The American Heart Association’s Ongoing A-Salt On Science

I believe the American Heart Association was founded with good intentions.  Really, I do.  But they’ve become a perfect example of the phenomenon described in the excellent book Mistake Were Made (but not by me):  after announcing a public position on an issue, they are incapable of admitting they were wrong.

On their web site, they recommend consuming less than 1,500 mg of sodium per day.  That’s been their position for years.  Since the average American consumes more like 3,500 mg of sodium per day, that means the AHA is telling us to cut our salt intake by more than half to avoid hypertension and, by extension, heart disease.  (We’ll come back to that “by extension” part.)

The AHA certainly isn’t alone in pushing this advice.  The Guy From CSPI has been on an anti-salt jihad for decades, the USDA Dietary Guidelines call for low-salt meals (the USDA compels schools to comply with that advice), and of course Hizzoner Da Mayor in New York City used the coercive power of government to impose his beliefs about the benefits of sodium restriction on food manufacturers.

So how do you suppose the anti-salt hysterics would respond to a big ol’ government-sanctioned study that says they’re wrong?  I’m pretty sure you can guess.  Let’s look at some quotes from a New York Times article titled No Benefit Seen in Sharp Limits on Salt in Diet:

In a report that undercuts years of public health warnings, a prestigious group convened by the government says there is no good reason based on health outcomes for many Americans to drive their sodium consumption down to the very low levels recommended in national dietary guidelines.

Those levels, 1,500 milligrams of sodium a day, or a little more than half a teaspoon of salt, were supposed to prevent heart attacks and strokes in people at risk, including anyone older than 50, blacks and people with high blood pressure, diabetes or chronic kidney disease — groups that make up more than half of the American population.

But the new expert committee, commissioned by the Institute of Medicine at the behest of the Centers for Disease Control and Prevention, said there was no rationale for anyone to aim for sodium levels below 2,300 milligrams a day. The group examined new evidence that had emerged since the last such report was issued, in 2005.

“As you go below the 2,300 mark, there is an absence of data in terms of benefit and there begin to be suggestions in subgroup populations about potential harms,” said Dr. Brian L. Strom, chairman of the committee and a professor of public health at the University of Pennsylvania. He explained that the possible harms included increased rates of heart attacks and an increased risk of death.

Say what?  A low-salt diet may increase the risk of heart attacks and death?  You mean the AHA is recommending we reduce our salt intake to a level that may be dangerous?  Well, take a peek at some of the evidence Dr. Strom’s committee considered (the bold emphasis is mine):

One 2008 study the committee examined, for example, randomly assigned 232 Italian patients with aggressively treated moderate to severe congestive heart failure to consume either 2,760 or 1,840 milligrams of sodium a day, but otherwise to consume the same diet. Those consuming the lower level of sodium had more than three times the number of hospital readmissions — 30 as compared with 9 in the higher-salt group — and more than twice as many deaths — 15 as compared with 6 in the higher-salt group.

Oh, dear.  In a randomized study, the Italians who reduced their sodium intake to levels that are still slightly above what the AHA recommends had more than double the death rate.  Pass the salt shaker, please, and let’s read on:

Another study, published in 2011, followed 28,800 subjects with high blood pressure ages 55 and older for 4.7 years and analyzed their sodium consumption by urinalysis. The researchers reported that the risks of heart attacks, strokes, congestive heart failure and death from heart disease increased significantly for those consuming more than 7,000 milligrams of sodium a day and for those consuming fewer than 3,000 milligrams of sodium a day.

Got that?  The death rate was higher for people who consumed less than 3,000 mg of sodium per day – and the AHA recommends cutting even that level of consumption in half.

So what about the higher death rate among people who consumed more than 7,000 mg per day?  Well, I can think of a couple of possibilities.  Perhaps that much sodium (double the average intake in the U.S.) truly is dangerous.  On the other hand, that’s a LOT of salt to sprinkle on your grass-fed beef, pastured eggs and spinach, so perhaps people who consume that much sodium are the same people who eat a lot of processed food — in all its sugar-and-flour-laden glory.  A super-high sodium intake could just be a proxy for a bad diet in general.

So why might too little salt in the diet be dangerous?  Read on:

There are physiological consequences of consuming little sodium, said Dr. Michael H. Alderman, a dietary sodium expert at Albert Einstein College of Medicine who was not a member of the committee. As sodium levels plunge, triglyceride levels increase, insulin resistance increases, and the activity of the sympathetic nervous system increases. Each of these factors can increase the risk of heart disease.

“Those are all bad things,” Dr. Alderman said. “A health effect can’t be predicted by looking at one physiological consequence. There has to be a net effect.”

Dr. Alderman, if memory serves, once warned that a national effort to force us to consume less sodium would be a giant, uncontrolled experiment that could have unintended negative consequences.  Kudos to him.  We all know what happened with the giant, uncontrolled experiment to remove saturated fats from our diets and replace the calories with grains and vegetable oils.

Anyway, now that a committee created specifically to study the effects of sodium has said there’s no evidence to support pushing low-salt diets on us, let’s see how the people pushing low-salt diets on us are handling the bad news:

Bonnie Liebman, director of nutrition at the Center for Science in the Public Interest, an advocacy group that has taken a strong position against excessive salt consumption, worried that the public would get the wrong message.

“It would be a shame if this report convinced people that salt doesn’t matter,” Ms. Liebman said.

Allow me to interpret Ms. Liebman’s statement:   We’ve been trying to scare people about salt for decades, so it would be a shame if people interpreted a report saying that their current level of salt intake is fine to mean “our current level of salt intake is fine.”

The American Heart Association agrees with her. Dr. Elliott Antman, a spokesman for the association and a professor of medicine at Brigham and Women’s Hospital in Boston, said the association remained concerned about the large amount of sodium in processed foods, which makes it almost impossible for most Americans to cut back. People should aim for 1,500 milligrams of sodium a day, he said.

“The American Heart Association is not changing its position,” Dr. Antman said.

Of course you’re not changing your position, Dr. Antan.  That would require you to admit you’ve been wrong for decades.  I’m guessing you’d rather rip your own ears off than do that.

The association rejects the Institute of Medicine’s conclusions because the studies on which they were based had methodological flaws, he said. The heart association’s advice to consume 1,500 milligrams of sodium a day, he added, is based on epidemiological data and studies that assessed the effects of sodium consumption on blood pressure.

I’ve seen the AHA’s explanation of how the epidemiological evidence supports their position elsewhere.  Here it is in a nutshell:  studies show drastically reducing salt intake can slightly reduce blood pressure, and high blood pressure is associated with heart disease, so that proves reducing salt would reduce heart disease.

If you’re a frequent reader of this blog, you recognize that (ahem, ahem) logic for what it is:  teleoanalysis.  We can’t prove that A causes C, but if we can link A to B and B to C, we can say A causes C.

High blood pressure is indeed associated with heart disease, but that doesn’t prove high blood pressure causes heart disease directly, and it certainly doesn’t prove that restricting salt would prevent heart disease.  As Dr. Richard Johnson has demonstrated in several experiments, hypertension can result from an excess intake of sugar.  It could be that sugar raises blood pressure and also causes heart disease by damaging the endothelial layer in our arteries.

If too much salt causes heart disease and restricting salt therefore reduces heart disease, we should see that relationship directly, not through goofball teleoanalysis.  But we don’t:

The Institute of Medicine committee said it was well aware of flaws in many of the studies of sodium, especially ones that the previous Institute of Medicine committee relied on for its 2005 recommendations. Much of that earlier research, committee members said, looked for correlations between what people ate and their health. But people with different diets can differ in many ways that are hard to account for — for example, the amount of exercise they get. And relying on people’s recall of how much salt they consumed can be unreliable.

The committee said it found more recent studies, published since 2005, that were more careful and rigorous. Much of the new research found adverse effects on the lower end of the sodium scale and none showed a benefit from consuming very little salt.

Although the advice to restrict sodium to 1,500 milligrams a day has been enshrined in dietary guidelines, it never came from research on health outcomes, Dr. Strom said.

Anti-salt hysteria was never based on studies of actual health outcomes.  Neither was anti-fat hysteria.  Yet the American Heart Association pushes both … along with sugary, grain-based cereals that almost certainly do actual damage to our health.

I don’t expect the AHA to ever change its position – on anything – no matter what the evidence.  As I said during a Q&A session after a speech when someone asked me how we can get the AHA, or the USDA, or the ADA to change their positions on diet:  my goal isn’t to change their minds, because I don’t believe that’s possible.  My goal is to make them irrelevant by convincing people to ignore them.

So let’s ignore them.  Pass the salt, please.


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83 thoughts on “The American Heart Association’s Ongoing A-Salt On Science

  1. Pierre Robert Groulx

    Sugar is often added to table salt as a cheap way to add flavor and bulk. This “salt” is then blamed for causing problems with the circulatory system. Crazy, huh?

    If sugar mixed with fat causes disease, they blame the fat. If sugar mixed with salt causes disease, they blame the salt.

    1. Gilana

      Sorry, but sugar is added to table salt? I have never seen that, read that, or heard that anywhere. I’d be very interested to learn where sugar is mixed with table salt so I can avoid it.

      1. K2

        Check out plain Morton’s table salt (not the sea salt… just the ordinary old salt). It has dextrose added. It has for years – I remember commenting to my father WAY back when I was in high school how I couldn’t believe there was sugar in salt.

  2. PrimeNumbers

    Mistakes were mad (but not by me), should be required reading by everyone, but even then the unfortunate outcome would be that many readers would still believe that the clearly presented cognitive biases that effect everyone don’t effect them.

    Indeed. I, of course, have no biases.

  3. Scott

    Did you see the new Subway ad were they brag about being the only restaraunt with food approved by the AHA, pathetic probally because they are the only fast food place willing to shell out money to them.

    Yeah, they paid more than $600,000 for that seal of approval.

  4. Peggy Sue

    I’ve been on a low-carb diet for about 1 year and have lost 12 pounds (I am still 5 pounds over the maximum weight range according to those ridiculous height/weight charts) , feel much better, have more energy and had a blood test in February in which all my numbers were good EXCEPT my blood pressure. It’s typically around 130/90 and has been for at least the past 3 years. So the low-carb diet didn’t make it worse, but it didn’t help either.

    My doctor handed me a pamphlet about a low-sodium diet and told me to try lowering my BP through diet and if that didn’t work, she was going to put me on medication. The pamphlet recommends 2300 mg or less daily, but states that 2000 mg or less is a low-sodium diet. I’ve been keeping it at 2300 mg per day or lower for the last two weeks, but my BP is still the same (I have a BP cuff at home).

    If the sodium reduction doesn’t work, is there another natural way of lowering my BP? Also, is 130/90 really horrible? Do I really need to take drugs for this? I am a 44 year old female. I don’t take any prescription medications right now and don’t wish to start. Thanks.

    Personally, if all my other health markers were good, I wouldn’t worry about that level. Blood pressure is reduced by potassium intake, which you can get with a supplement or green leafy vegetables.

    1. Suzie_B

      I added magnesium to my diet and in my N=1, it seemed to help lower my BP. Low serum potassium is often accompanied by low magnesium. In fact, I could never get my potassium levels up into the normal range until I added magnesium. Now the levels are normal and so is my BP.

    2. Phyllis Mueller

      Peggy Sue, what’s your caffeine intake? Switching to decaf coffee or decaf tea (or regular tea instead of coffee, even) could be helpful.

      So could increasing your potassium and magnesium. The Drs. Eades discuss potassium supplementation in Protein Power. There are whole books on the role of magnesium (The Magnesium Miracle and The Magnesium Factor are two good ones). Transdermal magnesium supplementation (e.g., Epsom salts baths or applications of magnesium oil) bypasses the potential for intestinal upset.

      There are numerous non-drug suggestions on The People’s Pharmacy website as well.

      1. Peggy Sue

        Phyllis, I’m not a coffee drinker. I drink one cup of black tea on work days if I don’t sleep well the night before (about once every 2 weeks). I have a chocolate tea daily that has some caffeine in it.

        I’ll look into the magnesium and potassium supplementation and see if that helps. Thanks.

    3. Jane

      Peggy Sue,

      Keep up the good work loosing weight. Body Mass Index (BMI) or “those ridiculous height/weight charts is actually a good measure unless you are a Olympic body builder. That is how out of shape America. Even the “skinny” people are overweight.

  5. Walter Bushell

    A few things stand out. One is that the people with the hyper low salt intake are probably the ones with the recommended health habits so if Jai Random Luser really reduced salt consumption to 1.5 grams/day the death rate would go up. Perhaps this would be good for Social Security, but it’s a rough way to the goal.

    How did they measure how much salt the people were eating?

    Very high levels of salt consumption probably occur from processed food where the salt is hidden. Most people don’t know that cola is a salt source and one of the methods of hiding salt is to add sugar so that’s another confounder, and the people who eat 7 grams or more of salt a day are probably mainly people who live on the worst snack foods and have terrible health habits and worse doctors.

    Besides if they changed their minds they would have to admit that their advice was not only depriving people of pleasure, but actually killing people, perhaps even there own families a realization that most people just cannot accept.

    In one study, they measured urinary sodium excretion. Yes, I think part of the reason they can’t change their minds is that they’d have to admit they’ve killed people.

  6. Kim

    Not long ago I read that back in the day, normal systolic BP in middle age and beyond was 100+your age. It is natural for BP to increase with age due to less arterial fexibility. There are actually quite a few health problems with LOW BP. My dad had a stroke recently and when he was in hospital, they keep BP on the high side. Too low is worse.

    I’d read that as well. The definition of “normal” blood pressure, like “normal” cholesterol, was redefined downwards.

  7. Cyborcat

    This is kind of funny to me because my mom always got on me for using too much salt because “it’ll give you high blood pressure”.

    I do use a lot of salt–I tend to dump it on, even on things that other people think are already salty, and yet I have never tested for high blood pressure. And other than excess weight (which was more likely from all the sugar and carbs I consumed) and some fluid retention in my feet (which could be attributed to sitting at a desk all day), I don’t have any real health problems.

    I don’t think I ever thought salt was healthy, but I think I always felt that the dangers of it were exaggerated. At least when it comes to table salt–those frozen dinners that contain something like 60% of your daily value of sodium are another matter, I’m sure.

    I’ve always had a taste for salt, but never had high blood pressure.

  8. Marilyn

    Epidemiological study of 1: I knew a woman who fried everything in lard and salted it heavily — and lived to 102.

  9. Lori

    When I’m working in the yard or exercising or dancing hard, I’ve got to eat some salt or I feel weak and dizzy.

    Salt is good when you have a cold, too. If your nose is running, you’re burning through more salt than usual.

    Re: potassium, Phinney & Volek say in The Art and Science of Low Carbohydrate Performance, “This state of salt depletion causes a compensatory loss of potassium, which has a negative impact on muscle mass…The easy solution is to routinely take 1-2 grams of sodium per day in the form of 2 bouillon cubes.”

    When I was in high school, the guys who endured two-a-day workouts on the football team were given salt tablets.

    1. Firebird

      When I was a kid playing Little League, my mom would do the same on a particularly hot and muggy day, as is the norm in the Philadelphia area.

      Me? I don’t have a sweet tooth, though I like my protein shakes and iced tea. Rather, I have a salt tooth. Even jarred spaghetti sauce…the good ones like Barilla that have very clean ingredients (3-4) are so low in sodium that I have to add salt when I put the sauce on the shiritaki noodles.

  10. Pierre Robert Groulx

    Sugar is often added to table salt as a cheap way to add flavor and bulk. This “salt” is then blamed for causing problems with the circulatory system. Crazy, huh?

    If sugar mixed with fat causes disease, they blame the fat. If sugar mixed with salt causes disease, they blame the salt.

    1. Gilana

      Sorry, but sugar is added to table salt? I have never seen that, read that, or heard that anywhere. I’d be very interested to learn where sugar is mixed with table salt so I can avoid it.

      1. K2

        Check out plain Morton’s table salt (not the sea salt… just the ordinary old salt). It has dextrose added. It has for years – I remember commenting to my father WAY back when I was in high school how I couldn’t believe there was sugar in salt.

    1. cavenewt

      My salt shaker is half-and-half Lite Salt (for the potassium) and Real Salt mined sea salt.

  11. PrimeNumbers

    Mistakes were mad (but not by me), should be required reading by everyone, but even then the unfortunate outcome would be that many readers would still believe that the clearly presented cognitive biases that effect everyone don’t effect them.

    Indeed. I, of course, have no biases.

  12. Janelle

    Peggy Sue, you might consider supplementing with magnesium. It’s a natural muscle relaxant and it’s thought many of us are deficient in it. It’s known to lower blood pressure. Give it a Google.

  13. Scott

    Did you see the new Subway ad were they brag about being the only restaraunt with food approved by the AHA, pathetic probally because they are the only fast food place willing to shell out money to them.

    Yeah, they paid more than $600,000 for that seal of approval.

  14. Peggy Sue

    I’ve been on a low-carb diet for about 1 year and have lost 12 pounds (I am still 5 pounds over the maximum weight range according to those ridiculous height/weight charts) , feel much better, have more energy and had a blood test in February in which all my numbers were good EXCEPT my blood pressure. It’s typically around 130/90 and has been for at least the past 3 years. So the low-carb diet didn’t make it worse, but it didn’t help either.

    My doctor handed me a pamphlet about a low-sodium diet and told me to try lowering my BP through diet and if that didn’t work, she was going to put me on medication. The pamphlet recommends 2300 mg or less daily, but states that 2000 mg or less is a low-sodium diet. I’ve been keeping it at 2300 mg per day or lower for the last two weeks, but my BP is still the same (I have a BP cuff at home).

    If the sodium reduction doesn’t work, is there another natural way of lowering my BP? Also, is 130/90 really horrible? Do I really need to take drugs for this? I am a 44 year old female. I don’t take any prescription medications right now and don’t wish to start. Thanks.

    Personally, if all my other health markers were good, I wouldn’t worry about that level. Blood pressure is reduced by potassium intake, which you can get with a supplement or green leafy vegetables.

    1. Suzie_B

      I added magnesium to my diet and in my N=1, it seemed to help lower my BP. Low serum potassium is often accompanied by low magnesium. In fact, I could never get my potassium levels up into the normal range until I added magnesium. Now the levels are normal and so is my BP.

    2. Phyllis Mueller

      Peggy Sue, what’s your caffeine intake? Switching to decaf coffee or decaf tea (or regular tea instead of coffee, even) could be helpful.

      So could increasing your potassium and magnesium. The Drs. Eades discuss potassium supplementation in Protein Power. There are whole books on the role of magnesium (The Magnesium Miracle and The Magnesium Factor are two good ones). Transdermal magnesium supplementation (e.g., Epsom salts baths or applications of magnesium oil) bypasses the potential for intestinal upset.

      There are numerous non-drug suggestions on The People’s Pharmacy website as well.

      1. Peggy Sue

        Phyllis, I’m not a coffee drinker. I drink one cup of black tea on work days if I don’t sleep well the night before (about once every 2 weeks). I have a chocolate tea daily that has some caffeine in it.

        I’ll look into the magnesium and potassium supplementation and see if that helps. Thanks.

    3. Jane

      Peggy Sue,

      Keep up the good work loosing weight. Body Mass Index (BMI) or “those ridiculous height/weight charts is actually a good measure unless you are a Olympic body builder. That is how out of shape America. Even the “skinny” people are overweight.

  15. James C

    I have no idea how much salt I consume and I have no intention of trying to figure it out. I listen to my body. If I crave salt it is clear my body is saying I need it. If the craving goes away, I don’t. It isn’t complicated.

  16. Walter Bushell

    A few things stand out. One is that the people with the hyper low salt intake are probably the ones with the recommended health habits so if Jai Random Luser really reduced salt consumption to 1.5 grams/day the death rate would go up. Perhaps this would be good for Social Security, but it’s a rough way to the goal.

    How did they measure how much salt the people were eating?

    Very high levels of salt consumption probably occur from processed food where the salt is hidden. Most people don’t know that cola is a salt source and one of the methods of hiding salt is to add sugar so that’s another confounder, and the people who eat 7 grams or more of salt a day are probably mainly people who live on the worst snack foods and have terrible health habits and worse doctors.

    Besides if they changed their minds they would have to admit that their advice was not only depriving people of pleasure, but actually killing people, perhaps even there own families a realization that most people just cannot accept.

    In one study, they measured urinary sodium excretion. Yes, I think part of the reason they can’t change their minds is that they’d have to admit they’ve killed people.

  17. moreporkplease

    Re: the lady trying to lower her blood pressure – Grapeseed extract is worth a try:

    Grape Polyphenols Reduce Blood Pressure and Increase Flow-Mediated Vasodilation in Men with Metabolic Syndrome J. Nutr. 2012 142: 9 1626-1632; first published online July 18, 2012.

    Also try a night-time relaxation system – any breath-based regime with pretty music will do, but a lot of people like the Breathe Easy system.

    Using these 2 methods, my husband lowered his BP 15 points in 10 weeks. But you have to keep it up to maintain the benefits.

  18. Peter Lawton

    For a long time iv’e been examining the topics of micro- and macro-nutrients, salts(not just Sodium salt), sugars(not just table sugar), anti-butter, pro-margarine, carbs in general, vegetable and seed oils, flesh/fish/fowl and their own fats.
    Some things stick out dramatically.
    #1 No massive campaigns were run to promote/propagandise good, natural, regionally and seasonally relevant ancient foods.
    #2 Big world-wide campaigns are continuously conducted to promote things like cigarettes, margarine, soda-pops and colas, processed carbohydrates, deodorized chemically stripped oils, sweets/bars/candies and ‘industrially-made eatables’.
    #3 The use-and-abuse of words to plant suggestions of causality/responsibility has been very obvious in anti-salt, anti-cholesterol, anti-fats, blood-pressure vs mortality, and almost all conclusory language in their promotional papers.
    #4 Mountains-of-money expended to promote drugs to lower BP, reduce intake of, or cellular production of cholesterol, at same time ‘eat potato crisps’, “buy-a-burger-get-a-free-coke”.
    I conclude that the more time, money and effort you see in promoting stuff, the more vigilant you should be. It is possible to say that something immoral and unethical is going on in the industrially-orientate food-and-pharma world.

    1. Linda R

      Your last paragraph, to me, is right on.

      I’ve made the decision to never buy or eat ANYTHING advertised on TV, and it makes it very simple to purchase healthy foods. After all, when is the last time we saw an ad for a lovely head of romaine or a gorgeous, red, ripe tomato, a succulent grass fed beef roast or pastured pork bacon?

      Good point. Real food is rarely advertised because real food isn’t brand-specific.

  19. Kim

    Not long ago I read that back in the day, normal systolic BP in middle age and beyond was 100+your age. It is natural for BP to increase with age due to less arterial fexibility. There are actually quite a few health problems with LOW BP. My dad had a stroke recently and when he was in hospital, they keep BP on the high side. Too low is worse.

    I’d read that as well. The definition of “normal” blood pressure, like “normal” cholesterol, was redefined downwards.

  20. Cyborcat

    This is kind of funny to me because my mom always got on me for using too much salt because “it’ll give you high blood pressure”.

    I do use a lot of salt–I tend to dump it on, even on things that other people think are already salty, and yet I have never tested for high blood pressure. And other than excess weight (which was more likely from all the sugar and carbs I consumed) and some fluid retention in my feet (which could be attributed to sitting at a desk all day), I don’t have any real health problems.

    I don’t think I ever thought salt was healthy, but I think I always felt that the dangers of it were exaggerated. At least when it comes to table salt–those frozen dinners that contain something like 60% of your daily value of sodium are another matter, I’m sure.

    I’ve always had a taste for salt, but never had high blood pressure.

  21. Marilyn

    Epidemiological study of 1: I knew a woman who fried everything in lard and salted it heavily — and lived to 102.

  22. Lori

    When I’m working in the yard or exercising or dancing hard, I’ve got to eat some salt or I feel weak and dizzy.

    Salt is good when you have a cold, too. If your nose is running, you’re burning through more salt than usual.

    Re: potassium, Phinney & Volek say in The Art and Science of Low Carbohydrate Performance, “This state of salt depletion causes a compensatory loss of potassium, which has a negative impact on muscle mass…The easy solution is to routinely take 1-2 grams of sodium per day in the form of 2 bouillon cubes.”

    When I was in high school, the guys who endured two-a-day workouts on the football team were given salt tablets.

    1. Firebird

      When I was a kid playing Little League, my mom would do the same on a particularly hot and muggy day, as is the norm in the Philadelphia area.

      Me? I don’t have a sweet tooth, though I like my protein shakes and iced tea. Rather, I have a salt tooth. Even jarred spaghetti sauce…the good ones like Barilla that have very clean ingredients (3-4) are so low in sodium that I have to add salt when I put the sauce on the shiritaki noodles.

    1. cavenewt

      My salt shaker is half-and-half Lite Salt (for the potassium) and Real Salt mined sea salt.

  23. Janelle

    Peggy Sue, you might consider supplementing with magnesium. It’s a natural muscle relaxant and it’s thought many of us are deficient in it. It’s known to lower blood pressure. Give it a Google.

  24. James C

    I have no idea how much salt I consume and I have no intention of trying to figure it out. I listen to my body. If I crave salt it is clear my body is saying I need it. If the craving goes away, I don’t. It isn’t complicated.

  25. moreporkplease

    Re: the lady trying to lower her blood pressure – Grapeseed extract is worth a try:

    Grape Polyphenols Reduce Blood Pressure and Increase Flow-Mediated Vasodilation in Men with Metabolic Syndrome J. Nutr. 2012 142: 9 1626-1632; first published online July 18, 2012.

    Also try a night-time relaxation system – any breath-based regime with pretty music will do, but a lot of people like the Breathe Easy system.

    Using these 2 methods, my husband lowered his BP 15 points in 10 weeks. But you have to keep it up to maintain the benefits.

  26. Peter Lawton

    For a long time iv’e been examining the topics of micro- and macro-nutrients, salts(not just Sodium salt), sugars(not just table sugar), anti-butter, pro-margarine, carbs in general, vegetable and seed oils, flesh/fish/fowl and their own fats.
    Some things stick out dramatically.
    #1 No massive campaigns were run to promote/propagandise good, natural, regionally and seasonally relevant ancient foods.
    #2 Big world-wide campaigns are continuously conducted to promote things like cigarettes, margarine, soda-pops and colas, processed carbohydrates, deodorized chemically stripped oils, sweets/bars/candies and ‘industrially-made eatables’.
    #3 The use-and-abuse of words to plant suggestions of causality/responsibility has been very obvious in anti-salt, anti-cholesterol, anti-fats, blood-pressure vs mortality, and almost all conclusory language in their promotional papers.
    #4 Mountains-of-money expended to promote drugs to lower BP, reduce intake of, or cellular production of cholesterol, at same time ‘eat potato crisps’, “buy-a-burger-get-a-free-coke”.
    I conclude that the more time, money and effort you see in promoting stuff, the more vigilant you should be. It is possible to say that something immoral and unethical is going on in the industrially-orientate food-and-pharma world.

    1. Linda R

      Your last paragraph, to me, is right on.

      I’ve made the decision to never buy or eat ANYTHING advertised on TV, and it makes it very simple to purchase healthy foods. After all, when is the last time we saw an ad for a lovely head of romaine or a gorgeous, red, ripe tomato, a succulent grass fed beef roast or pastured pork bacon?

      Good point. Real food is rarely advertised because real food isn’t brand-specific.

  27. Dave, RN

    One of the unintended consequences of salt reduction is the reduction of iodine. Salt is most peoples sole source of iodine from iodized salt.

    That, coupled with the consumption of bread, which has bromide (a halogen, like iodine) and chlorine in the water (another halide) fill the iodine receptor sites, resulting in a deficiency of iodine.

    Iodine deficiency is related to breast and prostate cancer besides goiter.

  28. Julie

    Wow, how could anyone face that kind of data and still believe it’s wrong. To believe your epidemiological teleoanalysistic (pardon me while I make up words) theories are correct while controlled, randomized studies are dead wrong…. that’s just crazy. That’s bad science, and it’s dangerous to everyone they’re trying to “help”.

    When I was on a low calorie vegetarian diet, at one point I decided to try to eat low sodium as well. My aim was 2100 mg of sodium, I think. It was nearly impossible. Most days I at at least 2300, and even when I went a little higher, my food was so bland it was almost painful. And keep in mind, I was only eating about 1300 calories a day, so to tell someone eating 2000 calories or more a day to consume only 1500 mg of sodium? Impossible. Unless they’re eating like a raw diet.

    They’re taking the Dean Ornish approach to the evidence: latching onto weak observational studies as “proof” while dismissing randomized studies. I guess that’s what you have to do when the science isn’t in your favor.

  29. gollum

    First thought “yeah heartsick grandma gets salt ban” but this was actually intervention, so we have only placebo effect to blame – still pretty impressive.

    I always thought (don’t know for sure) the small reduction in blood pressure to be an artifical effect, like: stopping pumping gas into car reduces gas odors and explosions. That’s technically true, but you’d better fix the gas valves. Same with cholesterol and poisoning your body bringing it down.

    Do you have any data on potassium and magnesium and its effect on blood pressure / health / sodium metabolism?

    Listening to your body may be fine but it may be unable to deliver exact specifications. “Get food”, “crave electrolytes” .. maybe “eating bread” or “eating sodium” may not be what you really need.

    I try to get enough potassium and magnesium, buying “diet” salt (as suggested, yes) not for the diet but the K+.. also E501 has K+. You gotta be careful with that stuff though – first, as with salt, if your kidneys don’t work well, second, overdose of K+ (hyperkalaemia) can induce instant heartstop (I think several grams needed)

    No, I don’t have any hard data on how much potassium or magnesium is required to lower blood pressure. My BP runs low/normal, so I’ve never worried about it.

  30. Carole Sampson

    A life without salt (and butter and wine and chocolate) is not worth living.

    Carole AKA CarbsaneR

    Indeed. I’ve been enjoying your blog posts, by the way, even though I haven’t read anything by the subject of those posts in years.

  31. Dave, RN

    One of the unintended consequences of salt reduction is the reduction of iodine. Salt is most peoples sole source of iodine from iodized salt.

    That, coupled with the consumption of bread, which has bromide (a halogen, like iodine) and chlorine in the water (another halide) fill the iodine receptor sites, resulting in a deficiency of iodine.

    Iodine deficiency is related to breast and prostate cancer besides goiter.

  32. Julie

    Wow, how could anyone face that kind of data and still believe it’s wrong. To believe your epidemiological teleoanalysistic (pardon me while I make up words) theories are correct while controlled, randomized studies are dead wrong…. that’s just crazy. That’s bad science, and it’s dangerous to everyone they’re trying to “help”.

    When I was on a low calorie vegetarian diet, at one point I decided to try to eat low sodium as well. My aim was 2100 mg of sodium, I think. It was nearly impossible. Most days I at at least 2300, and even when I went a little higher, my food was so bland it was almost painful. And keep in mind, I was only eating about 1300 calories a day, so to tell someone eating 2000 calories or more a day to consume only 1500 mg of sodium? Impossible. Unless they’re eating like a raw diet.

    They’re taking the Dean Ornish approach to the evidence: latching onto weak observational studies as “proof” while dismissing randomized studies. I guess that’s what you have to do when the science isn’t in your favor.

  33. Gerard

    Mecicine today is in a really sorry state. To really get to the truth….follow the money. This link is from the ADA…http://www.diabetes.org/donate/sponsor/banting-circle-supporters.html
    Notice anything. Yep, the top Donors to The American Diabetes Association
    are almost all Pharmacies. I believe this is true of all the alphabet soup medical outfits like AMA,ADA, NIH etc. Is this sick or what? Anyway, I really enjoy your blog. My wife and I both lowcarb going on 15 Years each. Even considered going on your Low carb cruise but my wife has motion sickness problems. Keep up the good work.

    Sorry to hear the motion sickness prevented her from coming aboard the cruise. I know some people wear a skin patch that helps with that.

  34. gollum

    First thought “yeah heartsick grandma gets salt ban” but this was actually intervention, so we have only placebo effect to blame – still pretty impressive.

    I always thought (don’t know for sure) the small reduction in blood pressure to be an artifical effect, like: stopping pumping gas into car reduces gas odors and explosions. That’s technically true, but you’d better fix the gas valves. Same with cholesterol and poisoning your body bringing it down.

    Do you have any data on potassium and magnesium and its effect on blood pressure / health / sodium metabolism?

    Listening to your body may be fine but it may be unable to deliver exact specifications. “Get food”, “crave electrolytes” .. maybe “eating bread” or “eating sodium” may not be what you really need.

    I try to get enough potassium and magnesium, buying “diet” salt (as suggested, yes) not for the diet but the K+.. also E501 has K+. You gotta be careful with that stuff though – first, as with salt, if your kidneys don’t work well, second, overdose of K+ (hyperkalaemia) can induce instant heartstop (I think several grams needed)

    No, I don’t have any hard data on how much potassium or magnesium is required to lower blood pressure. My BP runs low/normal, so I’ve never worried about it.

  35. Carole Sampson

    A life without salt (and butter and wine and chocolate) is not worth living.

    Carole AKA CarbsaneR

    Indeed. I’ve been enjoying your blog posts, by the way, even though I haven’t read anything by the subject of those posts in years.

  36. Gerard

    Mecicine today is in a really sorry state. To really get to the truth….follow the money. This link is from the ADA…http://www.diabetes.org/donate/sponsor/banting-circle-supporters.html
    Notice anything. Yep, the top Donors to The American Diabetes Association
    are almost all Pharmacies. I believe this is true of all the alphabet soup medical outfits like AMA,ADA, NIH etc. Is this sick or what? Anyway, I really enjoy your blog. My wife and I both lowcarb going on 15 Years each. Even considered going on your Low carb cruise but my wife has motion sickness problems. Keep up the good work.

    Sorry to hear the motion sickness prevented her from coming aboard the cruise. I know some people wear a skin patch that helps with that.

  37. Martí

    Thanks for the article Tom!

    I never fail to be amazed at what health agencies want us to be afraid of. Processed foods that are, by definition, extremely unnatural are considered ‘healthy’ but something as natural and necessary as salt is demonized. 😛 Our kidneys know how to deal with too high salt, filtering out the excess on a low carb diet is fairly easy for them=no problem. However, it makes much more sense for low salt intake to have terrible effects on the body. Salt is meant to regulate blood pressure, dip too low and the kidneys need to start working harder to filter toxins out of the blood and secrete lots of renin to keep your blood pressure up. Bowden and Sinatra’s book “The Great Cholesterol Myth” also mentions that insulin secretion causes the kidneys to retain salt. If insulin is necessary to retain what little salt we eat thanks to the AHA’s advice then increased insulin resistance is the next step on the logical progression.

    But hey! Its not that bad if your blood becomes more toxic, kidneys fail, you become diabetic and you still have a heart attack because you’ve done the AHA proud! The possibility of lowering that blood pressure was worth it, even if it removed happiness from food ^_^

    Keep tearing at the veil health agencies place between the public and the truth Tom, your blog always inspires me to think critically about what the scientific community teaches!

    Cheers!

    Yup, by telling us to eat crap cereals and crap sandwiches (low-fat!), they are telling us to consume food that raise blood pressure by provoking high insulin levels. Their advice is worse than worthless; it’s dangerous.

  38. Martí

    Thanks for the article Tom!

    I never fail to be amazed at what health agencies want us to be afraid of. Processed foods that are, by definition, extremely unnatural are considered ‘healthy’ but something as natural and necessary as salt is demonized. 😛 Our kidneys know how to deal with too high salt, filtering out the excess on a low carb diet is fairly easy for them=no problem. However, it makes much more sense for low salt intake to have terrible effects on the body. Salt is meant to regulate blood pressure, dip too low and the kidneys need to start working harder to filter toxins out of the blood and secrete lots of renin to keep your blood pressure up. Bowden and Sinatra’s book “The Great Cholesterol Myth” also mentions that insulin secretion causes the kidneys to retain salt. If insulin is necessary to retain what little salt we eat thanks to the AHA’s advice then increased insulin resistance is the next step on the logical progression.

    But hey! Its not that bad if your blood becomes more toxic, kidneys fail, you become diabetic and you still have a heart attack because you’ve done the AHA proud! The possibility of lowering that blood pressure was worth it, even if it removed happiness from food ^_^

    Keep tearing at the veil health agencies place between the public and the truth Tom, your blog always inspires me to think critically about what the scientific community teaches!

    Cheers!

    Yup, by telling us to eat crap cereals and crap sandwiches (low-fat!), they are telling us to consume food that raise blood pressure by provoking high insulin levels. Their advice is worse than worthless; it’s dangerous.

  39. LFM

    I could be wrong about this – I’m a beginner when it comes to nutrition even from the amateur’s point of view – but the conventional wisdom is that salt can be dangerous to someone already suffering from reduced kidney function, and that seems to have some truth in it. In that situation, the body can’t get rid of the salt via the normal methods excretion.

    However, the joke is that one of the most common causes of kidney damage is diabetes and the drugs people take for diabetes. If they hadn’t been eating too much sugar or starch in the first place, which put pressure on their kidneys, and then had to take drugs for diabetes, which put further pressure on their kidneys, they would not end up having to reduce their salt intake.

    I think – though I’m not sure – that the lesson is that if you want to protect your kidneys and aren’t yet diabetic, you should give up sugar and starch, not salt.

    LFM

    That’s correct. Once high glucose levels have damaged your kidneys, you can become sensitive to salt.

  40. LFM

    I could be wrong about this – I’m a beginner when it comes to nutrition even from the amateur’s point of view – but the conventional wisdom is that salt can be dangerous to someone already suffering from reduced kidney function, and that seems to have some truth in it. In that situation, the body can’t get rid of the salt via the normal methods excretion.

    However, the joke is that one of the most common causes of kidney damage is diabetes and the drugs people take for diabetes. If they hadn’t been eating too much sugar or starch in the first place, which put pressure on their kidneys, and then had to take drugs for diabetes, which put further pressure on their kidneys, they would not end up having to reduce their salt intake.

    I think – though I’m not sure – that the lesson is that if you want to protect your kidneys and aren’t yet diabetic, you should give up sugar and starch, not salt.

    LFM

    That’s correct. Once high glucose levels have damaged your kidneys, you can become sensitive to salt.

  41. Brandon

    My physiology professor went to a nutritional conference once in America. I remember him saying that they set a daily salt intake limit for people who cannot regulate salt levels in their bodies (a very rare condition), then they decided to apply it to everyone else as well with the reasoning of ‘lower salt consumption isn’t harmful.’

    Yup, they decided the easy solution was to tell everyone to cut back on salt.

  42. Sally

    I have PCOS which in my case and opinion is just a group of symptoms of insulin resistance. I believe I got this because my parents fed us the so called “healthy” way with high carbs, low fat, and low salt. I needed fertility interventions to have my previous children. Finally I convinced a doc to let me go on Metformin instead of BCPs. I did well and that dropped my blood pressure and helped me to loose some weight. Then I saw “Fat Head” and said let’s also try this HFLC diet. I lost more weight and bam I got pregnant again on my own, a big surprise because every doc said I would need help for any pregnancy I wanted. So now too low salt intake can also cause insulin resistance. Yes and lowering my sugar and insulin also lowered my blood pressure.

    Dr. Michael Fox (a reproductive endocrinologist) gave a talk on the cruise two years ago about why a LCHF diet makes it easier to get pregnant.

  43. Brandon

    My physiology professor went to a nutritional conference once in America. I remember him saying that they set a daily salt intake limit for people who cannot regulate salt levels in their bodies (a very rare condition), then they decided to apply it to everyone else as well with the reasoning of ‘lower salt consumption isn’t harmful.’

    Yup, they decided the easy solution was to tell everyone to cut back on salt.

  44. Sally

    I have PCOS which in my case and opinion is just a group of symptoms of insulin resistance. I believe I got this because my parents fed us the so called “healthy” way with high carbs, low fat, and low salt. I needed fertility interventions to have my previous children. Finally I convinced a doc to let me go on Metformin instead of BCPs. I did well and that dropped my blood pressure and helped me to loose some weight. Then I saw “Fat Head” and said let’s also try this HFLC diet. I lost more weight and bam I got pregnant again on my own, a big surprise because every doc said I would need help for any pregnancy I wanted. So now too low salt intake can also cause insulin resistance. Yes and lowering my sugar and insulin also lowered my blood pressure.

    Dr. Michael Fox (a reproductive endocrinologist) gave a talk on the cruise two years ago about why a LCHF diet makes it easier to get pregnant.

  45. Jill

    “make them irrelevant” – Out of the mouths of babes and ex-comedians!!

    I think you’ve just solved a problem for me Tom!! :)This sort of article requires me to readf it several times to understand it fully.
    But good stuff once again.
    I wonder if the Heart Foundation actually understand science, research and associated issues of nutrition.

    Meanwhile, in the exciting world down under (Australia) proponents of a fat tax -naturally, only on fast food, rather than duck confit – are pushing their satfat barrow.

    Yes, because cutting saturated fat from our diets worked so well.

    I think the AHA members engage in extreme selection bias when they read the science.

    1. Susan

      Some researchers are apparently on the right track. This article in the May 1, 2013, issue of Advances in Nutrition argues that the case against saturated fat has been overstated.

      http://advances.nutrition.org/content/4/3/294.long

      Among its conclusions, the articles says:

      “The influence of dietary fats on serum cholesterol has been overstated, and a physiological mechanism for saturated fats causing heart disease is still missing.”

      and

      “Saturated fats per se may not be responsible for many of the adverse health effects with which they have been associated…”

      Yay! Progress!

      Slowly but surely …

  46. johnny

    You goal is to make them (AHA, ADA, USDA et al.) irrelevant by convincing people to ignore them.

    In addition to that, my goal is to gather enough consensus among the people to sue/legislate these agencies out of existence and press criminal charges against the promoters of flawed science that have cause unnecessary deaths, pain and suffering.

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