The Tale of Evil Salt

by Dr.Harald Wiesendanger– Klartext

What the leading media are hiding

Eating low in sodium: This comes naturally to health-conscious people. It is said that high daily salt consumption increases the risk of high blood pressure, cardiovascular disease, and stroke. Doctors give correspondingly strict advice, and the inmates of hospitals, retirement homes, and care facilities must be cooked for in a correspondingly bland manner. It is much easier to consume too little salt than too much. By the way: Salt is not just salt – the quality decides.

“First salt, then scythe”: That’s how martially a doctor recently titled an article in the information portal doccheck – as if the salt shaker were a preferred tool of Grim Reaper. After all, it is “known that excessive daily salt consumption is a significant risk factor for high blood pressure and thus also for the development of cardiovascular diseases, especially sleep attacks.”

The concern of the Heidelberg general practitioner follows common doctrine. And this arose from uncontrolled case reports in the early 20th century. It has remained almost ineradicable ever since. It is reflected in the German Nutrition Society (DGE) recommendation to consume no more than 6 grams of salt per day and in the upper limit of 5 grams advocated by the World Health Organization (WHO).

The study situation has long given reason to question the almost immovable dogma. In 2018, for example, a systematic review of nine studies found that there is no solid, high-quality evidence that clearly supports a low-sodium diet.

Textbook wisdom disproved – the SODIUM-HF study.

In April 2022, the results of the large-scale SODIUM-HF study became public. (1) It involved 806 adult patients at 26 sites in six countries. On average, 66 years old, they suffered from chronic heart failure in stages II to III according to the New York Heart Association (NYHA) classification, i.e., with mild to severe limitations in exercise capacity but still with no symptoms at all rest. They were all supplied with medication in accordance with the guidelines.

Two equal groups were formed from these subjects: one received only general advice on sodium intake in the diet; the other should be on a strictly low-sodium diet of no more than 1500 mg daily.

For six years, cardiologists observed how these guidelines affected health.In the first year after the start of the study, the average sodium intake in the diet group fell from 2,286 mg to 1,658 mg per day and in the control group from 2,119 to 2,073 mg.

What was the effect of this difference up to the end of the six-year observation period? By then, 15% of the low-sodium group and 17% of the control group had cardiovascular-related hospitalizations, attended the emergency department, or died—a difference in incidence that was statistically meaningless. Surprisingly, the total mortality in the diet group was even slightly higher at 6% than in the control group at 4%.

And so the authors succinctly concluded: “In outpatients with heart failure, dietary intervention to reduce sodium intake did not result in a reduction in clinical events.”

What was the effect of this difference up to the end of the six-year observation period? By then, 15% of the low-sodium group and 17% of the control group had cardiovascular-related hospitalizations, attended the emergency department, or died—a difference in incidence that was statistically meaningless. Surprisingly, the total mortality in the diet group was even slightly higher at 6% than in the control group at 4%.

And so the authors succinctly concluded: “In outpatients with heart failure, dietary intervention to reduce sodium intake did not result in a reduction in clinical events.”

A shortcoming of the study could have falsified the results: the fact that the control group did not consume exceptionally high amounts of salt. In this regard, the two groups differed by only 415 mg per day. An adult German consumes an average of 8 to 10 grams of salt daily (https://www.bmel.de/DE/themen/ernaehrung/gesunde-ernaehrung/degs-salzstudie.html), an American consumes 9.6 grams, https://www.pharmazeutische-zeitung.de/2018-03/ernaehrung-zu-viel-salz-schadet-immer/ so that the control group does not really represent a population that indulges in a typical Western (mal)nutrition style.

Another criticism is that the patients included may not have been sick enough to benefit from a low-sodium diet. There might have been a benefit if patients with the most severe heart failure – stage IV – had also taken part.

However, these shortcomings in no way devalue the results. In his analysis for the information portal Medscape, the electrophysiologist Dr. John Mandrola states: “SODIUM-HF is (…) has shown that in a typical heart failure cohort, recommending a stricter low-sodium diet compared to general advice makes no difference in treatment outcomes… My conclusion is that we don’t have time and expend energy to get patients on an extremely low-sodium diet.”

A bigger problem: lack of salt.

The truth is, it’s quite difficult to get in harmful amounts of sodium – but easy to get deficient in it. The first symptoms of sodium deficiency include general symptoms such as nausea, vomiting, headaches, and muscle pain or confusion.

As an electrolyte – a substance that conducts electricity – sodium helps regulate the amount of water in and around cells, as well as blood pressure. If your salt levels are too low, you can become chronically dehydrated. Sodium levels below 115 nmol/l are considered critical. Then there is an increased shift of water into the interior of the cell, with functional disorders of various organs – such as kidney weakness – and the risk of brain swelling, leading to impaired consciousness through cramps and coma. A sodium level below 110 mmol/L that is not corrected quickly can be fatal.

In 2014, the PURE study with around 102,000 participants from 19 countries showed that too little salt increases the risk of heart attacks and strokes. Further investigations (2) confirmed them. Thomas Lüscher, head of the Center for Molecular Cardiology at the University Hospital Zurich, sees the reason in that the organism releases hormones that increase blood pressure when salt consumption is very low. “It’s similar to the blood sugar in diabetics,” he explains, “too much is dangerous but too little is too.” (3)

Many patients with high blood pressure are prescribed diuretics: water tablets that make the situation worse.

Recommendations for a low salt content only rarely consider coffee consumption – although drinking coffee quickly empties the salt stores. If you drink four cups of coffee daily, you can easily excrete more than one teaspoon of salt in your urine in four hours. Nevertheless, doctors recommend that he consume no more than one teaspoon of salt daily. And this corresponds to approximately 2,300 mg of sodium. Coffee drinkers who follow this advice can become sodium deficient severely within a few days as their bodies lose significant amounts of salt.

Coffee drinkers are even more at risk if they do intensive sports, regularly visit the sauna, or do physically demanding activities. Because his body also excretes sodium with his sweat: 700 to 2000 mg per liter. So if you sweat a lot, you may be shedding more salt than you’re putting back on a low-salt diet.

Salt intake was once ten times higher.

Also, historically and cross-culturally, the general recommendation to limit salt intake doesn’t make much sense, as cardiologist James DiNicolantonio points out in a book worth reading. (4) Earlier generations consumed ten times more salt than we do today – for centuries, it was used to preserve food. It is estimated that a Swede consumed an average of 100 grams of salt per day in the 16th century.

Why are so few doctors surprised to this day that the frequent occurrence of high blood pressure in the early 20th century was accompanied by a significant decline in salt consumption – due to the fact that cooling replaced salt preservation?

The Chinese and Japanese, whose life expectancies are among the longest in the world, also consume the highest amounts of salt: an average of 13.4 and 11.7 grams per day, respectively.

The obsession that salt intake correlates with blood pressure gained popularity with the DASH (Dietary Approaches to Stop Hypertension) study published in 1999. (5) Reducing salt intake was indeed one of the dietary approaches being pursued but by no means the only one. The DASH diet also limits the consumption of sugary and processed foods, which can affect blood pressure far more than salt.

The average Western eater gets the most salt, 75 to 90%, from processed foods: for example, ready meals such as pizza and chips, instant soups, bread and rolls, snack foods, and meat and sausage products. Such an unbalanced diet promotes obesity, which is the main factor responsible for cardiovascular diseases.

Avoiding salt can do more harm than good.

According to DiNicolantonio, reducing our salt intake can actually lower our blood pressure. Unfortunately, this worsens the ratio of total cholesterol to the “good,” protective high-density lipoprotein (HDL), which is a much more reliable predictor of heart disease than the “bad,” wall-damaging low-density lipoprotein (LDL). Triglyceride and insulin levels are also elevated. Thus, the risk of heart disease increases rather than decreases, even if the blood pressure readings seem better.

Worse still, a lack of salt also increases the risk of developing insulin resistance, as the body conserves salt by increasing insulin levels, among other things. Higher insulin levels help the kidneys retain more salt.

Insulin resistance, in turn, is a feature not only of heart disease but of most chronic diseases.

So, since the advice to eat a low-salt diet doesn’t consider the overall clinical picture, it can end up doing more harm than good.

Our salt status also directly affects our magnesium and calcium levels. When we don’t eat enough salt, our body not only begins to pull sodium from the bones, it also rips magnesium and calcium from the bones to maintain normal sodium levels. To the same end, it decreases the amount of sodium lost through sweat and excretes magnesium and calcium instead. Also, low sodium levels increase aldosterone, a sodium-binding hormone that reduces magnesium by causing the vital mineral to pass in the urine.

A rigorously low-sodium diet is one of the worst things we can do to our health—especially the condition of our bones and heart.

Let’s listen to our bodies better than questionable experts.

In short, there is no serious reason to worry about too much salt in your diet. A 2017 study confirmed (6) that a healthy body maintains a relatively constant sodium balance at all times; amazingly, regardless of how much it is ingesting, it excretes excess via the kidneys. According to DiNicolantonio, a person with intact kidneys can consume at least 86 grams of salt per day.

In addition, our organism has a built-in “salt thermostat” that tells us the amount we need, regulating our cravings for salty things. Those who have consumed too much salt become thirsty and drink water; in doing so, he dilutes his blood enough to maintain the proper sodium concentration. So let’s learn to listen to our bodies. And let’s remember that if we sweat profusely and enjoy a lot of coffee, we automatically need more salt than usual.

Some medical conditions can increase sodium loss – or prevent the body from absorbing salt well. These include inflammatory bowel disease, sleep apnea, adrenal fatigue, kidney disease, hypothyroidism, and celiac disease. Those suffering from any of these conditions may need a little more salt in their diet to compensate.

Also, there are some salt-sensitive populations who need to limit their salt intake to 2,300 mg per day. These include people with endocrine disorders, high aldosterone levels, Cushing’s syndrome, high cortisol, and Liddle’s syndrome, a rare condition that affects one in 1 million people; she will retain too much salt.

Much more important: the sodium-potassium ratio

While salt continues to be demonized as a cause of high blood pressure and heart disease, research shows the real key to normalizing blood pressure is the ratio of sodium to potassium – not sodium intake alone. (7)

While salt continues to be demonized as a cause of high blood pressure and heart disease, research shows the real key to normalizing blood pressure is the ratio of sodium to potassium – not sodium intake alone. (7)

Like salt, potassium is an electrolyte. But while most of the potassium is inside the cells, most sodium is floating outside. Potassium ensures that our artery walls relax, our muscles do not cramp, and our blood pressure drops. (8th)

As a rule of thumb, we should consume five times more potassium than sodium. Those who prefer a standard western diet of processed foods are likely to consume twice as much sodium as potassium.

The research results from the doccheck author cited at the beginning are based on her scythe horror show on how fatal the effects of such malnutrition can be. She refers to a study published in the European Heart Journal in early August 2022, which included health data from 501,379 people. In the beginning, the subjects indicated, among other things, whether and how often they add salt to ready-made meals at the table – an approximate measure of how great the individual preference for salty-tasting foods and the usual salt intake is. More than half, 277,931, reported never or only very rarely topping up; Another 140,618 people said they did this “sometimes,” 58,399 “usually,” 24,431 “always.”

At the end of the nine-year study period, 18,474 deaths had occurred among the participants. In the case of occasional re-salts, the mortality was moderately above average; in the case of constant ones, an enormous 28% increased the risk of death.

A key aspect of this study: Regular consumption of fruit and vegetables negated the significant statistical association between post-salting and mortality. How so? Because fruits and vegetables provide plenty of potassium. (Bananas and apricots are particularly productive, as are carrots, avocados, tomatoes, kohlrabi, potatoes, Brussels sprouts, peppers, and mushrooms. Nuts, dark chocolate, and certain types of flour also score points as sources of potassium.) It follows from this: Using the salt shaker extensively is primarily harmful to those who do not value healthy, wholesome nutrition.

Of course, this does not mean that any upper limit for daily salt intake is superfluous. At some point, it is too much. The 2018 INTERMAP study (9), which included 4,680 men and women between the ages of 40 and 59 from China, Japan, Great Britain, and the USA, found that even a healthy diet rich in fruit and vegetables did not reduce the harmful hypertensive effects can compensate for the impact of excessive salt consumption. There is also evidence that too much salt promotes inflammation and autoimmune diseases by damaging the intestinal flora. After just two weeks with 12 grams of salt per day, no lactobacteria could be found in the intestinal flora of the study participants.

Of course, it is a long way from a vague association to a clear causal connection. Until then, physicians should be careful not to overinterpret the fundamentally tiny effects of individual food components on our health and to inflate them into myths.

As always in life, it is crucial to find a middle ground when it comes to salt: between demonization and excess. It can help visualize the gap between claim and reality, which has permanently been attached to modern, scientifically rock-solid approved nutritional research. Which food preference hasn’t already revealed them to be unhealthy, even life-threatening? How often has she preached nonsensical, often even counterproductive renunciation of good taste? Usually only for a limited time – until it became clear at some point that eggs, for example, in no way alarmingly raise cholesterol levels. And thus cause hardening of the arteries and cardiovascular diseases; that a vegan diet is not necessarily malnutrition; that fat doesn’t have to make you fat; that five meals are not ideal, nor are sweeteners a good alternative to sugar. A lot of advice on the “right” diet “falls under the heading of religious freedom,” says Prof. Volker Schusdziara from the Technical University of Munich. “These are creeds that everyone is allowed to have. But they are not medically and scientifically substantiated.”

Unfortunately, asceticism is much the same as rumors and genetically modified organisms: once introduced, they are hardly easier to catch than Aladdin’s genie in a bottle.

Tunnel vision prevails on both sides in the dispute over salt. Joachim Hoyer, a nephrologist at the University Clinic in Marburg, warns that you shouldn’t just concentrate on this one health detail. “There is much better evidence that being overweight, smoking, or not doing enough physical activity increases the risk of heart attacks and strokes. Instead of struggling to avoid salt, it might be better to exercise more often in the fresh air.” (10)

Primary sources of salt intake

About 80% of your daily salt intake comes from processed foods.

Salt is not just salt.

By the way: Salt is not just salt – the quality decides. To take advantage of its physiological benefits, we should ensure that it is unrefined and as unprocessed as possible. And this speaks, for example, for the pink-tinted Himalayan salt; it is rich in naturally occurring trace minerals needed for healthy bones, fluid balance, and overall health. Other good choices are raw rock salts, natural sea salts, crystal salts, or the exquisite Fleur de Sel.

On the other hand, we should stay away from cheap, industrially produced table salt for several reasons. First, natural salt usually contains, in addition to 84% sodium chloride, 16% naturally occurring minerals such as potassium and magnesium, and trace elements, including selenium, zinc, silicon, phosphorus, and vanadium. On the other hand, processed table salt is over 97% sodium chloride; the rest is made up of manufactured chemicals such as moisture absorbers and anti-caking agents. Table salt for sausage products also contains carcinogenic sodium nitrite. A small amount of iodine can also be added – although we could cover our need for this trace element in other healthier ways. In addition, around 90% of table salt is contaminated with microplastics. In addition, industrial processing also radically changes the chemical structure of the salt.

Long story short: For optimal health, we absolutely need salt – but not all of it. Our bodies need natural, unprocessed salt with no added chemicals or plastic.

However, it will probably be a while before the Grim Reaper haunted the last dogmatic salt renunciator.

by Dr.Harald Wiesendanger– Klartext

See > Microplastics In Us: A Time Bomb

Remark

(1) Justin A. Ezekovitz u.a..: Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomized, controlled trial. Lancet, 2.4.2022. DOI: https://doi.org/10.1016/S0140-6736(22)00359-5)

(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041211/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064042/

(3) Zit. nach https://www.spiegel.de/gesundheit/diagnose/ernaehrung-schadet-zu-viel-salz-im-essen-wirklich-a-1020274.html

(4) James DiNicolantonio: The Salt Fix: Why the Experts Got It All Wrong – and How Eating More Might Save Your Life, New York 2017

(5) Cardiology Review September-October 1999; 7(5): 284-288https://pubmed.ncbi.nlm.nih.gov/11208239/. Weitere Studien, die für eine Reduzierung der Salzzufuhr zur Vorbeugung von Bluthochdruck zu sprechen scheinen, werden hier zusammengefasst.

(6) Journal of Clinical Investigation 2017;127(5):1944–1959https://doi.org/10.1172/JCI88532New York Times May 8, 2017https://www.nytimes.com/2017/05/08/health/salt-health-effects.html

(7) Advances in Nutrition, 2014; 5:712http://advances.nutrition.org/content/5/6/712.full

(8) Harvard Health Publications, January 23, 2017http://www.health.harvard.edu/heart-health/potassium-lowers-blood-pressureJournal of the American Medical Association 1997;277(20):1624https://www.ncbi.nlm.nih.gov/pubmed/9168293Journal of Human Hypertension 2003; 17(7):471https://www.ncbi.nlm.nih.gov/pubmed/12821954British Medical Journal 2013; 346:f1378http://www.bmj.com/content/346/bmj.f1378

(9) https://pubmed.ncbi.nlm.nih.gov/29507099/,  summarized  hier 

(10) Zit. nach https://www.spiegel.de/gesundheit/diagnose/ernaehrung-schadet-zu-viel-salz-im-essen-wirklich-a-1020274.html

Quelle Galileo-Grafik: https://cms-api.galileo.tv/app/uploads/2020/05/grafik_salz.png