Why High Salt Consumption Alone Will Not Increase Your Heart Disease Risk

By Dr. Mercola

Salt has long been a treasured food staple. Far from being harmful, high-quality salt is actually essential for life, but in the United States and many other developed countries salt has been vilified as a primary cause of high blood pressure and heart disease.

According to preliminary research presented at an American Heart Association meeting in New Orleans on March 21,¹ excessive salt consumption contributed to 2.3 million heart-related deaths worldwide in 2010; 42 percent from coronary heart disease and 41 percent from stroke.

This includes sodium intake from commercially available table salt and sodium found in processed foods and soy sauce. According to the researchers, 40 percent of deaths were premature, occurring in those under the age of 69. Sixty percent of the deaths were in men; 40 percent were women.

To reach these conclusions, the researchers analyzed 247 food surveys on sodium consumption collected between 1990 and 2010. From these, they tried to determine how the various salt intakes affected cardiovascular disease risks. The ideal salt intake was determined to be less than 1,000 mg per day.

Kazakhstan had the highest average salt intake at 6,000 mg per day. Kenya and Malawi had the lowest average intake at about 2,000 mg. Other salty regions included Central Asia, with an average of 5,500 mg sodium per day; high-income countries in the Asia-Pacific area, averaging 5,000 mg per day; and East Asia at 4,800 mg per day.

According to the featured article:²

"Global sodium intake from various sources such as prepared food and soy sauce averaged nearly 4,000 milligrams a day in 2010... In the U.S., the average intake was about 3,600 milligrams a day. While the World Health Organization recommends sodium intake of fewer than 2,000 milligrams a day, 181 of 187 countries representing 99 percent of the world's population exceeded the recommended level."

You Need Salt, But Make Sure It's the Right Kind

So is salt a dietary friend or foe? Salt is actually a nutritional goldmine, provided you consume the right kind, and maintain a proper salt-to-potassium ratio, which I'll discuss in a moment. Unfortunately, modern table salt has very little in common with natural, unrefined salt.

Salt provides two elements – sodium and chloride – that are essential for life. Your body cannot make these elements on its own, so you must get them from your diet. Some of the many biological processes for which natural salt is crucial include:

Being a major component of your blood plasma, lymphatic fluid, extracellular fluid, and even amniotic fluid	Carrying nutrients into and out of your cells, and helping maintain your acid-base balance	Increasing the glial cells in your brain, which are responsible for creative thinking and long-term planning. Both sodium and chloride are also necessary for the firing of neurons
Maintain and regulate blood pressure	Helping your brain communicate with your muscles, so that you can move on demand via sodium-potassium ion exchange	Supporting the function of your adrenal glands, which produce dozens of vital hormones

 

However, not all salts are created equal. Natural salt contains 84 percent sodium chloride, and 16 percent naturally-occurring trace minerals, including silicon, phosphorous and vanadium.

Processed (table) salt, on the other hand, contains 97.5 percent sodium chloride and the rest is man-made chemicals, such as moisture absorbents and flow agents. These are dangerous chemicals like ferrocyanide and aluminosilicate. A small amount of iodine may also be added.

Some European countries, where water fluoridation is not practiced, also add fluoride to their salt.³ In France for example, 35 percent of table salt sold contains either sodium fluoride or potassium fluoride, and use of fluoridated salt is widespread in South America.

Besides these basic differences in nutritional content, the processing—which involve drying the salt above 1,200 degrees Fahrenheit—also radically alters the chemical structure of the salt. So, while you definitely need salt for optimal health, not just any salt will do. What your body needs is natural, unprocessed salt, without added chemicals.

Does Salt Really Cause Heart Disease?

Overindulgence in the typically used commercially processed table salt can lead to fluid retention, high blood pressure, swelling of your limbs, and shortness of breath. In the long term, it is thought to contribute to high blood pressure, kidney and heart disease, heart attacks, and heart failure.

However, compelling evidence suggests that while processed salt can indeed cause fluid retention and related health problems, numerous studies have, overall, refuted the salt-heart disease connection.

For example, a 2011 meta-analysis of seven studies involving more than 6,000 people found NO strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death.⁴ In fact, salt restriction actually increased the risk of death in those with heart failure.

Similarly, research published in the Journal of the American Medical Association that same year revealed that the less sodium excreted in your urine (a marker of salt consumption), the greater the risk of dying from heart disease.⁵ This study followed 3,681 middle-aged healthy Europeans for eight years. The participants were divided into three groups: low salt, moderate salt, and high salt consumption. Researchers tracked mortality rates for the three groups, with the following results:

1. Low-salt group: 50 people died
2. Moderate salt group: 24 people died
3. High-salt group: 10 people died

The risk for heart disease was 56 percent higher for the low-salt group than for the group who ate the most salt! Some studies have shown a modest benefit to salt restriction among some people with high blood pressure, but the evidence does not extend to the rest of the population. So what's really going on? Well, there are at least three factors that need to be taken into consideration.

1. First, an ingredient that contributes to high blood pressure and heart disease across the board is fructose, and since so much of salt intake comes from processed foods, it's easy to see how the lines of causation may get blurred. Virtually all processed foods are high not just in sodium, but also fructose, particularly in processed foods sold in the US.
2. Another factor is that there's a huge difference between natural salt and the processed salt added to processed foods and salt shakers in most homes and restaurants. The former is essential for good health, whereas the latter is best avoided altogether.
3. A third factor that can have a significant impact on whether salt will harm or aid your health is the ratio between the salt and potassium in your diet.

That said, it's clear that many are consuming far too much processed table salt and not enough natural salt. This begins early. According to the featured article, nearly 75 percent of processed meals and snacks for toddlers contain 210 mg of sodium per serving or more. Some toddler fare contains as much as 630 mg per serving, which equates to 40 percent of the daily limit recommended by the American Heart Association for adults. Lead researcher Dariush Mozaffarian, MD, MPH told MedPageToday:⁶

"'These findings highlight both the tremendous disease burdens caused by sodium but also the incredible opportunities for prevention.' ...He urged global public health efforts rather than relying on individuals to control intake of so pervasive an element. 'Our results should inspire both food industry and policymakers to take rapid and decisive actions to reduce sodium in the food supply... If voluntary agreements are not enough, taxation or restrictions on amounts of sodium should be implemented.'"

The Importance of Maintaining Optimal Sodium-Potassium Ratio

As mentioned earlier, another important factor that needs to be taken into account is the potassium to sodium ratio of your diet. Imbalance in this ratio can not only lead to hypertension (high blood pressure) but also contribute to a number of other diseases, including those highlighted in the featured research, along with a few others:

Heart disease and stroke	Memory decline	Osteoporosis	Ulcers and stomach cancer
Kidney stones	Cataracts	Erectile dysfunction	Rheumatoid arthritis

 

The easiest way to achieve this imbalance is by consuming a diet of processed foods, which are notoriously low in potassium while high in sodium. (And, to reiterate, processed foods are also loaded with fructose, which is clearly associated with increased heart disease risk, as well as virtually all chronic diseases.)

Why is potassium so important?

Among other things, your body needs potassium to maintain proper pH levels in your body fluids, and it also plays an integral role in regulating your blood pressure. It's possible that potassium deficiency may be more responsible for hypertension than excess sodium. Potassium deficiency leads to electrolyte imbalance, and can result in a condition called hypokalemia. Symptoms include:

• Water retention
• Raised blood pressure and hypertension
• Heart irregularities/arrhythmias
• Muscular weakness and muscle cramps
• Continual thirst and constipation

According to a 1985 article in The New England Journal of Medicine, titled "Paleolithic Nutrition,"⁷ our ancient ancestors got about 11,000 mg of potassium a day, and about 700 mg of sodium. This equates to nearly 16 times more potassium than sodium. Compare that to the Standard American Diet where daily potassium consumption averages about 2,500 mg (the RDA is 4,700 mg/day), along with 3,600 mg of sodium... As mentioned earlier, if you eat a diet of processed foods, you can be virtually guaranteed that your potassium-sodium ratio is upside-down.

This may also explain why high-sodium diets appear to affect some people but not others. According to a 2011 federal study into sodium and potassium intake, those at greatest risk of cardiovascular disease were those who got a combination of too much sodium along with too little potassium.

The research, published in the Archives of Internal Medicine,⁸ was one of the first and largest US studies to evaluate the relationship of salt, potassium and heart disease deaths. According to Dr. Elena Kuklina, one of the lead authors of the study at the Centers for Disease Control and Prevention (CDC), potassium may neutralize the heart-damaging effects of salt. Tellingly, those who ate a lot of salt and very little potassium were more than twice as likely to die from a heart attack as those who ate about equal amounts of both nutrients.

How Can You Ensure Proper Sodium-to-Potassium Ratio?

So, how do you ensure you get these two important nutrients in more appropriate ratios?

1. First, ditch all processed foods, which are very high in processed salt and low in potassium and other essential nutrients.
2. Eat a diet of whole, unprocessed foods, ideally organically and locally-grown to ensure optimal nutrient content. This type of diet will naturally provide much larger amounts of potassium in relation to sodium.

I do not recommend taking potassium supplements to correct a sodium-potassium imbalance. Instead, it is best to simply alter your diet and incorporate more potassium-rich whole foods. Green vegetable juicing is an excellent way to ensure you're getting enough nutrients for optimal health, including about 300-400 mg of potassium per cup. By removing the fiber you can consume even larger volumes of important naturally occurring potassium. Some additional rich sources in potassium are:

1. Lima beans (955 mg/cup)
2. Winter squash (896 mg/cup)
3. Cooked spinach (839 mg/cup)
4. Avocado (500 mg per medium)

Other potassium-rich fruits and vegetables include:

• Fruits: papayas, prunes, cantaloupe, and bananas. (But be careful of bananas as they are high in sugar and have half the potassium that an equivalent of amount of green vegetables. It is an old wives tale that you are getting loads of potassium from bananas, the potassium is twice as high in green vegetables)
• Vegetables: broccoli, Brussels sprouts, avocados, asparagus, and pumpkin

Putting Salt Consumption into Proper Context

More than 80 percent of the salt most people consume is from processed foods. Indeed, there is far too much sodium in processed foods. But you shouldn't be eating those foods anyway—sodium is just one of MANY ingredients in packaged foods that will adversely affect your health. The salt added to these convenience foods is bleached out, trace mineral deficient and mostly sodium—as opposed to natural salt, which is much lower in sodium and contains a myriad of other critical trace minerals. Himalayan salt, for example, contains about 86 different minerals, and in terms of taste, you cannot compare it to regular table salt. Natural salt has flavor, over and above just salty taste.

The more you can move toward a diet of whole organic foods in their natural state, the healthier you'll be—whether it's veggies, meat, dairy products, or salt. And increasing your vegetable intake will help insure you're getting the ideal ratio of sodium-to-potassium, which may be more crucial for overall health than we currently imagine.

Given that salt is absolutely essential to good health, I recommend limiting, or ideally, eliminating processed foods and processed table salt and switching to a pure, unrefined salt. Generally speaking, it is perfectly fine to salt your food to taste, provided the salt you're using is natural and unrefined and you're eating plenty of vegetables.