Should You Eat Less Salt?

Vlog

I would love to have an albertnet podcast, but the fact is, I don’t know how. I would have to learn some new platform, and figure out how to make it available to the 4.3 billion users of the Internet, and I simply don’t have the time. Knowing that many people would rather passively listen to podcasts than scroll through large bodies of text, I’m providing the next best thing: a vlog version of the following post. If you aren't enthralled by the sight of me pretending not to read, just close your eyes. Or open another tab and look at pictures of Gal Gadot while you listen. Or bite the bullet and scroll down for the text. Your call.

Introduction

I am not a doctor or nutritionist, nor a scientist of any kind. I’m not in the business of making specific health recommendations to anybody. That said, I think blanket advice from nutrition experts to the population at large can be imprecise. This post examines the question of whether you, dear reader, need to worry about your salt intake. I don’t know who you are, of course, but I aim to slice and dice the question of “who” more finely than other sources you might encounter. I also review here the results of a simple survey I sent out to my cycling friends. You won’t (and shouldn’t) come away with a new approach to your diet, but perhaps with a few good questions and some (low-fat, all-natural, free-range) food for thought.

Why do I care?

Humans need salt. And so does food. As a dumb kid I thought salt just made food salty, but that’s wrong. Salt makes food yummy. As I learned to cook I was astonished at how you can have a dish 99% done and it won’t taste right until you salt it, and then suddenly it can go from edible to delicious. The end result doesn’t necessarily taste salty; it just tastes right.

Now, if salt were utterly, incontrovertibly bad for you, I might consider it a necessary evil. I’m not willing to go without it, despite being sufficiently health conscious that I’ve essentially given up bacon and other cured meats. But the amount of added salt needed for a complete gastronomic apotheosis doesn’t need to be large. Have you ever tried to eat unsalted peanut butter? It’s revolting. I’d rather eat my scabs. Hell, I’d almost rather eat your scabs. If salted peanut butter had twice the FDA’s recommended daily allowance of sodium in it, and cost twice as much as unsalted, I’d still choose it.

But you know how much sodium regular peanut butter actually has? A mere 140 mg, just 6% of the recommended daily value. (Note that trying to go lower than this wouldn’t necessarily be beneficial: humans actually need about 500 mg of sodium a day to conduct vital functions, as described here.)

So why does unsalted peanut butter exist, other than as a specialty product for sufferers of hypertension? I’ll tell you my hunch: many people who buy it are reacting to the vague sense that less sodium is always better for you. And peanut butter is just one example of this phenomenon. It breaks my heart that well-meaning people are eating inferior meals based on rule of thumb that may or may not apply to them.

[Above: this PBJ was such a work of art, my daughter asked for a bite and then made off with half of it. This never would have happened in my household growing up. More on this later.]

Does sodium actually increase blood pressure?

I won’t bother to provide a wide survey of the science on this, but here are the high points of an article from the Harvard Medical School, based on an interview with Dr. Nancy Cook, a professor of medicine there:

• On average, Americans eat too much salt
• Whether or not sodium is bad for everybody, vs. only those with certain risk factors, has been a matter of some debate
• There is a fairly undisputed effect of sodium on blood pressure, and it’s stronger in people with hypertension
• People respond differently to salt, one to the next

Regarding the mechanism of sodium’s effect on blood pressure, Cook explains, “When you eat too much salt, your body holds on to water in an effort to dilute it. This extra water increases your blood volume, which means your heart works harder because it’s pushing more liquid through your blood vessels. More strenuous pumping by the heart puts more force on the blood vessels. Over time, this increased force can raise blood pressure and damage blood vessels, making them stiffer, which increases the risk of stroke, heart attack, and heart failure.”

Now, I don’t know about you, but when I read that, I didn’t immediately have an “Oh, shit!” reaction. Perhaps my salt intake does cause water retention, but not for long because every time I exercise, which is generally around four times a week, I sweat a lot, and in fact after a particularly hard ride I’ll get these head rushes every time I stand up—a classic symptom of low blood pressure—until I rehydrate. Not that I expect Dr. Cook to base her guidelines on my particular case. Given that a fairly recent CDC study concluded that only 22.9% of Americans get enough exercise, it’s not hard to see why Dr. Cook would advocate for reducing sodium intake when addressing the general public.

Meanwhile, the CDC reckons that “Americans consume an average of more than 3,400 mg of sodium each day,” which is far more than the 2,300 that the U.S. Department of Health recommends. Clearly, overconsumption of sodium is a public health problem in this country.

But does this mean you and I and everyone should all cut down? I think that would be a problematic conclusion. If Americans by and large use too much petroleum and create too much pollution by driving giant SUVs, then yeah, I can try to mitigate the damage by driving a Prius. But if someone eats too much salt and doesn’t exercise enough, I can’t help him by lowering my salt intake. In other words, I may or may not be implicated in this public health crisis. (Again, I can’t fault the article; the safe bet when advising a wide audience is to advocate caution and restraint.)

As is so often the case, there’s a bit of a conundrum here: the people who are concerned about their health and go looking for dietary advice are often not the ones recklessly eating a lot of processed food, fast food, and salty snacks, and thereby creating frightening statistics around widespread hypertension. A good many conscientious folks may heed these general warnings about salt and reduce their consumption, thus depriving themselves of its goodness for no legitimate reason.

My own experience

In brief, I’ve been seeing borderline high systolic blood pressure readings since high school, while my diastolic numbers are always nice and low. Meanwhile, my blood fats (cholesterol etc.) are remarkably good, my body mass index is spang in the middle of normal, and my resting heart rate is in the low 40s. I’ve never had a doctor recommend a change in diet, and over time my systolic reading has come down a bit. I chalk this up to being less of a hothead than I used to be. In general I suspect the benefits of life balance, of stress release achieved through exercise or yoga, and of emotional hygiene such as self-compassion are underrated. Modern life has people working too much, exercising too little, over-consuming news and social media, and then trying to undo all the damage by eating less salt. Nice try.

My survey

I surveyed a bunch of my cycling pals, because they’ve always been an insightful and amusing bunch. Being cyclists, most of them seem to eat basically whatever they want, and they’re all pretty much fit as a fiddle. That said, they take their health seriously, which statement I base on a couple of decades of riding and eating together, and also on their reactions to a couple of articles that have come out about too much exercise possibly damaging your heart. I was curious about my cycling team’s approach to salt so I emailed them this simple question: Do you make any effort to limit your salt intake for health reasons?

Of the 23 responses I got back, 17 were some version of no (i.e., they eat all the salt they want) and 6 were yes (they limit their salt). Of course I got some interesting comments, too:

• No, but I’m also pretty naturally salt-averse. One of my most frequent complaints about restaurant food is that it’s too salty, and one of my family’s most common complaints about my cooking is that there’s not enough salt in it.
• No. But then again, I don’t really make any effort to limit my intake of anything. I’m a gluttonous hedonist. What could possibly go wrong with that philosophy???
• I double down on salt - I’ve got low blood pressure and find getting light headed when I stand up a bit irritating.
• How can a person cook without salt? It’s my understanding (possibly inaccurate) that salt is only a problem if you have high blood pressure, so not really an issue for healthy people with normal blood pressure.
• Switched to dry brining with kosher salt. Definitely healthier and tastes better but I cannot speak to any metaphysical benefit.
• I’m casually aware of salt intake but never limit myself vs. what tastes appropriate. I don’t buy potato chips very often but when I do I want ‘em salty.
• No. But I know when I’ve had too much and I don’t necessarily enjoy that feeling.
• No. Well, maybe. I salt liberally from the shaker/cellar, but I do try to be aware of how much sodium certain prepared foods contain, and err on the side of less is better there…
• Well, occasionally I think about limiting my salt intake but it doesn’t really happen.
• Yes and yes - Simply put, Salt= Hypertension, Sugar= diabetes. Controlling these substances through diet can extended the life of several organs. It’s no secret that food companies fill processed food with these as a preservative and as a sales angle. We don’t even realize how much is added … I haven’t added salt to anything in years.
• Several years ago, I went to the doctor and my blood pressure was slightly higher than it used to be, almost 140/70. (Getting older sucks...) Since then I’ve generally cut back on the Mexican and Korean foods, and now it’s back to 120/60. However, if I ride 4+ hours in the heat, then I’ll always reward myself with some Mexican food.

My favorite comments were from the two MDs in my survey:

• I maximize salt intake!
• Salt is not a major contributor to hypertension. The processed food that contains a lot of salt probably is. (I spent a 1/3rd of a course in college studying sodium.) However, from a public health perspective, telling the public to limit salt probably has beneficial effects.

Now, there are (at least) two conclusions I could draw from these results. One, I could assume that by not worrying about salt whatsoever, we are consuming huge amounts of sodium and yet somehow getting away with it. On the other hand, we could be well within the recommended range of sodium consumption quite by accident. Granted, we cyclists love us some big, rich meals, but we tend to cook them ourselves. I’ve never known any of these pals to eat fast food, and as health-conscious types we avoid processed food like frozen entrees, “lunch meat,” and snack foods, because of all the other crap in them (trans fats, nitrates, refined flour, artificial flavors, etc.) and because we’re frankly too epicurean. (I get frozen pizza for my kids a couple times a year as a guilty pleasure, and indeed, only the scarcity of it makes it a treat.)

Honestly, the Recommended Daily Value of sodium, 2,300 mg, seems pretty generous. I tallied up the amount of sodium I get from my typical lunch, and found no cause for alarm. Lunch is often my biggest meal of the day, and it’s invariably a big burrito (basically homemade but with canned refried or whole beans and store-bought tortillas). Look, here’s one now.

I just read some labels and have calculated that one of my big-ass burritos contains about 1,400 mg of sodium. Of the US Recommended DV of not more than 2,300 mg, that leaves just 900 mg free for dinner (since I don’t eat breakfast). This is probably okay because my wife does most of the cooking and seldom resorts to things like canned beans. Besides, even if I’m a bit over the guideline, I’m a big guy and my daily caloric intake is very high—some would say legendary. But I guarantee I’m far from the 3,400 mg of sodium that the average American takes in, without even trying … that is, without compromising the tastiness of my food.

According to the CDC, “Most of the sodium Americans eat comes from packaged, processed, store-bought, and restaurant foods. Only a small amount comes from salt added during cooking or at the table.” A Harvard medical school article concurs: “At least 75% of the sodium in the average American diet comes from processed foods, such as cold cuts and cured meats, pizza, burgers, and sandwiches.”

This makes perfect sense, of course. Food is big business, and if sacrificing the health of consumers is what it takes to ensure shareholder value, so be it. Take the case of Campbell’s soup: they were famously required by the FDA to desist using their old slogan “Soup is good food” because their soup had too much sodium to be called “good.” More recently, Campbell’s experimented with lowering sodium, but then reversed course when sales dropped. As described here, their new CEO announced at an investors’ meeting, “For me it’s about stabilizing [sales] first.” Campbell’s contends that “the proposed nutritional principles ‘describe products that manufacturers will not produce because children and teens will not eat them.’”

Obviously we can’t stake our health on the companies that pander to philistine tastes. But that doesn’t mean when we cook at home we should gild the lily and err on the side of blandness. If anything, that will just tempt us to eat out more. And with restaurants, of course, all bets are off.

Conclusion

Again, I’m not a doctor or a nutritionist, but I think I can you give this bit of advice: before you automatically seek to lower your sodium intake based on the general messaging we get from the FDA, CDC, etc., find out what your own blood pressure is and ask your doctor if you’re at any risk. And if you do have a need to keep an eye on your sodium intake, do so with precision, by reading labels and knowing what goes into your food. It could well be, for example, that a person with mild hypertension could still afford the amount of sodium in regular peanut butter, and doesn’t need to be shaking Mr. Dash on his or her dinner.

Appendix A – salt in peanut butter

I grew up eating a lot of PBJs. My mom was a great cook, but these sandwiches were atrocious. The bread was fine, and the jam (generally homemade) was great, but the peanut butter was awful. It was a brand called Deaf Smith, and as detailed here, it was the first organic peanut butter on the market. It came in a giant plastic bucket—it had to be at least a few gallons—and it looked like a cross between diarrhea and that old-fashioned Dijon mustard with all the seeds in it. It was a roiling, gritty, grainy, wet mess and we called it quicksand because if you lost your grip on the knife (which happened a lot because it’d get oily), the knife would quickly sink and you wouldn’t see it again until you eventually got to the bottom of the tub and there’d be like five knives there.

But you have to understand, my brothers and I were not picky eaters, and all this would have been completely forgivable if Deaf Smith didn’t taste so damn bad. It was just awful. We suffered through those PBJs because we had to—we were growing boys, after all—but it was just so gross. As soon as I moved away from home I switched to Skippy and discovered that peanut butter could be delicious.

A few decades later, though I’d moved on to natural, non-hydrogenated peanut butter, usually Adams or the Trader Joe’s brand, I was still totally digging it. And then one day my wife bought unsalted by mistake. The horror! It tasted exactly like Deaf Smith! Completely disgusting—I was right back in my miserable elementary school lunchroom! This was an epiphany. I realized that there had never actually been anything really wrong with Deaf Smith except the lack of salt. This omission was totally unnecessary and surely not why my mom chose that brand. She has always maintained that salt won’t hurt you if you don’t already have high blood pressure—it can only exacerbate it. She probably chose Deaf Smith simply because it was organic and available in bulk. So why did Deaf Smith eschew salt? Probably because they were a bunch of hippies and salt seemed evil to them somehow.

Postscript to this sad tale: a year or so later I mixed up a fresh batch of Trader Joe’s peanut butter (yes, this mixing is a pain in the ass and I do miss the hydrogenation of Skippy at times), and then made a PBJ. Yuck! Foiled again! Staring, enraged, at the label, wondering why my wife would poison the family again by buying more unsalted peanut butter, I realized this jar wasn’t actually labeled as unsalted. It was their organic variety, which had just 40 mg of sodium per serving, vs. 140 mg in the normal version. I guess they decided those who like organic food automatically want less sodium. I wrote an angry email to Trader Joes, which I’ve just found and reread. It ends, “When this jar is empty I will probably remove the label and burn it in effigy.” (In fairness, Trader Joe’s did apologize and gave me a refund.)

Appendix B – fact-checking the Deaf Smith tale

I fact-checked the bit about Deaf Smith peanut butter with my mom, to confirm that lowering our sodium intake wasn’t her goal in choosing it. This she corroborated, but she denied that we ate it that much. “I got it from the co-op, and hadn’t tried it before,” she said. “I think I only bought it once, and had no idea it wouldn’t be salted. It probably just seemed like we got it a lot, because it took so long to get through that giant drum.”

I thought this might have been wishful thinking … after all, no mother wants to admit she tortured her offspring for a protracted period. So I asked my brother Bryan. He responded, “It was just for a time as I recall, we didn’t really like it because it was so natural, and it separated so badly that the last few gallons of it were like concrete.”

My brother Max had a host of other memories around the Deaf Smith. “As I recall, the Deaf Smith was from ‘the co-op,’” he told me (via text). “That’s where those ginormous cylindrical loafs of Colby and Colby-Jack cheeses came from as well. I think there was more than just one five-gallon tub of Deaf Smith that came through [our household]. The Deaf Smith was really good in rice crispy squares. I remember that! When we complained about the Deaf Smith mom would laugh … for some reason she just didn’t believe that we really hated it.

“Remember the story of how Deaf Smith became deaf? He was a San Francisco kid and he had to take the trolley to school. One day he was a little running behind, as they say, and the trolley was already taking off. He ran up to the trolley and a man, who was just trying to be helpful, used the young Smith’s ears as handles to haul him up onto the trolley and he was deafened.”

At this point I replied, “I do not remember that story. Is that from the archives or did you just make that up?” Max’s answer: “True story as I remember it. I recall feeling that we had to eat this peanut butter because mom felt sorry for Deaf Smith. It may have been that the man ‘boxed’ his ears to punish him for his tardiness. I remember asking Mom what that meant, boxing the ears. I guess it was common back then for men to box the ears of wayward youths. As she described it, boxing the ears involves essentially punching a kid in both ears at the same time with the fists turned inward so the contact with the ears is made with the fleshy part of the hand between the wrist and bottom knuckle of the pinky finger.

“I recall that she may have been unsure whether the man dragged him up by his ears or dragged him up and then boxed his ears, but either way it resulted in two sure things: Smith became deaf and there was nothing more for him but to make peanut butter.

“Everyone who buys this product feels a bit guilty and a bit absolved simultaneously. I always tried to like the Deaf Smith out of guilt for the human condition. I’d think about the trauma that that kid endured, having his life ruined by some a-hole on the trolley, and how he had to crush peanuts for the rest of his miserable existence.

“It had to have been a miserable existence. If he had made any sort of meaningful recovery, he might have put some sugar or at least some salt in the peanut butter. It was almost as though he accepted being boxed in the ears. As though he deserved it for being late. That peanut butter was practically a punishment. Austerity in a five gallon tub.”

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