Salt is good for you

One of the most pervasive and stupid things that we are currently told to do is to reduce salt intake. This advice has never been based on controlled clinical studies, ever. Yet, as with the cholesterol myth, the dogma that we should all reduce salt intake has become impervious to facts. I find that the ‘salt hypothesis’ is rather like a monster from a 1950s B movie. Every time you attack it with evidence it simply shrugs it off and grows even stronger.

Very recently, a study was done in Australia looking at salt intake. Actually it looked at sodium intake, not salt intake. I find this interesting, as no-one that I know eats sodium. In fact, it would be interesting to see someone try. To quote from Wikipedia

‘Sodium is generally less reactive than potassium and more reactive than lithium. Like all the alkali metals, it reacts exothermically with water, to the point that sufficiently large pieces melt to a sphere and may explode; this reaction produces caustic sodium hydroxide and flammable hydrogen gas.’

Consuming two grams sodium would likely cause you to explode, splattering sodium hydroxide over the walls. Along with various organs and other body parts.

So why do people talk about sodium consumption? I have never really worked this one out. But it does make things rather confusing. The latest guidelines suggest we should consume less than 2300mg of sodium a day, even as low as 1500mg. Go on, try it. Any idea how much salt (NaCl) that would be? Any idea how much salt you consume every day? No, thought not.

Yes, we have been given guidelines that are totally meaningless, and impossible to follow. In fact 2300mg of sodium is roughly 6000mg of salt (NaCl). So why are we not advise to eat six grams of salt a day? I have no idea. Perhaps someone can tell me. What is this sodium nonsense? [Not that anyone has any idea what six grams of salt even looks like poured out of a salt shaker – I know, I have tried this several times.]

Of course, when I started looking into this area, I went at it sideways. If we eat salt we are eating both sodium, and chloride. You cannot have one without the other. So I became interested in the chloride issue, not the sodium. We are always warned about sodium, but no-one ever mentions chloride levels. Is there any evidence that high chloride consumption is bad for us?

This is an area mostly defined by silence, and zero research. But I have found a few papers looking at chloride levels in the blood and, guess what? They have all found that a low chloride level is associated with a higher mortality. Here is one such, entitled ‘Serum chloride is an independent predictor of mortality in hypertensive patients.’

‘Low, not high Serum Chloride- (<100 mEq/L), is associated with greater mortality risk independent of obvious confounders. Further studies are needed to elucidate the relation between Cl- and risk.’  (view here)

There you go. Having a low chloride level makes it more likely you will die early. Yet, having a high level of sodium consumption makes is supposed to kill you? And you cannot eat sodium without eating chloride at the same time. Go figure. You mean you can’t?

Anyway, to return to the, not yet published Australian study, here is what they found.

‘In a multivariate-adjusted model, those who consumed less than 3000 mg of sodium per day had a 25% increased risk of all-cause mortality and cardiovascular events compared with those who consumed between 4000 mg and 5990 mg/day (reference group).’ [1]

The guidelines tell us to eat less than 2300mg of salt. At this level, if we use the Australian data, overall mortality will be increased by 25%. Excellent advice then. And this is not just one contradictory study. Several other trials have clearly demonstrated that reducing salt intake significantly increases mortality in high risk patients. Particularly those with heart failure, where it would be expected that salt reduction would have the greatest benefit. Yet the trials showed the exact opposite.

As explained in the Journal Stroke. The section I have quoted below is taken from a reply to an article entitled “Reducing Sodium Intake to Prevent Stroke: Time for Action, Not Hesitation” In this article Appel, the author, argues strongly that we must, absolutely must, reduce sodium intake. In reply, three cardiologists make the following points:

‘In regards to patient-oriented outcomes, Appel dismisses randomized trials in patients with heart failure as irrelevant because of the unconventional treatment approach of the investigators. Yet these trials—showing increases in hospitalizations and mortality with low-sodium intake versus normal-sodium intake—tested identical diets in intervention and comparison arms with the only difference being the level of ingested sodium (making these trials more relevant than DASH-Sodium and other trials Appel cites). Also, Appel fails to cite 3 relevant heart failure trials, all consistently show harm with reduced sodium intake.’ [2]

In short, Appel, along with most ‘experts’ in this area had dismissed evidence he did not like.

The simple fact is this. If you strip out all the data on salt consumption there is considerably more, and considerably more powerful data, suggesting a strong link between low salt consumption and increased mortality than the other way around.

In reality, you can eat just about as much salt as you can stand – without harm. (Unless you have damaged kidneys and/or very high blood pressure)

How can I possibly state this? Well, a very wise Swedish professor pointed something out to me a few years ago. If a patient is very ill in hospital and cannot eat, or drink, they will have a drip put up to replace fluids. This very often contains 0.9% NaCl. Or nine grams of salt per litre. Quite often the patient will have two litres of this replacement fluid a day – which is (as you may have figured) 18 grams of salt.

So, we quite happy to give critically ill patients 18 grams of salt per day to help them get better – which has no discernable effect on their blood pressure, or anything else. Yet we tell people that they cannot eat more than six grams a day. Ho, ho. You earthlings are so funny.

References (may require site registration or membership to access)
[1] http://www.medscape.com/viewarticle/824749?src=emailthis
[2] http://webappmk.doctors.org.uk/Session/1405533-8qblkO84E9hsUXe6OUa4-aoqmidt/MIME/INBOX/125637-02-B/Stroke-2014-DiNicolantonio-STROKEAHA.114.005067.pdf to be published soon

98 thoughts on “Salt is good for you

  1. Spittin'chips

    G’day Dr Malcolm. Just in case you hadn’t heard yet, the Catalyst programs from last year were deemed to have breached editorial standards on impartiality, whatever that means, and have been taken down from the ABC website. It seems people will have to go to your youtube channel to see what all the fuss is about.

    Cheers.

    Reply
      1. Joanna

        Hi! The program will be more popular right now, it doesn’t happen very often that ABC takes anything off line! I’m amused.
        Good way to lower your cholesterol is to eat saturated fat, my cholesterol level dropped quite considerably when I started on HFLC diet. I love smell of melting butter!
        Malcolm, keep doing what you doing, it’s an inspiration to know that not everybody follow ‘Big Pharma’ religion, oops, advise.

    1. Jennifer

      The war of words is escalating across the Globe. The non- academic public have to decide which advice we consider is best for us, by reading around these controversial subjects as best we can. All I can add to the debate is that the removal from my daily regime of statins, hypoglycaemics of 3 types, anti-hypertensives, non-steroidal anti-inflammatory pills and antacids, has done wonders for my health and weight, my ability to think straight, and ultimately the quality of my life. My anecdotal story carries no substance in the research world, which appears corrupted anyway. So I am glad that I have the time and inclination to read these blogs, and am free from the interminable interference from my local medics, who must be as confused as me by now.

      Reply
    2. Clement Rhein

      Your missing the point! Sodium is a much needed mineral, like many others. However, table salt (NaCl) is detrimental to health. High sodium can be regarded as healthy depending on the source: chard, celery, beets, spinach, meats… But not if the source is table salt or fizzy drinks. Its not about the sodium, its about everything else around the sodium.

      Reply
  2. Anne

    When I recently had cardiac surgery (for a heart defect, not for heart disease) my “sodium” levels went too low – probably becasue they pumped me full of saline and unbalanced my fluid levels. Anyway, one of the nicest doctors I know, who is also quite ‘conventional’ (scared of cholesterol levels etc) told me to eat a bag of crisps ! The nurses were shocked and it made me laugh 🙂

    Reply
  3. Jennifer

    Well Malcolm, here I go again….”back in the day”, as they say, this business about salt that you highlight is exactly what I was taught 50 years ago….we cannot seriously be expected to measure intake from foodstuffs, let alone that added from the salt cellar! And…I was content to believe that, in a healthy body, homeostasis takes care of the variables, ensuring a necessary amount of the stuff stays available for healthy body functions. So why, oh why, did I join the anti-salt brigade when I worked on hospital wards where the salt cellar was banned? Because I was a wimp, just following contemporary guidelines, and not feeling able to quote my old fashioned human biology lessons, which are now proving to have been stupendous!
    By the way….I just loved the annual chemistry lesson whereby we were delighted to watch the half inch stick of sodium being carefully extruded from its stoppered bottle, and lowered into the thick walled, glass bath of cold water….then watch it go bombing around at great speed complete with gorgeous fiery glow…a practice hopefully eliminated from school labs these days.

    Reply
    1. dearieme

      “a practice hopefully eliminated from school labs these days”: I disagree entirely. Every chem course should have several exciting demonstrations and at least one lab fire.

      Reply
      1. Elle

        Absolutely. Naked flames, noxious smells, loud bangs and fizzing test tubes, hair alight. Bring it all back!

      2. Professor Göran Sjöberg

        This reminds me of what happened when there was a clean up at the chemical lab at my former company. The guy responsible for the lab, who was always inclined to practical jokes, could of course not resist to do something with the large lump (could have been a pound or two) of sodium metal to be disposed of.

        Since the company is located just by the shore of one of the larger waterways in Sweden with large boats passing by. Well, the lab guys joined him to the waterfront where he throw the lump of sodium as far out into the river as he could with a spectacular result. After a while the lump was shot out of the water to considerable height like a firework and went back into the river again and this cycle was repeated a number of times.

        At the same time a large freighter was approaching, probably with a rather scared crew.

        By the way, I use, as a person with a very serious heart disease with all arteries clogged since 15 years, large amounts of salt on my low carb high fat (LCHF) diet and am in an excellent health condition (after having lost about forty pounds) with a blood pressure of 110/60 at rest and without relying on any heart medicine. This didn’t refrain the stupid cardiologist I met a while ago to subscribe drugs to lower the BP further. “I am just following the guide lines!”

        Well, it IS a criminal health care system we are exposed to.

      3. Sean (well named now I'm bald)

        Worked for me when I was still teaching science. It was hopefully exciting sitting in the front row of my classes. A few good bangs, a chance to get zapped with an old telephone dynamo and maybe a row of students covered in foam from the classic fire extinguisher demo gone wrong made science FUN. Like it’s supposed to be, dammit.

    2. Dave

      Not quite died out. When my school closed the contents of my chemistry stock cupboard were going to be dispersed. I used a walnut sized piece of sodium and a plastic bucket outside on a lawn to demonstrate this reaction. The pupils were indoors, and behind a first floor window, and were totally safe, but exterior paintwork and lawn were permanently marked. The hydrogen ignited with a satisfying “whump” and the bucket reduced to fragments. It certainly helped my 12-year-olds remember the reactivity series:)

      Reply
      1. Jennifer

        Dave….too true. It is about half a century that I am going back….no loss of memory for those great explosions, despite the use of statins trying to wipe away the fun.

  4. Elaine hamnett

    I love your common sense in all issues, it appears to me that ‘evidence based medicine’ is a prescription to spend loads of money only then to disagree with results or make up hypotheses and market them as having been researched . Thank you for debunking all these wrong assumptions that are inevitably having a huge impact for the worse on our health and well being.

    Reply
  5. mikecawdery

    Dear Dr Kendrick

    A simple case of ignoring the facts – typical and very common tactics of believers in a myth.

    The Cochrane Collaboration as I remember had a review on this subject that basically showed that SBP drop was trivial (5 mm.Hg or less).  Other papers in healthy people and children showed even lower differences.  Personally I can drop my SBP by as much 20 mm.Hg in 20 minutes by simply resting and deep breathing.

    Yes, I can believe that a tiny minority with serious kidney conditions

    I append a pdf file of some of my salt references

    As an example I have lots of reports regarding living longer if one has higher salt intake, cholesterol, LDL, saturated fat, overweight, etc, etc.  The one study that I do NOT have is one that claims statin takers live longer.

    Consider the massive commercial value of such a report yet Big Pharma and its X-spurts have not yet been able to generate (manipulate or, more likely fabricate) data that would support such a claim.  My conclusion is that statins certainly do not lead to a longer life proven by the absence of any report to the contrary

    M. CAWDERY

    ________________________________

    Reply
    1. Tyrannocaster

      One good reason to avoid table salt might be simply that you wish to avoid eating the anti-caking ingredients and/or any preservatives that may have been added. Just remember that table salt has iodine added and if you switch to sea salt you should probably add some kelp into your diet. (I say kelp, but there are many other sources of this necessary nutrient; personally, I love dulse, which is high in idodine.)

      Reply
  6. Clare Hunter

    My understanding is that the data looks at salt content of processed and other foods? Food processing factories will use cheap table salt – look at the ingredients on a packet of table salt in the supermarket and it contains NaCl AND PRESERVATIVES. Is it the preservatives that are really the issue? Another words, a case of association rather than causation for NaCl.
    Put a piece of table salt on your tongue and it burns, put a piece of grey salt (fresh from salt pans with no preservatives) on your tongue and it tastes slightly sweet….

    Clare

    Reply
  7. V

    Back in 2009, as a ”heart patient” also with very high BP I was prescribed – obviously – a HCLF and zero salt diet that I tried to follow for almost one full week. But as the zero salt days went by, my body started to increasingly crave for NaCl, up until the craving became unbearable. To use a weak but suited metaphor, it was like ”gasping for salt”.
    Ever since then, but especially since I switched to a HFLC (and zero sugar) diet, I use an average of 5 g of salt daily and I feel great – BP is ”normal”, kidneys working fine, no chest pains etc.
    Interestingly enough, after I abandoned statins I started to also crave for anything sour, which led me to rediscover pickles – both sour and salty – and lemons. My current favorite, though, is the simple lettuce salad – thinly sliced lettuce with plenty of salt, plenty of lemon juice and plenty of olive oil. I can’t have enough of it.

    Thank you Dr. K. for another great article. Keep up the great work and please pass the salt! 🙂

    Reply
  8. Kay

    I don’t worry about my salt or sodium consumption, but did want to mention that the reason why they refer to it as sodium consumption is because of other dietary sources of sodium, mostly sodium bicarbonate (baking soda).

    Reply
  9. Spokey

    1950’s science fiction monster, Hah! The chloride thing is fascinating, I only knew we needed it to make stomach acid, but that’s about it. I certainly didn’t know low levels could predicate an early death!

    I’m still often told off by people because of my salt consumption. “Like a little dinner with your salt?”, they’ll say. Yes, but not too much. I find it overpowering and I like my sodium level where I can see it. I tell them that the salt monster is all a lie, but they are very hard to convince. Oh well, more salt for me then.

    By the by, people mention kidneys a lot here. I’ve read a couple of things that suggest low salt diets might actually be damaging to kidneys. I don’t know what the details are though, not had a moment to check. But kidneys are definitely tastier with salt.

    Reply
  10. David Bailey

    I suppose the idea behind quoting sodium intake is that people may obtain some sodium from other salts – such as sodium alginate heartburn tablets. Even so, it does seem unlikely that much of their sodium would come from chemicals other than from sodium chloride!

    Removing all the exciting chemistry experiments from schools, seems a sure way to reduce the numbers of people motivated to take chemistry at university. When I was a kid (a long time ago!) I actually managed to obtain some metallic sodium for my home chemistry experiments – and yet I am here to tell the tale!

    Reply
    1. Dr. Malcolm Kendrick Post author

      yes, thanks to all who pointed out that sodium comes from other sources. I knew this, but I would suspect about one in ten million people know how much sodium they are consuming from other sources e.g. baking soda. So, why bother quoting sodium intake requirements.

      Reply
  11. LeonRover

    Dr Malcolm,
    Thanks for providing Cl- ion narrative rather than Na+ narrative ( I am reminded of the figure/ground illusion).

    Until a few years ago I ignored the “cut down your salt meme” as doing so produced such a tiny lowering of BP.

    I let myself be persuaded to use Na/K Cl products from considerations different osmotic pressures of Na vs K thro’ cell membranes.

    It never occurred to me to focus on Cl requirements.

    I tune in here regularly, as Kendrick’s Cholesterol Con is as favourite a re-read as Le Fanu’s Rise & Fall.

    Sláinte

    Reply
  12. Stephanie

    Every visit to the UK I bring Himalayan salt (the least contaminated because it is millions of years old and contains lots of trace minerals) to my family in the UK, , because it’s a ;lot cheaper here in France. My great nephew who is 10 now refuses to eat refined table salt , saying he doesn’t like the taste as much.

    Reply
  13. Ash Simmonds

    Should also be noted, if you try and follow the guidelines you’ll be stuck between rock salt and a hard place for potassium:

    ———————————————–
    The 2010 US Dietary Guidelines recommended limiting intake of sodium to 1500 mg/d for people older than 50 years, African Americans, and those suffering from chronic disease.

    The guidelines recommended that all other people consume less than 2300 mg sodium and 4700 mg of potassium per day.

    The theoretical feasibility of meeting the sodium and potassium guidelines while simultaneously maintaining nutritional adequacy of the diet was tested

    Modeling analyses showed that the 2010 Dietary Guidelines for sodium were incompatible with potassium guidelines and with nutritionally adequate diets, even after reducing the sodium content of all US foods by 10%.
    ————————————————-
    Extract: http://highsteaks.com/forum/health-nutrition-and-science/minerals-and-electrolytes-salt-sodium-potassium-magnesium-etc-105.msg2916.html#msg2916

    Full paper: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878634/

    Reply
  14. Pingback: Salt is good for you | Bydio

  15. Valerie

    As a previous commenter pointed out, sodium doesn’t always come with chloride, and chloride doesn’t always come with sodium. And sodium occurs naturally in food, so giving guidelines about table salt wouldn’t work (assuming that sodium would be worth counting). BTW, we did do the sodium-in-water experiment in school, and it was awsome. One team even got an explosion!

    You suggest that people with kidney damage or very high blood pressure should avoid sodium, Do you have any data supporting that?

    I’m curious because I have malignant hypertension with hypertensive nephropathy, and both conditions get worse when I eat less salt. I become hyponatremic, I swell up, proteinuria comes back, and my blood pressure increases. Textbooks sometimes descibe those effects as “paradoxal” symptoms of hyponatremia, but I have never seen statistics regarding their frequency.

    Thanks.

    Reply
      1. Valerie

        🙂 Thanks for the candid honesty.

        On related note, I spent a few years with hyponatremic-hypertensive syndrome. Not a single health professional suggested that I may want to try eating more salt. I myself was not brave enough to test it on my own (for fear that it would worsen the hypertension, of course). I eventually ended up in hospital for hyponatremia (charming nephrologist thought that a diuretic would be a good idea for the hypertension–it was not). Even then, during the four days I spent with a saline IV, nobody suggested that maybe I should eat more salt. I eventually tried it by myself, as it became obvious that my doctor was an idiot. Lo and behold, my hyponatremia is gone and my blood pressure is lower.

      2. HenryL

        In the main blog post you say salt is not a risk “(Unless you have damaged kidneys and/or very high blood pressure)”. What is the definition of very high blood pressure in this case?

  16. js290

    Just like we can’t blame modern diseases on historical foods, it’s not logically possible for a self limiting but necessary nutrient/mineral to cause health problems.

    Reply
  17. amieres

    There is a condition called Hyponatremia which means low concentration of sodium in the blood. Very few people are aware of this condition which can be fatal. One of the way it happens is when people drink too much water without replenishing sodium, specially if they have been sweating profusely. The imbalance of salt concentration in the blood causes water to enter the cells, specially the brain cells, causing swelling of the brain which leads to seizures and death. Many marathon runners have died of this condition. The symptoms are similar to dehydration and they are often confused prompting people to take in more water.

    I know it sounds incredible but yes drinking too much water can kill you … and fast. Yet all you hear in the media is about the importance of hydration, hydration, hydration for the athletes, mostly to promote “sports drinks” which BTW do not contain enough sodium. Couple that with the demonizing of salt and you have a dangerous combination. Salt is better ingested with solid food rather than liquids which allows the digestive system to regulate the speed and amount of salt absorbed into the blood stream.

    Hyponatremia is so little known that even when diagnosed correctly in the hospital, many times they do not know how to treat it correctly and may tend to raise the sodium level too fast causing a chronic condition called Central Pontine Myelinolysis.

    Reply
    1. Dr. Malcolm Kendrick Post author

      You are absolutely right about this. As I remark to fellow doctors. I have never seen anyone die of a high sodium, but I have (in my working life), seen five people die of hyponatraemia. And yes, it is completely ironic that one of the most common causes of death in marathons is hyponatraemic encephalopathy. Yes, water can kill you, I have seen it happen.

      Reply
  18. Flyinthesky

    The Salt institute, http://www.saltinstitute.org/ , has a lot and cites a lot of off message research.

    A Harvard study,http://www.metabolismjournal.com/article/S0026-0495(10)00329-X/abstract, linked low-salt diets to an immediate onset of insulin resistance, a precursor to Type 2 Diabetes. Another study showed people with Type 2 diabetes are more likely to die prematurely on a low-salt diet.
    One has to wonder what drives this nonsense that is saltophobia, vested interest, seems like a good idea, abject stupidity, professor whatshisname said it so it must be true. I don’t know.

    Reply
    1. Flyinthesky

      There’s always an afterthought: Could the obesity epidemic be partly due to salt reduction? Having to eat more to satiate the need for salt.
      I n the USA a study has been made whereby reducing available salt increases the appetite in cattle thereby decreasing the time to gain optimum beef weight.

      Reply
      1. Ronnie H

        This is interesting. I have long thought that obesity could be a result of eating food that is so bland that you have to eat an enormous amount of it to feel satisfied. Industrial processes and the demand for a long shelf-life seem to take much of the taste away from most basic foods (and beer?). This is pure speculation on my part, and if anyone can point to any research I’d be interested.

  19. Linda Collier

    Stephanie
    You can buy pink Himalayan salt in the UK! You don’t need to bring it over in your luggage.

    Reply
      1. Jennifer

        I suspect our grannies must have tested a sample of their breast milk prior to each feed before daring to nourish their offspring, just in case the nutrients were not up to scratch, and the sodium police paid a visit. So…that must be how the ‘balanced baby formula’ came into being…..the pharmaceutical industry just had to know better how to feed babies than a simple woman ever could.
        Oh, this just gets more ludicrous, doesn’t it? Give me strength! Or at least a pinch of salt to digest this nonsense of over-interference with the blooming obvious.

    1. Flyinthesky

      ” the rule” the key issue, what happened to advisory. We have allowed all our services, from government to health care to evolve from service to authority.

      Reply
  20. Flyinthesky

    Let’s be clear, the government doesn’t care about you or me, it’s on a never ending quest to reduce it’s liability, insofar as the statin hypothesis, vested interest driven, it isn’t concerned with the effects or downsides of statin therapy just the percieved and persuaded, even though provably wrong, reduction of liability.
    Simmilarly they have accepted the salt hypothysis as a potential liability mitigator.
    One only has to look at the Dr Barry Marshall debacle, the establishment damn near ruined him, to understand what we’re up against. After witnessing, personally, the effects of MMR on my grandson you would have to go some to convince me that there isn’t something in what Andrew Wakefield proposed.
    It’s a damning indictment I know but science is dying, it’s giving way to sponsored opinion.
    Once an area of science is bought and paid for it leaves the rest under the greatest of suspicion.

    Reply
  21. Sarah

    Hi
    what I understand about salt is that one should eat naturally air dried sea salt as it also contains other micronutrients. But table salt has been processed and has sand added to make it run which scratches the inside of the arteries. do you think there is some truth in this?

    Reply
    1. Sean Thayer

      Define “sand”. No insoluble silicate particles are going to make it into your bloodstream intact, I promise you.

      Reply
      1. sarah

        http://articles.mercola.com/sites/articles/archive/2012/02/17/dangers-of-salt-restriction.aspx
        You might be tempted to think “salt is salt,” but even the structure of processed salt has been radically altered in the refining process. Refined salt is dried above 1,200 degrees Fahrenheit, and this excessive heat alone alters the natural chemical structure of the salt. What remains after ordinary table salt is chemically “cleaned” is sodium chloride.

        The processed salt is not pure sodium chloride but is only 97.5 percent sodium chloride and anticaking and flow agents are added to compromise about 2.5 percent. These are dangerous chemicals like ferrocyanide and aluminosilicate.

        ALSO
        http://www.naturalbalancett.com/products/celtic-sea-salt.php
        It has been found that people actually experience a reduction in high blood pressure when taking Celtic Sea Salt.

    2. Spokey

      Undigested particulates can enter the blood stream via gastric persorption. That’s a phenomenon apparently, and I’ve read they can do bad things to rats so I personally try to avoid stuff that has weird insoluble flow agents added to it until some one can show me some evidence I don’t need to worry.

      Reply
  22. Sean Thayer

    The reason we call it sodium intake and not “salt intake” is because we ARE in fact talking about dietary intake of elemental sodium. Sodium is bioavailable via a number of sodium salts other than sodium chloride, like sodium bicarbonate, sodium bisulfate, di and trisodium phosphate. Some dietary salts contain more or less, or even zero sodium. Similarly, chloride is bioavailable via various non-sodium salts which it forms with magnesium, potassium, and calcium. All of the above mentioned salts either occur naturally in food and water, and/or are used as food additives, and/or are sold as mineral supplements.

    Reply
    1. David Bailey

      I suspect every commentator here is aware of this, but the point is that it is surely reasonable to use a little simplification in health messages. For example, some foods digest in the stomach to produce a little ethyl alcohol, but it would be confusing to refer to this in campaigns about responsible drinking!

      Reply
    2. Dr. Malcolm Kendrick Post author

      Thanks for your response. My article was exaggerating a bit, for comic effect. My main point is that no-one has the faintest idea what salt they eat, most people have no idea that ‘salt’ is a term that can refer to many different substances. Setting guidelines for sodium intake would virtually require that we all sat with a mass spectrometer next to us to analyse the mineral content of everything we are eating.

      Reply
    1. David Bailey

      That was good to read, because it confirms what Dr Kendrick has written, and indeed this:

      http://www.scientificamerican.com/article.cfm?id=its-time-to-end-the-war-on-salt&print=true

      It is always good to find some corroboration when you are (so to speak) betting your life on it!

      The awful truth is that there is a (Political) science of many things – including climate change, saturated fat reduction, statin consumption,… – all urging expensive and inconvenient solutions to non-existent problems.

      Reply
    2. Joyce Ewing

      Found this post rather belatedly; very interested in the “salt debate”, having seen how much misinformation we have all been programmed with over the decades. The name Gary Taubes got my attention real fast- I have a copy of his book Why We Get Fat. Thanks for the link. Reading through all this has also brought to mind information in books by Ted Morter about the pH issue and how various forms of sodium in foods neutralize dietary acids to keep the very tight pH levels that your body must maintain to survive.

      Reply
  23. Mark John

    I’ve learned a lot from what I’ve read here – thanks guys. I’ve ordered some Celtic Salt and the supermarket NaCl is going in the bin!

    Reply
    1. David Bailey

      Before I would do that, I would want the answers to two questions:

      1) Is there any reason to expect that the additions to table salt are at a level that could be dangerous?

      2) Are the other minerals available in alternative forms or salt, things that might be lacking in a reasonably balanced diet?

      I am cautious about replacing one set of unnecessary rules (limiting salt intake) about what is healthy to eat with another!

      Reply
      1. Dr. Malcolm Kendrick Post author

        David,

        My rules are simple. Keep things as close to ‘natural’ as possible. Restrict the number of drugs that you stick into yourself, or other people, to the bare minimum. Don’t worry about things too much. Enjoy yourself, exercise, and be nice to other people (apart from medical ‘experts’).

  24. karinska2

    It’s so refreshing to be able to read these alternative views amidst all the health propaganda that we are bombarded with daily. I don’t know what we are supposed to do with all this information we receive but it appears to be causing us more stress than ever. Personally, I have never taken any notice of the salt police or the cholesterol brigade although I generally keep the subversive views to myself, However, I don’t allow my 90 year mother to take statins even though her doctor turns into something like the Incredible Hulk when challenged which isn’t pretty but we’ve stood firm. I shall continue to keep reading and re-reading all the fascinating info here and, Dr Kendrick, thank you so much for putting your head above the parapet and
    speaking out, Looking forward to your next book immensely.

    Reply
  25. GG

    I used to use Lo Salt when cooking and no added salt at the table. In this past year though I have started using Himalayan salt and although I have no actual evidence, I believe it is doing me more good than all the highly processed table salts.

    As always Dr K, you provide much food for thought (well seasoned in this case). I too am looking forward to reading your new book.

    Reply
  26. celia goldie

    I was horrified to hear Sir Magdi Yacoub on Saturday morning’s Today programme, extolling the virtues of statins with the apparent voice of calm reason and authority. I expect you heard him state they should be given to every adult over the age of 40, and sold over the counter. He said anyone who disagreed with this was “killing people”, as it had been proved they save lives. We’ve heard that phrase before. My question is – do you think he’s sincere in his beliefs?

    Celia

    Reply
  27. Eric Thurston

    Dr. Kendrick
    Another issue having to do with the amount of salt in the diet and in the body is mentioned in Volek & Phinney’s book “The Art and Science of Low Carbohydrate Living” on p 240:

    “When the human body adapts to a low carb diet, the kidneys fundamentally change how they handle sodium. Removinng most carbs from the diet causes your kidneys to aggressively secrete sodium (and along with it, extra fluid). This is why many people experience a dramatic early weight loss with carb restriction. But this means that a continuous moderate intake of sodium is necessary to keep youur circulation adequate to handle ‘heat stresses’ like hot weather, endurance activity, or even a hot shower.”

    So it appears that those of us on a high-fat, low-carb diet will need a higher intake of salt. Another little item that our beloved food policy makers seem to be ignorant of.

    Keep up the informative blogging!

    Reply
    1. chris c

      Jay Wortman was called a troll and banned from a diabetes forum for stating this. Quite unbelievable.
      I’ve read on the internet, so it must be true actually I can’t remember the reference, that only around 1/4 – 1/3 of hypertensives are sodium sensitive. Far more are potassium sensitive – one reason fruitandvegetables may be advantageous – but most hypertension is a result of hyperinsulinemia (raises hand) and reducing carbs improves or even normalises BP irrespective of salt/sodium intake.

      Reply
  28. Mark John

    Hi Eric

    What you say is perfectly true. “The Art and Science of Low Carbohydrate Living” was instrumental in me switching to LCHF. Shortly afterwards, I did experience the cramps which the authors said may / would happen. I’ve never experienced such night time cramps before (oddly, strenuous exercise didn’t bring them on) and it did take a considerable amount of time for them to clear. I suspect that the modern diet which people eat is the “problem” with regards to salt and not salt per se. In other words, eat natural, single ingredient foods to make meals and the body will take care of the rest. Eat processed sh1t and the body struggles, ultimately manifesting the modern day diseases which are now reaching epidemic proportions

    Reply
  29. Lord Slimeburger

    Brilliant and amusing article. Thanx Malcolm. I particularly like the irony that we give critically ill patients 3 times the recommended daily allowance of salt via a saline drip to make them better!…

    Reply
  30. Dana Green

    Have just come across this Dr Kendrick.Wonderful – the best find since your book “The Great Cholesterol Con” which I quite daily to my patients/friends/colleagues. Keep p the good work and great sense of humour.

    Reply
  31. Philippe Perrot Minnot

    To complete your idea about salt, you can read an historic forbiden reference in …
    http://ab-litho-veritas.blogspot.fr/2012/11/le-sel-na-cl-est-indispensable-votre.html
    5sorry; it’s in french, but with any translation box you can understand)
    In 1856 the use was to recommand 8 to 15 g salt for a person per day, when all meats, fishes were perserved in salt, tinned food was not existing.
    You can watch the tru copy of the reference book, Beclard is the FIRST Pr Med who has study the subject for medical students.
    Did the human body change between 1856 and now ?
    Read also
    http://ab-litho-veritas.blogspot.fr/2012/08/pourquoi-les-diabetiques-deviennent-ils.html
    you will understand why, without salt, or when you decrease to much natural salt furnishing
    all yours organs will fail…
    Before to speak about such or such chemical element interest in the body, the first steep is to study all chemical elements in the body. This is not in actual programms for medecin.
    It is why I do explain and teach “Natural Chemicals Elements”… for LIFE…

    Reply
  32. Pingback: Survive the Antibiotic Aftermath - An American Warning

  33. Tala

    Reblogged this on Tala's Tracks and commented:
    Very well written, and spot-on. Being that I have dysautonomia, as well as left ventricular hypertrophy, my situation is complex anyway. The fact is when I tried to reduce salt intake in the past, it never reduced my BP and always made me sick. Thankfully I now have proper diagnoses and had a great cardiologist familiar with the issues. I do not eat a processed diet, so other than the small amount of salt naturally occurring in foods, I have to get it from a salt shaker. The real problem in the American diet is not the “sodium content” in those processed foods. It’s the processed foods.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Our study extends the IOM (Institute of Medicine) report by identifying a specific range of sodium intake (2,645–4,945 mg) associated with the most favorable health outcomes, within which variation in sodium intake is not associated with variation in mortality. Moreover, this optimal range of intake, based upon available evidence, is coterminous with the current dietary intake of most of the world’s population and is in accordance with the IOM rules for definition of an AI and UL of sodium. Finally, an increased mortality risk was found to be associated with intakes that violate this range. In none of the primary or supplementary analyses was a low sodium intake associated with beneficial effects on ACM or CVD. Thus, these data are consistent with the hypothesis that a U shape best describes the relationship of sodium intake to health outcomes. http://ajh.oxfordjournals.org/content/early/2014/03/26/ajh.hpu028.1.full

      Reply
  34. sundancer55

    I do wish you wouldn’t cite wikipedia.

    This is fascinating. Sharyl Attkisson (former ABC reporter) for 10 1/2 minutes that will kinda sorta shock you, and if it doesn’t, it should.

    At exactly 3 min and 58 seconds, you’ll get a real eye-opening lesson.

    Fantastic stuff. It’s a don’t miss segment, for sure.

    Reply
  35. JDPatten

    Horrific leg cramps. Cured. With more salt.
    I hadn’t added salt to any meal for years. Better part of a couple of decades. I acted on what I was told at the time.
    In recent years I’ve experienced the excruciating pain of periodic leg cramps – both day and night – that wouldn’t let up. Imagine thigh cramps. Yelling for help. The sartorius muscle, longest in the body, seizing. Figure out how to stretch that thing!
    I decided to examine my electrolyte intake. Magnesium, calcium, potassium… fine.
    No sodium. No “extra” sodium chloride.
    I then decided to get no-additive sea salt and sprinkle it liberally on my usual freshly cooked veg and fish low carb meals.
    No more cramps! It was a bit of a rocky road actually, but after some weeks the cramps abated.
    Enough of a lesson for me!

    Reply
    1. Richard Cook

      The same thing happened to me years ago. I used to wake up with bad cramps almost once a week for as long as I can remember but then I started adding salt to my food and guess what, no more cramps for about a decade now.

      I try telling my parents that salt is actually good for you but they just look at me like I;m some sort of idiot.

      There are so many things that prove that it is good. The main one being that if if it was bad for you then we would have evolved to hate the taste of it.

      Reply
  36. Pingback: Salt and cardio-vascular disease | Rosemary Cottage Clinic Blog

  37. Mendoza

    Saline drips i think they call them , and you are 100% right .The body needs salt but it has to be the correct type of salt .Normal table salt or sea salt is not good for your body. I prefer himalayan puck rock salt myself. Its hard to know what type of salt is in manufacturered products and they only have to lable it as salt.

    Reply
  38. W stopford sr

    I agree with this assumption.
    I have a very high salt content diet, not from processed foods but from the shaker.
    I recently had multitudes of blood work done as well as other things and all results were, according to medical guidelines dead center of the normal scale including blood pressure.
    My Grandmother was the same way and she was healthy almost to the end of her life of 96 years. Makes you wonder why a doctor would try to restrict something that is beneficial for you, oh wait greed is the answer…

    Reply

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