As you may realize by now, salt has had a very colorful history, both in the development of human civilization as well as public health politics in the past century. While salt was originally prized by many cultures for thousands of years, in the past century it has been demonized; some have gone as far as calling it the single most harmful substance in the food supply. Yet as we know, sodium plays a crucial role in optimal health, and too little salt intake can be dangerous in the long run.
In Shaking up the Salt Myth: The History of Salt, I described the history of salt production and use, and its place in the Paleolithic and Neolithic diets. In The Human Need for Salt, I explained the physiological roles of salt in the human body and the basic dietary requirements for salt. In The Dangers of Salt Restriction, I examined potential negative health consequences of restricting salt unnecessarily. In When Salt Reduction May Be Warranted, I described conditions in which salt restriction may be necessary, and other minerals that are essential in determining blood pressure.
In this final article, I will describe the types of salt I recommend, and how much salt is ideal for most people.
How much, and what kind of salt to include in the diet
According to research, there exists a range of sodium intake that likely confers the best health outcomes for most people. As I explained in part 3, findings from a 2011 study de
Figure 1: Mean sodium intake among the participants of the Japanese National Nutrition Survey: 1973–2000
monstrate the lowest risk of death for sodium excretion between 4000 and 5990 milligrams per day. (1) Sodium excretion greater than 7000 milligrams or less than 3000 milligrams per day was associated with a higher risk of stroke, heart attack and death. This lowest risk range equates to approximately two to three teaspoons of salt per day.
The average American consumes about 3700 milligrams of sodium a day. This value has remained constant for the last fifty years, despite the rise in rates of high blood pressure and heart disease. (2) As a comparison, the Japanese, with one of the highest life expectancies in the world, consume an average of 4650 milligrams of sodium per day, and have a lower risk of cardiovascular disease than most other developed countries. (3, 4) Their average sodium intake has consistently hovered in the low risk range over the past 30 years, despite attempts by public health organizations to reduce Japanese salt consumption. (5) A caveat is that the Japanese also have a high risk of stroke, so their extremely high salt intake is not necessarily recommended as a model for our own intake. (6)
While salt recommendations vary between individuals based on age, gender, physical activity, and health conditions, I feel that the data supports an intake between 3000 and 7000 milligrams of sodium, or 1.5 to 3.5 teaspoons of salt, per day. People who are quite active or sweat a lot should consume salt on the higher end, and those who are less active may want to consume on the lower end. Of course, there may be some conditions where moderate salt restriction is warranted, but for the majority of healthy individuals, salting to taste will provide an appropriate level of sodium in the diet. Natural sources of sodium include sea vegetables, fish, shellfish, and meat, plus certain plants such as beets, carrots, celery, spinach, and turnips.
What type of salt should you buy?
One question frequently brought up in the Paleo community is what type of salt is best. This is a difficult question to answer. There are a wide variety of salts available on the market, all claiming health benefits over the others. While the answer to this is unclear, there is some research demonstrating a difference in mineral content and flavor intensity of certain salts that would be better options than common table salt.
A fascinating 1980 study examined the different indigenous, pre-industrial methods of salt production, and their respective mineral contents. (7) Some salt production methods included drying marine algae or fish eggs, fermenting marine fish blood and entrails, and even using sea water soaked in peat that was dried and burned to create salty ash. This study compared the mineral contents of these traditional salts with industrial table salt, as well as a variety of sea salts and other “health salts” on the market. The indigenous salts were found to be higher in combined essential and nonessential trace elements than both the table and sea salts.
Most of us do not have access to these traditionally prepared salts. Fortunately, sea salt and other commercially available natural salts have been shown to contain a higher trace mineral content than refined table salt. (8) In this study, the mineral content of sea salts differed depending on the harvesting location, but all salts tested contained various amounts of trace minerals (with the exception of table salt), and had small amounts of calcium, potassium, magnesium, sulfur, zinc, and iron. The various natural salts also had different time intensity profiles, due to the variety of minerals, so less of the salt is necessary to achieve the same level of flavor intensity compared to table salt.
Types of salt that are not recommended
One sea salt that is not recommended for dietary consumption is Dead Sea salt, due to its high bromide content. (9) The Dead Sea has the highest bromide concentration of any large body of water in the world, and bromide toxicity can occur after consumption. Some argue that sea salt is no longer healthy due to the level of pollution in our oceans today, though evidence for this is scant. (10) If this is a concern, there are salts produced from ancient geological oceans, like Real Salt from Utah beds or Himalayan pink salt, which would not have the same level of pollution as salt from much of the world’s oceans.
Regular table salt, conversely, is heavily processed, generally devoid of trace minerals, and commonly contains undesirable additives such as anti-caking agents like sodium silicoaluminate or sodium ferrocyanide. Therefore, generally avoiding table salt is a good idea, though care must be taken to ensure adequate iodine intake from other sources once iodized table salt has been removed from the diet.
Don’t stress the salt!
The amount of conflicting research that exists on salt is astounding. Hundreds of studies have been conducted on salt intake, and a consistent pattern has never been established for sodium’s role in a variety of negative health outcomes. At a minimum, it seems absurd that so much time, energy, and money is spent on trying to reduce the amount of salt that Americans eat, considering how weak the evidence is on this issue.
Ultimately, my perspective is that adding unrefined salt to a whole foods Paleo diet is perfectly healthy. By limiting grains and processed foods, the amount of sodium in your diet will already be drastically reduced as compared to the standard American diet. A bit of salt can make certain healthy foods, particularly bitter vegetables, far more palatable. Considering the evidence I’ve presented in this series, I believe that salt restriction for the general population is not only unnecessary, but potentially dangerous.