UPDATED: May 10, 2025
Welcome to the Healthy Living Is Good Medicine Newsletter, a totally free, health education publication covering a wide variety of topics with original articles intended to help people lead healthier and more fulfilling lives.
Pass the Salt
Salt: You can't live without it, and you can't live with it if you consume too much. Salt is an inorganic substance consisting mainly of the chemical compound, sodium chloride (NaCl). Both sodium and chlorine are toxic chemicals, but when combined (in a spectacular reaction) they produce an essential dietary mineral.
Ionized Sodium
Table salt is about 40 percent sodium by weight. When salt is dissolved in water, the sodium chloride molecules separate into positively-charged sodium ions (Na+) and negative chloride ions (Cl-). Dietary sodium ions play a vital role as an electrolyte, and activate the sodium receptors present in the taste bud cells on the human tongue. In the right amount, the taste of sodium can be highly pleasurable, leading to excessive consumption over the course of the day.
Although we vary in the degree to which we like the taste of salt, a craving for salt is commonly due to stress, boredom, or fatigue, and can sometimes be caused by the hormonal fluctuations of the premenstrual syndrome. Rarely, it can be due to more serious medical conditions.
Without sodium ions, nerves and muscles would be unable to function. Sodium ions are also involved in the body's fluid balance and regulation of the water content of tissues and organs. The sodium-potassium pump maintains cellular osmotic equilibrium and cell membrane electrical potentials.
Sodium Restriction
Diets that are too low in sodium can raise insulin levels and release hormones such as aldosterone, noradrenaline, renin, and angiotensin-II. These hormones can potentially contribute to insulin resistance and increase the risk of type 2 diabetes, primarily through the activation of the renin-angiotensin-aldosterone system (RAAS). Unnecessarily and severly restricting sodium can have adverse consequences for susceptible individuals, according to a recent article.
A 2023 review of 23 clinical trials found that sodium restriction was associated with insulin resistance. However, a 2023 meta-analysis found that higher blood glucose levels of hypertensive and normotensive people with low-salt diets did not show clinically significant differences compared to those with normal or high-salt consumption.
Too Much Salt
According to the World Health Organization (WHO), reducing dietary sodium is one of the most cost-effective ways for people to improve their health, as well as to reduce the social and personal economic burdens of non-communicable, chronic diseases. An estimated 1.89 million deaths each year are associated with consuming too much salt.
U.S. dietary guidelines and the WHO recommend that people consume no more than a teaspoon of salt a day (~5 grams), which contains about 2,300 mg of sodium. Our actual salt consumption is far higher, and globally the average per-capita consumption is twice the recommended limit.
Don’t be fooled into thinking that some salts are intrinsically healthier than others. Kosher salt, sea salt, and pink Himalayan salt are not healthier than iodized table salt, as this article makes clear:
The primary health effect associated with diets that are high in sodium is hypertension and the concomitant risk of cardiovascular disease and stroke. Clinical trials have confirmed a causal relationship between increased salt consumption and elevated blood pressure, but not everyone is at risk for developing salt-sensitive hypertension.
Other health impacts of a high sodium diet include stomach cancer, obesity, osteoporosis, Meniere’s disease, and kidney stones, as well as the disruption of our gut microbiome. You all know the importance of having a good relationship with your intestinal symbionts, so consider their needs as well as your own.
Sodium Sleuthing
According to the FDA, table salt is not the biggest contributor to excess sodium. Almost three-quarters of people's dietary salt comes from packaged and processed foods. This is why it is so important to carefully read package labels and make informed decisions about whether or not such foods are worth eating. Most of the foods that come with labels are manufactured for their taste, while often short-changing nutritional value.
The same caveat about salt also applies to many of the foods that are served in restaurants. Patients with high blood pressure who dine out may find their blood pressure spiking shortly after the meal. That's in addition to the typical caloric overload of menu items that are intended to keep people coming back for more. We need to be aware that our sense of taste is being exploited for profit. It would therefore serve us well to rehabilitate our taste buds by eating less salt, sugar, and saturated fat, the “unholy trinity” of unhealthy foods.
Although less than three percent of our average daily sodium intake comes from our dining table salt-shaker, I've replaced mine with a pepper mill containing black pepper corns. Because I've eliminated iodized table salt from my cooking, I make sure to include other sources of iodine in my diet, such as seaweed. Ocean fish and other seafood, eggs, and dairy also provide dietary iodine, which is necessary for the thyroid gland to produce its hormones.
Eliminating pretzels and chips will not be enough to sufficiently lower one's unnecessary salt intake. The bigger culprits can be foods such as bread, cheese, and processed meats. Canned vegetables may also contain lots of salt, and consequently should be rinsed before eating.
The American Heart Association suggests limiting the daily amount of sodium for at-risk patients to 1,500 mg, a little more than half a teaspoon. However, that may be an unrealistic goal for many people, and individuals can vary widely in their optimal salt intake.
Salt Substitutes
The original “Salt Substitute and Stroke Study” was published in 2021. The study concluded, “Among persons who had a history of stroke or were 60 years of age or older and had high blood pressure, the rates of stroke, major cardiovascular events, and death from any cause were lower with the salt substitute than with regular salt.”
A 2025 study has substantially added to the already compelling evidence that a lower sodium intake reduces the risk of cardiovascular disease and stroke, especially among those who are already at risk. Double-digit reductions in strokes, major adverse cardiovascular events, and deaths were seen in a randomized clinical trial. Investigators found the evidence persuasive enough to suggested that “The simple intervention of salt substitution could significantly improve secondary prevention of stroke and cardiovascular health on a global scale.”
This study also demonstrated that a salt substitute containing 25 percent potassium chloride (KCl) did not increase the risk for hyperkalemia, which had been a safety concern, particularly in regard to people with underlying kidney disease. One of the limitations of this study is that it was carried out in China, whose adult population has the world's highest per-capita consumption of salt.
Monosodium glutamate (MSG), which is only about 12 percent sodium by weight, has about a third as much sodium as table salt and can therefore be used as a substitute. It also adds a nice umami (savory) flavor to food. However, using too much MSG has been associated with some health risks. A 2023 review of this popular food additive found that MSG can have both positive and negative effects on metabolic disorders, depending upon the amount consumed. At ordinary usage levels (a little bit goes a long way), this should not be cause for concern:
Instead of using salt substitutes, there are ways to wean ourselves off our desire for the taste of salt, such as using no-salt seasonings that contain a variety of herbs and spices for our cooking. Rather than adding salt and tasting the food while cooking, adding salt after the food is cooked results in people using less. Adding a little acidity in the form of vinegar or the juice from lemons or limes will decrease the amount of salt that's needed to produce the desired taste.
Too Little Salt
People with normal kidney function can get rid of excess sodium by taking loop diuretics commonly prescribed for high blood pressure. Sodium loss can also be caused by medications, such as desmopressin and SSRIs, as well as from excessive perspiration. Intense physical activity in a hot environment can result in hyponatremia, producing symptoms such as muscle weakness and cramping, nausea, and headaches.
Severe hyponatremia can be life-threatening and requires immediate medical attention. Restoring lost fluid and electrolytes is imperative. Rather than so-called sports drinks, I recommend something that is far healthier for replacing what’s lost through sweat; tomato juice.
Lab Tests
A routine sodium blood test is part of a basic metabolic panel (BMP) or comprehensive metabolic panel (CMP) that is typically part of an annual medical exam. An electrolyte panel might be ordered more frequently if you are taking medications that can affect fluid and electrolyte balance or if your symptoms suggest that your serum sodium might be too high or too low.
If you don’t have a metabolic or endocrine disease, and have normal kidney function, your body will keep the serum sodium level within the normal range, so a lab test will not tell you if you are consuming too much salt. The only way to know if your dietary intake is outside the recommended range is by tracking your actual consumption. Since the forces of commerce conspire against a healthy level of sodium consumption, making a conscious effort to reduce your salt intake will most often be beneficial.
What Now?
So, what's the bottom line here? If you’re going to eat salt, is there a healthier choice? This recent article from the Center for Science in the Public Interest puts the most common choices into perspective. In general, I would avoid generic salt that comes in small packets. It generally contains a lot of other ingredients of dubious value.
Putting a total “halt to salt” clearly isn't the answer. Sorry, but there isn't a “one-size-fits-all” recommendation for the optimal amount of dietary sodium. The age, sex, weight, health status and specific medical conditions of individuals need to all be taken into account, along with their lifestyle factors and genetic susceptibilities.
The key is to cut back on foods that are high in sodium, such as prepared, processed, and restaurant foods, and to slowly reduce the amount of salt used in home cooking. After a few weeks, you might not even miss it. You’ll soon discover a whole new array of wonderful, subtle flavors that had been obscured by the taste of salt.
― ― ―
These Posts can be updated at any time. Please check back here again to find the most up-to-date information..
You can find many more articles about Healthy Living in my Post Archive.
Be sure to share my Website Link with others via your social media accounts. You can help friends and followers become healthier by suggesting they subscribe to my totally free Newsletter.