Let’s bring salt back to the table

We’ve all been told to eat less sodium, but James Dinicolantonio tells Victoria Lambert that by avoiding it, we’re drawn to the bad sugars instead

If there is one health message that has been taken to heart by the public in recent years, it is the call to eat less salt. Indeed, our national salt intake has fallen by 11 per cent in the past decade, according to data from Public Health England’s National Diet and Nutrition Survey, with average salt consumption now estimated at 8g a day for UK adults.

Yet a new book, The Salt Fix, is warning that our red-light approach to salt is all wrong. And it says that, far from reducing our use, we should be eating as much as we feel we want to.

“We should be positively embracing the salt shaker, not shunning it,” says its author James Dinicolantonio, a cardiovascular research scientist at St Luke’s Mid-america Heart Institute in Kansas, and associate editor of BMJ Open Heart, a cardiology journal.

Dinicolantonio adds: “For 10,000 years, we have used salt as a natural preservative and have probably eaten 10 times as much as we do today. And in places associated with longevity and health – Korea, Japan, the Mediterranean countries – salt is still used more freely.”

However, for the past 40 years, salt has been very much a nutritional bad-guy. According to the British Heart Foundation, eating too much salt may raise your blood pressure, and having high blood pressure increases your risk of developing coronary heart disease.

The independent scientific lobby group Consensus Action on Salt and Health (Cash) recommends salt intake should be an average of 6g (about one teaspoon) a day for adults, and even less for children. It believes this will have a hugely positive effect on national health: “This reduction will have a large impact on reducing strokes by approximately 22 per cent and heart attacks by 16 per cent, saving 17,000 lives in the UK as well as other health benefits for the population.”

In 2013, the World Health Organisation (WHO) revised its guidelines to suggest that adults should consume less than 5g of salt.

Dinicolantonio is not convinced. He says: “There has never been any evidence for the low-salt dogma; it was just written on the basis of a few opinions, and now gets repeated every five years.”

He adds: “It has never made sense to me consciously to restrict salt intake. The suggestion stems from the idea that we need to lower blood pressure and that by lowering salt intake, blood pressure will fall, too. But that’s not true: 80 per cent of us will see no difference.

“And no one challenges the idea that it is a good idea to lower blood pressure. I can tell you to drink less fluid and that will lower your blood pressure but it isn’t healthy to become dehydrated.”

He also points out that our bodies are sophisticated machines capable of managing our own sodium levels – the essential mineral in salt that we need for many of the body’s processes. “We all lose a ton of salt every time we drink a caffeinated drink. Four cups of coffee will cause you to lose a teaspoon of salt.” He adds: “Healthy kidneys will get rid of excess salt, the gastro-intestinal

system can stop absorbing it, or you may shunt excess salt into organs like the skin. And our bodies are set up so we simply don’t want to eat too much salt; we all know that feeling when we’ve eaten too much. We cringe, don’t we? That’s your salt receptors flipping out.

“On the other hand, if we lose too much salt, our bodies crave it. Another familiar feeling.”

But Dinicolantonio warns that we can’t follow low-salt guidelines on a daily basis and then just top them up with a bag of popcorn when we get that salt craving.

“If your body feels sodium-deficient, it activates its reward system, ready to release feel good hormones when you eat something salty. But foods that are sugary or made of refined carbohydrates can ‘hijack’ that reward system, so you feel good eating a chocolate bar and no longer crave the salt you actually needed.

“It’s entirely possible that if you are avoiding salt, your brain could send you towards sugar or even drugs instead in order to get that reward feeling. And our bodies have no aversion signal for sugar to let us know when we have eaten

too much.” But what about children? The WHO says that its guidelines on the consumption of salt are particularly important for youngsters, as children with elevated blood pressure often grow into adults with elevated blood pressure.

“The biggest issue with children is that parents think foods labelled low-salt are healthy so they end up buying junk food which has been flavoured with added sugar instead.

“When I started giving my kids fresh food with salt to cut through the natural bitterness of green vegetables, they ate a lot more. Salt is the antidote to sugar.”

Dinicolantonio also points out that a craving for salt can be a symptom of other illnesses and so is worth investigating, not ignoring.

“People with diseases like Crohn’s or ulcerative colitis, which causes damage to the intestine, will not be able to absorb salt properly. If you are losing too much salt, it might be due to

damage to the kidneys, which may actually be caused by overconsuming sugar.”

Ironically, if we are eating too much sugar in an attempt to replace salt, we may well be causing exactly that sort of damage to our digestive system.

So what happens if you don’t get enough salt in your diet? “You may have a really big increase in heart rate, dizziness, faintness, muscle cramps and spasms. It can lead to cognitive decline and memory impairment too because we need sodium to carry vitamin C into the brain.

“It can increase the risk of cardiovascular disease, because salt deficiency can increase blood clotting and platelet activity. And it may even cause the very high blood pressure you may be trying to combat, because salt deficiency can lead to increased insulin resistance and obesity, both of which cause the heart rate to increase and hence increase blood pressure.

He adds: “Don’t blame salt for what processed food and refined sugars did. It is a natural substance we all need. Let’s bring it back to the table.”

The Salt Fix by James Dinicolantonio is published by Penguin (£13.99). To order this book for £11.99 plus p&p, call 0844 871 1514 or visit books.telegraph.co.uk

‘If you’re avoiding salt, your brain could send you towards sugar or even drugs’