You may have noticed that I’ve been missing in action a bit recently. The blog took a vacation. During this period, on a long summer trip, I spent time with a variety of friends and relatives. As you can imagine, that meant special repasts, fancy restaurants, sharing dietary restrictions, dining outdoors and home-cooked meals.

Whatever the venue, clearly everyone has unique habits and diets. Let me recount just a few from my many stops:

— Gary and Linda grow almost all their food themselves. (They’d probably say, “just much of it.”)
— Leslie has an unusual pantry designed to avoid migraines.
— Linda and Mike are city-dwellers and plan meals carefully to avoid nut-allergy reactions.
— Tim and Tammie have a typical and flexible middle-class attitude toward food (something like “if it tastes good, it’s a go”).
— Shirley eats rather little, except perhaps for more sweets than she should. [In her mid-90s, I say “eat whatever you fancy, my girl.”]
— Vida demonstrates her European-family farmer skills on the dinner plate, and buys local veggies close by. (I pigged-out on the sweet corn.)
— Danny and Patty verge on the cusp of gourmet cooks (my evaluation, not theirs). The same might be said for Janis and Bob.
— Margie and John are always prepping for 2 or 3 generations.
— Ron probably eats most similarly to us, except that he enjoys the best of specialties and more-than-occasional treats from Zabar-like shops.

If I continued to describe all the food behaviors we encountered, you’d find them vastly different. That includes the use of salt. For some, it was regularly on the table as an antique salt & pepper set; others had to dig it out of their upper kitchen shelf. Still one or two “weren’t sure there was any in the house.”

I like salty tastes.  That’s not an especially stellar thing to admit these days, but nevertheless it’s true. Given the chance, I can overdo it. Sweets aren’t as drastic an alure for me. But when it comes to salt, like many people I need to work at restraint. However, the thing is this —- salt is not a total evil.

Salt of the Earth

People described as ‘salt of the earth’ are generally not perfect, but instead, just good ol’ folk with positive and negative attributes. What an apt metaphor for this spice.

Sodium chloride, otherwise known as table salt (and as Na+ on the periodic table), is probably the most popular flavor in life. It especially adds zest to our food. Now, we’re talkin’ – food with pizzazz.

The substance is not just tasty, but vital to life. Typically, after that vague nod to its benefit is when most favorable reviews end, and the warnings begin. Both are accurate and important to heed.

The (electro) Positive side of Sodium

On the positive side, the Na+ substance keeps our cells in balance, specifically intra-cellular and extra-cellular fluids (meaning inside and outside of cells). Sodium, in conjunction with Potassium, aids the directional slopes for electrical transmission. This is essential for nerve transmission, our muscular contractions and other functions. So, why does sodium get such a bad rap?

Water binds with sodium, and an excess will increase blood pressure (mildly or more). The increase in blood pressure (hypertension) makes the heart work harder and increases strain on that organ, others and arteries. Such ‘excess’ is common. The recommended daily limit is often noted as 2.3 grams (2300 mg), although most of us consume about 3.3 grams (3300 mg) per day. Yikes. That definitely sounds over the limit. But perhaps not as much as it seems.

Up & Down of Salt on Heart Health

One of our summer stops was in Hamilton, Ontario. Hamilton is the home of McMaster University, which did a data review of 133,118 people worldwide. The review ‘visited’ almost 50 countries, with the average age of 55 years old.

They found that both too much sodium (7,000 mg/day or more)
AND TOO LITTLE (under 3,000 mg/day)
are linked to an increased risk of cardiovascular (CV) disease.

Fortunately, while sodium can increase blood pressure (related to CV dysfunction), sufficient potassium helps the body rid excess salt and retain its benefits. Good sources include foods some people avoid: bananas, canned tuna, spinach, OJ, tomato sauce, sweet potatoes and milk sources.

The McMaster review result was not a lone wolf on the subject. According to JAMA (Journal of the America Medical Association), studies indicate that there is a ‘J-shaped’ curve of benefit and harm – too much AND too little salt are harmful. The sweet spot (like for many truths) is somewhere in between.

The precise relationship between these risks and sodium intake remains uncertain, although typical over-consumption is certain. Confusingly, what’s worse is that for some people (according to multiple studies on salt restriction) throwing away the salt shaker has unexpected adverse effects.

Don’t Throw Out the Salt-Shaker Just Yet

According to the Metabolism Clinical and Experimental Journal, salt reduction can increase insulin resistance (a leading cause of Diabetes and obesity). Surprising, and in contrast to what one would gather from their typical, supported and traditional ‘low-salt’ recommendations, the Diabetes Foundation study on Type II Diabetes stated that less sodium was associated with an increased risk of death. Uh, that begs the question, which is risker diabetes or death?  (I ask that totally tongue-in-cheek.)

The roller-coast continues on. There is a review of 57 studies from the National Center for Biotechnology Information (NCBI) which established that restricted salt diets were found to INCREASE LDL (‘bad’ cholesterol) and Triglycerides by rather significant amounts (4.6% and 5.9% respectively).

Another NCBI review of 7 studies basically concluded that, despite all the research, it is still unclear what side-effects restricted salt diets have, but that it’s still not time to contradict traditional advice.  Not ‘no salt, but reduced?’  Yet realize that benefits of reducing salt are probably slight on lowering blood pressure.

What about Salt and Hypertension?

While not a disease itself, hypertension is a major risk factor for some serious diseases, like heart, Stroke or kidney failure. That’s why major health organizations (such as American Heart Association, American Diabetes Association, Academy of Nutrition and Dietetics and the US Dept of Agriculture) have traditionally recommended cutting back on sodium.

It is also why in December 2015 the city of New York implemented additional rules for fast food menu items – a salt warning. (More on that later.) But is consumption the whole story?

Luckily, Exercise has a clear impact on sodium levels for people with mild hypertension. Further, JOY OF ALL JOYS, dark chocolate may be even more beneficial for avoiding heart disease than the reduction of salt.

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Considering all this, does the phrase ‘clear as mud’ come to mind? It doesn’t get miraculously crystal clear either, but a few key factors may help.

Is it Time to Eat all the Salt You Want?

So, is it time to shake-shake-shake the salt? No. (I weep.) This is especially so if you are currently being treated for hypertension, if you are African American OR if you are over 50 years old. The general recommendation for those groups regarding salt intake is slightly less than a teaspoon a day (approximately 2.3 g).

This may not be difficult. Not difficult, except for the fact that as we all know there is way too much salt hiding in prepared or processed foods (despite manufactures’ claims of products with reduced sodium content). For shame.

That is where the recent New York City rules come in. I don’t eat out as much as some people, and since Covid, most of us have reduced dining pleasure. Still, many folks (especially in large cities) continue to partake at restaurants and fast-food chains daily. Okay, that’s somewhat riskier in terms of health – but especially so if we have no clue as to WHAT we are eating.

Former NYC mayor Michael Bloomberg implemented a ban on trans-fat (a true evil). Perhaps just as significant was the implementation of calorie labels in fast food restaurants. Honestly, on the rare occasion I have eaten in these ubiquitous chains, I have changed one or two orders since this labeling became popular. [I changed my ‘special coffee’ selection when noticing that the desired drink accounted for half a day’s calories.]

Following in that tradition, the previous DeBlasio administration tackled salt. For me it’s a transparency issue – I want to at least know how much salt is in a particular dish, especially if that dish alone exceeds my level for the suggested daily limit.

The new warning symbol of a black triangle containing a small salt-shaker will let a patron know that the meal under consideration is high in sodium. As mentioned, while we do need sodium, we don’t need excess sodium.

Not surprising, the National Restaurant Association (through spokeswoman, Christin Fernandez) originally complained the new rules are “too far, too fast.” Conversely, in my mind, it’s good information and just fast enough (meaning before you eat the meal).

Practical Approach to Balancing Salt

In central Phoenix, Arizona a couple years ago I tried out a highly recommended Vietnamese Restaurant, where I ordered a ‘salty fish’ dish. Well, like I said, I like salt, but whoa! Wish that menu item had come with a little, black warning logo. And if you are thinking I should have known better by the very name of the dish, you are correct. No excuses. Still, more info may have helped balance my desire for zing with common sense.

The new warning logo is a start in helping us reduce or control levels of salt to improve our health. Moreover, I truly appreciated the comments of Dr. Howard Weintraub, co-director of the NY University Langone Center for the Prevention of Cardiovascular Disease, commenting on the NYC law. He agreed that it is too easy to get 2.3 grams of sodium in your daily Diet but added that “things are not going to work out great if all you do is just not eat salt.”

Weintraub was promoting more proactivity when he expressed his hope that “maybe, just maybe, they’ll start to watch how much they eat, maybe they will get off the subway a stop earlier and walk; instead of taking the elevator, they will walk two flights, there will be some weight loss.” Of course, his reference to ‘THEY’ is us.

Three Small Tips:

1. 1. There are great solutions to cooking without salt, like those offered from several University extension offices (like Colorado State University), Medline or the Mayo Clinic.  Yet, remember that actual salt substitutes do nothing to stop our addiction to the taste itself. Like sugar substitutes that encourage a sweet tooth, salt substitutions will not reduce my salt craving.
   2. At home, putting salt in the shaker with the smaller holes may reduce your intake. Just don’t shake twice as hard.
   3. Despite traditional cooking recipes and family advice, don’t add salt as you cook. There are exceptions (where the chemistry matters), but in general salting at the table (the bare minimum) will not ‘hide’ sodium as much as throwing it in the pot. Salt ‘in’ the food is most often diluted (in terms of taste, not function). Salt ‘on’ food has a chance to hit your tongue with full strength.

Final Thought

The Bottom line here seems to be that we eat too much salt (some of us, way too much). Still, even we Salty Ol’ Dogs don’t have to give it up completely.

On balance, it appears that a few steps help:

1) maintain other healthy habits (especially exercise and movement);
2) avoid excessively salty menu items (watch for the new warning logo); and
3) reduce our cooking and ‘shaking’ levels at home.

With little effort, we can continue to enjoy our flavorful food in a healthy manner.

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A portion of this blog by drb was originally published in SixtyAndMe

Picture credit: Mangrove Mike, Corn Eatin’ Couple (NC State Fair, Raleigh, NC), licensed under CC BY 2.0.

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Barbara Klein Blogger

I hit the Second 50 mark a while back, but have my sights on a different goal –much longer, quality living.

While I may have a ‘dr’ in front of my name, the credentials for this blog are the same as yours – I am on a journey to Age with Pizzazz, whether that is body, mind, spirit or just fun and learning.  It is important to me to share related information with others as well.

I currently live in Southern Oregon with my husband, Michael.  I have had the good fortune (well, usually good fortune) to have called several states my home: Vermont, New York (family home with various locations along the way), Massachusetts (a short stint), Georgia, West Virginia, Connecticut, Arizona and most recently (2014) Oregon.

I grew up in upstate New York to a financially-modest family and did most of my schooling there.  My undergraduate work was in education (music and special education).  I did post graduate work in music therapy (and became an RMT – Registered Music Therapist).  My master’s degree from The New School in New York was in Hospital and Health Care Administration – and also convinced me that along with wonderful advancements, much is wrong with our traditional American medical and health care system (at least at that point).  There was a year more of pre-med courses in the southeast and then a doctorate degree in chiropractic (an industry that also has its many up and down sides).

I often joke that I have had as many professions or jobs as I do fingers.  To live up to that claim, I will name some: waitress, low-level banker, music and special Ed teacher, music therapist, mental health professional, gig performer, real estate agent (for which I had a shot at being the worst ever), probation officer, chiropractor, author and consultant.