WHY Low Salt Stresses the Body (Sodium, Hormones & Potassium)

WHY Low Salt Stresses the Body (Sodium, Hormones & Potassium)


This episode is brought to you by the new
podcast, “The Thread” with OZY. In July 1995, it became unusually hot in Chicago. The temperature hit 106 degrees, and the heat
index which is like wind chill – how it feels to people, was 126 degrees. As mayor Richard Daley eloquently put it:
“It’s hot, it’s hot out there! We all walk out there, It’s very very very
hot.” “It’s so damn hot!” Eric Klinenberg, author Heat Wave: A Social
Autopsy of Disaster in Chicago explains that Roads were buckling under the heat, and drawbridges
had to be hosed down to close properly. This led to huge traffic jams; The city even
had to hose down hot school buses and provide the kids with bottled water in an attempt
to cool them down. Over 700 heat related deaths were logged in
as little as 5 days. While this was a difficult time for everyone,
most of the victims were elderly people. Klinenberg points out that this is likely
due to their being more isolated, and less likely to open their windows for fear of crime,
even if they had no air conditioning. But what else makes the heat so dangerous
for the elderly? In 2003, the European heat wave led to the
hottest summer since at least 1540, leading to a death toll of more than 70,000 people. Again, the elderly were hit especially hard. Now, as this report from the World Health
Organization Europe states: “As long as sweating is continuous, people can withstand
remarkably high temperatures, provided that water and sodium chloride, the most important
physiological constituents of sweat, are replaced.” So, if you are sweating a lot in the heat,
sodium preserving systems are very important in keeping you from losing dangerous amounts
of sodium. Well, these systems don’t work as well in
the elderly. As this section from a volume of QJM entitled
“Why do older patients die in a heatwave?” says: Older subjects have “diminished renal
tubular conservation of sodium and water during periods of dehydration.” Simply put, older people in general have a
harder time holding onto salt and are more at risk for hyponatremia – low blood sodium. Hyponatremia is associated with an increased
length of hospital stays, bone fractures, rhabdomyolysis and increased risk of death. In fact, Nursing home patients have a forty-three-fold
higher risk of being hospitalized with hyponatremia compared to patients in the community. And of course, what is served in nursing homes
is “heart healthy” low sodium food. As I pointed out in my last video, the salt
and hypertension link doesn’t entirely make sense when you look at consumption trends. And, there seems to be a higher risk of mortality
from getting too little salt compared to getting too much. This study suggests that getting less than
3000mg of sodium causes a much higher risk of mortality compared to getting far more
than that. In fact, actually following the WHO low salt
guidelines of 2000mg would pose more of a health risk than getting 6 times that amount. So what about our physiology would make this
the case? The reason has to do with how the body reacts
to low levels of sodium. As is explained in “The Salt Fix” by Dr.
James DiNicolantonio, the body works very hard to conserve sodium when your intake is
low. Sodium is a key component in our cells ability
to function in general. Without sodium, your neurons won’t fire,
your muscles won’t contract and several important processes cannot occur. Normally people pee out a fair amount of sodium
daily. However it has been found that when levels
are low enough, the kidneys refuse to release any sodium into the urine. When there is less sodium, the body increases
activity in the renin-angiotensin-aldosterone system or the RAAS. This system begins with your liver releasing
angiotensinogen, and, after a series of steps that you can read about in an endocrinology
textbook, angiotensin I is produced. Angiotensin-converting enzyme (ACE) then converts
it into angiotensin II, which stimulates the adrenal glands to produce aldosterone. Aldosterone is important because its job is
to hold on to sodium by conserving it not only in the kidney, but also in the salivary
glands, sweat glands and colon. Aldosterone has it’s purpose, but it’s
not a hormone you want to regularly have high levels of. High aldosterone is associated with increased
inflammation, Chronic kidney disease, Osteoporosis, and cardiovascular disease. In particular it’s implicated in oxidative
stress and myocardial fibrosis – an abnormal thickening of the heart valves. One more thing: Aldosterone secretion, combined
with blood vessel constriction due to impairment of nitric oxide synthesis – another consequence
of this renin-angiotensin aldosterone system, increases blood pressure. And, this blood pressure raising effect of
the RAA system is well known – a common medication given to people with high blood pressure is
something called an ACE Inhibitor. These drugs inhibit Angiotensin Converting
Enzyme, hindering an important step in the RAA system resulting in lower aldosterone
and lower blood pressure. But, as I mentioned earlier, this renin angiotensin
aldosterone system is stimulated by low salt intake. As this study shows, a low salt diet increases
aldosterone by more than 3 fold in healthy people. Another study shows that when salt intake
drops below 1.5 teaspoons per day, a significant increase in renin and aldosterone occurs. Keep in mind that the WHO “strongly” recommends
getting no more than 2000 mg of sodium per day, which equates to less than one teaspoon
of salt. This suggests that people actually following
the WHO guidelines are chronically raising their aldosterone. So, how does the body react to higher levels
of salt? On the flip side of aldosterone, there is
a group of hormones called natriuretic hormones, i.e. sodium urinating hormones. These hormones are secreted when sodium intake
is increased. As is discussed in Seldin and Giebisch’s
The Kidney, Fifth Edition, all 9 of the different Natriuretic Hormones discussed have therapeutic
effects ranging from improving kidney and heart function to preventing the growth of
cancers. One of these hormones called Atrial Natriuretic
Peptide, shows particular promise for promoting the health of blood vessels. In fact the therapeutic potential of this
peptide is significant enough that it has recently been approved in Japan to treat patients
with heart failure. So to sum all this up, you could inhibit the
blood pressure raising effects of the RAA system by taking a drug or you could get more
salt. And, you could take recombinant human Atrial
Natriuretic Peptide to improve heart function, or you could get more salt. Nonetheless, we’re recommended to restrict
our salt down to a single teaspoon a day to avoid heart disease? Now, I’m not saying you should consume as
much salt as you possibly can, as mentioned earlier, 11 grams of salt give or take seems
to be the optimal amount for most people. If you’re exercising and sweating a lot,
or you drink a lot of coffee or if you’re lowering your insulin via a low carb or ketogenic
diet, you may need more salt. While it’s helpful to try and measure out
how much you’re getting per day, it’s usually easier to just follow your built in
salt intake regulator – Your sense of taste. Most runners will notice that after sweating
a lot during a long run, salty foods suddenly start to look really tasty. But When we think of salty foods, it’s unhealthy
foods – pretzels, potato chips, hot dogs, and processed foods. If you’re craving those foods, you may just
be craving their salt content. So, you should add as much high quality salt
as tastes good on your next meal, or you could eat something like pickled olives, or just
put a bit of salt and lemon in water and drink that. Now, the advice “follow your craving”
might sound odd considering that’s usually bad advice. People can come to crave narcotics, alcohol
or sucrose. However, none of these substances are necessary
for life and the optimal intake is very likely zero. Also, the more you consume these substances,
the more you want them – in other words, it’s a positive feedback system. Salt on the other hand is a negative feedback
system – the desire for salt decreases as the sodium content of the body rises. This is why when you look at consumption trends,
salt has stayed steady the past 50 years and table sugar, which recently has been proven
to have addictive properties, continues to go up and up. Salt consumption used to be much higher because
salt had been the most effective food preservation technique at the time. When salt is freely accessible, people across
many populations tend to consistently consume between 3 and 4 grams of sodium per day. It seems that the body will push us to acquire
salt, but in accordance with our needs for the mineral. A 1986 paper titled “Taste changes during
pregnancy” shows pregnant women have a marked craving for salt. As the paper says, “The data suggest that
a physiological mechanism for increasing salt intake may develop during pregnancy.” The paper even cites a case from 1691 where
“a pregnant woman consumed, by actual count, 1,400 salted herrings during her pregnancy.” And, A craving for salt is definitely something
pregnant mothers don’t want to ignore. A study published in the Lancet in 1958 of
more than two thousand pregnant women found that women on a low salt diet compared to
a high salt diet, caused more miscarriages, premature babies, stillbirths, edema and preeclampsia. Salt is important to fetuses and children
because it is required for optimal growth. A 1987 article titled “Sodium deprivation
growth failure in the rat” found that low sodium diets decreased bone and muscle mass
in rats. Another 1983 study found that low sodium left
rats with smaller brains. But what about human studies? A study from the British Medical Journal concluded
that “…failure to provide [sufficient sodium to infants] may predispose to poor
neurodevelopmental outcome in the second decade of life.” Yet, the WHO guidelines specifically state
that the low salt recommendations apply to all individuals, including pregnant or lactating
women. So, if low sodium stresses the body, how did
the idea that lowering salt intake is good for blood pressure come up? As James DiNicolantonio points out in the
Salt Fix, blood pressure increase with a high salt intake can often be explained by a potassium
deficiency. Like sodium, potassium is also very important
for the function of your cells. For a while, Japan had been one of the strongest
arguments against salt. “Japanese people were known to eat lots
of salt, and while in general they had low rates of heart disease, they had a high rate
of cardiovascular conditions, such as stroke and hypertension.” Akita prefecture in specific had a high rate
of hypertension and did consume a lot of salt – which of course became the prime suspect. Though researchers had already been pointing
to factors unrelated to salt such as “deficiencies in the dietary life,” vitamin C deficiency,
and the presence of cadmium in the intestines of widely eaten river fish. But, The Akita stroke rates were striking
when compared with Aomori prefecture, which is adjacent to Akita, and was also consuming
a high salt diet. The rate of death due to stroke was almost
half in Aomori. And, The average blood pressure in Aomori
was relatively low (131.4/78.6 ). What was happening here? This 1962 paper by Naosuke Sasaki found a
dose dependent relationship between daily apple intake and lowered blood pressure. While the data only accounts for none, one
to two, or three apples per day, it shows that the more apples eaten, the lower the
blood pressure. And, Apples are good source of potassium. Dr. DiNicolantonio also shows that a similar
effect was seen in “Seventh-Day Adventist vegetarians, Seventh-Day Adventist omnivores,
and Mormon omnivores. The daily intake of sodium in these groups
was between 3,500 and 3,700 milligrams, slightly higher than what the average person in the
United States consumes. However, the average blood pressure in the
three groups was totally normal. Importantly, the potassium intake was between
3,000 and 3,600 milligrams per day (almost twice as high as the average potassium intake
in America).” In my other video on Salt I brought up how
the average South Korean consumes at least twice as much sodium as the World Health Organization
recommends yet has the lowest rates of coronary heart disease in the world. A September 2015 paper showed how the quartile
groups that consumed the most sodium had the lowest rates of hypertension, coronary heart
disease and stroke. But you’ll also see that the potassium intake
in these groups rose along with the sodium intake, probably because a lot of their sodium
comes with vegetables, like in Kimchi. So did the increase in potassium or the increase
in sodium improve their health? Or did the increase in both have a positive
synergistic effect? In any case, increasing potassium intake is
assuredly a better strategy for health than restricting your sodium intake below 3000
milligrams. So the advice to be gleaned from this is of
course to eat more vegetables. And, by making them taste better with salt,
you’ll be inclined to eat more of them. After all, the word salad comes from the name
of a delectable roman dish – herba salata. Salted Vegetables. So, I’m always trying to learn something
new from history as it’s interesting and can sometimes tie into the topics I talk about. I want to recommend a new podcast that explores
history’s surprising connections – it’s called The Thread with OZY. It’s like a cross between Malcom Gladwell’s
Revisionist History and six degrees of separation. They show how various historical strands are
woven together to create a historic figure, a big idea or an unthinkable tragedy — like
how John Lennon’s murder was actually 63 years in the making. Other episodes are about J.D. Salinger, the
wife of Charlie Chaplin and more. The show is already topping the charts. Get The Thread with Ozy, that’s O-Z-Y, on
Apple Podcasts at ApplePodcasts.com/TheThread or wherever you listen.

100 Comments

  1. The status quo always keeps things low, that is why I never listen to what the oficial agencies say. As you say, I keep my salt level in accordance with my internal craving. Great video.

  2. I remember when I moved to Canada from the Caribbean I always had a huge craving for salt. So much so that I started to periodically just eat some salt on it's own. Which kept me feeling great.

  3. This is in my extremely humble non relevant opinion to a majority of the the world one of the best channels on YouTube …awesome stuff consistently well researched and presented …transcripts are also a really nice touch …nice !
    Ric

  4. Where did our ancestors get this salt from.. The hunters were particularly 'athletic' but it's doubtful that their meat intake offered the 11g of salt worth of sodium.

  5. "Hypernatremia, also spelled hypernatraemia, is a high concentration of sodium in the blood. "
    Fool falls at the 1st hurdle. This guy is not getting his facts straight.

  6. eat cucumber, high in potassium low in fiber, umm i dont know what problems there may be with cucumbers, maybe they are poisonous who knows…

  7. People tended to make better decision 2000 years ago and with much fewer sources, the word "salary" also comes from salt, the word salarium (salary) came from salarius (salt), and said this was because in the old days soldiers were paid in salt. But the writings were referring referring to a nonspecific and hazily remembered distant past, and it"s due to the fact that salt was very pricy back then ! So when they did not have any money left, they would pay you with things like salt.

  8. my grandparents used to drink ayran (salty water yoghurt mixture) nearly every meal in summer. and at least once a day in winter. its traditional to provide people working in your fields with food and drinks, and its nearly always ayran with whatever food available. pickle juice and fermented salty beet juice is possible too, but not that often. yummy.
    tradition dictates you offer ayran to travellers too, if you cant give a meal that is. if only you dont have ayran, or its winter and hot beverages like teas are more apropriate, you offer water. as a last resort.
    other cultures probably offer similarly salty beverages too.
    unfortunately now we mostly drink sugary beverages, like all the world.

  9. I eat pink rock salt like candy. My sodium always tests low. My body knows it needs the salt. Oh, and I've had very low blood pressure my entire life. In fact, the one time I tried to reduce my salt, my blood pressure swung way UP and way DOWN. It was totally dysregulated. Back to my salt candy.

  10. Go to a store. Buy salt plus potassium chloride. Put as much as you want in or on food. You'll be fine. A fifty-fifty mix is fine, some say should be 80 percent potassium, but nobody knows.

  11. I remember being told that as long as we eat meat, we don't need to add it to our food. That was based on the fact that primitive man never used salt licks, but game did.

  12. I was diagnosed to be high aldosterone. Young hypertensive and low potassium 3.0+. Should I eat low Na? Normal Na? Or high Na diet?
    I was given 1200mg KCl slow release pill a day.

  13. i dont know about this, nowadays they back everything up with studies but then it turnes out it was false! (Cholestorol, sugar, veganism) . I dont believe that we need so much salt! Where did our ancestors find salt when they were not living nearby the sea ? I think salt is addictive and kills our normal hunger feeling. You think youre hungry but you actually crave salt or sugar. I believe anything what comes in crystal form you have to consume is addictive and causes harm to your body. Meth, Cocaine, salt , sugar etc.

  14. Since I changed my diet to a keto for cutting and now just a low carb diet my body water % has gone into the high range wondering if adding more salt to 4.5 gs a day will have an effect on this never payed attention to this but have passively consumed around 3 gs a day

  15. I eat a low salt diet and a lot of veggies, mainly I do this cause I like plain food but I'll try adding some salt to my rice and veggies going forward. Thanks for the info!!!!

  16. salt is literally the all-in-one flavour enhancer, i don't know how people can even propose the possibility of going without for any reason.
    it's almost definitely another contributor to why us Sardinians live so long.

  17. In Finland, it was possible to reduce salt intake by a third, making the death rate from strokes and heart attacks decreased by 80%

  18. You forgot to mention that those Japanese and Korean populations with high salt intake have a vastly elevated incidence of stomach cancer.

  19. 104 degrees F=40 degrees C. 105.8 degrees F=41degrees C. 122 degrees F=50 degrees C. 125.6 degrees F =52 degrees C. In the heatwave the temperature was reported to be 106 degrees F. With a heat index of 126 degrees F. A change of 1 degree C= a change of 1.8 degrees F.

  20. Thank you. I was wondering why my blood pressure was so high at MEPS it was something like 150/90 (I was nervous too which didn't help). I know I hadn't had much salt for the past while, and now it's down to 125/58.

  21. Love your videos and presentation! Love how you incorporate history and videos! And how you reason on the subject! Thank you

  22. Test your blood pressure, if you have high BP you need more potassium. Most people get enough salt, but not enough potassium.

  23. I love it.

    Diabetes Association pushes moderate/high carb diets to keep you consistently on insulin to treat you T2 diabetes. You may not need to take insulin if your blood sugar wasn’t high in the first place from said carbs…

    People with high blood pressure are put on low salt diets so they get prescribed ACE inhibitors.

    Have “high” cholesterol (which is actually preferred)? Here’s your statin (Pfizer) with all its side effects, like impotence. Don’t worry, we (Pfizer) make pills to fix that.

    🙄

  24. While fasting, some cream of tartar and pink salt give me my potassium and sodium fix and makes me feel much better

  25. There’s no point nor any benefit in adding salt to your meals, food is already salty. Eat a well balanced diet and forget about salt or any supplement.

  26. Very interesting…As someone with high blood pressure and kidney disease, I have no choice but to watch my sodium levels (or so say my doctors). I do have to wonder how our ancestors' got by when salt was a high priced commodity?

  27. My grandparents have less health problems than me and they eat alot of salty foods and I probably eat only a tablespoon or two a day

  28. wow.. this past weeks I demonized salt.. coz of documentaries I watched…and finally decided to give it up and dont use it in any of my diet recipes… and now I will add it again… thx again

  29. One reason low salt will correlate with poor health outcomes is that athletes (ie healthy humans) use a lot more salt and water daily, so nearly everyone who eats low salt is unhealthy to begin with. Low salt intake might make health problems worse, but it will also naturally correlate with ill health.

  30. I've gained more from this channel than from 10 years of school. You really do make a difference out here.

  31. Get a blood pressure machine and check your pressure every day. If it starts to go up as you increase sodium then you know to cut back. I have found salt intake has no bearing on my blood pressure. For some people it will.

  32. Thank you very much. Very enlightening. So how much salt should I put in a liter of water as replenishment for sweat and urine excretion?

  33. Hey, I know this video's really old, and you might not look into the comments here, but there's one thing I wanna actually bring up:

    There a special type of salt known as "nuchi masu (ぬちまーす)" This is sea salt created in Okinawa, and it's very carefully made. Now the most important thing about this salt, is that it contains a bunch of minerals along with its salt.

    Those minerals are: Potassium, Calcium, and Magnesium.

    When I happened to go to Okinawa and visited their salt museum, those minerals really caught my attention and was reminded me of this video immediately.

  34. After this video, I added on an extra dash of salt to my meats and veggies. Suddenly, as I was eating the meat, I had a sudden craving for something sweet, like orange juice maybe. Perhaps it was my body telling me it wanted potassium?

  35. Now the question which everyone needs an answer to is what is the best accessible salt that we can eat? Sea salt or mined salt? Please do not answer "neither, Himalayan salt is the best" because Himalayan Salt has MERCURY, LEAD and other TOXIC crap in it. Stop buying this crap people. just buy normal MINE salt or SEA salt. So please focus ONLY on mine salt vs sea salt. Some say sea salt is better but I have some doubts about it, the mine salt has been sitting there int he earth for thousands of years absorbing other minerals. I dont know if you guys in America have salt mines but here in Europe we have giant salt mines with tones of salt, the entire walls are made of salt, especially in East Europe like in Romania and Poland. So which salt is better MINE salt or SEA salt?

  36. Himalayan Salt has MERCURY, LEAD and other TOXIC crap in it. Stop buying this crap people. just buy normal MINE salt or SEA salt.

  37. as a guy with no stake in this game but a pretty remarkable health recovery story, its true that when I opted to eat more salt, or specifically more chloride, I went from going from being able to do 40 pushups in one set to 50 in just a couple days

  38. And I actually my Dr. Suggest me to get a antagonists of the receptor of angiotensin II drug, yes it lower my Blood pressure, but that is what i been missing, more salt, when in low carb diet. aka. Ketosis. And more water maybe. Thanks for this info… and it is the 20th time i see this.

  39. hmmm… This might be the reason why in my country "salt" you buy in grocery stores is a mix of NaCl and KCl already and optionally also some iodine, to make sure people don't get it one sided.
    But some people weave conspiracy theories about how "they" try to poison us with kalium/potassium… meh.

  40. From last 25 years I cut down on salt and fat. My BP went out of control, doctor gave me different medications but no help. I told the guy who works in Vitamin shoppe about my high bp. He recommended potassium. Now everything is making sense. I was researching about which hormones effects the blood pressure which lead to your video.
    I really appreciate your help.

  41. For those unfortunate enough to get migraines, increased salt helps a lot. Look up Angela Stanton, who wrote a book on the subject.

  42. 1 Teaspoon of salt has exactly 2000mg of sodium. It's not less than, it's equal to. Also these studies are far too broad generalizations and cannot apply to everybody in every scenario. If you're in a climate where you do not sweat, you do not need to load up on salt as much. The point about needing to increase potassium consumption is spot on however.

    I'd say most of the risks presented here aren't necessarily about getting enough sodium (especially if you never sweat) but getting enough potassium. Lots of problems happen with a low potassium diet.

  43. well as long as you eat real food like fish egg meat butter vegetables and fruits
    instead of processed crap
    you will pay more but instead of medicine you will pay for food.

  44. Don’t eat table salt, they take the minerals out and spay it with aluminum to prevent it from clumping up, take sea sale or pink Himalayan salt.

  45. This is just personal experience, but I used to get a lot of migraines and excruciatingly nasty muscle cramps in my legs. I started drinking water saturated with Himalayan pink salt whenever either happened to me. The headaches would literally go away in ten to twenty minutes and the leg cramps would stop. Mind your electrolytes! Magnesium, potassium and sodium. You need that stuff.

  46. Your content and your skill is excellent…..Having studied Sport and Exercise Sciences at, The University of Chester, England, I wish you were my Lecturer for all Subjects I took….. You have a way of explaining that is second to none….thank you

  47. 6:30 Eleven grams of salt, wtf? That would equate to above 20 grams of Sodium, which is way way way above what the study said.

  48. My whole life, I was told to avoid salt and fat,,,,funny part is, SUGAR is the #1 health destroyer, and salt and fat are needed in your diet!

  49. Wait so watching this and the video before it is makeing a lot of sense to me cause I should have very high blood pressure ect because I'm classed as morbidly obese. But I've always craved more salt than people around me and my blood pressure has always been normal. The only times it has spiked was when I wasnt consuming salt in the quantities I was craving.(most people cant eat what i cook for myself cause they say it is too salty) so cool.

  50. 7:18 follow your craving your brain knows what nutrients it needs, except sugar but if you stay healthy, listen to most of your cravings

  51. I worked for 15 years in the Sonoran Desert Region of the United States. I didn’t like the salt in my perspiration stinging my eyes. So I stopped all salt intake. I only ate unprocessed Whole Foods I prepared myself. I worked 18 hours a day, sleeping a full 6 hours a night. I never felt better in my life. Figure that one out.

  52. Are you a Medical Doctor or a Research Scientist? I need to know so I can trust your opinions. Tbh… who are you? why should I believe you? PLEASE RESPOND

  53. @WhatI'veLearned But aren't we always consuming more than enough salt with occasional processed foods and daily garnishing of our lunch dinner and breakfast with salt?

  54. All are rubbish. For the whole video, no definition of low salt mentioned is given. In fact, it is hard to lead a low salt live, as all the processed food consist of too much salt.

  55. Most people eating cheese are interested in its high level of salt. You can say "i like the taste" but your body needs the salt.

  56. This guy is dangerous. I consumed salt exactly they way he said until my massive coronary. Since then I restrict my salt to lass then 1200 mg p/day. If I go over that I get sick. Seriously sick.

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