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Salt Might Not Be A Villian After All

Salt Might Not Be A Villian After All
November 13, 2011 Patrick Nemechek, D.O.

There Doesn’t Really Seem to Be a Consensus About Salt

The growing conflict surrounding health consequence of dietary¬†salt¬†(sodium; table salt) intake¬†continues to get more interesting.¬† It reminds me of the emotional/quasi-scientific¬†rhetoric that still surrounds “low-fat” dietary recommendations.

A recent medical review by the Cochrane Collaboration has determined that a reduction in dietary salt (sodium) may not be as health promoting as suggested by¬†USDA’s 2010 “Dietary Guidelines for Americans”.

The Cochrane Collaboration is a large and highly regarded organization of scientists and physicians who work to provide the most unbiased assessment of the scientific evidence available.  They use scientifically advanced statistical techniques to combine information from many different studies.  There are very critical as to the scientific validity of the studies they include. 

Believe it or not, not all “studies” are created equal.¬† Many published studies contain errors and bias that render their conclusions less meaningful than their authors might wish

To Salt or Not To Salt

This review found a minimal effect of dietary salt restriction on blood pressure in patients with normal blood  pressure (an average decrease of only 1.27/0.05 to 1.29/0.45 mm Hg ).  Surprisingly, a reduced salt diet had no effect on blood pressure in patients with high blood pressure .

Furthermore, salt reduction resulted in a significant increase in plasma cholesterol (2.5%) and plasma triglyceride (7%), which expressed in percentage, was numerically larger than the decrease in BP (<1%). 

Elevations of cholesterol and triglycerides are known risk factors for increased heart disease.

Other Surprising Salt Studies

A separate Cochrane Library review published in July found no evidence that small reductions in sodium intake lowered the risk of heart disease or premature death.  Another study by Belgian scientists published in May of this year found that people who consumed lots of salt were no more likely to develop hypertension, and were statistically less likely to die of heart disease, than those with low salt intake.

Furthermore, reduced sodium intake seems to harm patients with heart failure and diabetes type 1 and 2. (see references 3-6 in present study). In all three patient groups reduced salt intake is associated with increased rate of death.

What To Do

Now that I’ve put this post up, many patients will ask me, “What should I do, reduce my salt intake or not?”¬† My approach is a practical one.¬†

The way I see it, if there really is some health benefit, it’s hard to prove so¬†any benefit is¬†probably small at best.¬†¬†And remember, some studies have shown¬†your health¬†may actually¬†worsen with dietary salt reduction.

I tell my patients with heart failure and kidney problems they should be careful to not consume too much salt as it can quickly worsen these conditions.

For everyone else, I think it is best to focus your efforts on health improvement elsewhere. 

I believe regular exercise, stress reduction, smoking cessation, wearing seat belts and limiting the carbohydrates and trans fats in your diet are all much more likely to improve your health that limiting the salt in your diet.


  1. Kirsten Claxton-Salcido 9 years ago

    I have limited my intake of salt due to my bells palsy. The Doctors told me years ago to back off of the salt because it makes you retain fluid, which makes the nerves get inflamed, which makes the palsy symptoms worst. Its been 23 years ago, and if I have a salt overdose, (eating pizza, pretzels, or anything real salty) my right side of my face droops! It also droops if I drink more than one glass of wine!

    • Author
      Patrick Nemechek, D.O. 9 years ago


      Recent studies fail to demonstate any significant association of inflammation with increased salt (sodium) intake.

      It could be the inflammation is worsened by the carbohydrates in the pizza or pretzels that cantain the salt.

      Dietary carbohydrates are major stimulus for systemic inflammation.

  2. And…if the concern is high blood pressure, rather than telling everybody what to eat, how about recommending that everybody have their blood pressure measured, you know, like first getting the information. A lot of places you can have it done in a drug store.

  3. “After all?” Who ever believed this in the first place? At a minimum, you don’t make recommendations on something where there is scientific disagreement. And, in a real science, the proponents, the USDA, would have an open discussion with their critics. Yeah, right. The Cochrane collaboration is a group of self-appointed experts with little training in real science. They have high standards according to the medical establishment which also has little training in science. Neither can see beyond the random controlled trial and both have given up on common sense compared to slavish addiction to computer printouts. Go with Dr. N: focus your efforts on health improvement elsewhere. If there were a risk, there is a chance that we have evolved with mechanisms for not consuming excessive amounts of salt, like “this tastes too salty.”

  4. Rob W. 9 years ago

    I used to work in the Oilfields in and around Bakersfield Ca. The summers were very hot, 105 to 112 degrees F. were typical. My typical lunch was a handful of salt pills and two quarts of Gatorade. The heat and hard work would kill my appetite. I was working with a rather large man named Nick, 6,4 275 lb’s 5% body fat, he said he sank when he jumped into the pool, the kind of guy whose knuckles dragged on the ground when he was walking, His doctor put him on a low salt diet. Not good for him, We were working on drilling location performing well completion, Nick was on top of the pump truck controlling the process during the operation. The rest of the crew were watching him as he started to turn pale and wobble, then he passed out cold. It took 6 men to get him down. Although he had been drinking lots of water and had water near him, His body was not retaining it. My guess is this was due to his low salt diet.

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