Salty Debate

Salt is essential to life. The sodium found in salt regulates the heartbeat and the body’s balance of fluids. Once known as “white gold,” salt helped establish civilization with the discovery of its food-preserving ability. Roman soldiers were paid in salt (from which the expression “worth one’s salt” is thought to derive).

A few centuries ago, battles were fought over it. Venice won a war with Genoa over salt, although Christopher Columbus helped destroy this Mediterranean salt trade when he discovered salt in the New World. It wasn’t by accident—he was told to look for it.

Modern times have not been so good to salt’s vaunted status. Of course, Americans still revere its taste—hence the multibillion-dollar salty snack industry that has thrived during the recession. But more than a century ago, scientists discovered a connection between blood pressure and salt intake. In recent decades, salt has been maligned for its ill effects on public health—for raising people’s blood pressures and increasing the risk for heart attack, stroke and kidney disease. Today, the federal government says most Americans need to cut their salt intake by half or more. The government is even researching whether to change salt’s status from a “generally recognized as safe” ingredient to, at certain levels, a substance with negative health effects.

No one questions that high blood pressure is rampant among Americans (affecting about one in three U.S. adults, according to the National Institutes of Health). But not all experts are convinced that salt should be a main suspect. Instead, they cast blame on so many Americans being inactive, overweight, overly stressed, and even the unlucky—10 to 20 percent with certain genes making them “salt sensitive” (their blood pressure goes up with an increase in salt consumption).

Some even say it’s dangerous to promote such a low-salt diet for millions of otherwise-healthy Americans.

Unlike oil, our salt supply is not going to run out. This mineral is available throughout the world; it can be evaporated from the sea or mined from land. Wherever it comes from, it’s a combination of two ions, sodium and chloride. Humans require a certain amount of sodium to maintain good blood pressure, blood volume and the proper functioning of most organ systems, says Edward Stricker, a professor and emeritus chair of the neurosciences at the University of Pittsburgh. For decades, he’s studied how animals process sodium—a process, he says, that in many respects works the same in humans.

Ancient humans got their sodium from eating the blood and flesh of animals and for thousands of years lived on less than one gram of salt a day but, Stricker notes, they may have had health problems associated with too-low blood pressure. Today, the average man in the U.S. takes in over 10 grams of salt per day and the average woman over seven. the most recent u.s. dietary guidelines call for consuming 1,500 mg of sodium (3.7 grams of salt) a day for anyone over 51, any African American, or anyone who has high blood pressure. And according to the government, consuming more than 2,300 mg of sodium can lead to health problems. Stricker, however, disagrees: “The government is recommending an amount of sodium that is too little for normal function… And 1,500 milligrams would be bad even for salt-sensitive people. Human physiology indicates that sodium intake should not fall below 2,300 to 2,760 milligrams per day; setting a goal for the general population of a salt intake below that level makes no biological sense.”

Whether or not Americans heed the government’s advice, they will likely take in less salt in coming years. A recent report by the Institute of Medicine states: “The U.S. Food and Drug Administration should gradually step down the maximum amount of salt that can be added to foods, beverages, and meals through a series of incremental reductions. The goal is not to ban salt, but rather to bring the amount of sodium in the average American’s diet below levels associated with the risk of hypertension, heart disease and stroke, and to do so in a gradual way that will assure that food remains flavorful to the consumer.”

The FDA is likely years away from deciding whether to force makers of prepared meals and processed food (where Americans get an estimated 75 percent of their sodium) to cut the salt, but many are doing so voluntarily. Heinz is among dozens of major food companies to pledge (through the National Salt Reduction Initiative) to reduce the sodium in their products by 20 percent in the next few years. PepsiCo, maker of Lay’s Classic Potato Chips, is going so far as to create a “designer salt” with crystals shaped in a way to get more taste out of smaller amounts. there is a large body of evidence and consensus within the scientific community that dietary sodium chloride is a major risk factor for cardiovascular disease. Other evidence suggests that a high-salt diet aggravates asthma, gastric cancer, kidney stones and osteoporosis.

If Americans reduced their daily salt intake by 3 grams (1,200 mg of sodium), this could prevent up to 92,000 deaths each year and save the nation up to $24 billion in healthcare costs, according to findings published in the Jan. 20, 2010 online edition of the New England Journal of Medicine. The study goes on to say that reducing daily salt intake by 3 grams could, each year, cut the number of new cases of coronary heart disease by as many as 120,000, stroke by 66,000, and heart attack by nearly 100,000. “Our study suggests that the food industry and those who regulate it could contribute substantially to the health of the nation by working toward reducing the amount of salt in the processed foods that all of us consume,” says lead researcher Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco.

In a Jan. 2010 fact sheet from the New York City Department of Health and Mental Hygiene (coordinating the National Salt Reduction Initiative), Commissioner Dr. Thomas Farley answers an important question: Why reduce everyone’s salt intake if only certain people are at risk? “ ‘Salt sensitive’ can be a misleading term. We know that salt affects blood pressure more dramatically in certain groups (e.g. African Americans and people over 40). But it’s a matter of degree, not a difference in kind. No test can predict how salt will affect an individual’s blood pressure, but we know that high blood pressure is more common in populations with high-salt diets than those with low-salt diets.” pitt’s Stricker is perplexed by the government’s dietary guidelines for sodium. Last fall he wrote in the American Journal of Clinical Nutrition that the government’s widespread salt-intake guidelines are potentially harmful. “A policy to impose restrictions on everyone in order to affect some seems misguided,” Stricker says. “And the physiology issue is real. Whereas excessive salt intake can be harmful to some, insufficient salt intake is harmful to everyone.”

Likewise, Dr. Paul J. Rosch, president of The American Institute of Stress and clinical professor of medicine and psychiatry at New York Medical College, writes, “There are no research reports that justify putting everyone on a low-sodium diet… When you restrict vital nutrients like salt (or cholesterol) all sorts of strange things can result. Low sodium can increase levels of renin (an enzyme), LDL (bad cholesterol), and insulin resistance, reduce sexual activity in men and cause cognitive difficulties and anorexia in the elderly.” He goes on to say, “renin is possibly the most powerful and dangerous blood pressure-raising substance known.”

Perhaps no one is more opposed to our nation’s public health policy on salt than “DrRich,” aka Richard N. Fogoros, a retired Pittsburgh cardiologist turned medical writer and biomedical research consultant. In a June 6 podcast called “The Right to Bear Salt,” he said, “public health experts, reaching heights of arrogance not seen since Mussolini, are now embarking on an experiment under which each of us—once again—is to become an unwitting research subject, an experiment whose results are unpredictable, but which has a realistic chance of producing harm to many of us.” He adds, “It might turn out the thing to do is to restrict the salt we eat, but we just don’t know at this point. We may find 30 years from now this was a big mistake.” He then cites the trans fat debacle; in the 1960s the “government demanded that trans fat be put in food” and now we know it turned out to be more harmful than naturally occurring saturated fat.

While the salt debate is likely to continue for years, there is consensus that, for people with certain medical conditions, reducing salt intake is an important part of treatment. Stricker has his own “salt-sensitive hypertension”; he watches his salt intake, avoiding bacon and pickles, for example. But, he doesn’t track his sodium and occasionally eats processed food. He wonders, though, if he had eaten less salt when he was younger, whether he’d still have high blood pressure today.

As a doctor, Fogoros used to prescribe low-salt diets to certain patients. But, he says, if you don’t have high blood pressure or a medical condition that causes sodium and fluid retention—especially heart failure and certain types of kidney or liver disease—don’t worry about adding up your recommended allotment of sodium milligrams. He doesn’t advocate loading up on processed food either and says, “You can’t go wrong with the Mediterranean diet.” This much-lauded diet happens to be fairly high in salt.