Don't Sweat Salt

White crystals always get a bad rep. Meth, heroin, cocaine, salt, and refined sugar. They're typically demonized in that order. Most for very good reasons. How salt made it on the list and considered more of a danger to heath than sugar, is a forty year old twisted narrative the FDA and sugar industry has constructed out of bad evidence and research. Check out Gary Taubes New York Times article [5] and Dr. Mark Hyman's interview with Dr. James DiNicolantonio of The Salt Fix [6] for an in-depth background on how we ended up with insufficient dietary salt guidelines from the AHA, CDC, FDA, and WHO.

 

Let me quickly sum up the incorrect view on salt and why it got such a bad rep [3][5].

Due to a couple of poorly controlled studies, skewed population research associations, and controversial political lobbying starting in the 70's, normal salt diets took the blame for high blood pressure or hypertension, which can lead to cardiovascular events. The truth is now known. Sugar was the cause the whole time. Not salt. The low-salt myth, like all complex and deeply engrained ideas, still resides in most of the medical/nutritional world. Therefore, proper change to our national and world dietary guidelines is very slow. 

This post won't go into any more of the demonization, but focus on the negative side of not getting enough salt in your diet and ensuring your body is holding enough sodium. Note: If you could care less about the role of sodium in our bodies, skip down to the "how" section.

 

What does sodium do?

Salt is made up of 40% sodium (Na) and 60% chloride (Cl): NaCl.

 
 

Sodium is an element or electrolyte essential for our existence. That's a lot of e-words. Electrolytes are minerals that carry an electrical charge in our bodies on a molecular level.

Our bodies are very similar to an ocean, containing about 70% salt water. On average we have more than a half pound of salt found in our body's tissue, plasma, blood, sweat, tears, semen, and urine. (This was so hard not to bust out a nice and salty sexual innuendo.)

Without enough sodium our muscles would be randomly twitching, brain misfiring and not performing correctly, and we'd be over-hydrated increasing a bunch of negative symptoms.

To sum up the function of sodium, it can be broadly broken down into three categories.

Nerve & Muscle Function Charged ions of sodium and potassium, electrolytes, facilitate muscle contraction and nerve cell transmission. When stimulated, potassium exits the cell as sodium enters, creating an electrical signal or nerve impulse. This action transfers information throughout the body. 

Hydration & Electrolyte Balance   Sodium and potassium coordinate to maintain normal water balance in the body. Both attract H20 assuring optimal levels of hydration are maintained both inside and outside our cells. The body does an amazing job at self-regulating this water-electrolyte balance through an elaborate series of controls. The blood vessels and brain hormonally signal the kidneys to retain or excrete sodium as needed. They also fine-tune the sensation of thirst and salt craving so you'll ingest water or sodium (salt) in astonishing accuracy to balance out this equation.

Blood Volume & Pressure Along with maintaining hydration balance, blood volume and blood pressure are regulated by monitoring sodium concentrations in the blood. Should blood volume or sodium levels rise too high, the body stimulates the kidneys to excrete excess sodium and return blood volume to normal levels.

 

The Goldilocks Zone

Can you have too much sodium or too little sodium in your system? Yes to both situations.

Too much sodium in the blood is called Hypernatremia, which can occur from sweating, vomiting, diarrhea, diuretic medication, sugar/carb abuse, or kidney disease. Too much sodium can cause high blood pressure and disrupt the circulatory system and compound any onset metabolic issues. Although, for decently healthy people, this is an easy fix (if you don't have kidney disease): feed your thirst, drink more water. 

Another way your body can retain too much sodium is with the hormone Insulin. Constantly spiking or activating insulin by eating refined carbs and sugar has other detriments such as making it harder to lose unwanted weight and increasing risk for metabolic syndrome

I'm not going to lie, the interplay between insulin and sodium is quite complex. Experts and studies are still inclusive on exactly how the mechanisms work, but one thing is certain. 

  • Insulin tells the kidneys to hold onto more sodium. Your body's sodium release organ, the kidneys, is backed up with sodium, not good.
  • Low sodium diets can promote insulin resistance, which increases blood sugar. Salt actually improves sugar tolerance [8].

Both of these bullets lead more towards high blood pressure or hypertension than salt alone. Hint: drop sugar, not salt. 

Not enough sodium in your blood is called Hyponatremia and has very mild short term symptoms like brain fog, headaches, nausea, or poor balance. Prolonged low-level or pre-hyponatremia is the main focus of this post due to the ill advised low-sodium dietary guidelines. We just now are learning of the repercussions from living a low-sodium lifestyle. There is strong evidence it is contributing towards our obesity and metabolic syndrome epidemic. 

Hyponatremia occurs in about 20% of hospital visits and is an indicator for increased risk of death. Even in endurance/sporting athletes, 10% of people after an athletic event are considered hyponatremic due to too much fluid or water consumption and sweating. We'll get to this in the "how" section, but the key is to increase good salts leading up to an event.

Too much or too little, how do you stay in the Goldilocks zone? Well, it gets even more complex in how your body works, but actually easier to implement by focussing on whole foods and natural sources of sodium.

The dance parter of sodium is potassium. 

 
Potassium-Electrolytes.png
 

Found in many of the same sources as sodium, potassium is involved in the same biological functions as sodium. The sodium-potassium electrically charged gradient across our cell walls allow for proper nerve and muscle function. Potassium also regulates the decrease in blood pressure. For these reasons a focus on sodium:potassium ratio is more important than either on their own [7]. This makes sense as they are very intertwined in their cellular functions.

Sodium:Potassium Ratio Goal: Less than 1

Let's use Swiss Chard's for an example. It's a deep leafy green with a beautiful red stem rich in both nutrients. 

  • 1 cup of Swiss Chard
  • 77 mg of sodium
  • 136 mg of potassium
  • 77 ÷ 136 = 0.57 ... significantly less than 1

You don't have to do this math for each food you consume. A quick glance to see that potassium is greater than sodium, the number will always be less than one.

If you look at the Na and P electrolytes' food sources, you'll see a lot in common. All underlined sources in potassium contain sodium and all have a significantly less than 1 sodium to potassium ratio. The average ratio of the underlined foods are .01! Terrific balance.

Therefore, if you're eating whole, natural foods the correct potassium and sodium levels are already built in. The problem only arises when you eat shitty: fast foods, packaged foods, overly refined or packaged foods. All these increase sodium and remove potassium as a result of increasing shelf life and paletability. 

Minding the sodium balance got easier, right?!

     

     

    Don't worry too much. Our bodies are amazing at self-regulating electrolyte and water levels with adequate whole/natural foods, salt, and water intake.

     

     

    Why

    My trial and errors with fitness and nutrition over the last 5+ years has shown proven the importance of increasing sodium and salt intake. I've experienced low-sodium fatigue and headaches from entering a low-carb and fasting ketosis. With the implementation of hot sauna, I can taste the sodium leaking out in my sweat. I now use these learned recommendations and check my sodium levels when I can to ensure good mental and physical healthspan

      Adequate salt or sodium consumption is necessary to achieve the following [3]:

      • Increases performance and endurance
      • Improves body hydration
      • Better cope with stress and anxiety
      • Improves insulin sensitivity 
      • Balances triglycerides, LDL, and stress hormones
      • Lowers risk of hypertension and sleeping disorders
      • Lowers risk of cardiovascular incidents 
      • Live longer
       

      How

       

      Daily Guidelines

      2 to 3 tsp salt per day
      +1/2 to 1 tsp for each hour of workout
      +1/5 tsp for each cup of coffee/tea (2 heaping pinches)
      Increase salt intake on hot-sweaty days

      Conversion: 1 tsp semi-course salt = 6 g salt = 2400 mg sodium

       

      Whole Food Balance

      Mind the sodium:potassium balance. Ensure you're getting more potassium than sodium in your diet.

      Balance-Na-K@1.5x.png

      Sodium rich: salts, full fat cheeses & dairy, Swiss chard, artichokes, spinach, beets, olives, pickled & fermented foods, wild fish, bacon, oysters, grass fed jerky, celery, carrots, tomatoes, radishes, broccoli, sweet potatoes, turnips, kale, cauliflower, leeks

      Potassium rich: white beans, spinach, full fat cheeses & dairy, broccoli, wild fish, sweet potatoes, tomatoes, celery, Swiss chard, avocado, kale, beets, cauliflower, leeks, squash, turnips, oranges, lemons, apricots, bananas, artichokes

       

      Sugar Addicts

      Kick your addiction to sugar completely by feeding your salt-tooth instead of the sweet-tooth. Sodium in salt helps your body become more insulin sensitive (a good thing), which reduces risks for obesity, diabetes, and metabolic syndrome.

      Replace sugar with salt.

       

      Brew Brothers

      Over consuming beer forces sodium flow out of the kidneys due to increase bicarbonate in urine. This is known as Potomania or frat boy syndrome (it really is), showing all symptoms of an electrolyte imbalance and sodium depletion such as dizziness, muscular weakness, neurological impairment and even seizures ... sounds like bad hangover. Hydrate and supplement with a good sea salt all day and the day following those must-drink bachelor party nights and special (very rare) occasions. 

       

      smoke, chew, & VApe

      Nicotine (JUUL's, cigarettes, tobacco, dip, etc.) increases anti diuretic hormone, which increases water levels in the blood.

       

      Low-Carb or Fasting

      If fasting or just starting a low-carb diet, as the body switches fuel sources from glucose to ketones the body’s sodium excretion increases.

      In low carb world a major driver of what’s known as the keto-flu or adrenal fatigue (headaches, cramps and/or fatigue) is a reduction in blood sodium levels as the body excretes more sodium, which takes a few weeks for metabolism to adjust. After which sodium excretion can normalize, but still requires more salt intake on a low-carb/keto diet versus a medium or high carb diet due to the reduction in insulin activity. Eating carbs/sugar and insulin spikes and insulin is involved in renal sodium metabolism [2].

      Also, around the 18-24 hour in a fast, cramps, headaches, and general fatigue can occur from a deficiency of sodium. In both cases increase or supplement your diet/fast with a quality salt source. 

       

      Other Considerations

      Blood sodium levels can be affected by all types of over the counter and prescription medications and ailments/diseases. Medications like antidepressants, pain pills, statins, Adderall, and MDMA deplete sodium. Conditions such as autism, depression, Chron's disease, IBS, and (obviously) kidney disease can all lead to sodium deficiencies. In these cases, you should do some personal research to weigh the pros and cons of that particular medication or at least consult your physician to get your sodium levels checked. 

       

      All out of whack?

      The Salt Fix contains a 5 step tactic to restore sodium levels and salt intake [3].

      1. Visit doctor for internal starvation check.
        • Low sodium intake, insulin resistance, high belly fat (adipose tissue), fatty liver disease. Jittery after 20g of sugar? Indicates over reaction of insulin. Tests: fasting insulin levels 5 µIU/mL, 2hr glucose challenge test, re-evaluate medications SSRI, beta blockers. Maybe insulin sensitivity med such as Metformin. 
      2. Replace simple sugars with simple salt.
        • Eat as much salt as your body craves, which is around 3-5g per day. Shoot for 0 added sugar, but consume 20g max added sugar per day if need to taper off your addition. Check out sugar substitutes or better alternatives to the sweet stuff in low moderation. Guidelines for salt intake above for us bachelors. 
      3. Focus on whole, salty foods.
        • Bring back all naturally salty and high sodium foods such as nuts, pickles, Swiss chard, sauerkraut, aged cheeses, soups, beets, tuna, sardines, artichokes, olives, salted and cured meats. Incorporate salt in every meal. Prepare and make your own meals to remove excess added sugar and to eat real Whole Foods. Salt to taste. 
      4. Add in naturally higher nutrient salt.
        • Contains beneficial trace minerals and elements without anti-caking agents, not bleached, and least amount contaminants. Redmond, Celtic, Himalayan pink or black, Hawaiian. Look to only use table salt when possible due to the over processing by bleaching, adding anti caking agents and having no trace mineral benefits. 
      5. Let salt fuel your exercise.
        • Increasing workouts helps with insulin sensitivity lowering blood sugar, but increase sodium excretion through sweat. Add extra salt/sodium to a pre-workout or meals throughout the day of exercise. Guidelines above. 1 tsp increases hydration, improves stamina and intensifies the muscle pump increase in blood circulation and blood volume. 
       

      Types

      Redmond Real Sea Salt - best trace mineral content with Iodine, not processed, and from an ancient ocean in Utah.

      Celtic Sea Salt - good trace mineral content and minimally processed from a modern ocean.

      Himalayan Pink - good trace mineral content and minimally processed from a modern ocean.

      Hawaiian - good trace mineral content and minimally processed from a modern ocean.

      Table salt - no trace minerals, iodine added to some, sugar added to some, and over-refined by bleached and heating.

      There are many more on the market. Seek any sea salt with a good trace mineral content and minimally process. Use table salt in a pinch (get it?), but try to purchase a good salt that's never bleached or over processed to remove trace minerals. Here's a good sampler pack.

       
       

      REFERENCES

      [1] Wikipedia: salt, sodium, potassium, electrolytes

      [2] Virta Health - Sodium, Nutritional Ketosis, and Adrenal Function Salt interaction with low carb and ketogenic diets.

      [3] The Salt Fix - Dr. James DiNicolantonio Summary, history, and reccomendations on salt in our lives.

      [4] The Facts About High Blood Pressure - American Heart Association (AHA) 

      [5] New York Times - Salt, We Misjudged You by Gary Taubes History on how salt got such a bad name based on such little and cherry picked evidence. 

      [6] Mark Hyman, MD interview with Dr. James DiNicolatonio on The Salt Fix 30 minute overview on salt history, explanation, and recommended actions.

      [7] Time to Consider Use of the Sodium-to-Potassium Ratio for Practical Sodium Reduction and Potassium Increase

      [8] Low Salt Diet Increases Insulin Resistance in Healthy Subjects