The Vegetarian Resource Group Blog

Where’s the Salt?

Posted on February 20, 2012 by Nina Casalena, The VRG Blog Editor

Most people in the United States eat more salt than is recommended. The 2010 Dietary Guidelines call for less than 2300 milligrams of sodium daily, and less than 1500 milligrams for at-risk groups (non-Hispanic blacks, persons aged ≥ 51 years, and persons with hypertension, diabetes, and chronic kidney disease). Close to 9 out of 10 Americans who should be consuming less than 2300 milligrams of sodium and a whopping 99% of those who should consume less than 1500 milligrams of sodium exceed these recommendations. That’s a problem because excessive sodium increases the risk for high blood pressure and for heart disease and stroke.

If we could identify foods that are the main sources of sodium on a day-to-day basis, we could start taking steps to cut the salt. A new study identifies the top 10 categories – foods that contribute the most sodium to the average American’s diet on a daily basis. Here they are, ranked from highest to lowest contributor of sodium:

  1. Breads and rolls
  2. Cold cuts/cured meats
  3. Pizza
  4. Poultry
  5. Soups
  6. Sandwiches
  7. Cheese
  8. Pasta Dishes
  9. Meat Mixed Dishes (like meat loaf)
  10. Savory snacks (chips, popcorn, pretzels)

While many categories on the list are not vegan, there are still a couple of messages here for vegans. First of all, some foods that may be eaten by vegans, including bread and rolls, soups, and salted snacks can supply more salt than we need. It’s a good idea to check labels for sodium and choose lower sodium foods. Secondly, notice what’s not on the list. That would be fruits, vegetables, grains, beans, among others. Cutting down on sodium on an individual basis means eating fewer processed foods. That’s where people who are already used to eating whole plant foods have the advantage. For a week’s worth of low sodium menus see http://www.vrg.org/journal/vj2005issue4/vj2005issue4lowsodium.htm.

The study's authors say, “Reducing the sodium content of the 10 leading sources by one fourth would reduce total dietary sodium by more than 10%. This could prevent an estimated 28,000 deaths and $7 billion in health-care expenditures annually.” We have to wonder what the effect would be of eliminating categories 2, 3, 7, and 9 completely.

This study was published in Morbidity and Mortality Weekly Report.

1 to “Where’s the Salt?”

  1. John Elliott says:

    Yes, many of us do dearly love our salt, especially on certain foods. I personally must fill my salt shakers many times each year. Yet my medical reports continue to be favorable. Am I really “endangering my health” when I sprinkle it on? Should parents continue to admonish children to “watch your salt”?

    A common phrase we can read nowadays says, “The recommended daily intake of sodium is 1,500 to 2,300 milligrams or lower for someone with hypertension or congestive heart failure. The average person consumes 5,000 mg daily.”

    If one teaspoon of salt is 2,300 milligrams, this means I use about twice the “recommended intake”. Worrysome indeed!

    HOW MUCH IS “TOO MUCH”?
    Out of curiosity and seeking a challenge, a few years ago I decided to undergo a sort of “Lent” abstention to completely remove salt from my diet for 40 days. Suddenly gone from my kitchen and dining table were the salt shakers. And I was also careful to not use processed or canned foods, which usually have “added” sodium. Although it was strange and even unpleasant for me to taste the blander cuisine, I did not experience any “withdrawal” symptoms. Yet I did not accrue any benefits of any sort in my health either. Based upon labratory results, my blood chemistry results before and after the experiment were virtually the same. I was hoping for some benefits or even subjective indications of this removal, but there were none, and after 40 days I resumed my normal intake of about (I estimate) 1 to 2 teaspoons per day (half I add and half is already in some processed foods I often eat such as vege-burgers).

    The challenge in debunking the myth relating salt to cardiovascular distress and outcomes such as strokes may be that there is, in fact, a small subsection of society (albeit larger in the Western world and Japan), which has a great sensitivity to sodium. These include people with hypertension, with coronary heart diseases, and with specific and impending risks of heart attacks. Moreover, since salt stimulates the taste buds, yes, people who are obese or simply over weight should remove salt from their diet, to reduce intake and weight, to thus recover health.

    Yet there is no concensus among researchers and physicians as to what “too much” means when it comes to salt; the spectrum of acceptance is wide, from “no adding salt” to the above cited “one tablespoon of added salt per day” and everything in between!

    No one wants to have “too much” of anything, but everyone has a different understanding of that term, whether it’s Vitamin C or relaxation or television viewing, etc. In contrast, when it comes to modern health innovations (remember that salt has often been a part of the human diet for thousands of years), such as Aspirin or Tylenol, there is a clear threshold for safety, and the dangers are present to all people, not just a subset as with salt.

    SALT IN EXTREMES
    The fact that salt is such an innocuous event in most of our diets may be, I feel, owing to the origin of our species and mammals––from the sea. Certainly, our bodies have a very efficient way of dealing with all but the most toxic amounts of sodium chloride (such as drinking a little sea water without flushing it with drinking water) and without impact. Mechanisms in the body undertaken through the functioning of healthy kidneys is referred to medically as the “resetting of osmostats”. Given the drinking of water or like liquids to flush excesses, this provides natural normalizing of bodily functions––even with sudden but improbable sodium increases of many teaspoons of salt at one sitting. I say improbable, because we have a natural barrier to ingestion of excess salt: our tongue. Even overcoming distaste, our bodies react violently to truely excess salt, resulting in vomiting.

    There is a medical condition of “salt poisoning,” or hypernatremia, but documented cases of it are extremIy rare. I could find scant evidence of it in the news; for example the key returns on a Google search were …

    * in the case of a foster child who was alleged to have been given “six teaspoons of salt” and 23 teaspoons of a seasoning at one sitting (!) http://www.mysanantonio.com/news/28701504.html
    * an English case in 2006, for which the conviction for “force-feeding a boy at least four teaspoons of salt” in one sitting was ultimately overturned,
    * another case in England, where a 3-year old was allegedly force-fed “up to six teaspoons of salt”. In this case, the normal resetting of osmostats was called into question, owing to medical condition in the boy. http://news.bbc.co.uk/2/hi/uk_news/england/west_midlands/4829368.stm,
    * a 1993 study of 12 children who experienced “salt poisoning,” of but which also showed concurrent physical abuse http://adc.bmj.com/cgi/content/abstract/68/4/448,
    * a 2000 study from an autopsy in the case of salt poisoning from drinking a large quantity of Japanese soy sauce, which contained 160 grams of salt (about 70 teaspoons, by my calculations * and weighing salt on my scale). http://sciencelinks.jp/j-east/article/200024/000020002400A0889092.php, and
    * many cases of Munchausen syndrome by proxy, in which a parent or caregiver fakes or induces illness in others to generate sympathy.

    SIFTING THROUGH THE DEBATE
    In late 2006, The Washington Post published an article citing a study appearing in The Journal of The College of Nutrition, which questioned the relationship between salt and heart disease. But within this article was a challenge to this conclusion, by a group called Integrity in Science Watch, which condemned the source study for being edited by “a paid consultant to the salt industry.” Many people who read this article or knew of the study, therefore, were not swayed from the traditional view that “too much salt is unhealthy.” Some even began to be suspicious of “Big Salt” lobbyists. So the effect of this study seems to have been blunted.

    I followed up on this debate and found a rebuttal by the editor of the actual study, which was received after the news article was published, (http://blog.washingtonpost.com/thecheckout/2006/10/the_salt_conspiracy.html ). He did not deny that his organization brought “balance” to an otherwise slanted (“anti-sodium”) perspective. His small group’s aims are admitedly transparent and their ability to “sway public opinion” are minor.

    Yes, we should all be aware of vested interests of business in promoting certain things which may actually be harmful, (classic cases are the Meat and Dairy industries), but the studies above are actually enlightening or helpful in shedding light on a historically dogmatic approach. For example it was interesting to read of a recent study by the International Society of Hypertension which found increased risk in health outcomes by reducing dietary salt.

    Recently, writers specializing in health and nutrition topics have come around to the facts regarding salt, combatting unfounded myths and old tales. An excellent article from 2011, With a Grain of Salt: Why You May Not Need to Limit Your Sodium Intake, focusses on the special requirements women have for salt, and the benefits of these sodium crystals. **

    RESEARCH AND CONCLUSIONS
    So the question might also be fairly distilled to, “which is worse: a no-salt diet or a salty diet?” This puts an interesting spin on the Great Salt Debate, in my opinion.

    I would like to point out that there are even other studies which show that adding salt to a diet provides benefits to people (like me) with lower-than-normal blood pressure. Also, a dramatic increase in salt and other minerals may be essential to athletic performance and proper bodily function under physical stress or heat.

    I try to stay as healthy as possible and, after making many off-the cuff comments over the years in defense of my “habit,” I am pleased to now conclude my initial research into this topic. After all, the topic is close to me (at least at dinnertime!).

    Here are some summaries of studies, for your convenience and further on-line research. There are, as you will note, sound studies which show that for the vast majority of people there is simply no correlation between health and salt, within a wide spectrum of use. Some, such as #12, point to benefits of reduced sodium intake, but only in specific, high-risk groups. Some, such as #18, state that reducing salt benefits those with “even normal blood pressure”. Others, such as #2 and #13, show contradictory results. Study #14 does not take into account the great differences between the Western and Oriental diet, especially regarding red meat and fish in the diet.

    1. A ten-year study of nearly 8,000 Hawaiian Japanese men concluded: “No relation was found between salt intake and the incidence of stroke.” (1985)
    2. An eight-year study of a New York City hypertensive population stratified for sodium intake levels found those on low-salt diets had more than four times as many heart attacks as those on normal-sodium diets ––the exact opposite of what the “salt hypothesis” would have predicted. (1995)
    3. An analysis by NHLBI’s Dr. Cutler of the first six years’ data from the MRFIT database documented no health outcomes benefits of lower-sodium diets. (1997)
    4. A ten-year follow-up study to the huge Scottish Heart Health Study found no improved health outcomes for those on low-salt diets. (1997)
    5. An 1998 analysis of the health outcomes over twenty years from those in the massive US National Health and Nutrition Examination Survey (NHANES I) documented a 20% greater incidence of heart attacks among those on low-salt diets compared to normal-salt diets.
    6. A health outcomes study in Finland, reported to the American Heart Association that no health benefits could be identified and concluded “…our results do not support the recommendations for entire populations to reduce dietary sodium intake to prevent coronary heart disease.” (1998)
    7. A further analysis of the MRFIT database, this time using fourteen years’ data, confirmed no improved health benefit from low-sodium diets. Its author conceded that there is “no relationship observed between dietary sodium and mortality.” (1999)
    8. A study of Americans found that less sodium-dense diets did reduce the cardiovascular mortality of one population subset, overweight men – the article reporting the findings did not explain why this obese group actually consumed less sodium than normal-weight individuals in the study. (1999)
    9. A Finnish study reported an increase in cardiovascular events for obese men (but not women or normal-weight individuals of either gender) – the article, however, failed to adjust for potassium intake levels which many researchers consider a key associated variable. (2001)
    10. In 2002, the prestigious Cochrane Collaboration produced the latest and highest-quality meta-analysis of clinical trials. It was published in the British Medical Journal and confirmed earlier meta-analyses’ conclusions that significant salt reduction would lead to very small blood pressure changes in sensitive populations and no health benefits.
    11. In 2003, Dutch researchers using a massive database in Rotterdam concluded that “variations in dietary sodium and potassium within the range commonly observed in Westernized societies have no material effect on the occurrence of cardiovascular events and mortality at old age.”
    12. In 2004, the first “outcomes” study identifying a population risk appeared in Stroke magazine. Researchers found that in a Japanese population, “low” sodium intakes (about 20% above Americans’ average intake) had one-third the incidence of fatal strokes of those consuming twice as much sodium as Americans.
    13. A 2006 analysis of the federal NHANES II database in The American Journal of Medicine found a 37% higher cardiovascular mortality rate for low-sodium dieters (2006). See their university’s news release.
    14. A 2007 report in the International Journal of Epidemiology studied 40,547 Japanese over seven years and found “the Japanese dietary pattern was associated with a decreased risk of CVD mortality, despite its relation to sodium intake and hypertension.”
    15. A 2007 article in the British Medical Journal found a 25% lower risk of CV events in a group which years earlier had achieved significant sodium reduction during two clinical trials (TOHP I and TOHP II).
    16. A 2007 analysis of a large Dutch database published in the European Journal of Epidemiology documented no benefit of low-salt diets in reducing stroke or heart attack incidence nor lowering death rates. The results, graphically.
    17. A May 2008 examination of NHANES II (the largest US federal database of nutrition and health) published in the Journal of General Internal Medicine confirmed two earlier studies of earlier NHANES surveys that there is no health benefit (CVD or all-cause mortality) for those on low-sodium diets.
    18. A 2007 report, Reducing Dietary Salt Lowers Cardiovascular Disease Risk: Lowering Sodium in Your Diet Reduces Risk of Cardiovascular Disease by 25 Percent (http://www.brighamandwomens.org/PressReleases/PressRelease.aspx). Note that the study included participants solely with “high-normal blood pressure”.

    A FINAL WORD
    Of course, there have been volumes of studies for decades which decry salt as an assassin, and I am not trying to dispute these studies here, simply to point out that there are also equal volumes of studies, (and the latest research at that) which points to the lack of relationship between health and salt intake.

    The only correlation I can’t avoid in this area is the height my mother’s eyebrows rise, to the amount of time I invert the salt shaker over my food!

    To your health…para a sua saúde…a votre sante…a su salud…zu ihrer Gesundheit!

    (John Elliott was for five years a member of the Advisory Council for the Gwinnett County Medical Center of Georgia. He is writing a book, In Your Face: Incontrovertible Scientific and Medical Support for A Vegetarian Diet. John presently serves as a vice consul at the Consulate of the United States of America in Rio de Janeiro, Brazil.)

    * Marshfield Clinic, “Cut The Salt” http://www.marshfieldclinic.org/patients/default.aspx?page=wtfoml_wau_mar08_salt1

    ** http://www.google.com.br/imgres?imgurl=http://coachlana.files.wordpress.com/2011/02/salt_shaker_upsidedown.jpg&imgrefurl=http://coachlana.wordpress.com/2011/02/&usg=__xpZmsReXl_qgrvM4Y9VCYxcyUZ0=&h=576&w=325&sz=130&hl=pt-BR&start=25&sig2=EncRlvExqEpOudBROVIYHw&zoom=1&tbnid=1sKFN89fB_KaWM:&tbnh=134&tbnw=76&ei=PxqUT76tK4K69QS5qvCKBA&prev=/search%3Fq%3DSALT%2BSHAKER%2Bhappy%2Bfamily%2Bat%2Bdinner%26start%3D21%26hl%3Dpt-BR%26safe%3Doff%26client%3Dsafari%26sa%3DN%26rls%3Den%26tbm%3Disch&itbs=1

    COMPUTATION SOURCES:

    http://urila.tripod.com/mole.htmhttp://forum.onlineconversion.com/showthread.php?t=1464

    http://www.wtv-zone.com/phyrst/sce/ozgmconv.html



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