Is Salt Worse Than Sugar?

in Blog June 5, 2020

You’re in the process of making dinner and you’re wondering, “should I really add all that salt in the recipe?” You grind some over your meal, and wonder if you should be using less.

Doesn’t salt cause high blood pressure? But isn’t it a necessary nutrient? Can we use it freely or is it bad for your health?

Salt, also known as sodium chloride, is an essential nutrient. That means your body needs it in order to function. However, there’s a narrow range in which it is healthy for the body. When you go over that limit, there are negative consequences, much like with sugar.

Salt and Cardiovascular Disease

The most well-known health issue caused by salt is cardiovascular disease. Large studies of thousands of people instructed to reduce intake have found an average 25% reduction in the risk of a cardiovascular event. The subjects were eating over 1,000mg more than the recommended amount, and were taught how to limit their intake to 1,500mg. (1)

When the body is functioning properly, it keeps blood pressure stable in response to a high sodium intake. It does this through adaptation, much like the way our metabolism decreases if we eat too little, in order to keep us alive. In fact, salt-induced high blood pressure is actually a disorder. It’s called salt sensitivity. On average, only about 50% of people with hypertension are classified as salt sensitive. (2)

This means that for half of people, reducing intake does not normalize blood pressure. Therefore, it’s clear that salt is not the only root cause. Instead, it looks like salt sensitivity may be caused by “endothelial dysfunction”, which basically means inflamed arteries. (3)

Now, it’s important to point out that a high salt diet over a long period of time creates inflamed arteries. However, these diets are also associated with fast food, processed meats like hot dogs, and packaged foods. So it’s hard to say if it’s really the salt that’s causing the dysfunction.

To further this point, risk of being salt sensitive increases as we age, and as weight and blood sugar increase. (4) So while the salt might be a trigger, it appears that the health of the body consuming it is what determines the effect.

Salt and Inflammation

For some people, salt is their trigger for inflammation, whereas for others, they have a different trigger. For example, a 2019 review study explained how the products coming from the microbes that live in our gastro-intestinal tract actually regulate blood pressure. When there’s an imbalance in our gut microbiome, it can lead to high blood pressure. (5)

But let’s get back to good ol’ sodium chloride. I just said it can be an inflammatory trigger. Let’s look into that a little deeper so we can make wise decisions about how much we eat.

It has been discovered that a pro-inflammatory compound called Th17 is increased with high salt intake. (6) Folks, this isn’t good. Th17 is also implicated as a main player in creating autoimmune disease.  Furthermore, salt can increase your white blood cells’ ability to damage your body by increasing the level of inflammatory compounds released by certain white blood cells. (7)

Increasing salt intake has also been shown to increase lupus disease activity in genetically-prone mice. (8) Indeed, sodium chloride increases an inflammatory compound that is associated with the development and perpetuation of multiple sclerosis, inflammatory bowel disease such as Crohn’s, rheumatoid arthritis, and psoriasis. (9, 10)

Salt and the Gut

This will come as no surprise to my regular readers: the gut microbiome controls much of this process! Studies show that probiotic strains in the Lactobacillus family significantly decline with high salt intake. A group of researchers then provided that strain of probiotic to mice, and it neutralized the negative effects of salt. Without the probiotic, the mice experienced both an autoimmune flare and high blood pressure. (11)

As further evidence of the sodium-gut connection, let’s look at a study on bloating. 412 people ate a high fiber diet, then a low fiber diet, and sequentially ate these diets with low, moderate, and high sodium. Results showed that regardless of fiber intake, bloating increased as salt increased! (12)

To me, this is some pretty mind-blowing stuff. For many reasons, we want to avoid high sodium intakes. Though, we also have to remember that it’s not as simple as salt causes disease. If you’re doing a lot in your life to quiet the inflammatory fire within, any inflammation caused by salt will quickly be put out. Indeed, studies show that in Asian countries where there is a very high intake (and a much healthier diet than the US), there’s much lower prevalence of hypertension and autoimmunity. (9)

So What Do I Do?

The FDA recommends up to 2,300mg of sodium per day.  For those with high blood pressure or heart issues, 1,500mg is recommended. The average American consumes 3,400mg! So how do we consume the right amount that meets our body’s needs?

  1. Become aware of your intake by reading nutrition labels. Even items that don’t taste salty, like granola, snack bars, and protein powders, often have significant salt.
  2. Choose low-sodium packaged foods. Think about sauces, dips, chips, crackers, canned vegetables, etc.
  3. Rinse and drain your canned goods. Rinse olives, green beans, regular beans, etc. Thoroughly drain canned tuna, pickles, etc.
  4. Emphasize fresh or frozen meat and fish in your diet. Limit processed meat such as hot dogs, sausage, bacon, jerky, and deli/lunch meats.
  5. Add less salt to your meals. When cooked, it loses much of its flavor, so only add it after you’ve plated your food if it’s needed. Choose salt-free seasonings like Mrs. Dash, especially if you tend to eat more processed or restaurant foods.
  6. Limit restaurant meals to twice weekly, and avoid or limit sauces. Alternatively, split an entrée and order a salad. You can bring your own dressing in a trial size bottle or ask for olive oil, vinegar, and lemon. Sauces can have half a day’s worth of salt in one serving! You might already meet your salt quota for the day by just having chips and salsa! (13)
  7. When eating out at a national chain, look up their nutrition menu so you can choose a lower sodium option.

Remember, the goal is not to avoid salt. While it’s not as bad as added sugars, our intake does need to be moderated. How much sodium do you think you’re eating, and what are the biggest sources in your diet? Leave a comment below!

References:

1. Long term effects of dietary sodium reduction on cardiovascular disease outcomes. 2007.

2. Impact of Salt Intake on the Pathogenesis and Treatment of Hypertension. 2017.

3. Novel Paradigms of Salt and Hypertension. 2017.

4. Impact of Salt Intake on the Pathogenesis and Treatment of Hypertension. 2017.

5. GUT Microbiome-GUT Dysbiosis-Arterial Hypertension: New Horizons. 2019.

6. Intersection of salt- and immune-mediated mechanisms of hypertension in the gut microbiome. 2018.

7. Salt, Hypertension, and Immunity. 2018.

8. High salt promotes autoimmunity by TET2-induced DNA. 2016.

9. Does dietary salt induce autoimmunity?

10. Implications of dietary salt intake for multiple sclerosis pathogenesis. 2015.

11. Salt-responsive gut commensal modulates TH17 axis and disease. 2017.

12. Effects of the DASH Diet and Sodium Intake on Bloating: Results From the DASH-Sodium Trial. 2019.

13. GET THE FACTS: Sodium and the Dietary Guidelines. 2017.

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