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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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March 13, 2008

The Salt/Blood Pressure Debate

By Worker Bee
33 Comments

In response to last week’s canned soup post, reader Dave offered this comment: “I’d just like to point out that just as many Apple readers believe in literature that debunks the lipid hypothesis, there’s a camp that says there is minimal effect on blood pressure from salt. There are two sides to many stories!”

We couldn’t agree more that nutritional (or general health) debates are rarely so simple as they’re made out to be. As long-time readers have probably noticed, we’ll mention salt recommendations now and then and generally try to keep our recipe suggestions fairly low in salt. We do tend to follow general salt recommendations. Blood pressure issue aside, high salt intake (as we mentioned last week) has been associated with osteoporosis, asthma, kidney disease and stomach cancer.

But what about the salt and blood pressure issue? Does it really hold water (pun intended)? We’d say it has enough bearing to figure into our choices, and for some people, research suggests, it’s crucially significant.

For years, scientists have researched the possibility of a “salt sensitive hypertension” that was the general result of a person’s genetic profile. In other words, salt sensitive peoples’ blood pressure is impacted more than the average person’s. To be precise, their blood pressure rises 10% or more in response to a salty meal.

In 2006, researchers at the University of Virginia Health Center announced that they had traced the “sensitive” salt response to particular gene variations and that they were in the process of completing a genetic test for the salt sensitive profile. Salt sensitivity, researchers say, whether it accompanies chronic high blood pressure, negatively impacts the vascular system in the same way high blood pressure itself does. African-Americans are more likely to be salt-sensitive than people of other races in the U.S. The test, once it becomes readily available, will hopefully be a useful tool for people who want to learn more about steps essential for their individual health.

But as for the rest of us, does salt matter for blood pressure? It’s true that many studies in this area, as in all areas, have their failings. And, it’s true that salt is just one piece (albeit an important one) involved in the process of fluid retention and its link to higher blood pressure.

Yet, there seems to be enough suggestion that salt can have a significant or at least measurable impact on blood pressure. A unique look into the connection was found in a recent study that compared blood pressure in groupings of salt mine workers in India, dividing those who worked directly with the processing of salt and those that worked away from the milling plant and its processing steps. The group that worked directly with the salt and had opportunity for inhalation of salt on a daily basis showed higher blood pressure (average of 4 points higher for the systolic measurement) than the group that didn’t work in the mill. After a group of mill workers used face masks and goggles for just four days, their blood pressure dropped an average of ten points in the systolic measurement.

While the above study examines a mode of salt intake other than ingestion, there is no shortage of studies that measure the effects of reducing dietary salt intake. Follow up research on two study groups from the 1990s help strengthen the argument for lower salt intake as helpful in preventing heart disease. Former subjects that had been part of the intake “intervention” group and were given the low salt diet, 10-15 years later had a “25% reduction in the risk of cardiovascular disease.”

Another study out in 2006 showed significant and positive impact of salt substitute use in Northern rural China, which is known to have especially high rates of hypertension as well as high salt intake. The salt substitute, researchers said, “demonstrated that it could reduce blood pressure to about the same extent as single drug therapy.”

And, ultimately, what does a low salt diet look like? First off, it should mean pretty much no processed food. We definitely support that! Up to ¾ of American’s salt intake comes from processed foods – those curious boxed creations you find in the middle of the grocery store, cured meats, etc. Cut those out, and you’re already in good shape. We certainly don’t begrudge anyone reaching for the salt shaker. We do, but we also don’t rely on it for taste. The more people moderate (yes, moderation is the key here, not elimination) their salt intake, the more likely they are to turn to other sources of flavorings, hopefully healthful ones like herbs and more varied, flavorful ingredients like peppers, onions and other vegetables and fruits. At least, that’s what we’d suggest.

This is one of those fascinating discussions that we love to continue. We’re always on the lookout for research from both sides of the issue. Keep your comments coming!

Further Reading:

10 Ways to Reduce Salt

10 Innovative Uses for Salt

Sugar Shock – Salt: The “Forgotten Killer”

The Migraineur: Salt No Longer Generally Recognized As Safe?

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33 Comments on "The Salt/Blood Pressure Debate"

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Migraineur
8 years 6 months ago
Ooh, pingback! Thanks! I loves me some salt. One of the most memorable foods I ate in France was a plate of radishes with soft butter for dipping. The butter was liberally sprinkled with coarse salt. This dish is absolutely not the same without the salt. I tried making at home and had to keep adding salt until I got it right. I’ve moderated my opinion on salt somewhat since I wrote the post you’ve referenced above. There probably are people out there whose pressure rises a bit in response to sodium. But I still do think the most effective… Read more »
Mike OD - IF Life
8 years 6 months ago
People’s BP is more related to other factors like a Magnesium and Calcium deficiency, not excessive Sodium. Also isn’t the balance of K/Na a factor? Doesn’t the body just get rid (pee) of excessive Na anyways? from http://www.second-opinions.co.uk/salt-and-hypertension.html “Michael Alderman, President of the American Society of Hypertension, Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, who wrote in 1997:[35] ‘Public health recommendations must be based on proof of safety and benefit. Even if a low sodium diet could lower the blood pressure of most people (probably not true) and both the diet and the change in blood… Read more »
JS
JS
8 years 6 months ago

Is there any information on salt and food intake? I was just wondering since there seems to be some connection between altering the flavours of processed food by adding extra sugar, sugar substitutes, or MSG and decreased satiety signals. Could the same be true for salt?

Crystal
Crystal
8 years 6 months ago
There are different camps because there should be! We have all heard that sodium is bad for us. This has caused more harm than good, in my opinion. The key is figuring out which camp you belong in. As mentioned above, the ratio of sodium to potassium is what is important concerning blood pressure. There is all kinds of possibilities. A person can have high sodium/high potassium or low sodium/high potassium. This results in higher bp and fluid retention but also dehydration. A person can have low sodium and low potassium leading to too low blood pressure, increased heart rate… Read more »
kara
8 years 6 months ago

I checked my favorite cereal – Cheerios and it has 280 mg sodium! I’m switching back to Shredded Wheat which has none.
I read we humans should keep our sodium intake under 3000mg (3gm)a day.

Sasquatch
8 years 6 months ago
I’ve talked with Dr. Robin Felder (the UVA researcher who studies the genetics of salt sensitivity), and “salt sensitive” people are actually pretty common, even among those of European descent. I don’t remember numbers. He has a protocol he uses to determine who’s sensitive by cutting out salt for a couple of weeks and looking at blood pressure. He claims (and I believe him) that many lives could be saved by cutting out salt alone. Although I will say that I think excess carbohydrate is the real elephant in the room, and without it the effect of salt would be… Read more »
Mike OD - IF Life
8 years 6 months ago

I’ve personally never “felt” my BP go up with additional salt…I have felt it go up with excess carbs.

I’m not a chemist but I would be willing to bet natural sodium found in fruits. veg and sea salt are completely different in how the body absorbs and use than processed food salts/sodium. Of course most fruits/veg have a higher ratio of K than Na.

Kara – I would bet the same people who tell me salt is bad…are also going to tell me to eat low fat and avoid sat fat. I would agree processed foods should be avoided anyways.

markus
markus
8 years 6 months ago
gary taubes hit the nail on the head a few years ago about the soft science of salt like the lipid idea, the obsession with salt masks a desparate desire to squeeze a lot of significance from a little stone of evidence his points still generally stand, despite more recent “evidence” the issue is really a red herring hypertension is part of the constellation of associative symptoms of civilisation diseases if salt – of itself – has an effect it is too minor to bother about one “real” issue is salt retention – leading to water retention – resulting from… Read more »
tatsujin
8 years 6 months ago
FWIW, I do not cook with salt for most of my cooking. When other people cook or when I eat out, the food is usually to “salty” for my tatste. However, when I make certain recipes were salt is part of the “flavoring of the recipe” (like roasted kale with generous sprinklng of sea salt) I never feel like it’s too salty, on the contrary, I could put on more. I never feel my bp spike when I eat it. Nor any other effects. I don’t use “commercial” salt. I agree with the majority of comments to stay away from… Read more »
Miguel Carrera
Miguel Carrera
8 years 6 months ago
Using the evolutionary template as a guide, we can see that the soium/potassium ratio (more important than the absolute amount of sodium) was much lower than it is today, mainly because of processed foods and table salt and a low intake of fruits and vegetables. But sodium and salt aren’t necessarly the same thing, as more than 50% of salt is chloride, and this has a big impact in the Acid-Base balance, as a recent study has shown(Frassetto LA, Morris RC Jr, Sebastian A. Dietary sodium chloride intake independently predicts the degree of hyperchloremic metabolic acidosis in healthy humans consuming… Read more »
The Natural Health Guy
8 years 6 months ago

This is a great article, informative and unbiased with information regarding both sides of the salt and high blood pressure story. I was thinking of doing an article just like this on my site.

The Natural Health Guy

Don
Don
8 years 5 months ago
At age 65 I have taken my BP twice a day for 5 years and record the pertinent information(calories of aerobic exercise, low sodium DASH diet, alcohol consumption and weight.)in a diary. I know I am a bit of a nut case but I like to keep the records so I know how I am doing and how often I can break the rules. There is ABSOLUTELY no question that sodium is important (for me). But sodium is just part of it. Hi potassium (vegetables and fruit), regular aerobic exercise and moderation in the consumption of alcohol are also very,… Read more »
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[…] The Salt/Blood Pressure Debate […]

micheal
7 years 11 months ago
MARK, INSANE, THE BATTLE ON SALT IS a no brainer… SALT IS VITAL… BUT… ONLY THE BEST SALT IN THE WORLD celtic salts, and crystal salt from the worlds best sources… FEED THE BODY IT’S SOURCE… PLEASE TELL PEOPLE that SALT ISN’T THE VILLIAN IT’S THE OVER USE OF IT… I.E AND TOO MUCH AT ONE TIME… PLEASE I AM an expert researcher… PLEASE LET PEOPLE KNOW A PINCH IS A PINCH AND A FEW TIMES A DAY OF THE BEST SALT IN THE WORLD MAKES YOU 10 times as healthy. ANY MORE THAN THAT AND it’s just like anything… Read more »
micheal
7 years 11 months ago
and IN RELATION TO SALT you MUST MOVE… LIKE 1 HOUR A DAY AT THE LEAST… I feel it’s important to sweat, to get your correct amount of water… and to have a relationship with a doctor to tell if you are salt sensitive or what’s going on with it per if salt if effective you wrongly it’s a complicated part of our system and in almost everything and could relate to test and updates etc. THERE ARE OVER 100 TRACE MINERALS IN HIGH GRADE, WORLDS BEST CRYSTAL-CELTIC SALTS. normal salt has 2 trace minerals… WHERE on earth can you… Read more »
micheal
7 years 11 months ago
ALSO a pinch is that 13 crystals? IS IT 130 CRYSTALS? IS IT ONCE IN A DAY? OR 5 TIMES A DAY 7 CRYSTALS IN EACH MEAL… IF YOU take anything in THE ( TOO MUCH ZONE ) IT will be HORRIBLE FOR YOUR HEALTH even if good for you. I noticed the debate of acidic-alkenline in past threads and just wanted to point out GO TO LOW OR EAT CRAP SALT and you will face A HORRIBLE disease IN MY BOOK… yes nuts have salts, but to get all the best trace minerals from the source, the source that’s… Read more »
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[…] a vegetable, but ketchup is definitely not a good choice – it’s loaded with so much corn syrup, sodium, and other pseudo-foods that the tomato can scarcely be detected. Instead, load up on the stuff […]

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[…] – Stock has these minerals in mostly trace amounts, but they’re all important for health. Sodium isn’t really an issue for most people, but potassium is undoubtedly important and often lacking. […]

Rich
Rich
6 years 1 month ago

Ever heard of Pansalt, used in Finland for many years? It seems to be a form of salt that does not cause hypertension.

http://www.imi.com.sg/productinfo.htm

I wish it were available where I shop.

(This is not intended as an advertisement. I have no connection to Pansalt.)

Jan
Jan
6 years 1 month ago

Rich: The salt used in Finland is available as Wright Salt (for Dr Jonathan Wright) It is sold on his website (and probably other places) for $7/3oz. Weston Price Foundation says celtic salt is top of the line

Bob Da Prato
Bob Da Prato
6 years 1 month ago
Since there are so many societies (primarily Asian, such as the Japanese and Koreans that have a much higher sodium intake (200-300% more), and in the case of the Japanese, anyway, live a few years longer, on average, than citizens of the US I can’t get excited about sodium intake. I think it is a natural appetite, like thirst, and the body knows better than ideologues what is required. Short term, of course, increased sodium intake causes increased fluid retention and blood pressure, but this only lasts a few days and then the body adjusts to the new level of… Read more »
Gary
Gary
6 years 1 month ago
Salt is not the problem. Even though it probably does have a short term effect on blood pressure, it is a small effect and is not a problem by itself IF your arteries are healthy (soft and pliable). Calcification of the arteries is the problem, causing them to be brittle thereby making you more succeptible/vulnerable to increases in BP. To combat calcification, increase your vitamin D (5000 IU) and vitamin K (200 mcg, etc. to stop the deposit of unwanted calcium in the arterial wall. There are other things you can do as well which I won’t go into here.… Read more »
Dave
Dave
6 years 1 month ago
I’m no doctor, nor am I an avid reader of nutritional books (although I should be) but when I switched to a basically NO salt diet, I was tired all the time, had horrible swelling in my legs, and when I did have energy, I had no stamina. My blood pressure wasn’t really “high”, but it was in the upper range (can’t remember the numbers…my bad). I reasoned that since the swelling and energy level issues paralleled the removal of the salt, I should reverse the process, and voila! The swelling issues disappeared overnight, as did the lack of energy.… Read more »
Art
Art
6 years 1 month ago

I think the discussion on salt must absolutely distinguish between refined and unrefined salt. I wouldn’t be surprised if all the evils associated with salt are related to refined salt. Dr. Brownstein has written about this:
http://www.drbrownstein.com

Dave from Hawaii
6 years 1 month ago
Here’s what the WAPF says about salt: The salt that you find in table salt and most processed foods is sodium chloride. Salt in this form has been processed at high temperatures, which changes the molecular structure and removes vital minerals from the salt. Table salt also contains additives, anticaking agents, and even sugar. Excess salt consumption is associated with high blood pressure, fluid retention, heart and kidney disease. Trash It: Dump out your salt shaker and toss out all other packaged or processed foods with a high sodium content. This should be pretty easy for most people. Stash it:… Read more »
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5 years 6 months ago

[…] chronic kidney disease (CKD) are, respectively, diabetes (45% of CKD cases) and hypertension, or high blood pressure.”Even” the Wikipedia entry on renal failure fails to mention “excess protein in […]

Peggy
Peggy
5 years 5 months ago
Interesting discussion. Too much of anything is not good at best, and dangerous at worst. Salt can be addictive for some individual (usually the ones with salt sensitivity – like my mother in law, sadly this lovely warm and caring woman died from using too much salt – she was only 65) Salt is everywhere in our foods, it can be a bit of a challenge to avoid over-consumption (1teasp tops pd) but if you avoid overprocessed packaged etc foods (and cheese) you’re half way there. Replace it with Sea Salt or Himalayan salt but not liberally because that is… Read more »
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[…] here’s what Mark says on the […]

MamaGrok
4 years 9 months ago
“The more people moderate (yes, moderation is the key here, not elimination) their salt intake, the more likely they are to turn to other sources of flavorings, hopefully healthful ones like herbs and more varied, flavorful ingredients like peppers, onions and other vegetables and fruits.” But that implies that salt is not healthful. I wholeheartedly agree that refined salt should be avoided all the time. Unrefined salt, however, is rich in trace minerals that most of us are desperately deplete in, as a result of the atrocious monocropping farming and wasteful waste treatment practices of the last 150 years. Real… Read more »
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[…] general processed food intake. I’ve discussed this before, but consider that processed food accounts for most of the sodium in the average person’s […]

gary
gary
2 years 8 months ago
I generally believe in studies that are made and published by universities, clinics etc. But sometimes I must argue – I do not believe in results. I have an elevated blood pressure. It was must worse than it is today – my blood pressure was in high 160/100 range. A call for action indeed (see this blood pressure chart to see how severe my situation was http://healthiack.com/health/blood-pressure-a-health-indicator#blood-pressure-chart) I talked to my personal doctor about it and he suggested me the following: more exercise, avoid stress, eat less salty diet and quitting smoking. I’ve went ahead step by step. I started… Read more »
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2 years 7 months ago

[…] a vegetable, but ketchup is definitely not a good choice – it’s loaded with so much corn syrup, sodium, and other pseudo-foods that the tomato can scarcely be detected. Instead, load up on the stuff […]

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1 year 4 months ago

[…] is definitely a connection between higher sodium intake and higher blood pressure levels, but the impact is highly individualized. A portion of the population is genuinely salt sensitive, […]

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