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Salt in the Wound

Hypothetically, we could find ourselves in trouble by eating too little salt. But hypothetically, we could incur injury from an excess of oxygen. That's not a good reason to stop breathing.
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We eat too much salt, and so do our children. We can reduce our intake by eating less highly processed food, which is the source of nearly 80 percent of the sodium in our diets. Doing that, and eating more foods direct from nature would be good for us anyway, because it would also reduce our intake of added sugars and sweeteners, refined starches, miscellaneous chemical mischief, trans fats, and calories, while increasing our intake of beneficial nutrients.

Wholesome foods in sensible combinations would reduce our ambient sodium intake. More importantly, it would fix everything else wrong with our diets, too. That's the punch line for those in a real hurry. For everyone else, here is rest of the story.

Once upon a time, we were relatively secure in our knowledge that we ate too much salt. That didn't mean we were inclined or likely to fix it any time soon, but at least we thought we knew what was broken.

That level of conviction about anything having to do with nutrition just won't do in our culture. For one thing, it's the job of the news media to afflict the comfortable. So any time we seem too comfortable about any part of our complete breakfast, lunch, or dinner, it's time to tell us why it's the root of all evil in the universe.

For another thing, we seem to prefer hopeless befuddlement about everything having to do with the basic care and feeding of Homo sapiens. So a never-ending parade of contradictory headlines works out well for all concerned.

So there we were, secure in the knowledge that most of us ate too much salt. The meant that every study indicating the potential dangers of eating too little salt, however theoretical, needed to make headlines; and so they did. The news we were getting about salt started to look like a Ping-Pong match. When it comes to science in general, and nutrition in particular, that's never good.

The propagation of confusion by competing studies, and associated headlines, reached its peak on August 14, when three studies on the perils of salt intake were published in the same issue of the New England Journal of Medicine. Two, by the same investigators, suggested that while too much salt is clearly harmful, so, potentially, is too little. I have addressed the studies in some detail before, so no need to do it again. Suffice to say they were converted into headlines implying we should abandon all restraint, and "pour on" the salt. The investigators themselves never said any such thing, of course -- but that's how this game is played.

The third article in the same issue of the New England Journal concluded that nearly 2 million global deaths each year are the direct result of sodium intake above the rather low threshold of 2.0 grams per day. We were getting too much, after all.

So perhaps we might have settled comfortably into a state of permanent discomfort and confusion about salt. But it was not to be. Along came yet another study just three days ago, pouring salt indeed on the still-raw wound.

The CDC analyzed a nationally representative sample of children in the U.S., and concluded that sodium intake is dangerously excessive in kids and adolescents. Average sodium intake for 6- to 18 year-olds was 3,300 milligrams per day from processed foods alone, which is not only higher than the current guideline, but even higher than what the guideline would be if we decided it were currently too low. The excessive sodium intake was linked to an already high, and rising rate of high blood pressure in children.

The study reaffirmed what we already knew about the salient contribution of processed food to the pickling of our population, and our progeny. Nearly half of the salt intake in our kids comes from just ten popular food items, before ever a hand reaches for the salt shaker. That list predictably includes the likes of deli meats, potato chips, and chicken nuggets.

Sodium is an essential nutrient. We can, of course, consume too little. But generally, in the real world, we don't. And certainly none of us is suffering from a baloney deficiency syndrome.

Of course, you're the boss. It's your life and your diet, and I'm just a guy with an opinion. Well, that and about 40,000 hours of post-graduate training, but we all know what that's worth. Either way, you're the boss -- and you have two options.

I put option A in the opening paragraph: eat good foods, and let salt (and every other nutrient) take care of itself. Option B is to restrict the salt intake of your children scrupulously, while simultaneously both carefully restricting and liberalizing your own intake of salt so as to avoid both deficiency and excess, while wearing a neck brace to deal with the permanent case of headline whiplash.

Most of us, and our children, eat too much salt, and the best way to fix it is modifications to the typical American diet that would be good for us all anyway. That's the prevailing reality. I recommend we act on that. I do.

That action does not require fixating on salt. Rather, focus on wholesome foods in sensible combinations, and sodium -- along with every other nutrient -- will tend to sort itself out. And yes, it is possible to get there from here. Not effortless, but possible.

Hypothetically, we could find ourselves in trouble by eating too little salt. But hypothetically, we could incur injury from an excess of oxygen. That's not a good reason to stop breathing. You might prefer to wait until there are no dissenting voices, no conflicting data, and no contradictory headlines about diet and health. That's your decision, but permit me to suggest that whatever you eat between now and then -- you not hold your breath.


David L. Katz, MD, MPH, FACPM, FACPeats wholesome foods in sensible combinations, and along with his family, loves the food that loves him back. As a result, his sodium intake averages less than 2,000mg per day. Also, he can fly. OK, he can't really fly- but he is still breathing.

Author, Disease Proof ("A helluva good book!" - Dr. Katz' Mother)

Co-parent, ("A helluva good website!" - Dr. Katz)