciferous vegetables may block the thyroid’s absorption of iodine. As a note of caution: always best to consult with your doctor about supplements right for you.

      See Dr. Greger’s optimal nutrition recommendations for more info.”
      Here’s the link to the original article which has all the video embeded links: http://nutritionfacts.org/questions/should-we-take-iodine-supplements/

  5. In all the tests / research that’s been done, has any consideration been given to the actual salt that was tested? Was it “pure” salt, untainted by anti-caking agents and other added ingredients? The reason I ask is that I wonder if it’s the salt or the other ingredients that trigger the high BP because I would guess very few, if any, food processing companies use pure salt, untainted by other ingredients. If that’s true, couldn’t the other ingredients be responsible for helping give salt a bad reputation? After all, haven’t we been eating salt for centuries? And long ago, wasn’t the salt more pure than it is now? And yes, too much of even a good thing like the untainted salt may give us problems, but isn’t it at least possible it’s the other stuff mixed in with the salt that’s causing the problems and not so much the salt? BTW – I’ve personally experienced spikes in my BP when consuming the salt mixed with other ingredients, but I don’t experience the spikes when consuming the “pure” salt – hence my interest in all this.

    1. Bill: re: “After all, haven’t we been eating salt for centuries?” This is not a meaningful question to me. Humans have been eating lots of things for lots of centuries and not all of it has been health promoting for us.

      While we have to be careful about the appeal to nature fallacy, my guide on the salt issue is to consider other herbivores of similar size to humans. Those animals are not shaking salt on their food. I can’t think of a reason why humans would be any different than those other animals. And I think it likely that adding a pure mineral like salt to our food in amounts significantly over what we would encounter in nature is likely to cause problems regardless of what else is included with the salt. Though I could see how some additives could cause even greater problems. Just my 2 cents.

      1. But “Many land-living herbivores experience ‘salt hunger’. Their diet of
        plants does not supply them with enough minerals (eg sodium), so they
        seek these out in any digestible form that they can find. In many places
        this leads to animals congregating around salt licks…”

        http://www.bornfree.org.uk/animals/african-elephants/projects/mt-elgon/elgon-elephants/

        This probably because their diets are so very high in potassium as well. Once again, it is probably the standard diet processed foods (which owe much of their taste to added salt and/or sugar) that is the culprit, and not our eating of natural salt per se. Adding some salt to a meal full of veggies high in potassium is not a problem for most people. As I stated above, sodium is a necessary nutrient but it MUST be balanced with potassium, and visa versa.

        Most of these studies are conducted on people eating the Standard American diet that is so devoid of veggies. and high in processed foods
        (full of salt) and refined carbohydrates.

        1. Linda N: re: “…Their diet of plants does not supply them with enough minerals (eg sodium),…” I wonder if that is an assumption or based on actual knowledge. If I saw animals licking a salt lick and I wasn’t a careful person, I might tell people that the animals needed the extra salt. But that by logic, by watching Americans I could conclude that Americans need fried foods and ice cream. Just because an animal does something, does not mean it is required or health promoting. The site you linked to does not provide any reference/backing for the statement. I’m not saying they are wrong. I’m just saying I am skeptical of the claim without some real evidence to back it up. (Cool pictures, though. I’m a *huge* elephant fan. Thanks.)

          1. Thea, it isn’t that difficult to google search for information that you consider valid on salt or mineral lick for animals.

            A mineral lick (also known as a salt lick) is a place where animals can go to lick essential mineral nutrients from a deposit of salts and other minerals. Mineral licks can be naturally occurring (natural licks) or artificial (such as blocks of salt that farmers place in pastures for livestock to lick). Natural licks are common, and they provide the biometals (sodium, calcium, iron, phosphorus, zinc, and trace elements) required in the springtime for bone, muscle and other growth in deer and other wildlife, such as moose, elephants, tapirs, cattle, woodchucks, domestic sheep, fox squirrels, mountain goats and porcupines. Such licks are especially important in ecosystems with poor general availability of nutrients. Harsh weather exposes salty mineral deposits that draw animals from miles away for a taste of needed nutrients. It is thought that certain fauna can detect calcium in salt licks.[1]
            Two examples.
            https://en.wikipedia.org/wiki/Mineral_lick
            http://www.thenaturalvet.net/mineral-wise-salt-poor_ep_52.html

      2. I’m just wondering aloud here: do pet foods have added salt? If they do, pet dogs and cats might be getting more salt than their wild counterparts. If that’s true, do pet cats and dogs develop high blood pressure. (Never had any pets other than fish so don’t have any personal experience with pets developing human diseases.)

        1. alan: Yes, pet foods (often/always?) have added salt. So do pet treats. It is my general understanding that pets *can* get too much salt. But I don’t know what ‘too much’ is nor if high blood pressure is a related consequence.

          In response to your question, I did a quick search. I’m not a huge fan of the WebMD site, but it is generally considered at least somewhat respectable. That website has a page of ‘foods not to feed your dog.’ This is what they had to say about giving dogs extra food with extra salt (like sharing your potato chips kind of thing–not necessarily trying to avoid kibble with salt in it): “It’s not a good idea to share salty foods like chips or pretzels with your dog. Eating too much salt can cause excessive thirst and urination and lead to sodium ion poisoning. Symptoms of too much salt include vomiting, diarrhea, depression, tremors, elevated body temperature, and seizures. It may even cause death.” from slide 15 on: http://pets.webmd.com/dogs/ss/slideshow-foods-your-dog-should-never-eat

          Yikes! But I think a single pretzel or chip is unlikely to hurt most dogs. (It’s never been a problem with my dog.) And unlike with humans, you can easily leave it to just one. So, I think we are back to asking, how much salt/salty food is too much?

          On the topic of pets developing human diseases, here’s a tidbit I find fascinating: It’s my understanding that cats do not develop atherosclerosis no matter how much animal foods cats eat. But herbivores, like bunnies, do develop atherosclerosis eating animal foods. That’s a big clue in my book about where humans tend to fall on the spectrum of herbivore to carnivore since our bodies react like bunnies to those foods. And this example shows that someone’s bunny can share heart disease with their owners when both are on an unhealthy diet.

          And because you mention fish, I just have to say that fish can be great. Fish can be trained to do tricks and have some fun personalities. So, yeah fish!

  6. After being on vacation for 2 months (retired age 80) I see how difficult it is to have less salt when eating at restaurants so much. Some restaurants do publish nutrition values but most do not. At places like Paneras, Chipoltes, who do have info on website, you can at least see it. Still not good to see a serving of black beans with 260 mg sodium and Brown Rice 195 mg. and fresh tomato salsa 500 mg. The real danger is eating away from your home.

    1. Here is a quote from a website promoting Celtic Sea Salt. You can google celtic sea salt and high blood pressure and get several hits that say the same thing. Is it true? i do not know. The Quote — Regulates heartbeat and blood pressure. Even though refined salt
      can cause high blood pressure, natural salt with adequate water intake
      can help to stabilize irregular heartbeats and normalize blood pressure.
      In other words, if you have low blood pressure, taking Celtic sea salt
      can help to raise it. If you have high blood pressure, it can help to
      lower it. They show 10 other benefits of Celtic sea salt at this link.
      http://www.waterbenefitshealth.com/celtic-sea-salt.html

  7. due to reading article such as yours quite all salt. after short while, found i wasn’t sweating, not urinating much, and was getting very weak. this was in wonderful fl. sunshine. went back to salt and am doing fine.

      1. Although I have not experienced hypnoatremia, this possibility concerns me too, since I drink a lot of water to help counteract gout attacks, which can be triggered by dehydration.

        1. Actually, mild hyponatremia is quite common, and may have been the cause of the weakness you experienced. It sounds like the case to me, given that your symptoms vanished when you resumed dietary salt.

          1. I am sure you meant to direct the comment about weakness to dennis above, but I had not been aware of the possibility of mild hypnoatremia. It’s something I will definitely have to keep in mind, given how much H20 I drink, especially in the summer when I am exercising outside. Thanks for bringing up that possibility.

    1. I eat a WFPB diet. I almost never add salt, but would often get some from bottled pasta sauce of something. Three times over the past several years I found myself with constant pain across my shoulder-blades and fatigue. Once I even noticed that a tear that happened to drop in my mouth when I yawned didn’t taste salty. Anyway, all three times I went to my doctor. All three times I was low on sodium and had to add a little salt to my food. Within hours the months-long pains started to ease. Each time took weeks to get back to normal and relieve the muscle pain. I still use very little salt, but if I’m not getting a small amount from some already prepared food, then I add just a small sprinkle as my total for the day. I too am one of those people that can’t rely on getting what I need from plants.
      Mark G

  8. Didn’t the Okinawan diet (centenarians) include salt? A low salt diet could be best, especially if doing sports. Na is the most abundant electrolyte in the body. Drinking too much water depletes it.

  9. I have followed low salt diet for many years. In the last few years I have increased hydration to two quarts of water per day, as well as another quart of chamomile tea to stimulate GABA receptors. Since drinking chamomile, I have not lost my car in the parking lot.
    Now my daily blood pressure readings are averaging 110/58, so I have begun to take some salt. BP is still under 120/70. I believe that some salt is needed to provide the chloride for HCl for proper digestion in the stomach. I also eat some raw celery every day. Daily soups are always home made from scratch without salt; no thank you, Campbell’s.
    Let us acknowledge that some salt is necessary for cellular ionic balance with potassium. Salt is not a “bad guy” like tobacco.

      1. The best study I’ve found on the lower range of BP and health outcomes is:

        Neaton JD & Wentworth D. 1992. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease overall findings and differences by age for 316099 white men. Archives of internal medicine,152(1), 56-64.

        Alas, its not open access. But here’s the age adjusted coronary heart disease death rate (per 10000 person years) for different blood pressures:

        systolic (mm Hg)
        91-100 9.6
        101-110 8.9
        111-120 10.5
        121-130 13.3

        diastolic (mm Hg)
        60-65 12.8
        66-70 10.4
        71-75 11.8
        76-80 13.6

        This suggest its perfectly healthy to lower blood pressure all the way down to around 101 / 66. Terry’s pre-salt 110 systolic was in this study’s sweet spot with the lowest risk. And perhaps 58 diastolic is too – the U-curve seen in the study may be reverse causation. Hopefully Terry consulted with doctors to exclude other possible reasons for low diastolic BP. Its not always salt.

        1. Darryl do you work out? A bit of a change in topic but kinda the same. Did you know about 60% of athletes are light headed when then stand up? It is a side affect of being so fit. Pardon me for not linking but I just got home from work and I am being lazy. My husband was having a huge problem–grabbing a chair or wall with positional changes. Once I told him it was because he was that fit it became a badge of honor. He is a cyclist.

          1. I could never get into running about or picking things up without an ulterior motive. So I walk the dogs briskly, bike to the grocer, and occasionally go out salsa dancing. Mostly I attribute my BP (which runs 112/70) to diet, and not so much low sodium (which is probably around 3000 mg), but high potassium from whole plants and no added sugars.

            1. Darryl: As you’ve said, if you eat a lot of whole plant food, you get a lot of potassium. As Dr. Greger suggests, if you don’t add salt to food, you get only a little sodium. These two actions make potassium to sodium ration (K/Na) very high. And then if you exercise, you lose sodium through sweat, making K/Na higher. And those who exercise a lot drink a lot of water, resulting in lose of sodium through urine, making K/Na even higher. Isn’t this asking for trouble? If that’s the case, can’t it be argued that salting food is bad only for those who eat a lot of junk food, don’t exercise, or don’t drink a lot of water? (This argument assumes that a bigger fraction of sodium is lost through sweat and urine than of potassium; I don’t have references to support the assumption.)

    1. Yeah, in my other posts I failed to mention that my blood pressure is consistently excellent and yet when I went off of salt entirely my blood pressure shot up to dangerous levels (210 over 140 when I was admitted to the ICU, but that was partly due to the fact that I was being escorted by a few cops along with paramedics.) We’re not all the same, and Greger’s peddling a one-size-fits-all approach to optimum health. I enjoy 3-4 grams of salt per day and my BP usually hangs out around 110/65. At the age of 60. Statistical significance has little to say to individuals who are unique and not composites of averages. I deplore the way medical research ignores this fact and treats people as if we were clones. “One man’s medicine is another man’s poison” — a very old saying that never seems to break through to the all-knowing medical establishment.

  10. I find this video a bit one sided. I admit the average Western diet has way too much salt. However, Salt is necessary for human life. Salt is one component that sends electrical signals throughout the body. Sodium also causes the body to become thirsty by activating electrolytes. The electrolytes make the body thirsty, forcing a person to consume more water. The water then allows
    the kidneys to distribute a healthy amount of electrolytes throughout the bloodstream, and this action regulates blood pressure. Sodium traps calcium and other nutrients in the bloodstream. Salt intake prevents heat-related complications, such as stroke and heat prostration.

    Sodium stops the muscles from cramping, and it invigorates the nerves. This is crucial for proper muscle contractions, and it benefits the adrenal glands.

    Salt assists the digestive system, including the absorption of nutrients. Sodium also assists the body in digesting and breaking down food. It is an important element that lines the stomach with digestive secretions and prevents the body from consuming itself. Salt helps the saliva glands by stimulating an enzyme known as salivary amylase, which allows the taste buds to get a sense of the food being consumed.A lack of sodium in the body can lead to such complications as dehydration,
    shock and heavy perspiration.

    Under such a one sided approach to the consumption of salt as displayed in this video I went on a very low salt diet and had painful leg cramp issues. By only increasing my salt intake was the propensity alleviated.

    No I don’t work for the salt industry.

    1. So…for some reason we aren’t getting enough sodium in a WFPB diet so we need to supplement? That just doesn’t seem logical to me.

    2. Every cell, plant or animal, contains sodium chloride. Thus a person who eats only plants will consume sodium, and for most people that amount will be sufficient. The Yanomamo diet was called a “no salt” diet, but actually it is a “no salt added” to the food diet.

  11. Dr. Greger’s take on salt is extremely irresponsible to me, as a survivor of nearly-fatal hyponatremia and an observer of innate preferences that are
    “hard-wired” in mammals via evolution. First, as to my own story, 5 years ago I spent a week in intensive care after becoming completely psychotic and delusional for no apparent reason. I had stopped adding salt to my WFPB diet for a couple months prior, and after a month on the no-salt diet I began to experience hallucinations, weakness, confusion, etc. By the time I was admitted to the ER, my sodium was so low that the admitting physician told my sister that I had “the lowest serum sodium I’ve ever seen in anyone who is still alive.” So, y’all beware, Greger’s an extremist about most of his views and only tells one side of any particular story. As with anyone who’s staking his career on his own opinions, he only reports evidence that supports his conclusions. I happen to agree with him most of the time, and I’m not disputing what’s presented in this video, but he is not telling the whole story and therefore his extremist conclusions are reckless to the point of malpractice.

    This leads to my other point, which is that salt and tobacco are not commensurable in the manner which is implied here. Sodium and chloride ions are vital to human health and we cannot live without them. The same is not true of tobacco. Yes, the industries themselves are comparable in terms of being supported by lobbyists and in their practice of purchasing favorable scientific research, but there is no amount of tobacco that is required for life, whereas salt is absolutely necessary. Most mammals enjoy salt, not as a result of “evil corporations and their evil marketing schemes,” but because of our healthy, evolutionarily-endowed craving for salt, a craving which has been exploited by those who profit from the sale of salt and salty foods. See the difference? Greger’s logic in trotting out the funding argument is like saying that we don’t need water because Nestle pays researchers to study the benefits of their bottled water. The fact that salt cravings are exploited for profit is not an indictment of NaCl any more than Nestle’s sales of bottled water infer the health-threatening consequences of ingesting H2O.

    To paint a picture of salt as an evil villain is as misguided as claiming that all fat is bad. We need fat, we need salt. Processed foods tend to have too much of both. Mix in a little nuance, Doc. Enough with the all-or-nothing videos, including the relentless message that anyone who eats the least bit of anything that has ever been part of an animal is going to suffer all manner of horrific maladies. That message plays well with vegan extremists but doesn’t match reality. I’d be vegan myself but I have to have a wee bit of meat a couple times a year so as to dissociate myself from the hysteria and histrionics of vegan activists. Oh, I kid the vegans… ;o)

      1. My current WFPB diet includes 3 to 4 grams of salt per day. During the time when my sodium crashed, I used no salt whatsoever, and ate no pre-salted foods. I was a little dingy at the time anyway because of my concussion, so I was eating like bowls of uncooked oats with berries and yogurt, handfuls of raw leafy greens, etc. To make matters worse, I was drinking a couple cups of coffee per day, and that’s a diuretic which depletes sodium. It seems that some people are getting the impression that I’m suggesting that everyone has the same salt needs that I do, but that’s not at all my point. I’m saying that there are plenty of people like me who are chronically hyponatremic and we don’t dare follow Greger’s extreme of zero added salt. It’s just bad marketing of his beliefs, so it rubs me the wrong way. If you want to persuade people, it’s not intelligent to come at them with such an unbalanced approach in which all animal food is deadly, all salt is deadly, etc. It’s one of the contemporary manifestations of Puritanical influences, in which we find ourselves to be sinners in need of purging evil from our holy temples, and so we turn to pristine diets and make a religion out of the way we eat.

        1. Lakota: What kind of salt do you use now? regular refined salt, sea salt, Kosher, Himalayan? I’m asking because my guess is that my daily consumption of salt is roughly the same as yours. (I use regular salt.) Thanks.

        2. Oh, now I understand. But, I don’t come away with the same take on Greger’s video. Maybe I’m biased but he was referring to prehypertensive people who consumed a standard American diet. If you look at the graph, 3 or 4 grams of total sodium may only have a modest impact on future CVD. It sounds like your diet was way more extreme than what Greger espouses in general – you must have a lot of self control to stick to such a stringent diet.

          As for Puritanical influences, I think one has to take the information here and decide for oneself what rewards are worth what risks. It may be true that eating animal products very occasionally will not impact health much, but I find it personally immoral to exploit animals and to cause them suffering and harm for my occasional pleasure – but that’s my choice. You’ll notice that Dr. Greger doesn’t weigh in on that subject at all.

          1. “referring to prehypertensive people who consumed a standard American diet”
            If that is what he is doing it should be very clear in the video and transcript. Somehow I missed that in the video and transcript. Or am I just to remember that that is all or most all that is ever talked about on this web site.

            “The reductionist paradigm that leads us to focus on parts of things separate from, and to the exclusion, of the whole.” Colin Campbell

            1. If you step back and look at the big picture, we are under a vast attack by the food industry, our own upbringing, our social pressures, self-serving contrarianism, and plain misguided thinking. Its so pervasive that we are completely oblivious to this. Dr. Greger is trying to poke holes in the conventional popular thinking about food so that we can remove the veil of denial from our eyes and think for ourselves. Its probably true that the real audience that he is targeting is not even reading the information on his site, those on the SAD, they are busy eating their bacon and eggs for breakfast. All I can do is lead by example to people around me – hopefully they will begin to question habits they’ve followed all their lives.

              1. I do understand all you say and more about the “big picture”. It is difficult sometimes to remember that the information on these videos/blog are for SAD eaters and not really aimed at WFPB. I get tired of this view. I left the SAD lifestyle years ago and need no more incentive to be WFPB. Trying to share this info with others doesn’t work well because they don’t like this format. I just need to change my expectations about what is presented here. Dr. Greger does do a good service if only the target audience would hear and apply.

      1. I have no idea how you made the wild leap from what I actually said to your conclusion that I am trying to foist my personal salt needs on the entire world. Settle down, Beavis! :P

    1. If dr Greger is incorrect then you are even more so.
      Simply put: your salt intake has to match your needs. In your case your needs were indeed very big. The same pertains to people who are on diuretics or drink a lot of water.
      So if you are trying to cut down on salt (because you want to normalize your blood pressure etc. in the simplest possible way, without drugs, and I can confirm that it works for my arrythmia) then you have to be careful. You have to remember. If you eat a lot of salt everyday then you don’t have to think about this issue at all.
      Evolutionary craving for salt doesn’t mean that we need salt. It only means that the supply and demand of salt (and sodium in general) were greatly imbalanced – the supply was quite scarce and the demand was always higher than the supply but still the body had to do with what it had.
      So basically this is why the claim that we don’t need additional salt can be quite well substantiated. But you need to be aware what your demand is.

      Statistically speaking not many of us have such a high demand because:
      – most of us do not live in a very hot climate
      – most of us do not have a need to drink a lot of water for reasons other than hot climate
      – most of us do not use diuretics

      1. You said:

        “Evolutionary craving for salt doesn’t mean that we need salt. It only
        means that the supply and demand of salt (and sodium in general) were
        greatly imbalanced – the supply was quite scarce and the demand was
        always higher than the supply but still the body had to do with what it
        had.”

        Really? Do you realize that there is rock salts and deposits pretty much anywhere, not to mention the coastline where you can get all the salt you ever wanted? It is false the “low supply” idea, and yes we do not only crave it, we have salt receptors in our tongue for a reason. Notice that we lack protein receptors in the tongue (omnivorous and carnivorous mammals have them), but we do have the ones for sweet (so we get the necessary fruits) idem the one for salt.

      2. Very well articulated, although I don’t see how your comments negate mine. My errors were more of the omission variety, in that I failed to provide adequate caveats pertaining to the specifics of my case. Even with my conscious intentional use of added salt, I still consume far less than a typical American who dines on fast food. I add about 3 or 4 grams of salt to food throughout the day, at most. Greger’s citations are studies that barely touch on the health effects of eating a small amount of salt vs. no salt — they focus most of their attention, and find most of their statistical validity, in the toxic sludge that is consumed on a daily basis by the average inhabitant of a modern industrial nation. I don’t eat pre-salted, packaged “food,” and I bet that the vast majority of Greger’s followers are similar to me in their eating habits, though most probably consume more salt than I do because I don’t eat out.

      1. Yes, although it’s a little-publicized factoid that hyponatremia is one of the most commonly diagnosed issues in hospitals, so it’s not particularly rare. But you’re right, I’m skewed to the hyponatremic extreme, as is one of my brothers. We’re chronically sodium-depleted, for reasons that no doctor has ever been ever to illuminate. Still, the problem with Greger’s approach is, again, that it’s so all-or-nothing. He’s addressing his comments to the standard American eater, and I can just about guarantee that there isn’t one such individual who watches his videos. You and I are more likely to err on the opposite side of the diet spectrum, going to extremes of what we believe to be good health, only to discover that we’ve somehow overlooked an important aspect of being a balanced, moderate eater who embraces the totality of what this beautiful biosphere has to offer.

    2. I agree with you, I find odd that Dr Greger postulates a “same doses fits all –which is pretty much none at all in his case– No added sodium in all situations” sodium recommendation; when different situations require different sodium intakes, otherwise you gamble with very serious conditions, and is easy to fall in electrolyte imbalance, if you don’t supply enough sodium and your requirements vary day by day, –depends on, local humidity levels, temperature, (high humidity levels and temperature, high sweating) whenever you has been loosing fluids, you better drink and get back sodium and potassium, no, is not enough with whatever happens to be naturally occurring in leafs.

      There were people commenting in this same forum, following the ill advise from Dr Fuhrman on this regard too, (another No Salt Ever) and ended up in the hospital under severe electrolyte imbalance, it is easy to enter in coma. In sodium, one size doesn’t fit all, even your daily requirements vary.

      The Dangers of Salt-Free Diets | John McDougall, M.D.

      https://www.youtube.com/watch?v=cT133MAEjzo

      The Starch Solution and Why Salt is a Scapegoat

      https://www.youtube.com/watch?v=yZ3hS9jpmm0

      A reminder to all, Dr. McDougall isn’t compromised by the salt industry, nor Dr Pam Popper.

    3. Lakota, I hardily agree with you. The folks that watch these blog videos are assumedly not nutritionists
      but rather people trying to stay healthy. I am a big fan of Doctor Greger and his website because it does offer
      some insights on the latest research. That said many of his videos are anything but balanced. If one watches all his videos on salt the laymen might conclude a salt free diet is healthy rather than potentially deadly.

      Highlighting that the Amazon tribe Yanomamos is highly healthy on an essentially no salt diet strongly suggest that these genetic abnormalities somehow apply to the general population is dangerous if not grossly misleading.

      As you state, suggesting salt is somehow synonymous to cigarettes is ridiculous.

      Salt is necessary for life. Cigarettes at any amount is unhealthy.

      It is unfortunate that Doctor Greger has taken a fanatics view of nutrition. Everything that he recommends or implies as fact based conclusions I am forced to research and often find the facts don’t support his suppositions.

      I really wonder how much harm he causes by those people that blindly follow his every video’s thrust.

      1. There is no such thing as a sodium free diet. Sodium occurs naturally in fruits, veggies and leafy greaens etc. you generally don’t have to ADD salt to your diet to be healthy.

  12. I was on a zero added salt diet for almost a year and never felt better. If you consume enough vegetable matter ( minimum of two pounds per day or more) you will get enough sodium. At least that’s how I understood it, and I was never healthier or felt better. That wasn’t only because of no added sodium however. I havent seen any evidence that isn’t anecdotal, that humans must have any added sodium in their diets to thrive.

    1. Please see my reply to Dennis (above). I eat a lot of vegetables daily. I eat a WFPB, low fat, organic. But if I rely only on natural foods for salt I end up each time in my doctor’s office with pain and weekness doing tests that confirm my sodium is too low. You’re lucky you don’t have to add any. As for me, I have to sprinkle some in my diet daily. The amount is tiny, but I have to have it.

      1. Do you eat a lot of leafy greens? They actually co takin quite a bit of sodium. Especially sea greens like seaweeds etc. you dont HAVE to add salt to get sodium, but I understand why you would want to.

        1. I typically eat daily a 10 oz bag of romaine lettuce, 2-4 oz of cooked baby kale, a few oz of radiccio, a cup or two of broccoli, and sometimes red cabbage. I’m not fond of eating sea weeds and vegetable, especially with all the contamination of heavy metals and now, radiation.

          I only add a few light shakes of salt to my morning oatmeal and that’s it for the day. I don’t see why so many people (not you) have lectured me about it. It’s a bit dogmatic given that we need salt.

          1. I feel ya. I hate getting lectured about anything. Lol. But no, that much salt would not effect you detrimentally from what I’ve seen. Sounds like your diet is great. Btw, I absolutely hate seaweed. Haha. I know people who eat that stuff out of the bag. Ugh. Kale is more my speed. Have you ever made baked kale chips? Yum.

            1. Well, if I don’t eat that much salt then within a month or two I’m low on sodium and experience horrible symptoms. After five times my doctor got a bit tired if testing me and said, I have 1200 patients. There are three of you like this for whom I prescribe a little salt daily. And you’re not the first to suggest eating sea plants. But in the end, what’s the difference if I get my salt from a shaker our guess how much I can get in since amount of food. It’s just not worth it.

              I prefer my kale steamed. I eat baby kale. I like the taste and texture best. And good thing too because in too lazy to bake it.

              1. I dont know how you a manage to eat a varied, healthy, whole food diet without doing a lot of prep and/or cooking. That’s one of the reasons I fell off the diet.

    2. The completely different experience of yours and mbglife ‘s with low sodium is evidence that one’s daily salt requirement is very personal. I reiterate Wilma’s question: why did you stop following a low-sodium diet?

      1. Because salt is addicting, at least the taste of it is. once I slipped and had some, I immediately started craving it and reverted. It’s not something I chose to do. I consider it a very large mistake. Of course, no added sodium wasnt the only point of my diet. It was also no sugar, no animal products or oils or anything processed. So yeah, it was a combo of factors that made me feel better. Plus, I ate tons of leafy greens everyday, which more than makes up for any lack of added sodium in the diet. If you truly eat a healthy diet, I’m convinced you won’t need added sodium.

  13. What about the effects of weather? Doesn’t sweat increase one’s need for a “little” more salt? Don’t steel workers get extra salt as their working conditions demand it? Doesn’t all food have an optimum amount for each individual in each condition? Seems to me to be pretty individualized. Learn the symptoms of your own body needs and do accordingly. Don’t follow fads. Just don’t eat processed food as they substitute flavor with salt and sugar.

    1. As best I can cipher, the body only releases salt in our sweat _when_ there is a surplus of salt in the system. I used to sweat salty, now I usually don’t. IE my sweat doesn’t burn my eyes or leave salt rings on dark clothing. This has only been the case for me off/on in the last dozen years or so. I tried a few different “avenues” before I converted to WFPB.

      1. When I was in the south working, I witnessed the local people there often eating salt straight. They sweat a lot more than we did, and seemed to be able to regulate themselves very well, they also ate a dominantly plant based diet, lots of rice and beans. It was interesting to see.

        I’ll agree that with much lower salt intakes my sweat is less salty than before as well.

      2. I use no salt and also no canned or processed foods (that might contain added sodium). When I’m out backpacking, sweating profusely for hours, I still get many salt streaks on my clothes.

        1. Maybe it’s potassium streaks? I used to have salty sweat, now I don’t. But then I did eat a lot of salt and now don’t. We’re all a bit different.

    1. My BP is pretty low (same levels all my life) and if I am not careful, gets way too low, I cannot take hibiscus for example, and of course, keep the salt.

  14. Those here who are accusing this video of being biased and inaccurate should take a closer look at what Dr. Greger is claiming. The association between CVD and sodium intake was for “prehypertensive” individuals. Look up that term please. It may very well be that if you have blood pressure levels of 110/65, i.e. not prehypertensive, that some added sodium may not be dangerous. People are so anxious to shoot the messenger that they concoct a straw man argument to shoot down. Also, if one takes extreme measures to eliminate all sodium from one’s diet and has negative impacts, that says nothing about those who eat a standard American diet which clearly contains excessive salt.
    These apples to oranges accusations are a waste of energy.

      1. Yes it varies between 200mg and 500mg per day. That is a fairly great range.

        But I guess that the average American gets *far* more than that in an average day.

    1. Good point, and I am perhaps the most guilty of violating your sage advice in this thread. But I’m under the impression that the video is generally stating that nobody should ever add salt to food, and that’s absurd to me. If he’s not saying that then he’s not making his point of view very clear. I think he spends too much time telling us things we already know, like constantly finding fault with meat in ways that provide absolutely no added value to our lives, given that most of us are WFPB eaters already. OK, see, I’m going off on a rant again, I need to re-read your comment and chill out! ;o)

      1. Lakota –
        I think what Greger was also stressing is that there is a deliberate attempt to hide the science from the public and to twist data. My girlfriend understands the risks and chooses to eat animal products anyway – but at least she is making an informed decision. That’s a good thing in my book.

      2. You appear to be reading things into this video that Greger has not said. And I suspect that Dr Greger quite sensibly wants to reach a much wider audience than just dedicated WFPB eaters which is why this and his other videos aren’t targeted at people like you (or me). Quite simply, the fact is that the great majority of people in westernised societies consume too much sodium. They and the media are the real target audience.

        I eat olives, wholemeal bread, and soy sauce plus canned mushrooms and beans from time to time Other folks here might eat miso, and pickled and fermented foods. All these will provide adequate salt/sodium for most people, especially when one considers that eg even oats and rice also contain small amounts of sodium. The World Health Organization states that;
        “Although the minimum intake level necessary for proper bodily function is not well defined, it is estimated to be as little as 200–500 mg/day (18, 27)”
        http://apps.who.int/iris/bitstream/10665/77985/1/9789241504836_eng.pdf?ua=1&ua=1

        There will be very few people eating diets that deliver less than 200 mg/day of sodium. Note also that the WHO guideline “does not provide recommendations for individuals with illnesses or taking drug therapy that may lead to hyponatraemia or acute build-up of body water, or require physician-supervised diets (e.g. patients with heart failure and those with type I diabetes).” Perhaps you think that Dr G should have spelled this out also?

  15. You could lick your palms right now. Are they so salty they make you gag? If so, you have a salt deficiency. It is very possible a Sodium deficiency is linked to Chronic Fatigue Syndrome. Medicine believes Salt and Potassium work in concert. This is true of Copper and Zinc, not of Potassium and Salt, which the body stores a set store of, in my opinion. I had always heard salt causes high blood pressure. I never ate salt to the extant that I developed an Iodine deficiency, pain and loud heart beat. I think high blood pressure is better treated by Magnesium, Sulfur, and Selenium. Sodium is not related to blood pressure in that way, in my opinion. I had just one teaspoon of salt and my heart beat vanished. I could no longer feel it in my chest. Salt and Salt with Iodine are spectacular in my opinion.

  16. Doesn’t it matter what *kind* of salt we’re talking about intaking?

    My ankles will swell if I eat “regular” table salt, but I get no such reaction eating Himalayan sea salt.

  17. I wonder if this salt issue is related to sodium only. What about the pink Himalayan salt which is a mix of electrolytes not just sodium.

  18. Dr Greger, please tackle also the subject of those who need to add some (not a lot) of salt to their diets if it is indeed the case. I didn’t add any at all for about a year and a half and had some issues. As soon as I started adding some salt in my diet (about an eighth of a teaspoon per day), my issues disappeared. I have no problem not eating salt at all, I just add it for health purposes.

  19. Is there a difference , health wise if one were to usesea salt or Himalayan salt? I thought that it was a totally different chemical than sodium chloride <table salt?

    1. Jacque: re: “I thought that it was a totally different chemical…” No, not a different chemical at all I believe. See:
      https://en.wikipedia.org/wiki/Sodium_chloride
      .
      Himalayan (or sea) salt is just slightly contaminated salt. Sea salt contains traces of various non sodium chloride substances, some of which are good for you and some of which are toxic. (But because the trace amounts are so small, are unlikely to have a health effect.) Darryl, a *great* and knowledgeable poster here on NutritionFacts, gave us a couple great posts, complete with a table, on this topic a couple years ago: http://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131297498 and dhttp://nutritionfacts.org/video/are-sugary-foods-addictive/#comment-1131500235 And another great poster on this site, Tom Goff, produced a link to a very helpful article talking about the hype around Himalayan salt. Just skip to the section, “What type of salt should we eat?”: https://www.sciencebasedmedicine.org/pass-the-salt-but-not-that-pink-himalayan-stuff/
      .
      Clearly special salts have great marketing. And for all I know, there may really be some kind of health difference between a ‘natural’ salt and one that has been purified of contaminants, but I have yet to see any compelling evidence to support such a claim.

      1. I read the above articles, thank you for sharing that info. There are many claims going around that pink salt and sea salt are better .. But after read those articles , I’m learning to dig deeper on claims such as those. Much appreciated. I will stick to my very low salt intake – it’s kept my heart healthy over the years.

    2. From what I’ve read, Himalayan salt is about 97% sodium chloride and the rest is other minerals, whereas regular table salt is about 98% sodium chloride and the rest is a desiccant, an anti-caking agent, and, if the salt is iodized, the source of iodine. So, for all practical purposes, both has the same amount of sodium in exactly the same form, namely the chloride. Implication: there’s no reason to switch to Himalayan salt in order to reduce salt consumption.

  20. There’s a practical problem for prospective studies of low salt diets: few practice them. In the cited study which attempts to demonstrate an always increasing relationship of salt intake to disease risk, out of 2275 participants, 1.4% (32) had intake in the AHA recommended range of < 1500 mg/d, while only 10% (236) had intake in the Dietary Guidelines for Americans < 2300 mg range.

    Small cohorts lead to wide 95% confidence intervals. Here the relative risk for those in the low sodium (< 2300 mg) range had a confidence interval from 0.34-1.37, ie we're 95% confident the true risk is between a 66% reduction and a 37% increase in risk. That interval is what's depicted by the lines above and below the average trend in the graph. That's for Model 3, which adjusts for changes the participants made during the follow-up period. If you look at their Model 1 (0.53-1.60) and Model 2 (0.48-1.58) confidence intervals, which attempt to account only for risk factors present at the beginning of followup, things are a bit more equivocal.

    1. As for Dr. Michael Alderman, perhaps we should hear his side of the issue:

      Science News Online reached supplement contributor Alderman by e-mail in Japan, where he was giving the presidential address “Salt, blood pressure, and cardiovascular disease” at the biennial scientific meeting of the International Society of Hypertension. “These peers would hardly have elected me president had they thought that my scientific work was not credible, and they certainly would not have invited me to present the keynote talk at this meeting attended by so many of the world’s leaders in blood pressure–related science,” he says.

      The basis of CSPI’s charges against him, Alderman says, is that more than a decade ago, “I published research findings that questioned the value of a low-sodium diet. The Salt Institute apparently saw this study and invited me to attend their consultant meeting. I did and believe I received an honorarium. Having been thereafter accused of being a shill for the Salt Institute, when asked to attend subsequent annual consultant meetings, I refused any compensation. Neither I, nor my collaborators, nor my family, have ever received any research support, speaking compensation, nor do we have any financial interest in anything related to salt or the food industry,” he says.

      “It bothers me,” he says, “that CSPI manages, somehow, to make my integrity the issue, rather than undertake a reasoned discussion of the scientific issues I and others have raised. Presumably, we all share a commitment to human health and well-being. It is certainly not helpful to discourage dissent based upon evidence publicly displayed in the medical literature—and open to refutation—because some group finds it inconvenient.”

  21. This is a very positive report that high blood pressure can be controlled. You have true relevance to this discussion. I like that you showed that Brazil Nuts can reduce high blood lipids. I actually think they relieve anxiety and lower blood pressure. It is important to release that the medical literature is slanted.

  22. The problem is, soils aren’t as rich in mineral salts apparently these days- so I feel I need a pinch of salt each day- pink Himalayan or Inkan- but is that fallacy? I don’t mean the tissue salts- I think those are important to finish the course… I always feel good after surfing – the salt water opens and cleans out the nasal cavities etc… And we need iodine in our intake for our thyroid function. Any advice?

  23. I’m vegan and I avoid processed foods and their added salt as much as possible, rinsing the salt off of canned beans, for example.

    Currently I use between 1/4 to 1/2 teaspoon of iodized salt a day for the iodine; I keep a jar of iodized salt on the dinner table with a 1/4 teaspoon in it in order to get an accurate dose of salt.

    I would like to rely more on sea veggies for iodine but I worry about the dosage.
    I haven’t been able to find dulse flakes in a shaker such as Dr Greger recommends for adding to your food, just the different dried sea veggies in bags.
    Is it possible to just sprinkle a little crushed wakame on my salad or soup and get enough iodine for maintaining a healthy level?
    Suggestions anyone?

    1. I started to use iodine-fortified salt when I went WFPB but then I studied and found that I eat enough iodine-containing foods to not need supplemental iodine. Potatoes, strawberries, etc. were on the list. It’s still in the shaker, but I rarely use it, preferring “seasoned” salts for most everything I use salt on.

    2. LK Skinner: If you have a food processor or some type of blenders, you can turn any of those hard, bagged sea veggies into granules that you can shake on anything you want. Dr. Greger recommends 2 sheets of nori a day as one option. Those sheets can also be blended up (you may have to toast or microwave them first to dry them out a bit) to make a powder if your preference is to shake rather than snack directly on them. :-) In his book, How Not To Die, I think I remember reading that Dr. Greger will make his own flavored nori sheets–thereby replicating the fun and tasty snacking option one can get from the stores, but skipping the oil and salt.
      .
      Dr. Greger says that kelp has too much iodine in it to safely take. But I don’t have regular sources of iodine. (I love the oil and salt laden kind of nori, but know those aren’t so good for me…) So, I sometimes take a pinch or two of kelp granules and put them in sauces or soups. I have no idea if I’m getting the dosage right or not. I could be getting too much or too little or both depending on the week. Thus, I’m not really recommending my approach. Just giving it as an idea. And so far, no iodine problems that I know of. So, so far so good???

      1. Hi Thea,
        Thanks for your response!
        I’ll try the idea of making sea veggie granules, the wakame I have is dry and crispy, probably very easy to blend or even crush to tiny bits with some layers of baking paper and a rolling pin.
        Hmmm, maybe I’ll mix in a little sesame seed for a seasoning to sprinkle on salads and soups.
        I remember Dr. Greger’s suggestion from his book, that also is worth trying, but I think I’ll skip the pickle juice :)

      2. We shake a small amount of Kelp granules into our smoothies. We use Maine Coast Sea Seasonings, and Kevin calculated from CO website that about 1/10th of a tsp. is about the right dose. We too, wonder about the dosage. We have nori now and then.

    1. There is certainly some evidence that, as far as cardiovascular health is concerned, the sodium potassium ratio may be more important than the total amount of sodium in the diet. And I think that this also applies to cancer.
      However, I’m not sure that this is true for all levels of intake or that simply increasing potassium intake is a licence for continued high sodium consumption. As one of the meta analyses (that found that the sodium potassium ratio is important) noted “The finding of a significant association between estimated usual intake of sodium and all-cause mortality adds weight to a direct sodium-mortality relationship.”
      http://archinte.jamanetwork.com/article.aspx?articleid=1106080#METHODS
      http://www.ncbi.nlm.nih.gov/pubmed/26039623
      http://ornishspectrum.com/zine/sodium-potassium-delicate-heart-healthy-balance/

    1. It is neither good or bad. One requires sodium to live, and one can get all of the sodium required from eating a varied diet of whole plant foods. If one eats anything that comes in a box, package or can on a daily basis, chances are they are getting too much sodium.

  24. It should also be noted that a high sodium intake can reduce T-reg cell function which could then increase the likelihood of autoimmune potential.

  25. Context is important.
    If these studies where bounded by the context in which they are applicable then they might actually be meaningful.
    However a study of New Yorkers who live a sedentary life with an unhealthy diet in a -10 to 20 degree low humidity environment is in no way comparable to people who live an active healthy life in a 20-40+ degree high humidity environment.
    Such advice puts these people’s health at risk; minor items such as muscle cramp and fatigue, major [life threatening] items such as heat stress and heat stroke.

    In answer to some other people’s questions;
    Yes, a basic intake and maintenance of sodium levels is essential for health and wellbeing, your body is not able to measure how much water it is carrying – your body determines whether you are thirsty or not by the concentration of the sodium in your blood. Thus [when this is explained – for somewhat obvious reasons] the intake and maintenance of an appropriate level of sodium for the environment in which you live is essential!

    The question should only be “What is an appropriate intake of sodium for the life you live in the environment in which you live” – anything else is bad advice.

    1. Alan, many thanks for your informative post. It’s a shame that Dr Greger has such a habit of putting out confusing, unnuanced and incomplete advice then leaving his viewers high and dry when they ask for further info in the comments.

    1. Giacomo: Here’s my perspective: Dr. Greger points out in his new book, How Not To Die, that *sodium* is considered the second-leading killer in the world. Me: So, while sodium may be an essential nutrient, we know that we can get some sodium from whole plants and we know that it is ridiculously easy to over-due sodium intake, usually from salt. So, for the vast majority of people in the world, caution when it comes to salt is in order.

      To round things out, consider that the Book How Not To Die has very few recipes in it. Yet one of those few (yummy!) recipes is for a dressing that has 2 tablespoons of miso in it. Miso is a high sodium food. Dr. Greger points out in other sections of the book that miso may not have all of the health problems associated with salt, but I think it is key that Dr. Greger balances out his concern over diets high in sodium with highlighting a recipe that has a lot of miso in it. I think Dr. Greger is showing that a truly healthy diet can have some foods in it with added sodium.

      In other words, in my opinion this means that you can have some salt in your diet and still be healthy. But the devil is in the details. Other than the bit of carefully controlled salt (or preferably miso?) what else is in your diet?

      What do you think?

      1. I am a fan of dr. Greger and NutritionFacts.org and I know that a whole food plant based diet is the best for our health. But salt is not a plant. I think that a moderate amount of salt is healthy like Dr. McDougall says. But if the optimum amount of salt is zero, what about the requirement of iodine especially for the populations that living away from the sea?

        1. Giacomo: Thank you for your reply. Interesting thought process. There’s one part I don’t understand though: “But if the optimum amount of salt is zero, what about the requirement of iodine especially for the populations that living away from the sea?” I don’t understand this question/point. Are you thinking that sea salt has sufficient iodine in it? Sea salt has only trace amounts of iodine.
          .
          But I don’t think that’s what you mean. Because populations that live away from the sea would not have access to the sea (though maybe they would have access to old sea salt deposits–though in that case, we are back to sea salt…). The typical table salt you buy from the grocery store has iodine added because people do not eat enough veggies. I read somewhere once that a medium potato has 40% of the RDA of iodine. I don’t know if that is true, but the general point about veggies is there. A lack of healthy plant foods was the original problem the government was trying to solve. What am I missing?

      2. I’m confused. The article to back up the claim that miso is not harmful cited in How Not to Die is Habitual salt intake and risk of gastric cancer: A meta-analysis of prospective studies. However, specifically what about miso counterbalances the bad effects of salt? Is it the soybeans or the fermentation or both? I mean, miso is much more challenging to cook with than simple salt. If I mash soybeans and salt together in the same proportion as miso then did I neutralize the bad effect of the salt? What about other legumes? Can I safely add salt to black or pinto beans? Maybe there isn’t research to answer my questions yet, but answers could make a big difference in recipe development.

        1. Hi, Joshua! The studies referenced in Dr. Greger’s discussion of miso in his book How Not to Die suggest that it is the soy in miso that counterbalances the salt. Soy appears to have anticarcinogenic effects, as well as blood pressure lowering abilities, that cancel out the detrimental effects of salt. Here are links to those studies referenced:

          Effect of Soybean Protein on Blood Pressure: A Randomized, Controlled Trial
          Intake of Soy Products and Other Foods and Gastric Cancer Risk: A Prospective Study
          Soy Milk Lowers Blood Pressure in Men and Women with Mild to Moderate Essential Hypertension
          Association of Lifestyle Parameters with the Prevention of Hypertension in Elderly Japanese Men and Women: A Four-Year Follow-up of Normotensive Subjects

          Dr. Greger has also made a video on miso that references the above studies as well.

          Based on the above information, in theory, it would seem plausible that mashing soybeans and salt together in the same proportion as miso would neutralize the negative impact of salt. Since it was the soy in particular that was shown to be beneficial, I am not sure if other legumes would produce the same effect. However, in general, beans have been shown to be protective against cancer and high blood pressure (see here, here, here and here).

          1. Thank you very much for your helpful reply. The data certainly suggested that we might use salt a little more freely than only in miso paste. That’s a relief.

  26. I find it fantastic how you take these guys on, Dr. Greger. I know other people abroad who tried to challenge big Pharma and got heavily attacked online. It would also be worth reporting how Wikipedia in health questions is manipulated by agencies that are paid of the big business.
    All the best for the future!!
    Regarding salt, the industry still does a great job in misinformation, there are many people still who believe salt is very good (even vital) for you and is only negative in the case of over-consumption. Too bad everyone over-consumes…
    Btw, is there a difference in the effects on us between “normal” salt, rock-salt, sea salt etc. Or is it all bad salt?

  27. sources and those coming from other sources non-organic plant based or
    non -plant based sources?

    It is ridiculous that in this day and age studies and research is done
    not distinguishing between plant based sources both organic and non-organic
    plus studies distinguishing between plants based sources organic and
    non-organic and artificial or non-plant based sources of vitamins. Is there
    clearly a difference or not? Such a study TODAY is worth its weight in gold and
    will benefit untold numbers of consumers although it might be detrimental to
    the profit based supplement business that lives off people’s fears and their
    lack of information coming from unbiased sources. I for one would like to know
    if scientific studies should all be thrown out the window until such a study I
    have requested has been made. Of course this would require wisdom in the field
    of science, a field that has no lack of intelligence, but wisdom is the anomaly
    among scientists, politicians, and the academic field in general. Intelligence
    without wisdom is another definition of ignorance.

  28. Have there been any studies comparing multivitamins or supplements
    coming from organic plant sources and those coming from other sources
    non-organic plant based or non -plant based sources?

    It is ridiculous that in this day and age studies and research is done
    not distinguishing between plant based sources both organic and non-organic
    plus studies distinguishing between plants based sources organic and
    non-organic and artificial or non-plant based sources of vitamins. Is there
    clearly a difference or not? Such a study TODAY is worth its weight in gold and
    will benefit untold numbers of consumers although it might be detrimental to
    the profit based supplement business that lives off people’s fears and their
    lack of information coming from unbiased sources. I for one would like to know
    if scientific studies should all be thrown out the window until such a study I
    have requested has been made. Of course this would require wisdom in the field
    of science, a field that has no lack of intelligence, but wisdom is the anomaly
    among scientists, politicians, and the academic field in general. Intelligence
    without wisdom is another definition of ignorance.

  29. Dr. Greger, are there versions of your video posts in Spanish? A local clinic that I go to could use these type of videos if they were in Spanish.

    1. Lisa: I don’t know the precise answer to your question, but I wanted to say that NutritionFacts has a program/method for volunteers who can translate videos into other languages. We already have a generous man who converts most of the videos to Portuguese. So, if we don’t have someone doing Spanish yet, this would be a great way for volunteer to contribute to NutritionFacts.

      Does anyone out there know how to check which languages these videos are already available in? Also, if you have the ability and interest in translating these videos into Spanish or some other language, please let the NutritionFacts staff know!!! Here is the page for translators to sign up: http://nutritionfacts.org/volunteer/

      1. Thank you Thea. I will be suggesting these videos at the clinic I attend. And if there are links for these in Spanish, please post them, and I will see to it they are available.

        Best.
        Lisa

  30. Dr. Greger. We appreciate your concern and diligence. By my question is not about your data, but rather types of salt intake. I use either Celtic or Himalayan salt which supposedly supplies healthy ingredients not found in common table salt and thus tends to mitigate the found negative impacts in the salt studies.

  31. I think for individuals making dietary choices, simply avoiding or restricting high sodium processed food is likely good enough for good health, if in combination with an otherwise healthy lifestyle (eg nonsmoking, low or no alcohol, regular exercise, high intake of fruits and vegetables, low or no intake of saturated fat).

    For society (government regulations) it would be wise to restrict sodium in processed foods and to implement a public education campaign to encourage people to limit their dietary sodium.

    I see the problem of promoting a low salt diet when the way it’s interpreted by individuals means that they’ll avoid eating unprocessed veggies (because they taste bad without added salt). They’ll avoid table salt in fear they’ll add too much (unlikely) and instead they will simply buy processed foods labeled “low sodium.” That can’t be the optimal way to eat a low salt diet.

  32. I can only speak to my situation. Drastically reducing sodium intake played a great part in allowing me to survive the last 11 years.

    I had CHF 11 years ago with left ventricular ejection fraction of 10% at time of occurrence. After 6 weeks in the coronary care unit, I rebounded to a whopping 53% for a short period, which has leveled off to <40% (around 33%).

    The first thing I did was quit smoking and alcohol – cold turkey. After that it took 6 years to completely change my diet from one heavily laden with sodium, saturated fats, carbs and sugars to a vegetarian lifestyle.

    My daily sodium intake is now 1000mg to 1600mg daily – I don't worry about saturated fats and sugar as they regulate themselves as long as I keep to mostly fresh foods with boneless, skinless chicken breast and very little dairy – usually organic Greek yogurt. In fact, I have the luxury of having to add table salt and or fat(s) to my diet on a daily basis because there is room for them. Just a few grains of table salt tastes great.

    11 years ago, my total cholesterol was in the high 400s and blood pressure was through the roof and I was 40 lbs overweight (which I have now lost – I'm down to 167 lbs). It took awhile, what with straying from my diet now and then, but this week my doctor took me off my second blood pressure medication along with the cholesterol medication. I'm sorry I don't have any numbers to post here for my old BP levels, but my current BPs run steady around 117 / 54 – and I go to the gym 3 days every week for 30 minutes of cardio cycling and 30 minutes of weights.. that helps a lot.

    Once my taste buds adjusted to very low sodium levels, everything just came together and clicked, diet-wise. I'm eating all day now, every hour or two – a small meal or piece of fruit. I'm eating about three times as much per day as I was before my CHF.

  33. I am discouraged the divergence we face on this salt issue from my favorite two diet specialists doctors, Dr Greger and Dr McDougall. Please see the later’s report which recommends the very opposite of Dr Greger, “The Dangers of Salt-Free Diets | John McDougall, M.D.” I tend to believe Dr McDougall on this one. Given Dr Greger’s similar divergence with Dr McDougall on the health value of white potatoes (Greger pans them with a red light, as unhealthy for humans)… I’m looking for some insight here. How can these two guys disagree so badly on these two issues? Discouraging!

    1. Tobias Brown: I waited a couple of days to see if anyone else would reply to you with a better answer than I have. But for what it’s worth, here’s my take: The differences on these details does not bother me, especially the one on salt. When I read what Dr. Greger writes about salt, I think he is making different assumptions than Dr. McDougall. I say go with whatever doctor’s advice makes sense to you based on your own values and situation. I tend to agree with you that a bit of added sodium in a diet which would otherwise be free of all sodium is a good idea (but that almost no one actually eats a diet like that–which I think is the data Dr. Greger is looking at). On the other hand, when it come to plain, white potatoes, I think the data is on Dr. Greger’s side. Better to stick with potatoes of colored flesh and/or sweet potatoes. Dr. Greger points out in his How Not To Die book that white fleshed plain potatoes are pro-oxidants. That’s a more scientific or at least satisfying response to me than I remember hearing from Dr. McDougall which was just that some populations in the past ate primarily plain potatoes. That sounds like a weak paleo argument to me without other data to back it up.
      .
      How can these two awesome docs disagree? I think it is because the science is pretty clear on some issues, but not on all of them. And also that no one is perfect. Everyone is wrong about something. And with such outspoken doctors speaking on a wide range of topics, I imagine they are wrong about more than just one thing. That’s why it is good to never give up your own judgment and to listen to a wide range of experts (who have integrity).
      .
      I realize I didn’t actually say anything all that helpful. I just hope that somewhere in there I might spark your own thoughts that lead you to less frustration.

      1. Take only the salt issue for a moment. I don’t understand how intelligent people in the same basic camp can read the scientific literature and reach OPPOSITE conclusions. By chance, you replied to this message today AND Dr Popper replied to my query on her Tube from a few weeks ago today as well, saying, “The research speaks for itself – I’ve reviewed studies on this topic for many years, and the vast majority do not support salt restriction. the Institute of Medicine just reversed its stance on the topic; the number of health authorities supporting salt restriction for the entire population is dwindling. The problem, in my opinion, is the continued application of restrictions for the general population that apply to subsets of the population. There are some people who should restrict salt intake. But this does not mean than ALL people should do so.”

        The thing is that this is not merely an academic issue but something I will confront a few minutes from now when I eat my lunch. It has a direct impact on behavior for many of us. Every time I eat a white potato I think of Dr Greger’s stance against them. And I will eat some for lunch today. :)

        1. One of the more recent studies (2004ish) on antioxidants in foods which was well publicized surprisingly found that russet potatoes (with skin left on the potato) are among the top antioxidant-rich vegetables along with beans and artichokes. Are russet potatoes not considered to be white potatoes? Thea mentions that Dr. G included in his book that white potatoes are pro-oxidants. Odd that a food can be rich in antioxidants when outside the body but pro-oxidant when consumed. I eat russet potatoes almost daily for at least one meal mixed with beans and other veggies. Bad idea?

          My own health is anecdotal evidence that eating a whole foods vegan diet with no added salt can be harmful to health. I was getting about 500mg of sodium a day from whole foods. Wasn’t eating any sea vegetables. I wasn’t feeling well and would occasionally have an odd sensation in my chest as if my heart had skipped a beat. I went to my doc. My blood tests showed an alarmingly low blood sodium after following this diet for about a year. I was diagnosed with hyponatremia (low blood sodium) which can be deadly. My doc was so alarmed when he got the result that he had me come into his office immediately. After explaining my diet to him, he made me eat a bunch of pretzels which he had in his office and suggested that I try adding a teaspoon of added salt a day. He made an appointment for me 10 days later to have a followup blood test to see if my blood sodium moved into the healthy range. I tried the added teaspoon per day added to food. I t was too much for me. Could barely eat my meals because of the overpowering saltiness after having such a low salt diet for a year. I instead decided to add half a teaspoon in total each day. This amount of added salt bumped my daily sodium intake from about 500mg (all in whole unprocessed foods) to about 1700mg. Food tasted fine so I stuck with it.

          I’d measure out half a teaspoon of salt every morning before eating breakfast and put it in a small condiment dish. That was my salt for the day to sprinkle on my meals. The new blood tests showed that my blood sodium had moved into the healthy range. I’m till adding half a teaspoon in total each day to my meals, which puts my daily sodium intake into the 1500mg to 1900mg range each day. This is still considered a low salt diet. It’s actually lower than the 2000mg daily limit on sodium intake for cardiac patients in a hospital. I feel fine now, so I’m sticking with it.

  34. I was diagnosed with vasovagal syncope and low blood presssure that is caused by a heart arrithmia. I have been instucted by my cardiologist to take a lot of salt in my diet so that I dont have dizzy spells. Is there something else that I can do to help this condition besides increase salt intake, since salt is so dangerous? Thank you!

    1. Your situation interests me. Did your doctor give you a grams of sodium per day recommendation? I assume the doctor was more specific than simply telling you to eat more sodium.

  35. Can anyone help me to understand what exactly he’s referring to when he says ‘sodium’?? Because there is sodium in celery, is this bad or is he just talking about a specific type of SALT and not SODIUM? I’m confused… And what about sea salt, this is no good either??

  36. Hi Dr. Greger,

    I’m currently creating my diet and I can’t seem to find an adequate source of chloride, because well, chloride isn’t even on the nutrition facts of any foods so I don’t know how much chloride is in any of the foods, if any. Now chloride is an essential nutrient and the RDA from the NIH is 2.3 grams per day, that’s a lot considering that on a salt-free diet i’m getting next to nothing. Please respond fast, I want to start eating healthy as soon as possible.

  37. Hi Dr. Greger,
    I was running through my RDA’s to see if i’m getting a sufficient amount of every essential nutrient and I discovered that I can’t figure out how much chloride i’m getting. The RDA is 2.3 grams and I am told that sea plants are a good source, however it’s not on any of the nutrition facts. There are other essential mineral nutrients such as molybdenum that are not on any of the nutrition facts therefore I can’t find out how much I need. Help please. Thanks.

  38. You mention that spinach is a super healthy food, but what about his huge sodium content ?? new zealand spinach for example have more than 300 mg sodium for 100g.

    1. Science Based Diet: You need *some* sodium in your diet. Getting sodium from whole plant foods appears to be a great way to do it, because to my knowledge, there are no correlations between whole plant food eating and high blood pressure. It’s only added salt that appears to cause health problems/increase health risks.
      .
      According to the book Becoming Vegan (a great reference book), the RDA for sodium is 500mg minimum. Maximum is hard to figure out. I don’t think we have good data on that, because the data is usually including people who consume added table salt. The National Academy of Science has suggested 2,400 mg maximum. In that light, 300 mg doesn’t look to be much of a problem. Note that some people on this site have expressed concern that a whole plant food diet may not supply enough sodium. So, that spinach would look pretty good to them!
      .
      Those are just some ideas to help you put the spinach question into perspective.

    2. Hello! I can’t seem to find the same numbers as you. I’ve found that 100 g of raw New Zealand spinach contains about 130 mg sodium. All fruits and vegetables are naturally low in sodium – so you can go ahead and enjoy large servings! :)

  39. What is the minimum sodium intake, and it the best way to reach that
    simply to add iodized table salt? Since I began a whole foods, plant
    based diet, lack of processed foods has made my sodium intake really low
    (and iodine, too). I’m struggling to get up to 1,500 mg. I’m
    struggling to get to 500 mg. I think I experienced the down-side of
    this last night when the temp was over 100 and I was at a baseball game.
    I was only in the sun half an hour before my stomach hurt, I got
    really dizzy and disoriented. I think it was heat exhaustion, something
    I have never had problems with before eating this way. Do I need to
    add some salt back into my diet?

  40. want to test this thing. How do I become deficient in sodium and what are the symptoms?

    Not consuming any salt for 30 days would do the thing?

  41. Dear Dr. Greger,

    My boyfriend finds that he gets migraines if he doesn’t eat enough salt. Especially when he returns from long bike rides, he has found that by drinking some bouillon or basically quite a bit of salt, he gets headaches. When I hear about the detrimental effects of salt, I get worried for him. He’s otherwise very healthy and a long-time vegetarian, but he seems to need a significant amount of salt to get by without headaches.

    1. Sorry I had a typo there. I meant, “by drinking some bouillon or basically quite a bit of salt, he can *avoid* getting headaches” or stop them when they start.

      1. Endurance athletes need to make sure they are getting enough sodium because hyponatremia (low blood sodium) can be a problem with athletes who sweat a lot during their sport. You’re boyfriend’s body likely needs that extra sodium.

  42. I’m all for low sodium intake, we have almost entirely eliminated salt from our diet a few years back. But then my mother had a epileptic seizure (her first one ever) and in the hospital they told her the seizure was caused by low sodium levels (and they actually injected her with sodium). One has but to wonder. Was she diagnosed wrong?

  43. One mystery I wish someone would clear up regarding salt it definition… I mean, what kind of salt? There is processed table salt which is pure sodium and chloride and there are supposedly ‘healthy’ salts like Celtic salt, etc. which apparently is loaded with lots of beneficial minerals. It seem that the arguments here mirror that other great debate that ‘experts’ cannot agree on, and that’s the great ‘fat or no fat’ debate. There there is a similar distinction that is often ignored between healthy fats and unhealthy fats, but people seem happy just to talk about salt and fat as if distinctions don’t matter.

    1. The confusion is compounded by the fact that we require fat and sodium. The debate is about how much is best for human health. If a person experiments with sodium intake and also monitors blood pressure while engaged in the experiment, it quickly becomes clear that blood pressure can be manipulated by altering one’s sodium intake. I happen to be a person with low blood pressure and by simply bumping up my sodium intake to 1500mg-2000mg a day I can keep my BP in the healthy range. This is enormously helpful as a tool to manage health.

      Similarly, fat as a percentage of consumed calories can be played with in one’s diet until a macronutrient ratio is arrived at that best supports health. I find that I do best with a fat intake of about 20% of calories. That’s easy to achieve on a whole foods vegan diet by simply adding an ounce or two of walnuts, almonds and a tablespoon of ground flax to meals. Adding no high fat whole foods such as nuts to my diet will mean that my fat intake can be as low as 5% of calories consumed. I’ve tried that and my skin was dry and flaky and I wasn’t sleeping well. 10% fat intake was better, but I still felt a bit off. I feel my best at 20%. 30% is too much as I started having problems with my skin breaking out during the month that I tried 30% fat.

      Rather than just listen to the debate about these issues and throw up my hands in confusion and frustration, it’s not tough to do a bit of experimenting on one’s food intake while monitoring how one feels in daily life to arrive at a diet that supports one’s health and fitness goals.

    2. David: David: I agree that for macronutrients, the type makes a big difference. For example, carbs from intact grains is healthy while carbs from refined grains is generaly not so healthy. When it comes to salt, however, the type really doesn’t matter. I’ll share with you what I have picked up on this subject.
      .
      When the analysis is done, it looks like natural/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!

    3. Re: “processed table salt which is pure sodium,” — it’s not. Synthetic iodine and aluminum-based compounds are added to commercial table salt.

  44. As an aside, if you are a person who is looking for more “natural” everything in your diet and you prefer to avoid the anti-caking agents typically included in processed salts, you can buy canning and pickling salt which typically includes no anti-caking agents, but it will also not have added iodine. Some brands of kosher salt may also have no anti-caking agents added. I don’t think there is any evidence that these anti-caking agents are harmful to human health, but if you want to avoid them, you can.

    1. Todd: Thanks for this helpful information.

      If you are the Todd I’m thinking about, you had decided to give a WFPB diet a try after having lived for several years in the paleo camp. ;-) I saw that you had some trouble with low salt. At least that’s easily fixable. Other than that, I hope things are going very well for you.

  45. The confidence intervals of sodium below 3000 mg/d on the “corrected curve” (at 6:20) are substantial, may be dependent on the method of establishing those confidence intervals, and ignore other measures of health besides cardiovascular disease. Accordingly, while Greger seems correct about the linear trend relating to CVD, any conclusions about exceptionally low or high levels of sodium relating to CVD or to health generally should be taken with a grain of salt.

  46. Dr. Greger is using this one study as an example. The vast body of peer-reviewed literature supports all his conclusions. In clinical practice, sodium sensitivity is wide-spread and increases with age, and it often takes very low sodium intake to normalize blood pressure….right in the zone that you’re questioning. Don’t get too lost in the stats from one study that is focusing on sodium excretion. Do evaluate all the relevant studies as Dr. Greger and other’s have.

    Dr. Ben

  47. What about a concern on the other end of the spectrum– eating too little sodium. If you don’t add salt to a whole food, plant based diet are you at risk for a sodium deficiency? In the long run could this cause harm like heart problems and even insulin resistance? Is there any way to know if you are on a diet that is too low in sodium, because it seems like populations have lived and thrived without salt shakers but many did eat animal based products. Does anyone else have other thoughts? Or, is it possible to eat a variety of fruits, vegetables, legumes, beans, and nuts to get adequate sodium without adding any?

  48. This video from Dr. Pam Popper ought to clear up the confusion about salt. There is no perfect amount of salt for every body. Most people do not need to restrict salt. They only need to stop eating processed foods and start eating whole food plant based. This usually addresses hypertension. Adding some natural salt (to taste) to your food after you prepare it is usually not a problem for most people.

  49. The USDA has a lower RDA of 1,500mg/sodium a day with an upper limit of 2,300mg/day. It seems very hard to get 1,500mg/day of sodium on a whole-food, plant based diet if there is no added sodium. My question is, is the RDA for salt high in this country, or do we really need to add salt to our diet? It seems like populations all over the world flourished without access to any kind of added salts, but in those scenarios the question of genetics comes into play since they have more of a predisposition to sodium storage.

  50. I’ve been eating a virtually no salt whole foods vegan diet for about 1.5 years now, and I’ve been dizzy nearly every day during that time period. Most days it’s just feeling light headed, but many days the whole room will be spinning and there’s nothing I can do to stop it. I recently came across another no salt vegan who had the same issue, and found out she had too LOW blood pressure! Her doctor had her add salt back into her diet and the dizziness went away. So I’ve started checking my blood pressure and everytime I have it’s been pretty low. I’m going to add salt back into my diet and see if it helps, so far it has but it’s only been a couple days. I think those studies were on to something with the U shaped curve!

  51. I was took on by a woman who claims people could die of salt defficiency, and some people with low blood pressure
    especially women during their cycles do need to eat food high in salt to boost BP. How is this true? Some people
    including her believe salt is a neccessary nutrient, and the idea that says too much salt is harmful for everyone is just
    incorrect. One another lady told her story where she had gotten head rushes, and it recovered once she ate salty chips.
    Is there any possibility that she was just iron defficiency and the recovery was caused by extra iron in it not by salt?
    Do some people really need extra salt? I can’t still believe this because I believe everyone should cut salt intake as much
    as possible for optimal health with damaging arteries. Any supporting evidence or explanations please?

    Thanks

  52. These “reports from friends” are not objective evidence. All available objective published evidence points to the fact that while sodium is a critically important nutrient, we only need about 200 – 400 mg per day which is automatically consumed in a whole food plant based diet, so there is no need or benefit from supplementation. There are some uncommon diseases in which sodium needs to be supplemented, but these need to be determined by a doctor with blood tests.

    Dr. Ben

  53. Good question, but Himalayan Pink Salt is sodium chloride (NaCl) just like every other food salt. It just happens to have some tiny amounts of other “stuff” in there that make it pink and that would not have any counterbalancing effect on the adverse effects cause by the NaCl. I.e. its not good for you.

    Dr. Ben

  54. My blood pressure was high but when I stopped adding salt to my WFPB diet it went down and is always below 120/70 now. I make all my food from scratch and use no packaged products. I also began eating a banana everyday for the potassium. However recently I have arrhythmia, a slow heart rate, and a first degree heart block and my cardiologist is considering a pacemaker. I’m 76 and have perfect numbers on all tests and no other risk factors except having to take generic Synthroid for low thyroid. On the metabolic panel the sodium number was at the baseline. Do you think I may not be getting enough sodium and this could be a factor in my arrhythmia?

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