DrG's Medisense Feature Article

Salt
By Ann Gerhardt, MD
August 2024
Print Version

Bottom Line is at the bottom: High salt (sodium chloride) American diets of processed foods contribute to high blood pressure. 

The Centers for Disease Control, World Health Organization and National Institutes of Health recommend reducing sodium intake below that in a typical American diet to about two grams (equal to five grams of salt).  That’s about 2 teaspoons of salt.  The goal of these recommendations is to normalize blood pressure and thereby prevent strokes.  Reducing salt intake lowers blood pressure in most people but more effectively in African American people, whose pressure tends to be more sensitive to sodium.

People eating high sodium diets don’t get all or even most of it from the saltshaker.  Most comes from processed and packaged foods, to which salt is added for taste or to prolong shelf-life.  When fat phobia took hold of the nutrition world and American dietary recommendations, food manufacturers maintained market share by replacing fat with salt and sugar for flavor.  That may have reduced cholesterol, but diabetes and obesity, each with their own propensity to cause strokes, soared. 

A few foods, like all vegetables, dairy and seafood, naturally contain sodium.  Since these foods are not the real culprits in a high salt diet, they should not be eliminated.  Salt restrictors usually become accustomed to less salt and have less salt sensitivity and craving.  Unless they have a strong family history of hypertension and stroke, people with normal or low blood pressure don’t need to restrict salt intake.  In the elderly, if sodium restriction is severe, the blood pressure can fall too much and cause falls, confusion and passing out.  Severe salt restriction can also backfire by causing release of aldosterone, a hormone that raises blood pressure. 

So, anyone with high blood pressure or a family history of stroke should routinely eschew the pre-prepared foods in the middle of the grocery store, choosing instead vegetables, fruits, dairy, and protein-foods around the outside of the store that are lower in salt to prepare their own food.  Other people would be wise to follow the same approach, without restricting salt too much.