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David Katz, M.D.

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Salt: Who's the Boss of You?

Posted: 04/28/10 10:10 AM ET

On April 20, the Washington Post reported that the FDA is planning to dial down the salt content in processed foods over a 10 year span by regulating the maximum levels allowed. It turns out this isn't quite right. The FDA has been encouraged to do just this in a report on the subject by the Institute of Medicine, but hasn't actually decided yet. In the end, though, the FDA is likely to follow the IOM's advice -- and if so, it will be a good idea, with one important caveat.

First, it's a good idea because an excess of sodium is linked to high blood pressure and consequently to stroke, the fourth leading cause of death and a major cause of disability in the US. Estimates vary, but some persuasively contend that excess sodium is the indirect cause of 150,000 premature deaths a year.

Second, it's a good idea because overwhelmingly, our salt intake is courtesy of processed foods which have salt engineered into them -- not from our own salt shaker. Nearly 80 percent of the salt in a typical American diet is put there by manufacturers, not by us.

Third, it's a good idea because that salt is not necessarily where you expect it. Many popular breakfast cereals are more concentrated in sodium than you want your diet to be on average. If your breakfast cereal pulls your average salt intake up above guidelines, what the heck is going to pull it down?

Fourth, it's a good idea because we all too readily acclimate to high levels of salt. Our love affair with dietary salt is of an ancient lineage. In fact, it should probably be traced back to the very first creatures that dragged themselves out of the briny shallows onto dry land. Going terrestrial meant giving up a constant supply of sodium, and suddenly made the mineral a prized commodity. Deer will come to a salt lick with good reason -- sodium in nature is hard to find for creatures not swimming in it.

And that's true of us, too. The native, Stone Age human diet provided roughly 10 times as much potassium as sodium (we actually get more sodium than potassium in the typical, modern diet). Yet, sodium is essential. So those of our ancestors who craved it, and thus were motivated to get enough of it, did a better job of passing on their genes. After all, those who don't survive to pass on genes make for very poor ancestors.

Those of us around today inherited genes from salt-loving forefathers and foremothers. But in a world of limited sodium, their salt-cravings fostered their survival and procreation; in a world of French fries, Cheerios, and Bugles, our inherited salt craving fosters hypertension, stroke and osteoporosis.

We sanctified our fondness of salt in our lexicon. The town of Salzburg, Austria was established as a commerce center dealing in salt. Its name means, in essence, 'Salt Village.' The word 'salary' means salt in Latin. Roman legionaries were actually 'paid' with the prized and precious mineral.

Fifth, it's a good idea because taste buds are very malleable little fellas: when they can't be with the foods they love, they learn to love the foods they're with. Familiarity is one of the more potent drivers of dietary preference.

The food industry case is that they are simply providing us the salt levels we prefer, and to some extent this is true. But we have learned to prefer such copious additions of salt to our diets because our taste buds are bathing in sodium excess all day long, and have habituated.

It works just as well in the other direction: if the feds help dial down our exposure to sodium, we will get more sensitive to sodium, and prefer less. My taste buds are beneficiaries of a very pure, 'practice of what I preach' diet. As a consequence, I simply can't eat most commercial breakfast cereals, because they taste way too salty to me. I suppose I could have them with beer, but not with milk!

I noted at the start that there is one caveat tempering my support for FDA's move. That comes from my work in measuring the overall nutritional quality of foods. All too often, in scoring foods with the NuVal system, we have seen scores for overall nutritional quality DECLINE in foods that are salt reduced, or for that matter, sugar or fat reduced. That's because such reformulations typically boast about the one 'good' change, but are mum about a host of compensatory, undesirable changes: salt comes out, but sugar goes in; sugar comes out, but salt and fat go in; sugar comes out, but so does fiber -- and so on.

We really cannot improve nutritional quality, diets, or health, one nutrient at a time. It is overall nutritional quality that matters. I do not want sodium to be the dietary scapegoat du jour that causes us to lose sight of all the other nutritional properties that matter.

Assuming we can dial down our salt exposure while maintaining or improving overall nutritional quality, FDA's efforts in this area promise to rehabilitate our taste buds and protect our health. As a contribution to efforts that take us to that place where we can still love food, but it loves us back -- I support it.

I can, however, imagine one vociferous protest to my position, and that of the IOM: isn't this just one more example of 'Big Brother' telling us what to do? The answer comes down to your preferences for salt, siblings and shelf life.

You see, salt content in processed foods has gone up for a number of reasons. Some research shows that the human appetite center is activated by combining multiple flavors at a time; I suspect that is at least part of the reason sweet cereals and desserts contain as much sodium as they do. Bet you can't eat just one!

Your preference for salt levels that are irrefutably at odds with your health, and the health of your children- is a by-product of native traits and tendencies from the Stone Age, clashing with modern food industry practices. I doubt you 'want' salty breakfast cereal, or cookies (yes, those too!)- but the industry is giving them to you, and manipulating your taste buds in the process. So, you are currently being bossed around, not by Pennsylvania Avenue, but by Madison Avenue. Is that really better?

In addition, and more obviously, salt extends shelf life. The longer foods go without spoiling, the less waste there is for the food company, and the higher the profits. But here's the rub: by and large, the longer the shelf life of the foods people eat, the shorter the shelf life of the people eating the foods. So, it seems, the government would like to prioritize the shelf life of people over products, and arguably, any resistant elements in the food industry would rather go the other way. You can decide which of these platforms you prefer in an older sibling, but I've made my choice, and it seems a no-brainer to me!

Since it is much easier to add salt to food than to take it out after someone else has added it, it seems to me the regulation under consideration puts more control where the salt shaker is -- in your hands. No 'sibling' has expressed any desire to take that shaker away. You can always add salt whenever you want. I doubt it will be when you are eating cookies, but you're the boss. Isn't that how it should be?

-fin

Dr. David L. Katz, www.davidkatzmd.com

 

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On April 20, the Washington Post reported that the FDA is planning to dial down the salt content in processed foods over a 10 year span by regulating the maximum levels allowed. It turns out this isn...
On April 20, the Washington Post reported that the FDA is planning to dial down the salt content in processed foods over a 10 year span by regulating the maximum levels allowed. It turns out this isn...
 
 
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08:54 AM on 05/01/2010
Whether reducing salt will effect health outcomes is an open question. We have been here before A recent study found that saturated fat was not related to heart disease www.ajcn.org/cgi/content/short/ajcn.2009.27725v1 several studies have however linked trans fat to heart disease. What was an original source of trans fat why margarine the healthy alternative to butter .A growing and under appreciated health issue is sugar http://www.youtube.com/watch?v=dBnniua6-oM
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RMankovitz
Researcher, inventor, entrepreneur, author
10:45 PM on 04/29/2010
I propose that one should avoid processed foods, salted or not. I believe they are quite toxic to your health. Compared to many of the other ingredients in processed foods, salt is a minor player when it comes to unhealthy ingredients. Why, even the packaging can be very unhealthy. One example is canned soups and vegetables (or canned anything) which contain plastic liners that outgas BPA, a known dangerous chemical.

I would also like to bring up the point that, to my knowledge, all of the studies performed to date regarding the effect of "salt" on blood pressure used the Frankensalt known as refined salt or table salt. This product is nowhere to be found in nature, yet is the one used by the majority of people.

What nature has in mind is "unrefined salt" (examples are Celtic Salt and RealSalt), which has very different properties than the refined stuff. Informal clinical trials have actually shown that use of unrefined salt can, after a brief adjustment period, provide a reduction in blood pressure!

For references on the healing properties of unrefined salt, see "Salt: Your Way to Health" by David Brownstein, MD. For alternatives to the use of medications to treat hypertension, see "The High Blood Pressure Hoax" by Sherry Rogers, MD. For references on what nature, not the medical community, has in mind for our salt intake, see "The Wellness Project."

Roy Mankovitz, Director
http://www.MontecitoWellness.com
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dongarb
Give Up The Ground and Embrace The Void
09:19 AM on 04/30/2010
When BPA is added to epoxy or lexan it is bound up in long chain polymers and only small amounts leach out over time. Since natural estrogens occur in the body in parts per trillion this is still enough to have bad effects. As shown by the 94 separate studies that the FDA threw away when they boldly chose to read only 2 studies done by bpa manufacturers that miraculously showed bpa is completely harmless. The fda then stamped bpa as safe, an astoundingly stupid thing to do, as the greatest form of stupidity is serving evil.

There is a war going on right now between real and fraud science and bpa is the battleground. What's at stake is not the money that bpa brings in but the danger of what would be discovered to be better than petro-plastics, something that is bio-degradable, sustainable and non toxic. If plastic products are developed using this organic source then many giant monopolies will fall, that's what has the boardroom poisoners pooping in their expensive diapers.

There is an another bpa source that puts truly massive quantities into people's bodies and that is the thermal paper used in cash registers and receipt machines. Touch that paper and unbound bpa powder comes off and goes directly through your skin. The battle over bpa must soon include thermal printer paper since it is one of the largest sources of any xenoestrogen that afflicts western societies.

Don Garb
http://mrrb.ca/page7.html
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Victoria-nola
There is no way to peace; peace is the way.--Muste
01:35 AM on 05/01/2010
Great post, Roy, thank you. Dr Katz never mentions that salt is as necessary to the body as air or water, but that the salt most people in the USA are eating is a refined substance that has been turned into a poison. Refined salt, such as Morton's at the supermarket, has been bleached and heat and chemically treated to be bright white and sparkle, and it has chemicals added to it to make sure it pours easily. The stripping of the rest of the minerals from the salt means that it is no longer balanced, and the heat treatment changes its chemical nature. The result is a substance that causes mineral imbalances which in turn cause cardiovascular diseases.

Unrefined salt, by contrast, is a whole food that is not bleached or otherwise treated, and it has the full mineral profile. In World War II, ocean water was used as a substitute for blood transfusions when they ran out of blood, because ocean water and our own blood have the same mineral profile. Unrefined sea salt is the salt left from ancient oceans, and it too has the same mineral profile as our blood. Unrefined salt cures diseases, it does not create them.
http://curezone.com/foods/saltcure.asp
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Victoria-nola
There is no way to peace; peace is the way.--Muste
01:55 AM on 05/01/2010
Continued, part 2:
People in the USA have been using the disease-producing bleached stuff because salt industrialists at the turn of the 1900s caused laws to be written that forbid the sale of unrefined salt for human consumption. This gave them a monopoly on the salt supply. It was only in the late 20th century that people could again buy unrefined salt for ingestion, and not just for bathing.

Real, whole, unrefined salt is the same substance humans used without any trouble for all the millennia we have existed as a species-- it was used as money to pay people for their labor ("worth your salt"), it was the cause of wars to control salt resources, and it is still a necessary part of our diets. If they want to pass laws about salt, they should pass laws that only unrefined salt should be sold instead of allowing poison to be sold for a basic human requirement for life. That would be doing something helpful indeed.

btw, unrefined salt tastes wonderful! Campbell's Soup Company has changed to unrefined sea salt because they recognize it is the healthy choice and they can use less to get more flavor.

People who care about their health should switch to unrefined salt. Real Salt brand is mined in Utah. Celtic sea salt is the traditional salt of coastal France. Himalayan salt is from ancient oceans, and there are many more sources of health-giving salt. http://curezone.com/foods/saltcure.asp
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Cedman
08:03 PM on 04/29/2010
My wife and I have begun reducing our salt intake and its really interesting how quickly you can tell how much salt is in "normal" dishes.
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HealthHabits
07:44 AM on 04/29/2010
Great article Dr. Katz,

In my personal experience, as I transitioned to my own particular version of a Paleo Diet, my cravings for salt died off.

Now, when I eat any "normal" meals, I find them way too salty.

I guess my tastebuds have re-set themselves.

If any of your readers are interested in cutting their salt cravings by switching to "A Paleo Diet for the 21st Century", they can get a free ebook here - http://www.healthhabits.ca/stuff-i-like/a-paleo-diet-for-the-21st-century/
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edejan
02:54 AM on 04/29/2010
Many have commented that they are leery of the government regulating the amount of salt in our food, but NOW the food industry de facto "regulates" the amount of salt in our food. I agree with the article. We are free to add as much salt as we want to our food, so I say pass regulation that takes the amount of salt we eat out of the hands of the food industry.
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tonygumbrell
retired working stiff
12:32 AM on 04/29/2010
I favor government action to make sure that the foods sold to me and to the rest of the public do not have unsafe or unhealthy levels of additives e.g. too much salt (which causes hypertension and cardio vascular failure etc). Once they (industries or corporations, which are motivated by profits sans any repsonsiblity for our health or welfare) put it (salt, or any other substance) in, there's no way for me or you to get it out. Our only option, and a good one, is for our gorvernment, i.e. your government and my government, to regulate them and inspect them rigorously, because they can't be trusted (businessmen care only about their bottom line, not yours or mine).
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HolliThompson
Nutrition Stylist
09:29 PM on 04/28/2010
Great post Dr. Katz! This says it all when it comes to the salt controversy. Thank you!
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07:44 PM on 04/28/2010
I think all of the comments about how "the government shouldn't control what we eat!" are hilarious considering that the sodium issues are thanks to corporations' regulations which are already in place. I see the government as the lesser of two evils in this situation seeing as the regulation would be to better people's health as apposed to making something fast and addictive with money solely in mind. To each their own I suppose.
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hoffalypse
04:21 PM on 04/28/2010
How about you just let people eat whatever they want and if it hurts them in the long run that is something they will have to deal with. America would also be more healthy if we outlawed candy/chocolate.
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dctackett
07:13 PM on 04/29/2010
first of all most people don't really know or understand the consequences of what they stick in their mouths... the effects are not immediate.

and this is about controlling what food manufacturers are putting in the food, not what you are or are not allowed to eat...

like he said... we can always add more salt ourselves...
03:53 PM on 04/28/2010
Good tasting food begins with a high quality of ingredients. There are lots of tasty alternatives to excessive salt. I know it's not always convenient in today's multi-tasking world, but learning to cook one's own food from scratch will always be the healthiest choice. That way one can minimize the use of salt and substitute herbs, spices, and herbal mixtures for salt. These alternatives are tasty enough to make one forget about salt. Unless one has become thoroughly addicted to junk food, home-cooked food tastes best. If you can squeeze it into a busy schedule, raise a vegetable garden.
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hoffalypse
04:18 PM on 04/28/2010
What if I like salt? isn't it my choice/responsibility? Just like gardening and cooking fresh foods is yours?
10:31 PM on 04/28/2010
As pointed out in the article, you can add as much as you want. Go for it. I live in an equatorial country where it is hot all the time and I add salt.
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dctackett
07:15 PM on 04/29/2010
then carry your salt shaker around with you... NO ONE IS STOPPING YOU
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kapalabhati
Lokah Samasta Sukhino Bhavantu
02:35 PM on 04/28/2010
I loved this post. I love salt. If Bill W. were a saltoholic, I'd be a friend of Bill. I love how you equate Madison Avenue with Pennsylvania Avenue.

I'm not entirely convinced the gubmint should be involved in actually regulating sodium content. It may. I do believe there is a role for government in promoting health education and therefore healthful choices. It works. Have you talked to a 9 year old about smoking lately?
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hoffalypse
04:18 PM on 04/28/2010
Education... good

Forced Behavior change... BAD
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dctackett
07:17 PM on 04/29/2010
regulation of big business... good

thinking the government is trying to force a change to YOUR behavior... BAD
01:54 PM on 04/28/2010
You stay out of my life..Dr. used to say tomatoes were poison too. Different stokes for different folks makes the world not stepford children...Just like I like vegs cooked one way, you dont. Doesnt make it wrong just different...I dont want to be anything like you, or a stepford child..
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dctackett
07:18 PM on 04/29/2010
then don't read his articles and don't do as he says... he's not getting involved in your life, you are involving him in yours... and complaining about it..
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Ragnar Danneskjold
Defender of Liberty
12:37 PM on 04/28/2010
Nobdoy is force feeding anyone. The sodium content is on the package. Stop with the nanny state garbage. Personal responsibility or the lack of is freedom.
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MajorKong
If the pilot's good, see, I mean if he's reeeally
01:53 PM on 04/28/2010
That's right! We need to get government back to it's primary purpose of regulating everybody's sex life and promoting Christianity.
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kapalabhati
Lokah Samasta Sukhino Bhavantu
02:28 PM on 04/28/2010
Excellent point. Thank you!
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HamletsMill
All Myth is Astronomy
11:10 PM on 04/28/2010
And taking the nation to continuous war. That is what they do best and they are very good at it. THAT is the main purpose of our system of government now: endless war. And, of course, paying huge salaries to people watching porn on government computers over at the SEC. Only in America!
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dctackett
07:19 PM on 04/29/2010
so big business should not be regulated?... hmmm... always been a bad idea
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mlaiuppa
Pres. Sarcasm Society. Like we need your approval.
12:24 PM on 04/28/2010
Easiest way to reduce salt intake is to cook your own food. Even if you use cheese or add salt, it won't have near the content of a canned soup or frozen dinner.

Cooking for yourself is healthier in other ways. You can choose a higher quality ingredient in what you make.

Find the time to cook.

Learn to cook if you have to.
03:20 PM on 04/28/2010
this is so true. I detest cooking, but I know I'm going to have to again for my health :(
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mlaiuppa
Pres. Sarcasm Society. Like we need your approval.
12:01 PM on 04/30/2010
I actually enjoy cooking. But I fell into the too busy trap and allowed pre-processed meals to take over.

I stopped that a year ago.

If I can schedule time for other important activities, I can schedule time to cook. My health is just as important as other things I plan time for. And if I don't have my health, those other things are going to suffer too.

Rather than thinking of cooking as a daily drudge, think of it as any other planned activity, like taking a walk, playing with the dog, reading a book or going to the movies. When I think about it, many of my cooking activities don't involve a lot of time. I can prepare whatever it is and stick it in the oven. Then I have an hour to go take a walk, play with the dog, read a book or do laundry or whatever. I don't have to stand there and watch the oven cook the meal.

And I find that I enjoy my food more now. I cook extra so I can have leftovers.

And......I find that I just can't tolerate the convenience pre-processed foods anymore. My palate has remember what real food tastes like. And I don't like the faux foodlike substitutes anymore.

I also find they are really, really salty. You really notice the salt once you've lowered your intake for a length of time.
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PathofTotality
Regret serves no purpose
12:10 PM on 04/28/2010
About 10 years ago, I stopped salting my food whether it was home cooked or bought.
About 5 years ago, my family and I all but gave up fast food.
About 5 years ago we also put more effort into cooking at home all the time not just on the weekends and if a recipe calls for a tablespoon of salt we would put half that.
Last year my wife found out she has Meniere's Diesease (a form of vertigo) and after 3 MRI's (to rule out tumors) and various other tests, the doctor told her to cut back on salt as it is one of the contributors. Up until that time, we didn't pay attention to every single thing we eat in regards to salt and let me tell you, once you do, you will be amazed (i.e. cookies and cereal as mentioned above). She is now averaging 1300 mg per day and she can tell a difference. Not long ago my son wanted to get a fast food hamburger (which is very odd) and I thought "why not". Once a year won't hurt. All I could taste was salt....literaly!!

Needless to say, we have become pretty good about using various herbs and spices plus, Mrs. Dash has become a staple. The simple step of not adding salt to what you get in a restuarant is easier than you think plus it's a good place to start.
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mlaiuppa
Pres. Sarcasm Society. Like we need your approval.
12:27 PM on 04/28/2010
Yep. Once you lower your salt intake you can taste it in everything.

I use unsalted butter even.

When I go to my parents' house once a week for dinner, I beg my Mother to please not salt the food until after it's on the table. I can eat what she cooks straight now, unsalted.

Now my Mom's doctor has asked her to lower her salt intake. She is amazed how much hidden salt she's been consuming. And she's cooking a lot more from scratch. No more frozen foods or canned soups. She'll be making her own chili too.