Home' Nova National : March 2011 Contents 22
Is salt the real problem that it is
made out to be? It seems that by
oversimplifying the information on
salt and its relationship to health
we complicate what is a really simple and
important issue. After reviewing more
than 100 scientific papers it became clear
salt is not the public enemy it is made out
to be; rather the issue appears to be an
imbalance of minerals as a result of eating
processed foods. And some very simple
changes can make a lot of difference. This
does not mean you go out and lather salt
on all your food and justify it from my
article; instead it means making some
common sense dietary changes.
Salt, in the form of sodium chloride,
has been consumed by humans since the
late Palaeolithic period, when it was used
to preserve and flavour food. In modern
times, however, some very limited studies
and an incomplete understanding of
nutrition have led to salt being labelled
"public enemy number one" when it
comes to blood pressure and cardio-
vascular disease. But is salt really so bad?
Salt in the human diet has been
the subject of a great deal of research.
Health professionals have, for many
years, recommended reduction or even
elimination of salt intake. This is mainly
due to findings that link the excessive
salt in the modern human diet to health
problems such as high blood pressure.
Yet it would be short sighted to simply
accept or reject such recommendations, as
there are other factors involved requiring
Salt intake is widely recognised by
public health and medical organisations
as the leading cause of blood pressure
disparities 1. However, it is simply not
valid to state that reducing salt intake will
lower our prevalence of hypertension; the
truth is that a number of factors, including
lifestyle and nutrition, play an important
Sodium is essential for many functions in
the human body. The average human body
© NOVA MARCH 2011
Along with fat and sugar,
salt is widely viewed as an
unpalatable health risk in
the modern diet. But are
we being too hasty in our
judgement, asks Dr Peter
'However, in humans at least, individuals seem to vary
significantly in how they tolerate salt.'
Is Salt the Culprit?
contains around 90 grams of sodium, most
of which is in the fluids that surround cells,
some in bones and the rest retained in the
cells 2. Sodium is passively absorbed and
hence excess intakes are easily achieved.
Sodium is excreted mainly by the kidneys;
so a high sodium intake must be balanced
with a large intake of water and other
fluids. Sodium is the main component
of the body's extracellular fluids; it helps
carry nutrients into and waste products
out of the cells, regulates body functions
such as blood pressure and fluid volume
and works on the lining of blood vessels to
keep the pressure balance normal 3. So you
can see it is pretty important.
Chloride (Cl), the other half of the
salt molecule (NaCl), is just as important
as sodium yet often ignored. Chloride
is essential for the production of hydro-
chloric acid, which is necessary to
digest proteins in the gut and is vital for
destroying bacteria and other potentially
How much salt?
In terms of the adequate amount of
daily intake of salt, various organisations,
including the National Academy of
Sciences' Institute of Medicine, have
published recommendations for daily
sodium intake between 1,500 milligrams
(mg) and 2,400 mg per day for healthy
The main regulators of sodium levels
in the body are the kidneys. If sodium
levels drop too low, the hormone
aldosterone is released and this increases
the amount of sodium held in the body
by reducing the amount lost in urine.
Excessive sodium loss is very rare, but
low sodium levels in the body can be
dangerous if not treated. Some people
do not get rid of enough sodium through
their urine; this causes the body to retain
water, resulting in swelling of the body
and, with the increased blood and fluid
volume, in turn causes high blood
pressure 5. The high blood pressure puts
a strain on the heart, which must work
harder to pump the increased volume of
blood (Fox 2007). This is one reason that
many health professionals recommend
a reduction of salt intake -- to reduce the
risk of excess sodium in the blood; they
believe that lower sodium intake has
a beneficial effect on blood pressure.
Thus people with existing hypertension
and kidney disease may benefit from a
reduction in salt intake.
While there is evidence to suggest that
salt plays a role in hypertension, it is a
bit simplistic to target salt and ignore
information that contradicts this. It is
critical that we assess all the information
available. It is important to take a
multidimensional approach and look at
the whole body. The increase in blood
pressure as a result of increased salt
intake may be due to the human kidney's
inability to excrete large amounts of
sodium 6,7,8. Results from various studies
-- epidemiological, animal and migration
studies as well as randomised trials --
support the claim that as dietary salt
increases, blood pressure increases 6.
However, in humans at least, individuals
seem to vary significantly in how they
tolerate salt. Some people appear to be
salt sensitive or have certain conditions
that predispose them to hypertension.
High dietary salt intake in some
individuals has been shown to contribute
to cardio vascular conditions including
the incidence of stroke 9. Research has
found that individuals with a high salt
sensitivity (in particular, those with
hypertension) have an increased risk of
cardiovascular disease and death 10. High
dietary salt intake can increase the risk
of osteoporosis because of high urinary
calcium excretion. In particular, it has been
found that individuals with hypertension
excrete high levels of calcium in their
urine 11,12. However, provided that intake
of calcium and potassium are at
recommended levels, the risk of
osteoporosis is low 13.
Salt is not the problem
So what is the problem? Research dating
back to 1964 contradicts the simplicity of
the link between salt and hypertension 14.
In one study, a significant blood pressure
decline was observed as a result of
acute dietary salt increase 14. While limited
studies of salt levels and blood pressure
support the salt-hypertension link, the
data is somewhat contradictory 14-23. It
appears that this link affects only those
with existing health conditions, not
healthy people. The question that remains
is whether beneficial hypertensive effects
of sodium restriction will outweigh its
Inadequate salt intake has also been
associated with undesirable metabolic
situations such as alteration in plasma
lipoproteins and inflammation 24, a potential
increase in cardiovascular stress, and
increased serum cholesterol, triglycerides
and insulin resistance 25. Contrary to
common belief, the effects of low-salt
diets -- the unfavourable effects on blood
coagulation, inflammatory and metabolic
disturbances -- outweigh the benefits of
lowered blood pressure (Nakandakare et
al. 2008). One study found that low-salt
diets can actually cause harm to people with
high blood pressure 26,27. So too little salt
has greater adverse effect on health than
too much salt. Epidemiological evidence
suggests that a reduction in salt can
decrease the risk of coronary disease
significantly for overweight patients 28;
however, low-salt diets are not warranted in
patients with normal blood pressure 24.
continued page 36
Peter Dingle is Associate Professor
in Health and the Environment at
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