The Nutrition Debate #74: No Added Salt? Why?

Why add salt? Well, maybe YOU shouldn’t. Many prepared and processed foods in cans and boxes already have a lot of added salt. It is added to enhance flavor and make the product more palatable. Of course, if you eat mostly real food, i.e., whole foods – the meats and vegetables found in the cases on the perimeter of the supermarket, you may find them tastier if you add salt in their preparation or on the plate. I do. I add lots of salt. I do it because I believe my body has a natural sodium “appetite.” I add salt “to taste.” I believe adding salt to food is a fundamental behavioral response to a primary survival mechanism – to maintain homeostasis and electrolyte balance. I do it so I can live in that healthy state.

 

 So then why is salt restriction universally recommended by the public health authorities and the medical establishment? There is very little evidence (and no “proof”!) that salt “causes” hypertension. It’s another one of those hypotheses that, according to Gary Taubes in his 2007 book, “Good Calories – Bad Calories” (pg. 146), scientists say is based on “biological plausibility – it makes sense and so seems obvious,” like eating fat will make you fat. Taubes first addressed the subject of salt reduction here in his award-winning article “The (Political) Science of Salt,” published in Science on August 14, 1998. He revisited the subject here with “Salt, We Misjudged You,” an op-ed in the New York Times on June 3, 2012.

 

There is also evidence that salt restriction in some populations, among them Type 2 diabetics, may be harmful. On February 2, 2011, Diabetes Care online reported a University of Melbourne study that found “patients with the highest levels of sodium in their urine had the smallest risk of dying over a 10-year period. The study followed “638 people with longstanding Type 2 Diabetes, often accompanied by heart disease and high blood pressure.” The report describes, “At the outset of the study all the patients were in their 60s and nearly half of them were obese.” The researchers reported, “Over the decade the study spanned, 175 patients (27%) died, mostly due to heart disease.  The average amount of sodium in their urine (the ‘gold standard’ for measuring sodium consumption) was 4.2 grams per day. For every extra 2.3 grams of sodium (equivalent to 1 tsp. of table salt) in their urine, their risk of dying during the study dropped by 28 percent.” Doctors who worked on the study said, “It raises the possibility that in people with Type 2 diabetes, low salt intake is not always beneficial.” Boy, those Aussies are cautious (but open-minded) scientists!

 

In his series “Shaking Up the Salt Myth,” Paleo blogger Chris Kresser wrote an article, “The Dangers of Salt Restriction,” in which he reported on a study in JAMA in 2011 that “demonstrates a low-salt zone where stroke, heart attack and death are more likely.” He concludes, “These findings demonstrate the lowest risk of death for sodium excretion is between 4 and 5.99 grams per day” (emphasis mine). The 2010 Dietary Guidelines recommend that Americans “reduce daily sodium intake to less than 2,300 milligrams (1 tsp) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults,” the guidelines state (emphasis again is mine). So, the lowest risk of death is associated with consuming from 267% to 399% more sodium than Type 2s or hypertensives or older adults are being “guided” to eat. What a disconnect!

 

Then there’s the physiological explanation for why Type 2 diabetics who are following a Low Carb or Very Low Carb diet should not restrict their sodium (salt) intake. Michael Eades, M.D., author with his wife Mary Dan Eades, also M.D., of “Protein Power,” blogs about it here in “Tips and Tricks for Starting (or re-starting) Low Carb Part II.” He explains that when your body is depleted of carbs, your blood insulin drops and your insulin sensitivity improves. The excess insulin that made you store fat also drove your kidney to retain fluid. When the insulin level drops on a low carb diet, “the stimulus to the kidneys to retain fluids also goes away.” Dr. Eades says, “The kidneys begin to rapidly release fluid” (urine) and sodium, changing your electrolyte balance. When this happens, “symptoms often occur: fatigue, headache, cramps, and postural hypertension” (light-headedness). “You simply need to take more sodium drink more water,” Dr. Eades says. “You’ve got to start thinking differently.  The low carb diet is one that absolutely requires more sodium. A lot more sodium.” “An easy way to get extra sodium, along with magnesium and potassium, is by consuming bone broth.” “You can also use commercially available bouillon,” he adds, which might help you “get through carb cravings.”

 

In my opinion, the Dietary Guidelines recommendation that salt should be restricted is just bad advice.  And it certainly should not be a universal recommendation. In particular, it should not be applied to Type 2 diabetics who eat a diet of less than 50 grams of carbohydrate a day, aka a Low Carb Diet. This population should eat more salt. This may sound crazy when the “accepted wisdom” of the government “Dictocrats” is that we should eat less; remember, however, that these are the same “experts” who tell us that T2s should be eating a balanced diet containing carbohydrates and sugars.

© Dan Brown 11/10/12