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What is Your Approach to Salt?

At the World's Healthiest Foods, our emphasis is on whole, fresh foods. Part of the reason is their nutrient-richness and amazing health benefits. But another part is their incredible taste—especially when enhanced with the right combination of herbs, spices, and cooking methods. For both of these reasons, we don't rely on table salt in our recipes or meal plans either for taste or for nourishment. Typically, we will include a phrase like "salt to taste" if we mention salt as a recipe option.

Salt Intake in the United States

Table salt has been a somewhat controversial condiment in the U.S. diet, primarily for two reasons. The first reason involves our overreliance on it. The average U.S. adult consumes somewhere between 2,900 and 3,500 milligrams of sodium per day, and most of this sodium comes from salt, either incorporated into processed, prepackaged foods or added to foods at the table. (Plain table salt, of course, is composed of sodium and chloride, with 40% of the composition coming from sodium.) The amount of sodium consumed by the average U.S. adult exceeds the level recommended by public health organizations like the American Heart Association (AHA) and the National Academy of Sciences (NAS).

The NAS established Dietary Reference Intake (DRI) guidelines for sodium in 2004, with the Adequate Intake (AI) level being set at 1,500 milligrams for males and females ages 9-50; 1,300 milligrams for ages 51-70; and 1,200 milligrams for ages above 70 years. These AI recommendations were not recommendations for maximum intake, however, but rather general intake guidelines. However, limits for sodium consumption were also set by the NAS in the form of Tolerable Upper Limits (ULs). These limits were 2,200 milligrams for 9-13 year-olds and 2,300 milligrams for males and females 14 years and older. In terms of table salt, these ULs translate into 5.5 grams of sodium chloride for 9-13 year-olds and 5.8 grams of sodium chloride for persons 14 years or older. Since one teaspoon of table salt contains approximately 6 grams of sodium chloride, these ULs also represent slightly less than 1 teaspoon of salt per day from all dietary sources, including both table salt and natural sodium contained in whole, unprocessed foods.

In the case of the AHA, however, review of the blood pressure research in 2010 led to a stricter recommendation of 1,500 milligrams of sodium per day. This level was set forth as a maximum recommended amount, and it was based on an estimated decrease of 25% in blood pressure for the U.S. population if this average sodium consumption could be reduced to this level. It is readily apparent that our average U.S. intake is approximately double the AHA recommendation and also above the Upper Limits recommended by the NAS.

Sodium Levels in WHFoods Recipes and Meal Plans

At WHFoods, our recipes and meal plans typically keep you consistently below the UL level for sodium. They can also keep you at or below the AHA level, with a couple of stipulations. Our Healthiest Way of Eating Plan, for example, averages 1,315 milligrams of sodium per day, or 88% of the AHA level. If you added 1/16th teaspoon of table salt to this amount (which is the way that a "pinch" of salt is often defined), you would end up with 1,461 milligrams, or 97% of the AHA recommended level. But you could not add a pinch of salt at each of three meals and stay below the AHA level. If you used 2 tablespoons of a regular prepackaged chicken or vegetable broth in a Healthy Sauté, you would be adding about 70-80 milligrams of sodium to the 1,315 average amount. So once again, you could have two Healthy Sauté meals per day with regular broth and stay close to the AHA level. As you can see, there is some "wiggle room" in our Healthiest Way of Eating Plan for you to add a few sodium-containing dishes or some pinches of salt and remain close to the low AHA level, even though there is clearly not limitless room here if you want to meet the 1,500 milligram guideline.

Salt Sensitivity

A second aspect of the salt controversy has involved salt sensitivity. Without question, people can react differently to intake of sodium. "Salt sensitivity" is the term generally used to describe this phenomenon, and it is usually defined as a change in blood pressure of at least 5-10% following a change in salt intake. In recent years, scientists have begun to revisit the issue of salt sensitivity due to advancements in our understanding of salt, blood pressure, and genetics. While not yet widely available in the commercial marketplace, researchers have identified a wide range of genetic markers that can help identify persons with salt sensitivity. These genetic markers include:

  • genes associated with the renin-angiotensin-aldosterone system that helps regulate processing of sodium by the kidneys and that is associated not only with specific receptor types like AT1R and AT2R, but also with the enzymes angiotensin I converting enzyme (ACE) and aldosterone synthase, as well as the solute carrier family (SCF) of proteins
  • genes associated with exosomes and renal proximal tubular cell (RPTC) metabolism
  • total microRNA (miRNA) in exosomes excreted through urine

Researchers are not yet certain what percentage of the U.S. population might turn out to be salt sensitive based on these new genetic markers. Past measurements of U.S. adults have shown as many as one quarter to one third of persons without high blood pressure ("normotensives") to be potentially salt sensitive, and as many as half of all persons with high blood pressure ("hypertensives"). In studies on African-Americans with high blood pressure in the U.S., this percentage has been shown to be as high as 75%. However, even though these research findings have been fairly consistent, there has been controversy about the exact levels of dietary sodium intake needed to help promote healthy blood pressure levels in clinical treatment of salt-sensitive individuals. For anyone diagnosed with high blood pressure or other cardiovascular problems, or anyone concerned about possible salt sensitivity, the input of a healthcare provider is important for determining the best approach to dietary sodium and use of salt.

Types of Salt

Table Salt

As mentioned earlier, plain table salt is composed of sodium and chloride (and abbreviated by chemists as NaCl). Although sodium and chloride are the only two minerals in plain table salt, there are often anti-caking agents added to the salt to keep it from clumping. Examples of anti-caking agents include aluminosilicate, sodium ferrocyanide, potassium ferrocyanide, and calcium silicate.

Iodized Table Salt

Iodized salt is table salt that has been fortified with iodine. The general government standard for fortification of salt with iodine is 76-77 micrograms of iodine per gram of salt. However, many iodized salts don't actually end up containing this much iodine. An average marketplace range seems to be closer to 45-50 micrograms per gram. At 6 grams per teaspoon, this level of 45-50 micrograms would mean that 1 teaspoon of iodized salt would be likely to contain at least 270-300 micrograms of iodine and 1/4 teaspoon would be likely to contain at least 67-75 micrograms. Our Iodine Nutrient Profile explains more about dietary iodine and the possible role of iodized salt in providing this mineral.

Sea Salt and Iodized Sea Salt

In addition to this basic distinction between regular table salt and iodized table salt, other types of salt are available in the marketplace. One popular type is sea salt, which can be purchased in regular or iodized form. (The difference here is essentially the same as the difference between table salt and iodized table salt.) Sea salt is typically produced by evaporating sea/ocean water or the water from saltwater lakes. Once the water has been evaporated, sodium and chlorine are left behind, along with other minerals. These minerals can include magnesium, potassium, calcium, and strontium. Relatively little research is available showing the quantities of additional minerals provided by sea salt, but we know that these quantities can vary widely. We also know that the overall quality of the sea salt is related to the overall water quality of its source, and that contaminations in sea water can introduce contaminants into sea salt. Once again, we are not aware of broad-based research in this area.

Regardless of its additional mineral components, sea salt appears to remain high in both sodium and chlorine. Based on the manufacturer's information, for example, we have not found a commercially available sea salt that would qualify as a low-sodium alternative to table salt.

Some of sea salt's popularity may involve its unique varieties. Unlike regular table salt, the varying sources of sea salt can bring with them differences in flavor, intensity of flavor, color, and texture. There are pink sea salts, black sea salts, and other sea salt colors as well. Like rock salts, sea salts be can be coarse in texture, and are not limited to finely granulated forms. The diverse flavors, textures, and colors of sea salt can add enjoyment to eating that some people prefer over use of other salt forms.

Rock Salt

Like the name suggests, rock salt is sold in chunks instead of granulated particles. Most table salt starts out this way, before it is ground into finer granules.

The term "rock salt" reminds us that most U.S. salt is mined, either through direct excavation of underground deposits or through solution mining. Solution mining involves the digging of a well above the salt beds, with injection of fresh water and pumping of brine to the surface. The brine is then piped to an evaporation facility for creation of the salt. In parts of Europe and Australia, it is also common for salt to be produced through wind and sun evaporation of water off surface pools of saltwater.

Some grocery stores offer rock salt in a salt mill, very similar to a pepper mill. In the same way that a pepper mill can be used to crush peppercorns into desirable degrees of coarseness, a salt mill can be used to crush rock salt in the same way.

Various processing techniques give rock salt lots of different shapes and uses, from block salt for livestock to coarse salt for grinders to fine-grained popcorn salt. (Bet you didn't know that more than 90% of all salt manufactured in the U.S. is rock salt?)

Kosher Salt

Like rock salt, kosher salt is typically sold in the form of large crystals and it has been typically been certified as kosher by an organization like OK Kosher, OU Kosher, or KOF-K Kosher. In terms of chemistry, kosher salt is the mineral equivalent of table salt, or sodium chloride.

The derivation of kosher salt is likely related to the koshering of meat. According to kosher dietary law, and within the context of other animal food practices required for kosher food preparation, the blood of an animal must be removed following slaughter, and the salting of meat was traditionally used as a means of drawing out blood from the tissue. Finely granulated salt was sometimes too thin to accomplish this task and could dissolve into the tissue, while very coarse rock salt was sometimes too bulky and could roll off the meat. Salts that provided the right size and texture became known as "koshering salts."

Organic Salt

As a mineral versus agricultural product, sodium chloride (table salt) is not eligible for determination as organic under U.S. Department of Agriculture (USDA) organic labeling regulations. Although you might see the green organic logo on salt-containing products, these products contain ingredients other than sodium chloride—for example, "celery salt," "herb salt," or "salt seasoning" that contain herbs and spices along with sodium chloride. You may also find salt labeled organic that has been certified by an agency other than the USDA.

World's Healthiest Foods Recommendations

As described at the beginning of this article, we don't rely on table salt in our WHFoods recipes or meal plans. This approach to table salt is based both on nourishment and taste. Fresh herbs and spices are whole food-based seasonings that provide broader nutrient richness than salt in any form. In addition, fresh herbs and spices—especially when combined in time-tested cuisines and culinary traditions—can provide exquisite flavors, aromas and textures not possible with any type of salt. For these reasons, we recommend a reliance on whole natural foods and fresh herbs and spices rather than a reliance on salt in any meal plan.

Some people may need to consider the addition of small amounts of iodized salt to their meal plan in order to achieve adequate iodine intake. The possible addition of iodized salt is more likely to need consideration for persons who consume no sea vegetables, fish, shellfish, or dairy products. Since the Daily Value (DV) for iodine is 150 micrograms and since 1/4 teaspoon of iodized salt is likely to provide about half of this amount of iodine or more, a person consuming none of the foods above yet still obtaining about 50% of his or her iodine requirement from food would be likely to reach the DV with the amount of iodine provided by this amount of iodized salt. Any decision about the deliberate addition of iodized salt as a method for meeting the iodine DV should be made with the help of a licensed healthcare provider.

From our perspective, it makes no sense to consider processed, high-sodium foods as a way of obtaining iodine, since many manufacturers use non-iodized salt during food production.

Staying below the Tolerable Upper Limit (UL) for sodium of 2,300 milligrams per day makes sense to us as a public health guideline based on cardiovascular research and the phenomenon of salt sensitivity. Because the average U.S. adult intake falls somewhere between 2,900 and 3,500 milligrams of sodium, most people will need to change their food choices in order to stay below this level. Increasing the proportion of WHFoods in your meal plan should be able to help you reduce your total sodium intake, since our recipes and meal plans stay well below this level.

We would also point out that there is not much room for added table salt within the 2,300 milligram UL. One teaspoon slightly exceeds the UL all by itself. On the other hand, a "pinch" of salt—usually defined as 1/16 teaspoon, only provides about 145 milligrams of sodium, or about 6% of the UL. There would often be room for this small additional amount of salt in a meal plan that was composed of 100% WHFoods.

In a meal plan with room for small amounts of added salt, we don't see any reason not to explore some of the diverse flavors, textures, and colors offered by sea salts or some rock salts, provided that you have assurance about product quality and lack of contaminants, either from the product labeling or directly from the manufacturer. In some cases, these "specialty" salts may provide you with additional nutrients (particularly minerals). However, we haven't seen enough research evidence to encourage reliance on sea salts in this way. And it's important to remember that sea salts provide sodium in an amount that is similar to ordinary table salt.

Staying at or beneath the stricter American Heart Association recommended level of 1,500 milligrams of daily sodium is a more difficult task. Our Healthiest Way of Eating Plan, for example, averages 1,315 milligrams of sodium per day without the addition of any "salt to taste" and without the addition of salt contained in broths or other salted prepackaged foods. So as you can see, even a 100% WHFoods meal plan comes very close to the AHA recommended limit. We would not discourage anyone from maintaining this AHA recommended intake level. However, it is also not clear to us from dietary research exactly how much more advantageous it would be for a healthy person to restrict his or her sodium intake to this 1,500 milligram AHA level versus the 2,300 milligram UL. In either case, we believe that you will reap greater health benefits from consumption of sodium from whole, natural foods versus table salt, and that you will discover greater delights from meals prepared with fresh herbs and spices as well.

References

  • Castiglioni P, Parati G, Brambilla L, et al. w index of sodium sensitivity risk from arterial blood pressure monitoring during habitual salt intake. Int J Cardiol. 2013 Oct 9;168(4):4523-5. doi: 10.1016/j.ijcard.2013.06.104. Epub 2013 Jul 23.
  • Delahaye F. Should we eat less salt? Archives of Cardiovascular Diseases, Volume 106, Issue 5, May 2013, Pages 32—332.
  • Drenjancevic-Peric I, Jelakovic B, Lombard JH et al. High-salt diet and hypettension: focs on the renin-angiotensin system. Kidney Blood Press Res 2011; 34:1-11.
  • Felder RA, White MJ, Williams SM et al. Diagnostic tools for hypertension and salt sensitivity testing. Curr Opin Nephrol Hypertens 2013 January; 22(1):65-76.
  • Li C, Yang X, He J, et al. A gene-based analysis of variants in the serum/glucocorticoid regulated kinase (SGK) genes with blood pressure responses to sodium intake: the GenSalt Study. PLoS One. 2014 May 30;9(5):e98432. doi: 10.1371/journal.pone.0098432. eCollection 2014.
  • Richardson SI, Freedman BI, Ellison DH, et al. Salt sensitivity: a review with a focus on non-Hispanic blacks and Hispanics. J Am Soc Hypertens. 2013 Mar-Apr;7(2):170-9. doi: 10.1016/j.jash.2013.01.003. Epub 2013 Feb 19.

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