What's Up With Salt?
Do we need to limit our salt intake?
Before I answer that question, let me start with one critical fact that is often forgotten: sodium and chloride, the minerals that make up “salt,” are essential nutrients. If there is one thing we know for sure, it’s that humans need to consume more than zero salt. The fact that we NEED salt is often lost in the barrage of public health advice to limit it. Sodium and chloride ions are part of our blood and lymph fluids, and they play a vital role in cardiovascular function and in the nervous system. Chloride is also a component of hydrochloric acid, which is critical to the digestion of food and destruction of food-borne pathogens. Research clearly shows that low sodium intake is associated with a higher risk of cardiovascular death and worse outcomes in type 2 diabetes, as well as a higher risk of falls, fractures and cognitive decline in the elderly.
Alright, so we know we need SOME salt. But is there such a thing as TOO MUCH salt? The salt we eat ends up in our blood. And since sodium attracts water, too much sodium in the blood could lead to higher blood volume and higher blood pressure. But that’s where the kidneys come in. The burden of a high salt diet largely falls on the kidneys. Blood is constantly being filtered through the kidneys where sodium is either retained in the blood or excreted into the urine. Healthy kidneys are designed to respond to a wide range of sodium levels, excreting it if blood pressure is rising, and retaining it if blood pressure is low. One thing that is worth mentioning is potassium’s role in keeping this balance. Without adequate dietary potassium, the kidneys can struggle to excrete sodium. Potassium is largely found in fruits and vegetables, items conspicuously missing from most fast-food menus.
The problem(s) with the modern diet
The restaurant and processed foods that make up such a big portion of our food supply are indeed high in sodium, but there’s so much more to the story. They are also super LOW in potassium – when’s the last time you ordered veggies through the fast-food window? And how about all that broccoli in a box of Velveeta’s Rotini & Cheese with broccoli? Ha! Instead, these high-sodium foods come with a heaping side of refined grains, seed oils and sugar. A truly deadly combination that invokes high blood sugar, high blood pressure and loads of inflammation throughout the body – the cornerstones of the diseases being blamed on squarely on salt.
Salt as a scapegoat
So why does salt get thrown under the bus? Well, when public health officials and governments are tasked with finding a solution to modern diseases, it’s with the caveat that it needs to be acceptable to the powers that be (cough…the food industry…cough). Add more potassium? No thanks, fruits and veggies cost too much and go bad too fast. Get rid of refined grains, seed oils and sugar? Haha, yeah right, those hyper-palatable and super cheap ingredients are the building blocks of profitable junk. So, in the 1970’s a researcher named Lewis Dahl gave them a more palatable option. He “proved” that salt was the root cause of high blood pressure by feeding rats the human equivalent of 500 grams of sodium per day – 50 times more than the average intake. He also pointed to a cherry-picked list of cultures that happened to have high salt intake AND high blood pressure. Just two decades later new research had thoroughly disproven his theory, but the public health and food industry wheels were in motion. Companies touted their new, lower sodium products while quietly replacing salt with sugar and a litany of other preservatives and additives. Now, 50 years later, we are still being fed this scapegoat solution, and our health continues to decline.
The reality is that salt, in and of itself, has little to no negative impact on the vast majority of the population. One exception might be individuals with kidney disease, who should work one-on-one with a skilled practitioner to determine their salt needs and limits. There is also a subset of individuals that are considered “salt-sensitive,” meaning their blood pressure does appear to rise after a salty meal. However, research indicates that simply incorporating high potassium foods (aka fruits and vegetables) into the meal can mitigate this effect.
Unintended consequences
In my opinion one of the worst consequences of low sodium propaganda is the decline of home cooking. I’ve had countless patients stop cooking with salt in the name of “health.” The result: their homecooked food tastes terrible. Their restaurant and processed food tastes great. And their attempts at home cooking last about 2 days before they’re back at the delicious drive through window. We NEED to elevate our home cooking so that we actually want to eat it, and salt is a harmless way to do it.
But what about babies?
The idea that babies can’t have salt is a myth, and a well circulated one at that! The actual research supporting this claim is extremely limited and weak. I’ll save my breath and direct you to the world’s most thorough summary of this issue by Lily Nichols, but to sum it up, we do not actually have reason to believe that salt harms babies. Just like adults, babies will simply excrete excess sodium in their urine, thanks to their kidneys.
One other quick note on this topic. Usually, this myth plays out in the form of unsalted baby food. Clients often tell me that they can’t feed the baby the same food as the rest of the family because the “adult” food is salted. So instead, they feed the baby unsalted homemade food or store-bought baby food. It’s expensive and time consuming, but they’re doing it for their baby’s health! Then, when it comes time to offer a kiddo some Goldfish (perhaps the saltiest, most addictingly delicious snack cracker of all time), no one blinks an eye. Please, stop doubting your own home cooking, and by all means, stop putting so much trust in packaged “kid foods!”
Does the type of salt we eat matter?
You have to ask yourself two questions when choosing salt: where did the salt originate, and how was it processed. Salt comes from two places:
Sea Salt: produced through evaporation of salt water from oceans or lakes
Sea salt typically undergoes very little processing and can be rich in minerals, depending on the water source
Rock Salt: Mined from underground salt mines
Rock salt also contains minerals, but in most cases they are removed during extensive processing
Most rock salt becomes what we call “table salt,” wherein the minerals are removed and anti-caking agents, iodine and sugar are added
The other main product of rock salt is “kosher salt,” which is also stripped of minerals but typically does not have any additives
As is usually my stance, the less processed a food, the more compatible it is with our body. I typically keep three brands of salt on hand. Two are sea salt: Redmond Real Salt and Maldon. Redmond Real Salt is mined from an ancient seabed located in Utah. Not only is it naturally rich in minerals, but it is also lower in modern pollutants because it is buried under layers of volcanic ash and clay. Maldon is harvested from the Blackwater estuary in Maldon, England. It has a high mineral content, amazing taste, and world-renowned texture that is flakey, crunchy, and, well…perfect. It’s gourmet salt. The only rock salt product I use is Diamond Crystal Kosher Salt. As with most kosher salt, it is pure salt, no additives, but it has been stripped of most minerals.
Generally speaking, I use Diamond Crystal when I am cooking and a recipe calls for a specific amount of salt. Salt measurements vary based on how big the crystals are, and I find that Diamond Crystal is typically the type of salt recipes are written for. I use Redmond Real Salt whenever I’m cooking and just salting “to taste.” It’s great for things like eggs and soup. And finally, I use my precious Maldon as a finishing salt, adding it to cooked meat, salad, veggies, eggs…I think I would probably eat my right arm if it had Maldon on it.
What about iodine?
Table salt has been fortified with iodine for about 100 years. No doubt, iodine deficiency causes a host of issues, most notably goiter. It is also correlated with breast cancer, and during pregnancy a severe iodine deficiency can lead to mental disability in the baby. Fortification of the salt supply drastically decreased the incidence of goiter and iodine deficiency in general, so many consider it a success. However, fortification of the food supply is a risky practice. For starters, supplementation is rarely a one-size-fits-all solution. Depending on a myriad of factors including your thyroid health, your ancestry, your overall diet and more, you may need more or less iodine than the person sitting next to you. Short of complex and repeated testing to see what your levels are, your next best bet is to eat a varied, real food diet and stay in tune with your body. Symptoms of iodine deficiency are somewhat vague, but can include unexplained weight gain or loss, swelling of the neck (goiter) and brain fog. If you notice these symptoms, it may warrant testing. In the event of a clinical deficiency your healthcare provider may recommend supplementation.
For those without symptoms, you can take a number of actions to reduce your risk of iodine deficiency. I would recommend any combination of the following strategies to increase your iodine intake:
Eat more sea vegetables. Most of the iodine in the world is located in the sea, so sea vegetables tend to be quite high in iodine. These include kelp, kombu, wakame, dulse and nori. You’re probably most familiar with nori, as that’s what sushi is wrapped with.
If you know you’re not going to start eating sushi and seaweed salads every day, it’s actually pretty easy to add sea vegetables to your regular meals. Kelp is one of the best sources of iodine and it’s sold in little shakers to add to food. They have very little taste and can be added to anything you would add salt to, especially soups, fried rice and any Asian dish. And Celtic, a great sea salt brand, even sells an all-purpose seasoning that’s amped up with sea veggies. It tastes AMAZING and can be used to season veggies, meat, even popcorn!
Use iodized salt at home some of the time. I love my Diamond Crystal kosher salt, but if I was really worried (or perhaps if I was pregnant), I might swap that out for iodized salt. I wouldn’t eliminate sea salt, I’d just go back and forth.
Eat iodine-rich foods. Nothing comes close to sea vegetables, but there are some foods that have more iodine than others. As you might guess, seafood is pretty high, especially cod, haddock, whiting, lobster, shrimp, sardines, salmon, tuna, oysters, scallops and mussels. Milk and butter also have some iodine, although the amount varies.
I hope that (very long) explanation helps put your mind at ease about salt. Now get in the kitchen and cook up something DELICIOUS!