by Marion Nestle
Jun 13 2013

The endless debates about salt: Don’t worry. Eat (real) food

Since 1980, U.S. dietary guidelines have advised eating less sodium (salt is 40% sodium, 60% chloride).  Although sodium is an essential nutrient, most Americans consume way more than they need or is good for them—around 3,400 milligrams a day.

The 2010 guidelines advised healthy people to consume no more than 2,300 mg per day (~6 grams, or 1.5 teaspoons).  They advised even less, 1,500 mg, for people with or at high risk for high blood pressure.  Since blood pressure increases with age in countries with high salt intake, this applies or will apply to just about everyone.  

In 2011, the Institute of Medicine said it was imperative to find effective strategies to lower salt intake.  This means dealing with processed and restaurant foods, because that’s where most of the salt comes from, as can be seen from this list of major food sources

Because consumers have no choice about the amount of salt in processed and restaurant foods, education cannot be enough to achieve salt reduction.  Scientists in Australia have just proved this point.

As I explained to a reporter,

Why anyone would think that nutrition education alone would change behavior is beyond me. By this time everyone should know that to change behavior requires not only education, but a food environment—social, political, economic—that supports and promotes the behavior change.

Most dietary sodium comes from processed foods, restaurant foods, and other pre-prepared foods.  All the label can do is say ‘don’t eat me’ It can’t help with what people can eat.

The easiest and most effective way to help people reduce sodium intake is to require food producers and food preparers to use less of it. Good luck with that. I’m not optimistic, particularly given the conflicting and confusing science. 

Ah yes.  The conflicting science.  The IOM now says that there’s no evidence one way or the other that reducing sodium below 2,300 mg per day, or even to 1,500 per day, does much good, and that low sodium intakes could be harmful (but this too is controversial).

Yes, they could, but as Mark Bittman blogs,    

It may be true that there are no benefits in an ultra-low-salt diet, but almost no one is eating an ultra-low-salt diet. It’s not quite like worrying about whether we get “enough” sugar, but it’s nearly as ridiculous.

And now, as Food Navigator explains, the IOM committee is complaining that its report has been badly misinterpreted.  All they said was:

As to whether we should cut back to 1,500 mg or to 2,300 mg sodium a day, meanwhile, the jury is out, says the IOM, not because consuming 1500 mg/day is dangerous, but because there is just not enough data on the benefits of consuming such low levels to support a firm conclusion.

IOM committee members were so bothered by misleading press accounts that they wrote an op-ed to JAMA to clarify:

Rather than focusing on disagreements about specific targets that currently affect less than 10% of the US population (ie, sodium intake of <2300 mg/d vs <1500 mg/d),  the IOM, AHA, WHO, and DGA are congruent in suggesting that excess sodium intake should be reduced, and this is likely to have significant public health effects. Accomplishing such a reduction will require efforts to decrease sodium in the food environment….

The bottom line, Bittman says (and I enthusiastically agree), is that

Salt intake — like weight, and body mass index — is a convenient baseline for public policy people to talk about. If you focus on eating less salt — and, indeed, less sugar — you will inevitably eat less processed food, fast food, junk food (it’s all the same thing.) If you eat less processed food (etc.) you eat more real food. If you eat more real food, not only are you healthier, but you probably don’t have to pay attention to how much salt you’re eating. Wowie zowie. 

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  • TJ

    Most people don’t equate eating less salt with eating less processed food – they equate it with physically putting less table salt on their food.

    The average consumer has no idea how much salt they are consuming. They end up restricting the amount they *physically* add, while scarfing up salty processed food.

    I ultimately blame the similarly ridiculous calorie-watching attitudes at the USDA. Because people are so focused on calories, they completely miss the fact that the procssed food they are eating is still the root cause of their problems. By focusing consumers on calorie and salt numbers (both which can be manipulated in labels), the processed food companies win big.

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  • http://www.fabfittraining.com Jill

    This is spot on. Everyone wants to know how much of this, that and the other they should eat, when just eating real food all of the time, with variety, pretty much takes care of everything – no need to monitor intake of anything in particular. Humans evolved eating real food and until very recently it wasn’t necessary to monitor intake of anything! Processed food, while certainly convenient, has drastically altered our society’s entire approach to fueling our bodies.

  • http://www.rosaceatreated.com Rachel

    It all boils down to mindfulness in eating, in my opinion. It has become more and more common (and I confess, I am guilty on occasion) to stuff whatever you can get quickly and easily and eating it whilst doing something else – e.g. walking from A to B, watching television, working on the laptop. This attitude to food means that you not only consume too much, but don’t give food the care and attention it deserves. I know this isn’t directly relevant to salt intake, but I do believe the more you take time to consider and enjoy the food you eat, the more likely you are to eat better and healthier food.

  • Janknitz

    What TJ says is key: “Most people don’t equate eating less salt with eating less processed food – they equate it with physically putting less table salt on their food.”

    If agencies focused on health encouraged people to eat REAL WHOLE food instead of processed garbage, the problem would go away. Telling people who eat processed food to eat less salt is futile because they don’t understand how much salt is in their processed food in the first place.

  • Peggy Holloway

    Because I am follow a ketogenic diet and am physically very active, and eat no processed foods (that’s right – none), I have to add a lot of salt to my food. I actually worry more about not getting enough on hot days when I am biking 30+ miles and sweating alot!

  • http://www.diabetes24-7.com Elizabeth B. Snouffer

    Such a clever post. The message is simple “Eat real food” Love it!

  • Annette Matzke

    I agree. Switzerland try to reduce salt in processed food:

    The Federal Office of Public Health of Switzerland started the “salt strategy” (2008; http://www.bag.admin.ch/themen/ernaehrung_bewegung/13258/13744/index.html?lang=en) and activities in reduction of salt content in processed food – the so-called promises of firms http://www.bag.admin.ch/themen/ernaehrung_bewegung/05245/11318/index.html?lang=en. Therefore, we have already some products with less salt like soups and bread. There are also a dialogue and research about less salt in cheese!

    A little bit….

    Kind regards to the other side of the globe!

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  • Rosemary Clarkson

    I agree with the basic message that having as much control as possible over what foods and ingredients you consume is the goal.

    However, I have often wondered, has it ever been shown that people who ingest more salt because of their environment (those who live near the sea and those drinking/cooking with relatively salty water from local sources) have higher rates of heart disease?

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  • http://fingersandtoes.wordpress.com Sarah

    “If you focus on eating less salt — and, indeed, less sugar — you will inevitably eat less processed food”

    It’s more the other way around isn’t it? If you focus on eating real food you will eat less salt. For me that means adding salt to my food. I have weighed 6g of salt and that’s a big pile of Maldon, let me tell you. I don’t add anywhere near that to my food but I do need to be careful I get enough or I really don’t feel well (cramps, lightheadedness, etc), and the odd packed of crisps is sometimes just what I need!

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