It is often claimed that humans must consume salt (added salt). Do we? While there is no absolutely final answer to this question, I would bet on: no, we don't have to eat salt at all.
Now, that was the more radical question of eating no salt add all. But the more relevant question for your arteries - and your heart, brain, and every other organ connected to your arteries (EVERY organ) - is: should we reduce our intake of added salt? Should we actually not just reduce our salt intake somewhat but minimize it?
The answer seems to be yes, at least for very many (probably most) people.
There is another claim making rounds, however (at least in science-y circles): that too little salt could also be bad (which would bring us back to: do we need to eat salt at all?) and that too much salt isn't bad at all. This is the claim.
A quite brilliant review article by Cappuccio et al. (published in June 2022) titled "Sodium and Health: Old Myths and a Controversy Based on Denial" debunks the abovementioned claims and, frankly, attacks the authors (scientists) who have spread these rumours as (not in these words) corrupt liars who knowingly twist the scientific evidence and (my words) as a consequence of their published articles sacrifice people (like you and me) on the altar of greed (so to speak).
In their review article, Cappuccio et al. have included a table which summarizes all the "myths and facts" about salt, and I have copied and pasted that whole table into this blog post (which is acceptable because this article is "open access").
Original table 1 from Cappuccio et al.'s article below. I have added some comments in square brackets, highlighted in yellow. I have also highlighted (in yellow) some of the text by Cappuccio et al. which I particularly like.
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Table 1
Misperceptions about salt reduction: myths and facts
| Myths | Facts |
|---|---|
| Our body needs sodium [This is not really a myth. Our body needs sodium. But we do not have to eat added salt (sodium chloride). ] | The body efficiently conserves sodium. It is difficult to eat too little sodium as sodium is already in most foods we eat every day [even those without added salt, especially in vegetables - I mean, among unprocessed plant foods]. People in some remote areas of the world or in rural areas of developing countries still survive on a fraction of the amount of sodium eaten in the Western world (as low as 100–200 mg per day). Although much table salt is iodized, the required level of iodine can be achieved with sodium intake of 2300 mg/day [This depends on the country because different amounts of iodine are added to salt]. There is no evidence of harmful effects of a modest reduction in sodium intake down to 2300 mg per day. |
The current sodium intake is a physiologically set normal range in adult humans | During several million years of evolution mankind has survived on very little sodium in the diet (under 1000 mg per day). Even in modern times, this low intake is still seen in the Yanomano and Xingu Indians [They mean Native Americans] living in the humid and hot environment of the Amazon jungle. They eat far less than 1200 mg of sodium (3 g of salt) per day [and traditionally (!), they do not eat any added salt, as far as I know], their BP [blood pressure] does not rise with age and stroke events are rare. Meanwhile in industrialized populations, the high sodium intake, typically 3000 to 4800 mg of sodium (7.5 to 12 g of salt) per day is recent phenomenon in evolutionary terms. In these groups, BP rises steadily with age, followed by stroke and CHD [coronary heart disease, which causes heart attacks]. |
| The ‘‘normal’’ sodium intake is between 5.0 and 7.5 g per day (12.5 and 18.8 g salt per day) and a “moderate” intake between 3.0 and 5.0 g per day (7.5 and 12.5 g salt per day) | The range of dietary sodium reported by some as ‘‘normal’’ is only the ‘‘usual’’ range in industrialized westernized countries. It is not a physiological normal. The physiological level compatible with life is seen when access to added dietary sodium is limited, as in parts of Africa, Asia, and South America. Furthermore, this excessive sodium intake is not a matter of personal choice. Only 10–20% of sodium in our diets comes from that added to food by consumers [because people eat a lot of processed foods which include added salt]. |
| Only old people need to worry about how much sodium they eat | Eating too much sodium raises BP at any age, starting at birth and affecting children of all ages. It is best to reduce sodium intake [starting] at a young age to form low-salt taste preferences and forestall the onset of hypertension. |
| Only people with hypertension need to reduce their sodium intake | A reduction in sodium intake reduces BP in both normotensive and hypertensive individuals [i.e. people without or with high BP]. It is even more important that people ‘‘without’’ hypertension reduce their sodium intake [at the population level], because the population-wide number of cardiovascular events that can be attributed to their level of BP is high, but their BP does not make them eligible for drug therapy. [That means, practically everyone should reduce their salt intake but especialy those with non-low blood pressure.] |
| Sodium intake below 3.0 g per day (7.5 g of salt per day) could be potentially harmful | This claim is based on either flawed or unreliable evidence, as extensively argued in recent years (see “Case study: the European Heart Journal” section). On the contrary, there is much evidence that a modest reduction in daily sodium intake (down to 2000 mg) has many beneficial effects on health and is one of the most cost-effective ways to reduce CVD in the population. |
| Sustained reduction in sodium intake is not feasible in free-living individuals | The experience in the UK (15% or 1.4 g salt per day population reduction achieved in 7 years) and longer in Finland and Japan (about 3 g salt per day population reduction achieved over two decades, though intakes are still excessive) demonstrate that public health policy can lead to substantial reductions in population salt intake. This is paralleled by significant reductions in population BP and in stroke rates, with ensuing cost savings. These salt reductions have very little to do with changing individual behavior, but mainly reflect a healthier environment: the reformulation of industrial-produced and distributed food with lower sodium content. Most individuals in most developed countries have little choice over how much salt they are eating because of the ubiquity of processed food. Secondly, the health benefits of, and progress in achieving, salt reduction are greater if mandatory regulations for food reformulation are introduced. [Also: try it yourself. You will quickly get used to cooking with much less or no salt at all. Use plenty of spices and vegetables. Also note that many imported vegetables in the supermarket are pretty tasteless. Find some tasty vegetables.] |
| A reduction in sodium intake below 3.0 g per day activates the renin-angiotensin system [which is here claimed to be a bad thing] | There is no evidence for choosing 3.0 g of sodium per day as a cut-off point. When sodium intake is reduced, the activation of the renin-angiotensin system is a normal physiological response, like that which occurs with diuretic treatment. Outcome trials have demonstrated clear benefits of diuretics on CVD outcomes. Additionally, with a longer-term modest reduction in salt intake, there is only a very small increase in plasma renin activity, and this is true in any ethnic group. |
| Rock salt, sea salt or other expensive salts are more healthful than table salt [myth] | All these salts contain > 95% sodium chloride, whether in grains, crystals, flakes, or with different color appearance. [It's quite unlikley that these salts are more healthful to a relevant extent.] |
We need sodium in hot climates [They mean "we need to eat salt in hot climates" = myth] or when we exercise because we sweat a lot | We lose only a small amount of sodium through sweat. We are adaptable. The less sodium we eat, the lower the sodium content of our sweat. Thus, in hot climates, it is important to drink plenty of water to avoid dehydration. But we do not need to ingest more sodium. |
| Consumer taste preferences make change impossible [This statement is equivalent to saying "change is impossible".] | As sodium intake falls, the taste receptors for sodium in the mouth become more sensitive to lower concentrations within a couple of months. Furthermore, consumer experience in the UK and elsewhere confirms that where sodium has been gradually reduced in major brand products, sometimes concomitant with other reformulations, there has been no reduction in sales and no complaints about taste. Furthermore, once sodium intake is reduced, many people prefer food with less sodium. |
| Food technology cannot change | The effective UK Food Standards Agency sodium reduction program, as well as other experience, demonstrates that it is possible to remove as much as half of the sodium out from some products gradually without noticeable changes in flavour or consumer acceptance. Finland and Japan have done better still. |
| Food Safety requires the use of salt | Many companies could reduce sodium significantly in processed meats and other preserved foods. Furthermore, many microbiological modelling tools can be used to help the industry predict the safety and shelf-life of food. [They're talking about processed foods here. But also: if you want to kill bacteria on raw fruit and vegetables (for example, when traveling in the tropics as a "Westerner"), you can wash them with plenty of salt and then wash the salt off again, and you can kill bacteria with heat] |
" [1]
Also check out Cappuccio et al.'s table 2 (below). I have highlighted what I consider most relevant in yellow.
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Table 2
Proposed nomenclature for sodium (salt) intake and the reductions in dietary sodium (salt)
| Terminology | Sodium (mg per day) | Salt (g per day) |
|---|---|---|
| Intake | ||
| Normal (physiological) | < 1000 | < 2.5 |
| Recommended | ≲2000 | ≤ 5.0 |
| High | ≥ 2000 | ≥ 5.0 |
| Very high | > 4000– ≤ 6000 | > 10– ≤ 15 |
| Extremely high | > 6000 | > 15 |
| Reduction | ||
| Small | < 1000 | < 2.5 |
| Moderate | 1000–2000 | 2.5–5.0 |
| Large | > 2000 | > 5.0 |
"
I would say, if you have high or "high normal" or "quite normal but not so low" blood pressure, try to minimize your intake of added salt. It's not all or nothing, and salt is not everything, but it's something.
Side note 1:
Rastafarians traditionally do not eat added salt. One article from National Geographic states:
"The style of primarily vegan eating is known as ital cooking. Rastas commonly say, “Ital is vital,” pointing to how the diet got its name. [...]
Herbs and hot peppers like the fiery Scotch bonnet that is native to the Caribbean replace salt and processed flavor additives. [...]
Since they shy away from added fats and salts, Rastas are acutely skilled at creating complex flavor profiles from herbs and spices like lemongrass, allspice, nutmeg, and thyme." [2]
Side note 2:
Don't just assume that a vegan diet on its own will protect you against high blood pressure. The beneficial effect of vegan diets on blood pressure may be quite small [3] (i.e. we can do much more, among other things, with salt reduction, plenty of exercise/physical activity, and much more of that "just chillin'"). A recent meta-analysis - based on randomized controlled trials - concluded: "We identified no effect [of vegan diets] on blood pressure" [4]. Now, randomized controlled trials are usually short term, and it might the beneficial effect on blood pressure might be seen in the long term, but as I said, beneficial effect doesn't mean there's a MASSIVE effect, and surely it doesn't make you "heart attack proof", and heart attacks are the number one killer practically everywhere, including the number one killer of vegans.
Side note 3:
Also check out my post about cholesterol if you're interested (in your arteries).
Side note 4:
Even relatively healthy foods such as "added sugar-free" soya milk or "added sugar-free" soya yogurt typically contain added salt (at least in Europe they do).
Side note 5:
If you avoid salt, that means you will also avoid iodized salt and you need to make sure you get iodine from somewhere (see number 4).
References:
1) Cappuccio et al.: Sodium and Health: Old Myths and a Controversy Based on Denial, Curr Nutr Rep, 2022, Jun;11(2):172-184. doi: 10.1007/s13668-021-00383-z. Epub 2022 Feb 14.https://pubmed.ncbi.nlm.nih.gov/35165869/
2) National Geographic: For Rastas, Eating Pure Food From the Earth is a Sacred Duty, by Kelsey Nowakowski, 19 July 2016, https://www.nationalgeographic.com/culture/article/for-rastas--eating-from-the-earth-is-a-sacred-duty (checked 2 August 2022)
3) Benatar & Stewart: Cardiometabolic risk factors in vegans; A meta-analysis of observational studies, PLoS One, 2018, Dec 20;13(12):e0209086. doi: 10.1371/journal.pone.0209086. https://pubmed.ncbi.nlm.nih.gov/30571724/
4) Termannsen et al.: Effects of vegan diets on cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials, Obes Rev, 2022, Jun 7;e13462. doi: 10.1111/obr.13462. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/35672940/
