Retrospective #74: You don’t add salt?

You don’t 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. It’s also a preservative.

On the other hand, 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 at the table. I do. I add lots of salt. I add salt “to taste” to maintain homeostasis and my electrolyte balance. I do it so I can live in that healthy state. If you’re still not sure of our animal requirement for salt, think “horse lick” or “deer lick.”

So then why is salt restriction universally recommended by the public health establishment? There is very little evidence 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 restriction in his award-winning article “The (Political) Science of Salt,” published in Science on August 14, 1998. He revisited the subject 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 Type 2 diabetics may be harmful. In 2011, The ADA’s 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.” “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 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.” Do ya’ think?

In his series “Shaking Up the Salt Myth,” Paleo blogger Chris Kresser wrote about, “The Dangers of Salt Restriction,” in which he reported on a 2011 JAMA study 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”. The 2015 Dietary Guidelines still recommends that Americans “reduce daily sodium intake to less than 2.3 grams (1 tsp). Conclusion: The lowest risk of death is associated with consuming from 2 2/3rds to 4 times more sodium than Type 2s or hypertensives or older adults are being guided to eat.

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 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.

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.