Dr. Brownstein is a family physician and the Medical Director of
the Center for Holistic Medicine in West Bloomfield, Michigan.
He has authored six books including Salt Your Way to Health.
by Dr. David Brownstein, MD
Dietary Villain or Foundation of Health?
Low-salt diets have been recommended for many years. It is not
too hard to find an article in a magazine or medical journal recommending
that the readers lower their salt intake. Like dietary fats,
salt has become a convenient boogeyman, responsible for all manner
of health ills. Government agencies, the American Medical
Association, and many dietary groups all recommend a low-salt
diet.
Conventional wisdom holds that consuming less salt will lower
your blood pressure and reduce your chances of heart disease or
a stroke. By now, everyone knows that a low-salt diet is healthy,
right? Wrong. But unfortunately, this is another one of those cases
where conventional medical wisdom simply does not add up.
To develop an accurate understanding of the importance of
salt in a healthy diet, we must look beyond what passes for "conventional
wisdom." A review of the research literature, as well as
my own clinical experiences have convinced me that unrefined salt
is vital to good health.
Hypertension and Salt
Early in my medical career, I accepted the "low salt = lowered
blood pressure" hypothesis unquestionably. My medical training
was clear: A low-salt diet was good and a high-salt diet was
bad. In all hypertensive cases, I was taught to promote a low-salt
diet. In fact, I was taught that in order to prevent people from
becoming hypertensive, it was better to encourage them to adopt
a life-long dietary plan of low-salt. However, my experience with
promoting a low-salt diet to treat hypertension was not successful.
Not only did I find a low-salt diet relatively ineffective at lowering
blood pressure, but I also found a low-salt diet made my patients
miserable due to the poor taste of their low-salt food.
It wasn't until I began to look at my patients in a more holistic
manner that I began to research the medical literature about
salt. What I found was astounding; there is little data to support
low-salt diets being effective at treating hypertension for the vast
majority of people. Also, none of the studies looked at the use
of unrefined sea salt, which contains many valuable vitamins and
minerals such as magnesium and potassium, which are vital to
maintaining normal blood pressure.
The conclusion that salt causes high blood pressure is based
primarily on a couple of studies; neither have conclusively established
a causal link between salt consumption and hypertension.
Although considered a part of medical orthodoxy, the idea
that salt consumption causes high blood pressure is relatively recent,
and is, in fact, based on questionable conclusions drawn
from a handful of studies.
The first report of a relationship between salt and high blood
pressure appeared in 1904. Two researchers, Armbard and Beujard,
asserted that salt deprivation was associated with lowered
blood pressure in hypertensive patients. Over the next 50 years,
this theory was tested in various studies, which usually involved
giving test animals huge amounts (10-20 times greater than normal)
of refined salt, to induce hypertension. As would be expected,
when the animals were no longer overdosed, the blood pressure
levels returned to normal.
Given the high amounts of salt being given to the animals, the
correlation to a human population should have been suspect, but
that did not stop medical researchers from erroneously extrapolating
the results to human salt consumption.
The most popular study cited to prove the "increased salt =
elevated blood pressure" link was the INTERSALT Trial. This
study looked at over 10,000 subjects aged 20-59 from 52 centers
in 39 countries. The authors of the study looked at the relationship
between electrolyte excretion (i.e. sodium in the urine) and
blood pressure. A higher salt intake will result in a larger amount
of sodium excreted in the urine. Although there was a slight relationship
between blood pressure and sodium excretion, a "smoking
gun" could not be found. This study showed only a mild decrease
in blood pressure, even when there was a dramatic decrease
in salt excretion.
The results of this study did show that various indigenous
groups in South America and Africa did consume relatively little
salt and had low blood pressure. But these tribes were relatively
untouched by modern life as whole - they generally did not drink
or smoke, they were physically active and their diets consisted primarily
of whole, unprocessed foods. In all likelihood, these factors
were more significant in determining blood pressure levels than
relative salt intake.
Study after study has failed to establish a significant causal
relationship between salt intake and hypertension. In fact, there is
some research that would seem to point to a different conclusion.
Every 10 years, the government conducts the National Health
and Nutrition Examination Survey (NHANES). This comprehensive
analysis of thousands of citizens looks at various markers
of health, including the relationship between inadequate mineral
intake and hypertension. After reviewing the data gathered from
several surveys, researchers concluded "Our analysis confirms once
again that inadequate mineral intake (calcium, potassium and
magnesium) is the dietary pattern that is the best predictor of elevated blood pressure in persons at increased risk of cardiovascular
disease."
The Center for Disease Control's own data over the last 30
years clearly shows little relationship between low-salt diets and hypertension.
This data unequivocally shows that ensuring adequate
mineral intake is much more important to maintaining low blood
pressure.
Salt & Heart Disease
Another purported benefit of a low-salt diet is a reduced risk of
cardiovascular incidents, such as heart attacks or strokes. But again,
the evidence is less than overwhelming. In fact, there is some compelling
research which seems to indicate that low-salt diets may actually
increase the likelihood of a cardiovascular event.
Eleven trials, which included follow-up from six months to
seven years, were reviewed. Researchers found that there was no
difference in deaths and cardiovascular events between the low-salt
groups and the high-salt groups. Systolic and diastolic blood pressure
declined in the low-salt group by very small amounts. The authors
of this review comment that the miniscule lowering of blood
pressure with a low-salt diet did not result in any significant health
benefit. They also comment, "It is also very hard to keep on a low salt
diet."
In another study, researchers examined the relationship between
a low-sodium diet and cardiovascular mortality. Nearly 3,000 hypertensive
subjects were studied. The result of this study was that
there was a 430% increase in myocardial infarction (heart attack)
in the group with the lowest salt intake versus the group with the
highest salt intake.
Why would a low-sodium diet predispose one to having a heart
attack? Low-sodium diets have been shown to cause multiple nutrient
deficiencies, including depletion of minerals such as calcium,
magnesium and potassium, as well as exhausting B-vitamin stores.
There are numerous studies touting the benefits of magnesium in
treating cardiovascular disorders. Adequate amounts of potassium
and B-vitamins are also crucial for healthy heart. Many studies
have shown that a deficiency of minerals, particularly calcium, potassium
and magnesium is directly related to the development of
heart disease as well as hypertension.
Unrefined Salt & Health?
We have established that a low-salt diet is not very effective at significantly lowering blood pressure in most people. In fact, as salt
levels have declined in this country over the last 50 years, there has
been no trend toward lowered blood pressures in the population.
Could mineral salt usage result in a significantly lowered blood
pressure? Many minerals, including magnesium and potassium
have a direct anti-hypertensive effect. As previously mentioned,
the NHANES study revealed that a pattern of low mineral intake,
specifically magnesium, potassium and calcium were directly associated
with hypertension. Repeated measurements over 20 years
have confirmed the relationship between low mineral intake and
elevated blood pressure.
Unrefined salt has a wide range of minerals including potassium
and magnesium, providing the body with a complex of nutrients
that it needs to function optimally. The use of unrefined salt
will not cause elevated blood pressure; in fact, due to its abundance
of minerals, it can actually help lower the blood pressure in hypertensive
patients.
Salt & Special Health Concerns
Researchers have looked at numerous studies to arrive at their recommendations
for sodium intake. Hypertensive patients can improve
blood pressure moderately by limiting their sodium intake
to 3-7 grams (app. 1.5-7 teaspoons) per day. Too much of anything
can be a problem for the body. Salt, like any other substance,
should not be taken in excess. Since refined salt is a toxic substance,
there should not be any refined salt in anyone's diet.
However, there is a great difference between refined and unrefined salt. I recommend only the use of unrefined salt in one's diet.
This will supply the body with over 80 minerals that are useful
for maintaining the normal functioning of the body. My experience
has shown that the use of unrefined sea salt has not resulted
in elevated blood pressure in my patients. The addition of small
amounts of unrefined salt to food or cooking will not adversely
affect blood pressure or other health parameters in someone with
normal kidney function.
While there is considerable research indicating that unrefined
salt can be an important part of a healthy diet, there are some situations
that do require special consideration.
For example, there are some hypertensive patients who are salt
sensitive. Salt sensitivity is defined as an increase in blood pressure
due to a high sodium intake. Not all hypertensive patients exhibit
salt sensitivity. The only way to tell if an individual with hypertension
will respond (via lowered blood pressure) to a low-salt diet is to
institute a low-salt diet. The research shows that older individuals
with hypertension will have a modest response. A review of 56 trials
showed that a low-salt diet had minimal effect on blood pressure
in the vast majority of people studied.
Another special concern related to those with kidney problems.
Salt is excreted in the kidneys and individuals with renal failure
will have a decreased ability to clear salt from their diets. These
individuals must watch their salt intake carefully. If you have renal
failure, I suggest you speak with your doctor before instituting any
dietary change, including a change in salt intake.
Final Thoughts
Although promoted by conventional medicine as part of a healthy
diet, my experience has clearly shown the fallacy of low-salt diets.
They are not associated with a reduction in blood pressure for the
vast majority of the population and also have adverse effects on
numerous metabolic markers including elevated insulin levels and
insulin resistance. Low sodium diets have been associated with elevating
total cholesterol and LDL cholesterol levels, which, in turn,
has been associated with cardiovascular events.
Furthermore, it has demonstrated that mineral deficiencies are
present in most chronic illnesses and it is impossible to overcome
these disorders unless mineral deficits are corrected. What conventional
doctors and most mainstream organizations have failed
to grasp is the difference between refined and unrefined salt. Unrefined salt contains over 80 minerals in a perfect proportion for
our bodies. Our bodies were meant to function optimally with
adequate mineral levels and adequate salt intake. Only the use of
unrefined salt can provide both of these factors.
For the great majority of people a low-salt diet does not work.
Patients do not feel well when sodium levels are lowered. Their
energy level drops and they develop hormonal and immune system
imbalances. It is refined salt that needs to be avoided - it is a toxic,
dangerous substance that fails to provide the body with any benefit.
Unrefined salt should be the salt of choice.
This article was re-printed from the
Winter 2006 issue of A Grain Of Salt©.
Call 800-867-7258 to request a complimentary
issue.
A pdf version of this article is available. Click here to download.
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