Salt and High Blood Pressure: What are the facts?

Go Ahead, Salt Your Food

For thirty years, people have believed salt should be avoided at all costs. It's time to put that myth to rest.

By John Mariani

Image Of A Salt Shaker In A Wanted Poster

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For thirty years, salt has been Public Enemy No. 1 in the kitchens of the misguided and health-obsessed. Back in 1976, Jean Mayer, then president of Tufts University, called salt "the most dangerous food additive of all." Four years later,The New York Times linked excessive consumption of salt to high blood pressure, heart and kidney disease, and stroke. The die had been cast. Salt was an evil thing to be avoided at all costs.

Pardon the pun, but it's time that this long-standing idea was taken with a grain of salt. Science has proven that salt is an essential part of our well-being as humans and very effective in combating iodine deficiencies. At a time when nearly every old nutritional shibboleth is under new scrutiny -- including everything from red meat, eggs and sugar to fat, carbos and cholesterol -- the merits of salt has taken on a political dimension.

"Indeed, the controversy over the benefits, if any, of salt reduction now constitutes one of the longest running, most vitriolic, and surreal disputes in all of medicine," wrote Gary Taubes inScience. 


On the one side, says Taubes, are those physicians who believe caution is the best policy until the data prove one way or the other that a low-sodium diet is beneficial; on the other are those physicians who do not support the conclusions of current data and worry about negative side effects from a low-sodium diet.

Salt's demonization had its roots in the early 1970s, when studies seemed to show a link between sodium intake and high blood pressure. As a result, doctors made the general recommendation that everyone should reduce their sodium intake. 


But by the mid-1990s newer studies were calling those data into question, including the Journal of the American Medical Association's 1998 meta-analysis of 114 clinical trials that did not support a general recommendation to reduce salt intake.


Two years later, another study in the journalHypertension concluded that "no single universal prescription for sodium intake can be scientifically justified." In a more recent statement, the founder of the American Society of Hypertension, Dr. John Laragh, goes further: "Is there any proven reason for us to grossly modify our salt intake or systematically avoid table salt? 


Generally speaking the answer is either a resounding no, or at that, at best, there is not any positive direct evidence to support such recommendations."

"Better safe than sorry" is not science, but it may be fear-mongering, the specialty of the Washington, D.C.-based nutritional group called the Center for Science and the Public Interest. Over the last few years, the CSPI has taken on the evils of movie popcorn, called fettuccine Alfredo "heart attack on a plate," labeled Mrs. Fields' Cinnamon Roll with Cream Cheese Icing "food porn," and continues to insist that "a diet high in sodium increases the risk or severity of high blood pressure, which increases the risk of heart attack and stroke. Everyone should eat less salt." (They're so unrelenting on this point, they've even sued the Food and Drug Administration over it.)

This isn't to say that salt is safe for everyone. Studies show that 30 percent of the Americans who have high blood pressure would greatly benefit from a low-sodium diet. But that's about 10 percent of the overall population -- the rest of us are fine with sodium. And drastically cutting out sodium may actually hurt some people.

"Nothing works for everybody. Low-sodium diets can be dangerous," says Dr. David Case, a hypertension specialist at Weill Medical College of Cornell University. "Clogged arteries have nothing to do with salt intake, though congestive heart disease does. Kidney disease is affected by salt intake, but healthy kidneys excrete excess salt. 


The bigger issue is what happens if people do restrict salt, which may make them more vulnerable to hemorrhaging, diarrhea, and water loss. There were some tragic results when some mothers restricted their infants' salt intake, which sent them into shock. Some even died."

It's about time that common sense drove the arguments about salt, not one-size-doesn't-fit-all harangues about its insidiousness for all people at all ages. While American diets tend to be high in processed food, which usually have incredibly high sodium content, most people do not consume salt excessively. "The average adult American has no reason to limit salt in his diet," says Dr. Chase, which is a far cry from what so many have told us for so long.

So unless you've got high blood pressure, the next time you're in the kitchen -- don't be afraid to pick up that saltshaker. Your taste buds will thank you.

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