Some scientists claim that a diet with too little salt is just as dangerous as consuming too much salt.
What is reality?
Turkish chef Nusret Gokce went viral in 2017 after a video of him seasoning a huge steak with a pinch of salt.
The video had millions of views online and earned him the nickname "salt bae".
But it wasn't just his attention to detail that caught attention.
We are simply obsessed with salt despite the warnings.
Almost every population around the world spends twice as much as it should and that is harmful to health by the way.
But in recent years, an argument has become increasingly popular that challenges decades of research and sheds new light on questions that remain unanswered about our favorite spice.
Sodium, a key element that can be found in salt, is essential for our body to maintain overall fluid balance, transport oxygen and nutrients.
It allows our nerves to pulse with electricity.
But most populations have historically eaten more salt than is recommended, and health authorities around the world have had trouble convincing us to cut back.
The World Health Organization (WHO) recommends limiting sodium consumption to less than of two grams per day, what is about five grams sodium chloride salts.
The Dietary Guidelines for Americans suggest adults limit their intake to less than 2.3 grams of sodium per day, or about one teaspoon of salt.
Research from 2022 concluded that a moderate sodium intake (between three and six grams per day) was best when it came to heart disease risk, compared to low- and high-sodium diets.
The British National Health Service (NHS) guidelines recommend that adults consume no more than six grams of salt a day, including the amount already in purchased food and the amount we add ourselves during or after cooking.
In Great Britain, average consumption salt is closer to 8,4 grams per day, while in USA 8,5 grams.
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Meanwhile, the World Health Organization estimates that the average salt intake worldwide has jumped to nearly 10,8 grams per day.
Only a quarter of our daily intake comes from the salt we add to our food, the rest is hidden in purchased foods, which include bread, sauces, soups and some cornflakes.
Confusion also arises because manufacturers often list sodium content instead of salt on food labels, which can lead us to think that we are consuming less salt than is actually the case.
Salt is made up of sodium and chloride ions.
In 2,5 grams of salt, there is about a gram of sodium.
"People are unaware of this and think that sodium and salt are the same thing."
"Nobody is telling you this information," he says. May Simpkin, nutritionist.
About 40 percent of the sodium consumed by people in America comes from foods such as pizza, deli meats, burritos and tacos, spicy snacks, poultry and burgers, data from the US Centers for Disease Control and Prevention (CDC).
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Health risks of consuming too much salt
Studies have shown that too much salt causes high blood pressure, which can lead to stroke and heart disease.
Experts generally agree that the evidence against salt is compelling.
Our bodies retain water when we eat salt, increasing blood pressure until the kidneys can clear it.
Too much salt over a long period of time can put pressure on the arteries and lead to prolonged high blood pressure, known as hypertension, which causes 62 percent of all strokes and 49 percent of coronary heart disease events, the WHO indicates.
She estimates that excessive sodium intake is responsible for 1,89 million deaths worldwide each year.
A meta-analysis of 13 studies published over 35 years showed that there is 17 percent higher risk of full-blown cardiovascular disease and a 23 percent higher risk of stroke from consuming an extra five grams of salt per day.
Health benefits of reduced salt intake
Reducing salt intake can have the opposite effect.
The drop in blood pressure was likely due to a 1,4 gram reduction in salt intake, which in turn contributed to a 42 percent drop in fatal strokes and a 40 percent drop in deaths from heart disease, The data is from the eight-year English Health Survey..
A more recent clinical trial published in 2023 showed that a low-sodium diet for a week had a blood pressure-lowering effect that could be compare with the drug most commonly given to patients with high blood pressure.
However, researchers who conducted these studies often concluded that it is difficult to completely separate the effects of eating less salt from other dietary and lifestyle habits.
Those who are more aware of their salt intake are more likely to eat healthier overall, exercise more, smoke less, and drink less alcohol.
Selective studies comparing people who eat a lot of salt with those who eat little could determine cause and effect.
But very few such studies exist due to funding requirements and ethical implications.
"Selective studies showing the effect of salt on the body are almost impossible to do," says Francesco Cappuccio, professor of cardiovascular medicine and epidemiology at the University of Warwick's medical school.
"But there aren't any studies like that for obesity or smoking, which we know kill you," says Cappuccio, the author of the eight-year review.
Meanwhile, notable evidence abounds.
Japanese government launches campaign to persuade people to reduce salt intake late 1960s.
Their intake decreased from 13,5 grams to 12 grams per day.
During the same period, there was a drop in blood pressure and 80 percent reduction mortality from stroke.
In Finland, daily salt intake fell from 12 grams in the late 1970s to as little as 9 grams by 2002, and there was a 75-80 percent drop in deaths from stroke and heart disease over the same period.
How salt intake affects everyone differently
An additional factor complicating matters is that the effects of salt intake on blood pressure and heart health vary from individual to individual.
Studies have shown that our sensitivity to salt varies, influenced by various factors such as ethnicity, age, body mass index, health, and family history of hypertension.
Some research has shown that they with greater sensitivity on salt more at risk than salt-related blood pressure.
Some scientists now claim that a low-salt diet is as much of a risk factor for high blood pressure as a high salt intake.
There is a J- or U-shaped curve with a threshold at the bottom, where the risk starts to rise again.
One meta-analysis, for example, found a link between low salt intake and cardiovascular events and death.
Researchers claimed that consuming less than 5,6 grams or more than 12,5 grams per day was associated with negative health outcomes.
Study published in 2020, showed that strict salt restriction was associated with poorer health in patients with heart problems, especially among younger and non-white people.
Cured meats such as turkey, ham and roast beef have about 1,5 grams of salt per serving, while two slices of whole wheat bread can add another 0,6 grams.
Study conducted on more than 170.000 people had similar findings: an association between "low" salt intake, defined as less than 7,5 grams, and an increased risk of cardiovascular events and death in people with or without hypertension, as opposed to "moderate" intake of up to 12,5 grams per day (between 1,5 and 2,5 teaspoons of salt).
This moderate intake is up to twice the British recommended daily intake.
Reducing salt intake from high to moderate reduces the risk of high blood pressure and has no other health benefits beyond that, the conclusion is Andrew Mente, lead author of the study.
Increasing salt intake from low to moderate could also be helpful.
"Finding the perfect middle ground is consistent with what you would expect for any essential nutrient - at high levels you have a glut, and at low levels you have a deficiency."
"The optimal level can always be found somewhere in the middle," he says.
Not everyone agrees with him.
Capuccio is unequivocal that reducing salt intake lowers blood pressure in everyone, not just people who eat too much.
The wave of studies that have reached contradictory conclusions in recent years are small, involve participants who are already unhealthy and rely on flawed data, he adds.
His study used a urine test on participants after an evening fast instead of the “gold standard” of spreading several tests over a 24-hour period.
Sara Stanner, scientific director at the British Nutrition Foundation charity, agrees that the evidence that reducing salt intake in people with hypertension lowers blood pressure and the risk of heart disease is strong.
Not many people consume as little salt as three grams, a level that some in these studies call dangerously low.
This would be difficult to achieve due to the salt levels in the food we buy, Staner points out.
"A large part of the salt we consume is in everyday food," she says.
"Therefore, reformulation throughout the food supply chain is the most successful approach to reducing national salt levels, as has been the case in the UK," he explains.
Experts also have conflicting opinions about whether high salt intake can be reversed by an otherwise healthy diet and exercise.
Some, like Stanner, say that a diet rich in potassium, found in fruits, vegetables, nuts, and dairy products, can help reduce the negative effects of salt on blood pressure.
Ceu Mateus, Senior Lecturer in Health Economics at Lancaster University, advises prioritizing awareness of hidden salt in our diets rather than trying to avoid it entirely.
"The problems we have with too much salt could be similar to those associated with too little, but we still need to do more research to understand exactly what's going on. In the meantime, a healthy person will be able to regulate small amounts," says Mateus.
"We need to be aware that too much salt is really bad, but we shouldn't completely eliminate it from our diet," he adds.
Researchers in a 2022 paper concluded that a moderate sodium intake of 3-6 grams per day is best for reducing the risk of heart disease, compared to low and high sodium diets.
Despite recent studies claiming potential dangers of low-salt diets, and individual differences in salt sensitivity, the most robust conclusion from existing research is that too much salt definitely increases blood pressure.
Take the rest with a grain of salt - you already know what.
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