A few years back, I was working for a company in Portland, Ore., and I got a phone call from the hospital saying that my mom had been admitted via ambulance due to a heart issue (undefined at that point).
You can imagine what taking a call of that nature was like. Of course, I immediately left and went to the hospital to find her resting in a gown, awaiting test results and answers. For all intents and purposes, it was truly out of the blue. She was (and is by the way) very healthy and active, eating well, with no prior signs of heart issues that we recognized. She lived near where I worked, and I had been staying overnight with her about once per week instead of making the hour-plus daily commute. We ate together and spent time together. She took my dog for walks when I was working, and everything seemed fine. I had noticed she was using a fair amount of salt — adding it to meals already prepared with it — and I was not spared the brainwashing of “salt is bad for you; eat less of it.”
So, when she landed in the hospital and conventional medicine wisdom had her drastically cut her salt intake (less than 1,500 mg/day), that seemed to make sense to me because “salt causes hypertension and water retention.”
Do bear in mind that she has always had low, sometimes very low, blood pressure. For the next year or so, she accounted for every milligram of salt she ate, and because of fear surrounding the ramifications of salt (again, conventional wisdom), she was often taking in less than 1,000 mg. We did a lot of math when baking … tallying baking soda, baking powder, any added salt, and dividing by how many portions, on and on.
She was so diligent with her diet and heart medications that she actually “got over” congestive heart failure which is really unheard of. Down the road, however, her blood tests were repeatedly coming back low in sodium. There’s no mystery there since she had cut it out of most everything. And, guess what? It ended up that she needed a pacemaker because, in fact, her heart was not operating properly. The valves were not opening and closing in sync, due to faulty electrical operations and weakened valve strength. So, what’s the deal? Was salt a culprit or wasn’t it?
Well, it is true that the flash pulmonary edema she experienced - caused by congestive heart failure, according to the doctors - was triggered by her body retaining fluid and not releasing it properly. Her lungs suddenly filled with fluid (essentially drowning her), her heart went arrhythmic, and she likely would have died had EMS not responded quickly. Maintaining proper sodium concentration in the blood is part of kidney function (among other things), and after consuming salt, people do have a period of time when their blood pressure is elevated as the kidneys work to flush and do their job.
So, in the case where my mom’s heart was already compromised (which she did not know), it’s possible that salt played a role in adding burden to the heart by way of that temporary blood pressure increase.
SALT CONSUMPTION & HYPERTENSION
Salt may have been the culprit of the moment, but not for the reasons conventional campaigns would have one believe. On top of it all, we also have to bear in mind that our bodies are incredibly complex; each bodily function directly and indirectly relates to and affects every other function. I think I’ve said it before that we in our modernized world have endeavored to study the parts in our efforts to understand the whole, but often forget to put the pieces back together after the dissection. It should be noted that there was no hard and fast, conclusive evidence in the first place that proved salt caused chronic hypertension.
The campaign to demonize a substance critical to our health began based on hypotheses and less-than-thorough science. In fact, just last year, a paper was published based on a study that reviewed 25 case studies focused on the level of salt consumption and its relevance to mortality. It concluded that both low and high levels of salt intake were detrimental to health. It’s also important to note the range of “normal” that was indicated.
Even with this and other studies showing that too little sodium is life-shortening, the CDC, though it acknowledges the studies, still maintains its recommendation that 2,300 mg should be the upper limit of sodium consumed, less than 1,500 for those older than 50 or with certain health conditions.
Here’s an excerpt from the conclusion of the paper, “Compared with Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated with Increased Mortality: A Meta-Analysis,” American Journal of Hypertension, March 2014:
“Our study extends the IOM [Institute of Medicine] report by identifying a specific range of sodium intake (2,645–4,945 mg) associated with the most favorable health outcomes, within which variation in sodium intake is not associated with variation in mortality. Moreover, this optimal range of intake, based upon available evidence, is coterminous with the current dietary intake of most of the world’s population and is in accordance with the IOM rules for definition of an AI [adequate intake level] and UL [upper level] of sodium. Finally, an increased mortality risk was found to be associated with intakes that violate this range. In none of the primary or supplementary analyses was a low sodium intake associated with beneficial effects on ACM [all-cause mortality] or CVD [cardio-vascular disease]. Thus, these data are consistent with the hypothesis that a U shape best describes the relationship of sodium intake to health outcomes.”
Recently, I saw a post floating around on social media touting the worst nutrition advice in history: Don’t eat the egg yolks; eat a low fat high-carb diet; use polyunsaturated fats for cooking (see my article on oils to review that topic!); eat margarine not butter, etc. Without a doubt, in my opinion, “eat less salt” should be added to that list! Think about life prior to modern history for a second. A LOT more salt was used back in those days to preserve foods, etc., and our extreme troubles with high blood pressure have really only mounted starting in the 20th century when we consumed much less of it (and much more sugar, by the way).
To be fair, not all salts are equal, so we’ll explore that a little bit. Let’s take a look at some salt basics – the role it plays in the body, and some of the types of salt available.
UNREFINED SALT & THE BODY
What we call salt is a compound made up (minimally) of sodium and chloride elements. Both are essential to life, and they work in tandem with each other and other elements to maintain the proper level of fluids in the body. They are key players in the electrolyte mix, the others being potassium, magnesium, calcium, etc.
In its natural form, salt is abundant in trace minerals vital to health, and it is an alkaline substance which helps maintain the pH level in our bodies. When salt is ingested, it dissolves into its individual components which then serve various functions in the body. Of course, the major role is to maintain the proper water level in the blood, i.e. maintain the proper concentration of sodium and other electrolytes in the fluid.
Think of the example where you sweat a lot, or take some kind of diuretic (like caffeine), and your body releases excess water, and then you become thirsty because the fluid to element concentration has become imbalanced. It’s no wonder that popular soda makers started adding (and increasing the levels of) salt to their beverages along with drastically increasing fructose levels to mask the taste; this makes people thirsty so they want to drink/buy more (cha-ching). Conversely, if you’re low on sodium, you will likely have cravings for salty things.
Here’s an example of how elements interact with one another: Sodium and potassium work together back and forth across cell membranes (known as the sodium-potassium pump) to regulate intra- and extra-cellular fluid levels, as well as to facilitate the expenditure of energy from those cells. That is true in regular cells, and even more so in neurons which accounts in part for the essential role electrolytes play in proper nerve and muscle function in the body. In fact, electrolyte activity activates the electrical tissues of the body- nerve and muscle tissues. Without adequate electrolyte balance, those functions are impaired.
Think about a time when you may have physically worked really hard, sweated a lot, and found that your muscles began cramping. Or, have you ever been told to eat a banana (good source of potassium) to help against Charlie horses?
Another (funny) Mom anecdote: Recently she came to visit me and stay overnight. We decided to do the almost unthinkable and go out to a restaurant for dinner. When we got back home, it was movie night. She settled into her chair, and I asked if she wanted a little treat. Like for most people, popcorn is the expected norm on movie nights. But, in my mind (unbeknownst to her), I had already run through some facts: We had just eaten a dinner fairly high in sodium; maintaining healthy body fluid balance is important, and sodium likes potassium; I knew what I had in the house that would be highest in potassium; and, for years, I have often turned to avocado to balance out something overly salty. So, the offering I expressed with no advanced explanation was, “Would you like some avocado or banana?” The look on her face was that of pure, astonished dismay, followed by a, “What?!?”
I immediately realized how absurd that must have sounded, being that she expected popcorn with plenty of butter and salt. Once I stopped laughing, I explained. ;-)
So, when we talk about salt, we’re first talking about sodium chloride. For unrefined salts, we are also talking about the other trace minerals bound with them. Depending on the origin of the salt, it could have as many as 60+ trace minerals included. By understanding that it’s crucial to maintain a balance of all the various nutrients in the body because they depend on each other to function, it is easy to see why consuming unrefined salt vs. standard table salt (which is stripped of all additional nutrients) is important.
HIMALAYAN SALT, SEA SALT, CELTIC SALT
To me, this is pretty simple and follows the same general principles as any other food you might choose to eat. Know your supplier, choose the least processed version that you can, know what’s being stripped out and put back in (if anything), and consider the sustainability of the harvesting or production methods used. That said, there are a lot of great salts out there, and I happen to love to mix them up! In a veggie soup I made last weekend, I think I used five different types - Real Salt, Himalayan, bamboo sea salt, smoked salt, and Celtic onion salt - and it may have been my best soup yet!
By understanding that it’s crucial to maintain a balance of all the various nutrients in the body because they depend on each other to function, it is easy to see why consuming unrefined salt vs. standard table salt (which is stripped of all additional nutrients) is important.
So, let’s look a little closer at salt’s makeup in general. Standard white table salt is about 97-plus percent sodium chloride with the remaining 2-plus percent being anti-caking agents, chemical additives, sugar (dextrose), and NO trace minerals. It must also be said that harsh chemicals and extreme heat are often used when stripping away the trace minerals.
Unrefined salts vary in their percentages (pretty dramatically), but a Celtic Sea Salt might be roughly 85 percent sodium chloride with 15 percent trace minerals in varying concentrations, while Real Salt is 98 percent sodium chloride and 2 percent trace minerals (no additives). Interestingly enough, Dead Sea Salt is one of the most unusual in the world in that it is only roughly 12-18 percent sodium chloride.
In actuality, all salt is “sea” salt because it either comes from an ancient sea bed, the Dead Sea, or an active, modern-day ocean. Salts from ancient sea beds would be those that were locked beneath the Earth’s surface back in ancient times when mountains were forming. Some may have been encased in volcanic rock during mountain formation like Himalayan pink salt, and some is protected by a layer of clay or another substance like the deposits mined by the Real Salt company in Utah. In addition to having a full spectrum of trace minerals, these salts have been sealed away and protected from modern day pollutants.
Some say the Himalayan tends to be a little earthier in taste, and Real Salt a little “sweeter.” Celtic Sea Salts are traditionally hand-harvested and sun-dried in the region of Brittany, France, on the northern coast. They are high in trace-mineral content and are not altered - no additives, bleaches, or extreme temperatures. Celtic Sea Salts offer rich, full flavor. Sea salts in general come from any modern day, living ocean or sea, from New Zealand to the Hawaiian Islands to the Mediterranean and beyond. When harvested and processed sustainably - such as those sea salts carried by Azure - they tend to be unrefined, thereby carrying a broad spectrum of trace minerals. Sea salts convey various nuances in taste, depending on where they were harvested. Now, how about the grind? An entire article could easily be dedicated to the types of grinds — from coarse, to fine, to crystalline, etc.
So, a couple quick thoughts here: First, consider the fact that salt is fairly moisture sensitive; that’s why conventional salts use all those anti-caking additives. Coarse salt is less sensitive, so if you have a grinder, it is a nice way to have fresh ground salt that stores well. Finer ground salts that have not been adulterated will tend to clump between uses. It simply takes a couple taps of the shaker to break it loose- better than any alternative with chemical additive. It is also important to keep in mind that crystalline or fine salts are more densely packed than their coarser counterparts; there’s more salt in a teaspoon of fine salt versus a teaspoon of coarse. Coarse salts are excellent for flavoring dishes – soups, meats, stews; fine salts are better for finishing.
As for “organic” salt, unlike France, New Zealand, and the United Kingdom, the United States has no organic certification for salt. However, for salt to be included in any organic products and not affect that status, it must be organic compliant, meaning it cannot include any chemical additives.
One final note: Nearly every morning, I do a vigorous walk, and I start it out with mindful focus on my body, beginning with feeling each toe as it takes a step, then the flats of my feet to my ankles, and on up. I deep breathe as I go, and the word that comes to mind is symphony. It truly is joyous to think of our bodies as a symphony. Just as a single flute does not a symphony make, the same is true for salt, or any other thing we consume. We must strive for the balance that creates the harmonies. Please note that nothing in this article should be taken as medical advice. It is intended as an expression of personal experience, understanding, and opinion. I am not a medical professional.
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