The Missing Ingredients in the Salt Debate


As early as the 1960’s, leading voices in the medical profession have called for drastic reductions in the salt intake of the American public. Salt has been called the most dangerous food additive of all, and blamed for a host of health problems including cardiovascular disease, stroke, and kidney disease.

Now, the decades-old debate over salt consumption has flared once again, this time at a new fever pitch. As it is being circulated in several media outlets, the US Government has implemented new dietary guidelines that drastically cut suggested salt intake.

Shaky science, foregone conclusions

Dramatic measures such as this are not new, and they receive a great deal of media attention. What isn’t widely debated is the science these regulations are based on. For example: consider hypertension, the primary medical issue linked in the public conscience to salt consumption. Few Americans are aware that the scientific evidence linking blood pressure to salt consumption is weak, conflicting, and not at all conclusive.

In 1999, Gary Taubes received a Science in Society Journalism Award for his article “The (Political) Science of Salt.” In it, he exhaustively reviewed the political history and clinical trials behind the salt debate, concluding that the issue had “devolved into an argument over whether extreme reductions in salt intake, perhaps impossible to achieve in the general population, can drop blood pressure by as much as 1 or 2 millimeters of mercury, and, if so, whether anyone should do anything about it. For people with normal blood pressure, such a benefit is meaningless; for hypertensives, clinicians say that medications have a much greater effect at a cost of a few cents a day.”

For anyone interested in a detailed scientific history of salt and public health, Taubes’ article is illuminating. Though much of the content is technical, drawing heavily from numerous studies and clinical trials, the conclusion is clear: the general recommendations for sodium restriction are rooted more firmly in opinion and bandwagon-style thinking than in actual scientific fact.

More recently, a 2008 Esquire article by John Mariani summed up the evidence for salt reduction this way: “Studies show that 30 percent of the Americans who have high blood pressure would greatly benefit from a low-sodium diet. But that’s about 10 percent of the overall population—the rest of us are fine with sodium.”

If the clinical evidence suggests that medication and diet are much more effective than sodium restriction in controlling hypertension, why has salt received such a negative reputation? Without a true medical justification, the issue has become a touchstone for nutritional educators, whose goals of public education go far beyond what is scientifically defensible.

Changing the Debate: Are all salts equal?

Scientific justification isn’t the only thing missing from the salt debate; also absent is a fundamental understanding that not all salts are the same. Rather than debating whether or not processed salts should be in processed foods, Americans should be clamoring to replace table salt with whole, unprocessed sea salts. Processed, iodized salts have a much different nutritional profile and biological effect than whole sea salts, which contain significantly less sodium and an array of bioavailable trace minerals. While primarily available through natural foods outlets, whole sea salts are gaining in popularity among medical professionals.

According to Selina Delangre, owner of Selina Naturally® and distributor of several varieties of whole salts, “Many of my customers are surprised when I tell them that our salts are truly doctor recommended. They’ve been so conditioned to believe that all salts are bad for them, and they have no concept that not only is salt a component of a healthy diet, some are actually physician-approved.”

Delangre, who has been in the natural foods industry for over thirty years, has seen what’s happening in the salt debate manifest in other ways.

“I remember throughout the eighties, everyone was focused on eating a low-fat diet. Then, we gained an understanding that there are good fats, those that are essential to our health and wellness. In the nineties, the fad was low-carb. Once again, we later realized that whole, minimally processed grains are a vital part of a healthy diet. I’m hoping that 2010 will be the year people realize that just like fats and grains are of varying qualities, there are a variety of salts in the world. They’re not all the same!”

According to Delangre, who has traveled the world visiting salt harvesters and learning about the industry, salt quality comes down to a few basic criterion: trace minerals, electrolytes, flavor, and purity.

“You can do a side-by-side comparison of a whole sea salt and a processed iodized salt. They don’t look or taste the same. They perform differently in recipes, and they act differently in the human body,” she says.

One example Delangre cites is the way electrolytes in unprocessed salt react within the body. Pure water doesn’t conduct electricity. Salt water does. Since electrolytes have an electrical charge they can move through your cell membranes and thus carry other nutrients with them into the cells. They also carry messages along your nerves and help control things like your heart beat. The human body uses these minerals and trace elements to create electrolytes and maintain bodily fluids. This “internal ocean” is vital to the proper functioning of every system within our body. Whole sea salts have this property, table salts don’t.

According to Ronald Halweil, MD, “Typical table salt is not a natural product. It could just as easily be sold as the chemical sodium chloride (NaCl). Avoid it, in any amount, whenever possible, because it lacks many essential minerals and combinations of minerals that are important to good health.”

Halweil and other doctors like him compare table salt to other adulterated food ingredients, such as refined sugar and partially hydrogenated oils.

As for Delangre, she’s made it her mission to educate the public on the benefits of whole, unprocessed sea salts.

“Bit by bit,” she says, “the public is coming to an understanding of the concept of whole foods. Real, whole salts have an important role to play in this new way of thinking about nutrition, and I’m doing my best to advance the debate.”

Salt: A Timeline of Scientific Inquiry

1985 A ten-year study of nearly 8,000 Hawaiian Japanese men concluded: “No relation was found between salt intake and the incidence of stroke.”

1995 An eight-year study of a New York City hypertensive population found those on low-salt diets had more than four times as many heart attacks as those on normal-sodium diets.

1997 A ten-year follow-up study to a large Scottish Heart Health Study found no improved health outcomes for those on low-salt diets.

1998 A health outcomes study in Finland found 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.”

2003 In June 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.”

2007 An October 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 in lowering death rates.

2008 Italian scientists published the first-ever randomized controlled health outcomes trial comparing congestive heart failure patients who consumed normal salt intakes with those treated with reduced salt diets. The low-salt dieters fared far worse.

Courtesy of the Salt Institute