Contrary to what your doctor may tell you, low salt intake is linked to high blood pressure, obesity, and diabetes. And reducing your salt intake could even raise your risk for heart disease and insulin resistance. So rather than focusing on cutting back on salt, follow this three-step strategy.
Story at a Glance
- If you eat a lot of processed foods, which contain processed table salt, your sodium-to-potassium ratio is likely out of balance.
- It's generally recommended that you consume five times more potassium than sodium, but most Americans get the opposite ratio, eating two times more sodium than potassium.
- Consuming more potassium is just as important for limiting chronic disease risk factors as limiting sodium.
- A New England Journal of Medicine (NEJM) study found those with the lowest risk for heart problems or death from any cause were consuming 3 to 6 grams of sodium a day—far more than U.S. daily recommended limits.
- Unprocessed, natural salt, such as sea salt and Himalayan salt, is higher in potassium than table salt.
Why You Should Focus on Increasing PotassiumIt's generally recommended that you consume five times more potassium than sodium, but most Americans get the opposite ratio, eating two times more sodium than potassium. But realistically, it's best to get a minimum threshold of about 5 grams of potassium from fresh fruits and vegetables, and then your sodium intake becomes less of an issue.
"When dietary potassium intake is elevated, the kidneys—composed of millions of small tubes working together—shift fluid to the area near the end of the tubes where potassium secretes into the urine. This shift reduces the amount of sodium and water that's reabsorbed into the body. In this way, high potassium diet signals the body to reduce the amount of sodium that is retained.
"This circular pattern regulates the levels of both minerals in the body, which in turn helps lower blood pressure. Higher intake and excretion of potassium has also been found to slow the progression of kidney and heart disease."Even the American Heart Association explains, "Foods with potassium can help control blood pressure by blunting the effects of sodium. The more potassium you eat, the more sodium you process out of the body."7
I personally get all my potassium from food and not supplements. I take in about 5 grams of potassium daily, primarily from watermelon, boiled red potatoes, oranges, and orange juice. My sodium intake is about the same at 5 grams (half from salt and half from baking soda), so I am not convinced by the general recommendation to take twice as much potassium as sodium as long as you are getting about 5 grams of potassium from your food.
The Type of Salt MattersWhen considering what type of salt to eat, remember that it's not all created equal. Salt provides two essential elements—sodium and chloride. In the United States, most of the salt consumed comes from processed foods. This processed salt contains 97.5 percent sodium chloride, with about 39 percent sodium.
Why Low-Salt Advice Can Be HarmfulFrom my recent review of Ray Peat's work, it is clear that low sodium intake is associated with a decreased breakdown of serotonin, just like an SSRI drug. You might be thinking that was a good thing, but you would be mistaken, as serotonin is not the "happy hormone" it is promoted to be but a toxic neurotransmitter when levels reach high concentrations.
Studies suggest excess serotonin, rather than a dopamine deficiency, is likely a major contributor to Parkinson's. Dopamine is a highly beneficial neurotransmitter and has an inverse correlation with serotonin. So when its levels are low, it tends to increase serotonin, likely the more significant contribution to the disease.
"There is a large fraction of body sodium deposited in the bone, suggesting that bone might serve as a sodium reservoir which is mobilized during homeostatic stress. Salt also has a crucial role in maintaining positive magnesium and calcium balance.
"If a reduction in serum sodium occurs, the bone may be stripped of sodium (as well as magnesium and calcium) to maintain normal serum sodium levels. Indeed, a low-salt diet has been shown to lead to negative calcium and magnesium balance which could result in osteoporosis. Thus, a low-salt diet may cause osteoporosis by stripping the bones of sodium, calcium, and magnesium."
Does a Low-Salt Diet Worsen Heart Risks?Meanwhile, according to Mr. DiNicolantonio, your blood pressure may indeed go down when you reduce your salt intake. The problem is that your total cholesterol to high-density lipoprotein (HDL) ratio, which is a much better predictor of heart disease than low-density lipoprotein (LDL), is worsened along with it. Triglycerides14 and insulin are also increased.
So overall, your heart disease risk increases rather than decreases, even though your blood pressure readings appear better. What's worse, salt deficiency also increases your chances of developing insulin resistance because one of the ways in which your body preserves salt is by raising your insulin level.
"There is evidence that a low-sodium diet may lead to a worse cardiovascular prognosis in patients with cardiometabolic risk and established cardiovascular disease. Low-sodium diets may adversely affect insulin resistance, serum lipids, and neurohormonal pathways, leading to increases in the incidence of new cardiometabolic disease, the severity of existing cardiometabolic disease, and greater cardiovascular and all-cause mortality.
"Although a high sodium intake also may be deleterious, there is good reason to believe that sodium intake is regulated within such a tight physiologic range that there is little risk to leaving sodium intake to inherent biology as opposed to likely futile attempts at conscious control."Further, rather than focusing on reducing salt intake, researchers suggested that using self-monitoring tools to gauge sodium-to-potassium ratio via urine is a practical strategy for achieving healthier blood pressure levels:16
"Reducing the Na/K ratio is essential for preventing hypertension and CVDs [cardiovascular diseases] prior to clinical onset …
"The individual estimate of the 24-h urinary Na/K ratio that can be obtained by the repeated casual urine Na/K ratio may be useful in detecting individuals who need an easy dietary lifestyle modification during the prevention stage. For the treatment stage, self-monitoring devices may increase patient awareness of their dietary level and help to maintain appropriate levels."
How Much Salt Do You Need?Mr. DiNicolantonio recommends eating about 3,500 milligrams of sodium daily,17 which is far more than the American Heart Association's recommended maximum limit of 2,300 milligrams a day and its "ideal limit" of less than 1,500 milligrams a day.18
However, your body also has a built-in "salt thermostat" that basically tells you how much you need by regulating your craving for salt. So learn to listen to your body and remember that if you sweat profusely, either through exercise or sauna use, for example, or drink caffeinated beverages, you automatically will need more than usual.
Several medical conditions can also increase sodium loss or prevent your body from absorbing salt well, such as inflammatory bowel diseases, sleep apnea, adrenal deficiency, bariatric surgery, kidney diseases, hypothyroidism, and celiac disease. So if you have any of these, you may need a bit more salt in your diet to compensate.
- Endocrine disorders.
- High aldosterone levels.
- Cushing's syndrome.
- Elevated cortisol.
- Liddle syndrome, a rare condition affecting about 1 in 1 million individuals, causing them to retain too much salt. Salt intake probably does not need to be restricted if treated with amiloride.
3 Steps to a Better Sodium-to-Potassium RatioRather than focusing on cutting back on salt, most people are better served by switching to natural salt and limiting their intake of processed foods. In short, to optimize your sodium-to-potassium ratio for better health, focus on the following three steps:
1. Eliminate all processed foods, which are very high in processed salt and low in potassium and other essential nutrients
- Orange juice.
- Coconut water.
- Winter squash.
- Boiled red potatoes.
- Wild-caught salmon.
- 1, 2, 19 New England Journal of Medicine August 14, 2014; 371:612-623
- 3 American Journal of Physiology — Endocrinology and Metabolism April 4, 2017
- 4 Harvard Health Publications, January 23, 2017
- 5 American Journal of Physiology — Endocrinology and Metabolism April 4, 2017, Conclusions and Implications
- 6 Science Daily February 21, 2017
- 7 American Heart Association, A Primer on Potassium
- 8 Science Direct, Table Salt, Different salts in snacks
- 9, 11 The Ultimate Age-Defying Plan
- 10 Foods. 2020 Oct; 9(10): 1490., Table 2
- 12 BitChute, Mercola October 26, 2021, 00:19
- 13 Mo Med. 2018 May-Jun; 115(3): 247–252
- 14 Curr Opin Cardiol. 2018 Jul;33(4):377-381. doi: 10.1097/HCO.0000000000000525
- 15 Am J Med. 2013 Nov;126(11):951-5. doi: 10.1016/j.amjmed.2013.05.020. Epub 2013 Sep 18
- 16 Nutrients 2017, 9(7), 700; doi: 10.3390/nu9070700
- 17 Penguin Random House Canada, Excerpt From “The Salt Fix”
- 18 American Heart Association, Why Should I Limit Sodium?
- 20 Harvard T.H. Chan School of Public Health, Potassium