Perhaps no food item has garnered a greater love/hate relationship among us than salt. Ever since the Lord turned Lot’s wife into a pillar of the substance we’ve looked askance at salt. We can’t live without it and we can’t do well with too much of it. So, what is it with salt? Should we shun it or enjoy it without remorse?
While most people would probably say that avoiding excess salt intake is a good thing – and it probably is – the proof of salt as a bad guy is still heavily debated and studied, leaving consumers wondering if they should make a greater effort to reduce sodium intake or not?
Credit: Salt InstituteAccording to the U.S. Centers for Disease Control and Prevention (cdc.gov), too much sodium can increase your blood pressure and your risk for a heart attack or stroke, the leading causes of death in the United States. The current sodium intake guidelines suggest that adults should consume no more than 2,300 milligrams of sodium each day (interestingly, our bodies only require about 180 to 500 milligrams per day). But, for older people, African Americans, people with high blood pressure and/or diabetes or kidney disease, the recommendations are much lower – no more than 1,500 milligrams of sodium per day. Yet, on average, we consume upwards of 3,000 milligrams per day. And research has uncovered evidence that children are also at risk for excess salt in their diets. There is evidence that high salt intake in children may predispose them to a number of diseases later in their lives.
The over-consumption of sodium is not new; it’s been developing for decades. The average sodium intake has increased over the past 30 years from already high levels to more than double the recommended amount.
That doesn’t mean we should attempt to drain ourselves of any and all salt. We need salt to survive. The question is how much is too much?
A report by the National Research Council on Dietary Reference for Water, Potassium, Sodium, Chloride and Sulfate,  found that “the typical Western diet is high in salt and low in potassium -- the opposite of what evidence shows is optimal for good health and reducing the risks of chronic disease … research is needed to find ways to help people select better food choices to reduce their salt intake and boost their potassium consumption.”
We’re often surprised when we find out where salt resides. We commonly know that a potato ship or pretzel is salty just by tasting it. But, we’re surprised to know that food items, such as cottage cheese, are also filled with salt. Even lettuce can have trace elements from salt. The average can of soda has some 50 milligrams of sodium. Certain energy or sports drinks are loaded with salt – a good thing when you are into sports and need to replenish what you lost during long and hard physical exertion.
World Action On Salt
The concern over excessive salt intake is not just a problem for developed countries with lots of fast food outlets, snack food options and the like. It is an international problem.Credit: Centers for Disease Control and Prevention
A coalition from 81 countries established the World Action on Salt and Health (WASH) in 2005 to improve the health of populations throughout the world by achieving a gradual reduction in salt intake. Through such efforts as the yearly “salt awareness week” and other initiatives, WASH is looking at the global problem, particularly in underdeveloped or developing countries, of excess salt consumption. In fact, it is in developing countries that the overuse of salt is a major problem because salt is a long-used staple, and healthier food options are often unavailable.
The World Health Organization (WHO) also has looked at what can be done to reduce salt intake worldwide. The organization investigated  how many deaths could potentially be averted over 10 years and how much it would cost to take action worldwide to limit salt consumption – as well as tobacco use – to healthier levels than currently exist. WHO found that over a 10 year period 13.8 million deaths could be averted, at a cost of less than 40 cents per person per year in low-income and lower middle-income countries, and 50 cents to $1 per person per year in upper middle-income countries.
In the United States there are a number of efforts seeking to reduce salt consumption. The National Salt Reduction Initiative (NSRI) – a cooperative of more than 70 U.S. cities, states and national health organizations – has established a goal of reducing the amount of sodium Americans consume by 20 percent over five years. More specifically the organization wants to reduce salt in processed and restaurant food by 25 percent. Many food manufacturers, restaurants and grocery chains have signed up for the initiative.
Such a reduction could have significant results. Research suggests that a decrease of 9.5 percent in sodium consumption would probably prevent hundreds of thousands of strokes and heart attacks and save more than $32 billion in medical expenses over the lifetimes of adults aged 40 to 85 years who are alive today . And achieving that goal is doable. When salt reduction efforts were launched in earnest in the United Kingdom in 2003 sodium reductions of 20 to 30 percent in most processed food sold in stores was achieved.
Despite the preponderance of evidence on sodium’s detriments, there are many organizations that are actively trying to promote the benefits of salt – and at the same time downplaying some of the evidence suggesting over-consumption of salt is a problem.
The U.S. based Salt Institute is a trade association dedicated to advancing the many benefits of salt. Its membership includes most major salt manufacturers, salt mining companies and the like. Among its tasks is promoting the value of salt – whether it is salting icy roads in winter, or salt’s use in foods. In advocating for salt the institute goes to great lengths to suggest salt is not all that bad. In a news release issued in 2011, the institute referred to “a dozen medical studies [that] showed the health benefits of salt or revealed the significant risks of low-sodium diets -- providing vindication for this essential nutrient and the people.” The president of the institute went on to say that “the vindication of salt is probably the biggest health and nutrition story of the last year … [and] the latest research published in leading medical journals confirms that salt is good for you, too. The medical studies underline what we have been saying for years: science is on salt’s side.” The institute also suggests that the U.S. government’s efforts to promote a low-salt diet raises questions and may be a precursor to efforts to regulate salt or the salt industry.
The institute quotes several medical studies that suggest, among other things, that patients with Type 1 diabetes who maintain a low-sodium diet were more likely to acquire a renal disease and suffer premature death; that Type 2 diabetes sufferers on a low sodium diet had an increased risk of death from cardiovascular disease; that a study published in the American Journal of Hypertension purports to show eating less salt will not prevent heart attacks, strokes or early death (“on the contrary, low-sodium diets increase the likelihood of premature death,” touts the institute); that another study, in the Journal of the American Medical Association, concluded that lower salt intakes resulted in higher death rates.
The pro-salt lobby, of course, has good reason to doubt the salt-reduction advice given by numerous other studies. According to the book Food Politics: How the Food Industry Influences Nutrition and Health by Marion Nestle, the “Salt Institute is particularly adept at fostering doubt that salt has anything to do with high blood pressure.” Nestle goes on to say that the institute “invariably publicizes studies that seem to show no adverse effects [of sodium] but minimize research that might contradict that agenda.”
So, what should one do? Go with your taste buds and enjoy as much salt as you wish (some research says that’s ok if you have no indicators – such as hypertension – that suggests salt is a problem for you), or moderate your intake for better health?
Most doctors and researchers advise the latter. Even if you don’t currently have an issue that is exacerbated by sodium intake that doesn’t mean you won’t have a problem as you age. Why wait?
According to the CDC some very simple things can have a big impact. At the very least know what the minimum sodium intake per day is and what level is best for you. Choose to purchase healthy options – even if sodium isn’t a concern for you, eating healthy can be good for you in many other ways. Be informed about sodium by reading the nutrition facts label on food to find the lowest sodium options of your favorite foods. Try to cut down on processed foods that are high in salt. And when you eat out, many restaurants have – and in some locales are required to have – their menu items listed with the salt and other nutritional information available. Having the lower sodium options isn’t going to limit your fun or eating enjoyment.
 National Research Council. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press, 2005.
 Chronic Disease Prevention: Health Effects and Financial Costs of Strategies to Reduce Salt Intake and Control Tobacco Use. Perviz Asaria MPH, Dr, Dan Chisholm PhD, Colin Mathers PhD, Majid Ezzati PhD, Robert Beaglehole DSc. The Lancet - 15 December 2007 (Vol. 370, Issue 9604, Pages 2044-2053 )
 Smith-Spangler CM, Juusola JL, Enns EA, Owens DK, Garber AM. Population Strategies to Decrease Sodium Intake and the Burden of Cardiovascular Disease in the United States. A cost- effectiveness Analysis. Ann Intern Med. 2010;152.