Good (?) Salt

What is Salt?

The chemical name for salt is sodium chloride (NaCl).  All types of salt, whether table salt, Himalayan salt, sea salt, Kosher salt, etc., are chemically composed of sodium and chloride.  

The differences in the various types of salt have to do with factors such as colour, flavour, texture, and the degree to which they are processed.  

Good (?) Salt

Some people have been misled by marketing campaigns and internet chatter into believing some types of salt are “good” salt or “healthy” salt.  

The truth is that an excess of “good” salt can have the same negative health effects as any other type of salt used in excess.  

Himalayan Salt

Himalayan salt is touted as being “healthy” on the basis that it is less processed than regular table salt and that it has a lower sodium content than table salt per teaspoon.  That’s a bit misleading because the only reason Himalayan salt can boast lower sodium per teaspoon than table salt is that Himalayan salt is coarser than table salt so less of it will fit into a teaspoon. 

Table salt and Himalayan salt have the same sodium content.  They each contain about 40% sodium.  Per the USDA, table salt has roughly 2,330 mg of sodium per teaspoon.  Himalayan salt can have between 1,600-2,300 mg of sodium per teaspoon, depending on the brand and on how coarse it is.

Himalayan salt “may contain trace minerals”. In reality, “trace minerals” means that while calcium, iron, zinc, magnesium, and other important minerals may be present, they are in such tiny amounts as to have almost zero nutritional value unless it is consumed in enormous amounts.  

The calcium content of Himalayan salt is generally no more than 1.6 mg per teaspoon.  You would need 625-750 teaspoons (13-15.6 cups) per day to meet the recommended daily calcium allowance of 1,000-1,200 mg.  

The magnesium content of Himalayan salt is just over 1 mg per teaspoon.  That’s more magnesium than you’ll find in table salt, but you’d still need three or four hundred teaspoons (6-8 cups) of Himalayan salt to meet the recommended daily allowance of 320-420 mg of magnesium.

The same holds true for other minerals in Himalayan salt.  You would have to eat staggering amounts of it to get any nutritional value from the mineral content.  

One study on the nutritional claims of Himalayan salts confirms that “any potential health benefits provided by the higher nutrient content in pink salt would be counteracted by the large amount of sodium that would also be consumed”.  

The amount of Himalayan “good” salt you’d have to consume to get any value from the mineral content is almost guaranteed to give you a heart attack and/or kidney failure within a week.

Sea Salt

Sea salt is not any better for you than table salt.  “In a survey conducted by the American Heart Association, 61% of respondents incorrectly agreed that sea salt is a lower-sodium alternative to table salt.”  

Because the granules of most brands of sea salt are coarser than table salt, less of it will fit into a teaspoon, but both table salt and most brands of sea salt contain about 40% sodium.  A teaspoon of sea salt has about 2,000 mg of sodium, which is 30% more sodium than the recommended daily maximum of 1,500 mg.

The mineral content in sea salt is miniscule.  A teaspoon of sea salt has a maximum of 12 mg of calcium, a tiny contribution to the recommended daily allowance of 1,000-1,200 mg of calcium.

As with Himalayan salt, you would have to consume such enormous amounts of sea salt that any nutritional value would be more than offset by the damage to your heart, your kidneys, your stomach, and other vital organs that the sodium would do. 

Pollution of the oceans from which sea salts are derived may also be a concern.  The American Heart Association reports that “a group of researchers studied the chemical composition of 16 brands of sea salt and found particles of various plastics in those salts”.  

Sea salt may also contain other impurities from the ocean such as lead.  According to the World Health Organization, “there is no level of exposure to lead that is known to be without harmful effects”.

How Much Salt is Too Much?

Salt is not inherently bad for you.  Salt contains sodium and chloride, both of which the body needs in limited amounts.  The recommended daily allowance for adults varies depending on age, gender, and some health conditions, but generally 1,200-1,500 mg/day of sodium and 1,800-2,300 mg/day of chloride is suggested by Health Canada. 

Salt can be part of a healthy diet, in moderate amounts.  The health concerns arise from the overconsumption of salt. Health Canada reports that between 56% and 96% of Canadian men and between 24% and 45% of Canadian women consume too much salt.

Many people are inadvertently eating much too much salt, particularly those whose diets include fast food, prepared food, and salty snacks.  Adding salt, including “good” salt, to their food adds even more to the sodium overload.  

A high intake of salt, any kind of salt, means a high sodium intake.

Sodium, while an indispensable mineral to various metabolic functions, should be consumed in moderation.  The American Heart Association suggests “an ideal limit of no more than 1,500 mg per day for most adults”. 

Many people consume more than that just from processed foods such as breads and rolls, prepared soups, deli meats, frozen foods, canned foods, and junk food snacks such as potato chips and pretzels, salted nuts, and various condiments.  Salt is routinely used as a preservative in processed foods and the manufacturers tend to be quite liberal with it to keep their products saleable for as long as possible.

Adding salt, any kind of salt, to the food ups the sodium intake even more.

How Much Salt is Too Little?

There are some very specific circumstances in which someone could become sodium deficient such as advanced health problems like cancer, congestive heart failure, diabetes, or kidney or liver disease.  

Other common causes of a temporary drop in sodium levels include some acute conditions such as vomiting and diarrhea.

The individuals who are most likely to become sodium deficient are those who regularly engage in competitive sports such as bodybuilding, hockey, football, and other strenuous activities such as intensive athletic training.  These people are often very health-conscious and have a minimal to no sodium diet.  They do not eat any processed food or snacks, canned food, or fast food.  They make everything they eat from scratch.  In those exceptional cases, they often need a small amount of salt on a regular basis.

Some of the symptoms of too little salt in the diet resulting in hyponatremia (too little sodium) include low energy, dizziness, nausea, and vomiting.  

According to one study, hyponatremia occurs in only 1.72% of the general population and is more common among those with conditions such as diabetes, stroke, chronic obstructive pulmonary disease, cancer, and some psychiatric disorders.

Because any of the symptoms of hyponatremia could be caused by many different types of health conditions other than sodium deficiency, self-diagnosis is strongly recommended against.  Anyone with the symptoms of hyponatremia should consult a competent health care practitioner for a diagnosis and treatment plan.   

There is no such thing as widespread sodium deficiency in North America.  What has become widespread, perhaps even to epidemic proportions, is the health problems caused by salt consumption and the misleading information being perpetuated to promote “good” salt.  

Salt as a Source of Iodine

Iodine is an essential trace mineral that the body needs to make the thyroid hormones that regulate physiological processes such as growth, development, metabolism, body temperature, and heart rate.  The recommended minimum daily requirement of iodine for adults is 150 mcg (micrograms).

The body does not make its own iodine so it must be ingested, ideally from food sources.  However, the iodine distribution in soil is variable, with most of it found in coastal areas.  Due to Canadian farm soils being generally iodine-deficient, the federal government mandated the addition of iodine to table salt in 1949.   

Specialty salts such as kosher salt, sea salt, and Himalayan salt were exempted from the mandate on the basis that they represented a tiny portion of the salt-consuming market at that time.  Generally, specialty salts do not contain iodine or if they do have some naturally occurring iodine the content is so small as to have no appreciable nutritional value.

Iodine deficiency is common among Canadians.  Statistics Canada reported that 22% of Canadians aged 3 to 79 are mildly deficient and 7% are moderately deficient in iodine.

Do you need salt to get the minimum daily requirement of iodine?  No, you do not.  Hard boiled eggs, for instance, are a good source of iodine.  Seafood, particularly cod, shrimp, and tuna, is another good source of iodine as are prune and lima beans.

Supplements containing iodine can compensate for any iodine deficiencies in the diet.  A number of multivitamin or multimineral supplements contain iodine, and there are also supplements of iodine-containing kelp (a type of seaweed).

Any benefit of iodine intake from consuming iodized salt is far outweighed by the damage that an excess of salt can do.

Salt as a Source of Chloride

One of the chemical constituents of salt is chloride.  Chloride is an important electrolyte.  It works with other electrolytes such as sodium and potassium to help regulate body fluids to help balance acids and bases in the body, and it is part of the body’s electrical conductivity process.

Like sodium, there is a limit to how much chloride the body needs.  Health Canada proposes a limit of 2,300 mg per day.  Food sources of chloride include tomatoes, lettuce, celery, and olives.  Chloride is also available in some supplements.

Salt and the Body’s Electrical System 

The body has a neuroelectric system that conducts electrical impulses along the nervous system throughout the body to signal various functions such as muscle contractions including the heart muscle, skeletal muscles, and bowel muscles.  

The body needs a small amount of sodium and chloride along with other minerals such as potassium, calcium, and magnesium to conduct these electric impulses.  It does not need in excess of the 1,200 – 1,500 mg maximum daily recommended amount of sodium. 

There are numerous food items that contain these electrolytes such as bananas, salmon, white beans, potatoes, mushrooms, clams, spinach, chicken, and many others.

Salt Substitutes

There are salt substitutes available in most grocery stores.  A common one is potassium chloride, also called potassium salt.  

Potassium is a mineral that performs various physiological functions.  In combination with other minerals, it helps to maintain normal levels of fluid in the cells, transmit nerve signals, balance the pH between acidity and alkalinity, and maintain normal blood pressure.

Like any other nutrient, there is a limit to how much potassium is healthy.  The recommended daily maximum of potassium is 3,400 mg per day for adult men and 2,600 mg per day for adult women.  One study notes that “very high amounts of potassium supplements or salt substitutes that contain potassium could exceed the kidney’s capacity to excrete potassium, causing acute hyperkalemia [higher than normal potassium levels in the blood] even in healthy individuals”.

Potassium chloride is used by some food manufacturers in products such as prepared soups, potato chips, cereals, condiments, electrolyte replacement drinks, and others.  

Potassium chloride provides a salty taste in small quantities.  In larger quantities, it has a bitter or metallic taste.  Food manufacturers may use potassium chloride either alone or mixed with salt in their “reduced salt” or “low sodium” products.  

Potassium chloride may be a feasible salt substitute for some people if used in moderation.  There is no established recommended daily allowance for potassium, but the generally accepted level is 1,600-2,000 mg per day.  

An excess of potassium, in its mild form, can cause symptoms such as abdominal pain, diarrhea, nausea and vomiting.  In its severe form, it can affect the heart and cause sudden, life-threatening symptoms including chest pain, heart palpitations, irregular or fast heartbeat, muscle weakness or numbness in the limbs.

Very Good Reasons to Limit Your Salt Intake

We have been seeing an increasing number of patients whose blood pressure levels are high, whose immune systems are taking a beating, and who are suffering other health conditions because they think that they’re eating “good” salt.

Salt and Blood Pressure/Cardiovascular Disease

One of the functions of the kidneys is to balance the amount of sodium in the body. When sodium is low, the kidneys will retain it. When there is too much sodium, the kidneys remove it from the body in urine.

If the sodium level is so high that the kidneys can’t keep up, the sodium builds up in the blood. Sodium is hygroscopic, meaning that it attracts and holds water.  Sodium pulls water out of the cells and into the extracellular space.  This results in intracellular dehydration. 

The increased water increases the blood volume.  The increased blood volume causes the heart to work harder to pump blood, which increases blood pressure. 

Excess salt consumption almost always leads to elevated blood pressure (hypertension) and can also contribute to heart disease and stroke.  

Salt and the Immune System

Excess salt can damage your immune system.  The lymphatic system is a network of tissues and organs. Its main function is to transport lymph (the fluid containing white blood cells) throughout the body to fight infection.

Excess salt thickens the blood and makes the lymphatic system sluggish and less able to deliver white blood cells and antibodies to the parts of the body where they’re needed. 

Salt and Osteoporosis

A high salt intake is a factor in the development of osteoporosis, a bone disease characterized by the loss of bone mineral density and bone mass.  Osteoporosis weakens the bones and makes them susceptible to fracture.

One study notes that:

Dietary consumptions of sodium chloride (salt) and excess protein are known to increase urinary calcium excretion.  Therefore, a high salt intake is considered one of the major risk factors for osteoporosis due to increased calciuria [calcium in the urine].

That means that the sodium-induced draining of calcium from the bones causes lower bone density which can lead to osteoporosis.  Osteoporosis is the primary cause of bone fractures in postmenopausal women and in older men.  Any bone in an individual with osteoporosis can fracture, but the fractures occur most often in the hip, vertebrae, and wrist.

Salt and the Kidneys

A high salt intake is hard on the kidneys.  Salt is crystalline.  It has sharp edges that can cut and abrade the delicate microtubules of the kidneys.  

A recent study notes that “Experimental studies show a direct tissue effect of salt on the kidneys … including hypertrophy [enlargement of the kidneys], fibrosis [a thickening or scarring of the tissue], and a decrease in glomerular basement membrane anionic sites [a membrane that helps filter the blood].”  

There is also a correlation between high salt intake and the formation of kidney stones.  It has been found that:

Some studies focusing on dietary habits of idiopathic [a disease or condition arising spontaneously] calcium stone formers have clearly demonstrated that these individuals have a significantly higher daily intake of salt and a more frequent consumption of salty foods, such as sausages and ham …

The kidneys will try to get rid of excess sodium in the urine.  Sodium increases calcium excretion and takes the calcium with it through the blood to the kidneys.  When the kidneys get rid of excess sodium in the urine, some of the calcium is left behind in the kidneys which contributes to the formation of calcium oxalate stones, the most common type of the kidney stones.

Salt and Cancer

A high salt diet presents a risk of gastric cancer.  

An excess of salt can lead to atrophic gastritis (chronic inflammation and thinning of the stomach lining) and gastric intestinal metaplasia (precancerous gastric lesions).  This condition, known as CAG (chronic atrophic gastritis) can progress to gastric (stomach) cancer.

One study, among others, confirms “a significantly positive association between high salt intake and gastric cancer compared with low salt intake” and concludes that “higher dietary salt intake increased the risk of gastric cancer”.

A high salt diet has also been linked to CRC (colorectal cancer), a type of cancer that affects the large intestine or rectum.  CRC represents 10% of cancer cases in Canada and is the “second leading cause of death from cancer in men and the third leading cause of death from cancer in women”.

Bottom Line on Salt

Your body needs a limited amount of sodium to conduct nerve impulses, contract and relax muscles, and help to maintain water and mineral levels. 

How much sodium you need depends on which source you are consulting as there is some debate on the subject.  As noted in one study published in 2020:

Recent guidelines in the US, Canada, and the UK call for lowering sodium consumption below 2300-2400 mg/day, but some organisations go even lower. The American Heart Association recommends no more than 2300 mg/day but suggests an ideal limit of 1500 mg per day for most adults, especially those with high blood pressure. The World Health Organization calls for <2000 mg/day.  Others conclude that the optimal range is much higher.

 Based on our real-life clinical experience, health organizations such as Mount Sinai Hospital and the National Academy of Medicine who recommend no more than 1,200-1,500 mg of sodium per day (depending on age) are correct.  

What we are seeing in daily practice is that anything over 1,200-1,500 mg of sodium a day is causing significant health problems for our patients, not the least of which is high blood pressure.

Many people are overdosing on sodium without meaning to.

Health Canada notes that “the average sodium intake of Canadians is currently estimated at 2,760 mg per day”, a staggering 84-130% over the recommended daily intake of 1,200-1,500 mg per day.  

Most of the sodium intake is coming from processed food.  Health Canada estimates that 77% of sodium intake is from “processed foods like deli meats, pizza, sauces and soups. Packaged and ready-to-eat foods, fast foods and restaurant meals are also often high in sodium.”  An additional 5% of sodium ingestion is from condiments, sauces, and dressings.  

Statistically, you are probably already eating too much salt, likely without meaning to.   

Patients with high blood pressure, kidney problems, and other health conditions caused by a high sodium intake have become common and routine.

Adding any kind of salt, including “good” salt, to food further compounds the health problems that we see in our clinic every day.   

Marketing campaigns promoting “good” salt are doing you a grave disservice.  You would be very wise to ignore the hype about “good” salt and limit your salt consumption to the amount appropriate to your health status.   

Getting the Salt Monkey Off Your Back

There could be different reasons why people eat too much salt.  It could be that they’re eating more salt than they’re aware of from the widespread use of salt by food manufacturers.  

The relentless marketing campaigns promoting “good” salt might also be a factor in the overconsumption of salt.  These campaigns would have you believe that adding “good” salt to food is healthy.  That’s marketing, not medicine.  An excess of “good” salt can have the same harmful effects as any other kind of salt.

There’s also the habit-forming nature of salt. One study, among others, determined that “sodium chloride, which is not classified under the psychoactive drugs, is capable of producing addiction.”  

Perhaps people eat too much salt simply because nobody has told them about the health dangers of excess salt.  The relationship between excess salt intake (including “good” salt) and high blood pressure is well known, but how many people know about the relationship of high sodium intake and other health problems?  How many people keep track of their sodium intake?

If you want to maintain your blood pressure in a healthy range, reduce your risk of diseases associated with salt intake, help to maintain bone density, and give your immune system a fighting chance of protecting you from bacteria, viruses, and other pathogens, you really need to pay attention to your salt intake.  

We’re not suggesting zero salt intake.  Zero salt in the diet is not feasible, nor is it desirable.  What is realistic is limiting salt intake to no more than the recommended daily maximum or, even better, less than that.  If you have hypertension (high blood pressure) or any of the other health disorders caused by high sodium intake, 500 – 1,000 mg a day may be a good goal to have.

Restricting your sodium intake will, for instance, lower your blood pressure to a normal range.  It won’t be an immediate process.  It may take some time, perhaps months, but lowering your sodium intake is an effective remedy for hypertension. 

You may have to make some dietary changes:

• Don’t eat at fast-food outlets like “burger joints”, chain sandwich shops, and deli counters.  The food at most of them is mass produced, highly processed, and loaded with salt, sugar, and unpronounceable chemicals.
• Avoid smoked, cured, or canned meats such as bacon, cold cuts, ham, frankfurters, and sausage.  These types of meats have a high salt content.
• Eliminate or limit salty snacks such as potato chips, salted nuts, some types of yoghurt, bagels, burritos, and tacos.
• Limit ketchup, mayonnaise, soy sauce, teriyaki sauce, and other high-salt condiments, including the reduced-sodium versions. 
• Don’t add salt to food.  For those who find that unsalted foods are bland and unappealing, there are alternative seasonings such as garlic, lemon juice or lemon zest, onions or onion powder, ginger, paprika and various herbs and spices.

Making food that you have prepared at home is a great way to regulate salt intake.

Eat whole foods (those that have been processed as little as possible).  There are a number of fruits and vegetables that naturally contain sodium.  The sodium in whole foods is usually a small amount but can quickly add up over meals throughout the day to the minimum daily requirement. Sodium-rich fruits include apples, guavas, avocado, papaya, mango, pineapples, bananas, melons, and pears.  

There are a number of vegetables such as carrots, radishes, cauliflower, broccoli, and cabbage that are good sources of dietary sodium.  Likewise, unprocessed meats such as beef and pork naturally contain sodium.   

Sodium Intake Self-Audit

A sodium intake self-audit is a calculation of your sodium intake each day.  When you add up all the sodium sources, you may discover that you are consuming far more than you realize.  

Health Canada lists the “Nutrient Value of Some Common Foods”.  This list can be useful, but a more accurate method is to use a sodium tracker app or do your own calculations of the sodium content of everything you eat because the sodium content of packaged food items will vary from brand to brand.  

You’ll find the sodium content on the “nutrition facts” labels of packaged food.  Many of them will list the sodium per serving size (per cup, per teaspoon, per piece, etc).

For example, if you have a breakfast of two slices of bacon, two fried eggs, two pieces of buttered toast, and a glass of orange juice from concentrate, it could add up to this: