It's Time to End the War on Salt (2011) | Hacker News Reader

It's Time to End the War on Salt (2011)

scientificamerican.com

114 pointsdanielam71 comments

To me, the story of salt strongly highlights the difference between science (as in, the results of scientific experiments and careful reasoning), and "science", the things the general public is told science has found by journalists and policymakers.

Not only was there was never a strong scientific basis for telling people to reduce their salt intake, my anecdotal observation is that it's fairly easy to wind up salt-deficient and get symptoms. Sweat contains salt (1g/L), so when exercising or in high temperatures, I need to eat more of it, or I'll get fatigued and physical exertion will become impossible. (Sweat also makes exercise a confounder in studies that look at urinary excretion.)

Meanwhile, foods that we think of as "salty" are usually not actually salty, but rather, are designed to create salt pica. If you start eating potato chips, with most American brands, you'll get to 2000 calories before you get to a typical salt intake (which is 3.5g).

Just looked up a bag of chips:

   100g:
     525 cal
     1.5 g salt

Multiply by ~3.8:

  380g:
    2000 cal
    5.7 g salt

Your mileage may vary, but in Norway, a typical bag of chips contains more than 3.5g of salt per 2000 calories.

Looked up a nutrition label online: https://healthyeatingrocks.files.wordpress.com/2012/08/lays-...

    1 oz:
      150 Calories
      180 mg sodium

multiply by 20/3:

    6.667 oz:
      2000 Calories
      1.2g sodium

The kosher salt in my cupboard (ingredients: salt and an anti-caking agent) is 40% sodium by mass (480 mg sodium per 1.2 grams). Or, going by the atomic mass listed here ( http://www.chemicalelements.com/show/mass.html ), sodium chloride should be 39% sodium by mass. Assuming an even 40%, that's 3 grams of salt (NaCl) in 2000 Calories of american potato chips. (Or, assuming the less generous actual amu ratio, 3.05 grams of salt per 2000 Calories ;D )

HOWEVER: the nutrition label also indicates almost twice as much potassium (330 mg) as sodium. If that potassium is also salt (KCl), the chips will handily exceed 3.5 grams of salt per 2000 Calories.

I've read somewhere before that the issue may be K vs. Na balance.

Take that with a grain of ... nevermind.

If that's true, those potato chips should be made with a lot more sodium. (Or, you know, some more sodium and less potassium. I don't think people would eat the "now with 62% more table salt" version of the chips.)

Wikipedia says: an ion pump exchanges 3 sodium ions for 2 potassium ions. ( https://en.wikipedia.org/wiki/Sodium )

3 sodium ions is 69 atomic mass units. 2 potassiums is 78.2 atomic mass units.

150 times 20/3 is 1000

Right you are! Double the other figures. :(

I think this is a difference between Norway and the United States.

The major difference appears to be the label's use of "salt" rather than "sodium" as in the US.

Using the data from my other comment, and assuming the potassium in the potato chips is also "salt", the 2000 Calories of US potato chips contain 7.25 grams of salt, of which 3.05g is sodium chloride and 4.2g is potassium chloride.

Indeed, things you think are salty are not the foods you get most your salt intake from. The biggest source of salt in your diet is actually often bread! Typical store-bought bread is around 0.75g of salt per 100g. Several EU countries recommend a daily intake of 250g of bread, which gives you the same amount of salt as a 100g bag of potato chips.

Back on the farm we always had a bottle of 'salt pills' on the dashboard of the pickup. Anybody who felt the effects of the sun was encouraged to suck on one.

Problem is: the real scientists didn't speak out loudly.

And, the bigger problem: many of them as well as others have very good reasons for keeping shut. Few people want to be vilified by mainstream media and the PC crowd.

Bigger problem is - real scientists lack the built in unmovable conviction of being right the frauds and quacks have.

what is "salt pica"? the only thing I see on google is eating actual table salt. it seems like you are talking about something else.

"X pica" in my local dialect means "doing something because you need or want X, when that doesn't provide it". It's a generalition of the medical condition pica, which is eating non-food things like ice cubes because you need more iron.

http://lesswrong.com/lw/15w/experiential_pica/

you'll get to 2000 calories before you get to a typical salt intake (which is 3.5g)

Challenge accepted!

It's a public health thing, no? If they tell 10,000 people to decrease their salt intake, they've saved (made up figure) 10 lives. So they say everyone decrease salt, rather than the more nuanced message which is "Salt might be dangerous for some people."

> ...the less sodium that study subjects excreted in their urine—an excellent measure of prior consumption—the greater their risk was of dying from heart disease

When you have no idea about the consequences of an act, the right thing to do is not to go out and tell everyone to do it.

How many of the 10,000 are you endangering by cutting their sodium intake? Worse yet, you are not cutting their potassium intake. What long term consequences will it have on their muscular and nervous systems? Nobody seems to know.

And the point is moot anyway. It's not like we can't detect sodium sensitivity. In fact, it's almost certainly easier to discover who those 10 people are than to get the population to reduce their sodium intake.

Yes, I'm not disagreeing with you. I'm arguing that they should be explicit in their message and not get everyone to take (often unneeded) action.

Unrelated to the article directly, but a pretty fascinating story of salt:

By the end of the 2nd century CE, workers had devised a system of leather valves and bamboo pipes which drew up both brine and natural gas, which they burned to boil the brine (the technology they developed for the bamboo piping was eventually applied to household plumbing).

https://en.wikipedia.org/wiki/Salt_in_Chinese_history#Ancien...

As someone who eats strictly keto (low-carb/high-fat), I actually have to make a concerted effort to get enough salt in my diet due to my naturally retaining less water than non-keto people.

This includes making somewhat high-salt food choices wherever reasonable — bacon, pickles, salted butter, cooking with salt in general, etc. — as well as actually adding a salt/electrolyte solution to the water I drink throughout each day. Not only is my blood pressure fine, my most recent blood test sodium levels are actually on the low end of normal (so I've been trying to bump up my salt intake even a bit higher).

Not sure if this says anything interesting about salt, except maybe that carbohydrates could be the real problem that got salt unfairly blamed.

I've also been on a mostly-keto diet for the past two years. I don't really pay attention to salt; didn't eat that much to begin with even before keto.

But yes, it's one of those big food myths. I even know a health teacher in the Peace Corps who is telling 6th graders to cut down salt. It's really sad.

I gotta ask. I don't mean to offend. Keto diet sounds like a good way to lose weight. But does it make ones breath smell?

I can jump in here. I lost 16kg on a ketogenic diet.

My gut is a lot happier as evidenced by more regular and better (firm, soft, not runny) bowel movements.

There is a definite smell (breath) associated with ketosis. It varies by person but it is often noticeable.

I asked my wife to track it as it's very hard to notice it yourself and she says that my system produces a slightly metallic smell the isn't objectively bad, just different to normal.

I have Muslim friends and during Ramadaan there is a noticeable smell which is subjectively bad from some of them.

A friend who works as a nurse in a very low income area says that she can detect someone who isn't eating normally by the smell - very important to spot if that person is also pregnant.

It's a long way of saying: yes there is a smell, it varies by person.

During Ramadan Muslims are not allowed to drink water, right? That probably means their mouth is very dry during the fasting time meaning there's more than usual amount of odor-causing bacteria in their mouth.

I'd pick better health before better breath! Keto is amazing, I'm never hungry - you not only live longer, because it's less harmful, but you save so much time and energy having to think about food and eating it! I eat 1-2 times a day, ideally, I want to eat once a day and I can, but for social reasons, I eat twice most of the time. Eating once at night has a name - Warrior Diet [0].

[0]: https://en.wikipedia.org/wiki/Warrior_diet

This might be an effect of too much protein in a diet. If you are controlling for carbs, then the solution is to replace protein with more fat.

Keto diet makes your body produce ketones for energy, so you get the acetone breath - or something like that

As someone who eats strictly keto (low-carb/high-fat),

How much time have you been doing it?

About two years now, and I'd been doing it less strictly / on-and-off for a year and a half before that.

I've definitely noticed feeling much more focused and productive since starting, and it also helped with dropping from 210 to a bit over 150 pounds in the first few months of 2014.

Also anecdotal, my cofounder at my current startup Cyph has been on keto for close to a year now, and in that time has had a heart condition almost entirely vanish and his body fat drop to something like 6%.

+1 for keto here.

the only real downside is that it's extremely difficult to maintain the discipline to avoid carbs! also the social aspects.

I would actually say that it's extremely easy, but only because any carb cravings I may have are met with the flour/sugar substitutes and pre-baked goods from LC Foods (holdthecarbs.com), along with other common carb replacements like shirataki noodles. It's pretty nice that I can freely eat awesome dishes like pizza with the crust fried in clarified butter that people who aren't on a high-fat diet would never touch.

That said, it would certainly take some discipline without something like LC Foods, and I suppose there's also the issue that keto kinda forces you to become an amateur chef (but I at least enjoy that aspect and don't find that it's super time-consuming).

While the social aspect is of course an issue, one interesting thing socially is that anything I cook for guests at home is LCHF, and people are always shocked when I mention it in passing later on; e.g. one reaction to my stevia ice cream was something like "I thought it was weird that I wasn't getting a headache like I usually do after eating sugar!".

yeah, sure, all that stuff. but it's still hard to not order fries when i go out to eat.

the reason i got fat in the first place is because i love, love, love, love, love carbs. real honest to god carbs, not half-assed replacement like fake noodles.

Ah, then maybe it's just easier for me because I've never really liked fries and have always seen noodles as nothing more than vessels for sauces/cheeses/meats/etc. (a common complaint about shirataki is that it's flavourless, but to me good quality shirataki is indistinguishable from ramen noodles — probably because I'd never noticed any particular flavour of noodles to begin with).

Think the jury is still somewhat "out"...salt sensitivity variations are difficult to test for...

It is fairly well known that reducing salt intake lowers blood pressure...that has been prescribed for decades, with proven results....

Modern carbs, especially those that are "processed", very often have salt added...no doubt we get too much from modern diets....

Sounds as your dilemma is similar to that of humans from the past...which made salt valuable as an item for trade...

The article specifically points out the scientifically demonstrated opposite relationship between salt intake and blood pressure than the one you have stated here. "It is fairly well known" is nearly always weaselspeak for unfounded opinion, especially in this case.

I'm tired of this from people who discuss eating habits, because personal changes are personal yet many people interpret them as scientific. If you argue about eating on the Internet, step back and understand that your experiences will always vary. Just own that it's an opinion, and I won't begrudge you an opinion. I'll call it wrong, but I'll let you have it. It's your opinion.

I understand your point...

By my reading, the article simply presents evidence that a "broad recommendation" that the public reduce salt consumption may not justified...included is one of the reasons I mention in the first sentence of my reply--the variation in salt-sensitivity from individual to individual in a population...some will benefit, others may see either very marginal gains, or none at all...

We disagree on whether or not the article presents evidence of a scientifically "opposite" relationship...suggesting that there is not enough evidence to support proposing a course of action is not the same as saying that proposing that course of action is clearly contraindicated...

A reduction in salt intake is one of several recommendations that a physician will make if you're diagnosed with hypertension...there are others...weight loss, exercise, medication, etc...any, or all combined, may contribute to lowering your blood pressure...if you have a high salt-sensitivity, as some segments of the population do, you can expect gains...if not, then not...

Recommending bodies, in instances like this, primarily concern themselves with an intended effect on a population...statistics serve a purpose, but don't as readily apply to individuals, as you correctly infer later on in your reply...e.g.,"your mileage may vary"...

Science is a beautiful self-correcting mechanism...given time...it may eventually be decided that recommending salt reduction is harmful as a general strategy...in that case your contention that a "scientifically demonstrated opposite relationship" is what's being pointed out in the article may be eventually be validated...

I don't think we're there yet...hence, I think the jury is still "out"...

Oh good grief. Another article mangling science into sound bites?

I particularly enjoy the seemingly wilful conflation with hyponatraemia (too low sodium).

> European researchers publishing in the Journal of the American Medical Association reported that the less sodium that study subjects excreted in their urine —an excellent measure of prior consumption— the greater their risk was of dying from heart disease

Nobody has ever argued that NO SALT is the right idea. So of course people with the lowest output, people with hyponatraemia and knackered kidneys, are going to have other issues. Sodium is essential for neural function and osmotic control.

And the outcome of main meta-analysis in this wasn't "DO THIS INSTEAD" it was to recommend conducting an actual long-term controlled study to see what the actual effects of sodium control are.

Either which way, repeatedly highlight articles that say "EVERYTHING YOU KNEW BEFORE WAS WRONG: DO THIS INSTEAD" just makes people give up completely. Especially when the meta-meta-analysis is as weak as this is.

I think I agree with you about the quality of the science journalism here[1], but I thought the actual text wasn't as sensational as you're making it out to be, despite the title.

I didn't read it as a call for completely reversing dietary policy on salt immediately. I think it was a call to end a crusade that isn't supported by a compelling body of evidence. It seems clear that better controlled studies are needed.

[1]I spent a few minutes on google scholar trying to find the paper you called out (mostly because I wanted to know if the study actually entails hypo atresia--the linked article doesn't mention it). I haven't been able to find it yet. I'm disappointed that something published in Scientific American has such inadequate citations...

> Nobody has ever argued that NO SALT is the right idea.

Some people have been saying exactly that, e.g.: http://www.enformy.com/blog/benefits-of-no-salt-diet.php

It's called the "No Salt Diet" but it doesn't actually cut out salt completely. It's more about processed rubbish and vast quantities of added salt.

Either which way, you are probably right. If you look hard enough, there probably is somebody out there saying anything you want. I should adjust the statement to:

> Nobody qualified to talk on the subject has ever ...

In Neil deGrasse Tyson's StarTalk radio show he interviewed The author of "Salt: A World History"[1|2] who said (paraphrased) that statistically, it makes some sense to tell the public to not each too much salt, but on an individual basis you can either eat as much salt as you want or you have a health problem like high blood-pressure.

[1] http://www.startalkradio.net/show/the-salt-of-the-earth-part...

[2] http://www.startalkradio.net/show/the-salt-of-the-earth-part...

(I cannot remember if it was part 1 or part 2, so I linked both parts.)

Yep. And to clarify, the health problems that may make salt restrictions helpful generally involve impaired renal function or other kidney problems. If you have chronic renal disease, you need to be damn careful about your sodium intake, because you're not going to be able to excrete it properly.

There's a war on salt? Whole foods has an entire wall of salt. There are entire physical and online stores selling nothing but salts.

Sea salt? Would you like it from France, Alaska, or Iceland? How about colored salt? Pink from the Himalayas, green jasmine salt, blue salt that I'm not sure where it's from. Smoked salt?

Salt bath scrubs? Salt bars for cleansing? Heck, you can even buy a salt lamp.

A war by doctors, not businesses. I'd consider it "common knowledge" that salt raises blood pressure and that you should eat less salt if you have high blood pressure. My father and at least a couple other 50+ year old people I know try to limit their salt intake for health reasons.

This "common knowledge" is incorrect. It applies only if you have sodium-sensitive hypertension, and chances are, you don't.

http://www.gbhealthwatch.com/Trait-Salt-Sensitivity.php

Yes exactly, that's what the article is about.

This is one of those "listen to your body" things I'm doing.

I've done pretty physical construction work during summers. Drinking 6L of water during the day in the process. After three weeks, sucking grains of sea salt tasted better than any candy. Until they suddenly didn't.

On the other hand, during the winter pickles started to taste really bad.

I try to eat my salt so that I actually taste it. When you mix it evenly to mashed potatoes, you only get to taste fraction of the actual salt. And if you put lot's of salt to bacon, your belly will prioritize fat over getting too much salt. This is all based on the idea that my body knows what is best for it. But I have to enable that sometimes.

That sounds good for you. But there's evidence that gut microbes work against your body to serve themselves rather than your health

The strictly non-commercial, science-based public service called NutritionFacts.org researched the health effects of sodium and published a video two days ago summarising the evidence that salt raises blood pressure.

http://nutritionfacts.org/video/the-evidence-that-salt-raise...

What I find interesting is that this issue about sodium being unhealthy never really reached Europe (or at least Germany). While the US was advertising "low sodium" on their products we are still mostly advertising "low fat" and have some "low carb" pioneers. It seems to me that the whole "sodium is bad" scheme was a poorly supported health tip gone viral.

It certainly reached the UK. I recall salt manufacturers being up in arms when the government started pushing for lower salt intake a good few years ago.

A few brave scientists even appeared onscreen to say that sugar not salt was the real problem. At the time though there was less hostility to sugar so the salt restrictions went into force and I believe the sugar lobby even were able to squash a few reports condemning excessive sugar intake.

Yep, here in the UK it's one of those 'facts' that everybody 'knows'.

It's so ingrained in many people that reviews such as this one will not change their attitude.

France has passed a law a few years ago that makes it mandatory to have the phrase "For your health, limit your salt, sugar and fat intake" on all ads for food.

In my corner (Portugal), there have been noises to legislate lower salt in bread, etc. And the health professionals are definitely on board with that, they've been advising lower salt intake for blood pressure for many years.

Reducing sodium intake has been a thing doctors recommend in Finland, at least. Ask any nurse, and they will tell you that sodium intake is definitely connected with high blood pressure and heart disease.

Also, they will tell you need to drink lots of milk to keep your bones strong. Also a piece of "science" on it's way out.

I was under the impression that many Finns have a genetical risk of hypertension. Thus studies about the link between salt intake and hypertension have been conducted, for example http://www.ncbi.nlm.nih.gov/pubmed/17046432. I haven't actually read the paper, but the abstract has this claim:

"During the past 30 years, the one-third decrease in the average salt intake has been accompanied by a more than 10-mm Hg fall in the population average of both systolic and diastolic blood pressure, and a 75% to 80% decrease in both stroke and coronary heart disease mortality in Finland."

Same in Denmark, but probably mostly amongst my parents' or grandparents' generation (I'm mid 20s).

I think it's important to look beyond hypertension before completely ending the war on salt.

Very high salt intake may influence the risk of H. pylori infection - the main cause of stomach cancer. It increases the risk of atrophic gastritis (chronic inflammation of the stomach), which makes the stomach more prone to infection, and increases the susceptibility of mucosa to neoplastic change once an infection occurs.

If you think nobody consumes this level of salt, the Chinese and Japanese had extremely high levels of stomach cancer decades ago before reducing their salt intake and preservative consumption. To some extent, these problems persist to this day. Completely ignoring salt (especially in convenience foods) could reignite the issue.

> (especially in convenience foods)

I think this is the key. Most salty processed foods have enormous amounts of salt that you'd never add if you were cooking it yourself. Same with sugar in sweet snacks.

It tallies with what my renal dietician (i have serios kidney problems) said when I asked her about switching to low salt versions of soy salt.

"its been well marketed, but what they don't tell you is the shit they replace salt with in these lo salt versions"

According the the latest news release we should be having a new jihad on salt, damn the lack of evidence.

You’re probably eating too much salt, new guidelines say

https://www.washingtonpost.com/news/to-your-health/wp/2016/0...

I'm another person who was avoiding salt - thinking it was bad for me - and then discovered that I wasn't getting enough salt. My body's temperature regulation was a mess - hot & not sweating with a dry mouth and dry sinus. So I started putting a teaspoon of salt into my morning fruit smoothy - and suddenly all the symptoms went away. I wish I had known sooner.

I've started using sea salt exclusively, since grocery store salt is just extracted NaCl - which isn't what traditional salt, the salt that's been eaten for centuries, really is. Sea salt is said to have a composition of trace elements which closely resembles the human body. Sea salt has a much lower percentage of NaCl than the processed salt.

I should add that I don't eat a lot of processed food. I cook basic foods and put them in the freezer so I can eat them throughout the week. That is most of my diet. So most of my salt was probably just the occasional junk food I would eat.

This is just wrong. Brine wells have been used for centuries, and industrial mining of salt, while newer, has still occurred for hundreds of years.

Further, sea salt and table salt both contain approximately 40% sodium.

If you prefer the taste or texture of sea salt, that's fine, but don't claim that sea salt is inherently better for you, because we have studies that show this isn't the case.

Well, I'm no expert on salt - but as a Neti pot user I can instantly tell when I'm using grocery store salt. And, coincidentally, I worked for several years at the shore beside salt collection fields. We all used to joke that we hoped the salt we bought wasn't from those fields - since the water was known to be very polluted (and fishing was often prohibited.) So I can't take seriously any claim that grocery store salt is the same as any given sea salt. And there are plenty of studies showing significant differences. And, at this point, the only studies I've seen about grocery store salt just tout their purity of NaCl (which, again, is not historically what salt was), and claim that the only significant consideration about salt is the things I don't care about (typically their definition of "purity").

It amazes me how bad much of the dietary advice out there is, scientifically speaking. Somehow something like politics gets mixed in. It would be comical if it didn't lead to so much unnecessary death and suffering.

You'd be surprised. I was. It's even worse than you think. Most of nutrition "out there" is bullshit.

http://fivethirtyeight.com/features/you-cant-trust-what-you-...

https://news.ycombinator.com/item?id=10851843

So excess of it ceases to cause higher blod pressure or liquid retention, especially in overweight and obese?

I'm not sure what your question is, but the complicated thing with blood pressure is that it is regulated by your body. So if you do something or eat something that raises your blood pressure, your body will respond by lowering your blood pressure. And if you do things to lower your blood pressure, as it says in the article, your body will respond by releasing renin and aldosterone to increase your blood pressure.

According to the very basics of human physiology, excess of Na in blood stream will cause water molecules to leave cells and bind to sodium, which causes dehydration of cells and higher blood pressure, to which kidney should respond. That's why we feel thirsty after salty foods - to take more water into the system so eventually cells will go back to balance.

Prolonged exess of sodium which is maintained by habitual consumption of packaged foods causes imbalance and unnecessary burden to the system, so it works much less effective with obese people.

Water retention in various places of the body is also caused by exess of salt, which is a side-effect of a chronic imbalance.

NaCl, sorry.

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