“Pass me the salt and pepper please!” This all too familiar phrase rings clear at every family meal. Has it become habit or is it numbed taste buds driving us to salt overuse and abuse? Or maybe ignorance of the effect that salt has on our health?
Standard table salt consists of sodium and chloride ions. For healthy functioning of the body, the macro-minerals potassium and sodium need to be balanced in the right ratio. Failure in maintaining the right relationship and ratios between them can have serious health consequences. Sodium and potassium imbalance results in limited ability of the body to use vital micro-nutrients from food or supplements. Body cells in this imbalanced state are less able to resist infection, less competent to carry out their physiological functions, lack vigour and are more likely to die or become cancerous than balanced active cells. Chronic and long term disturbance of tissue levels of sodium and potassium might appear to be without danger at first, but in time will lead to deficiencies in other nutrients and challenge the immune system, resulting in an increased vulnerability to serious chronic and degenerative diseases, such as heart disease or cancer.
The balance between sodium and potassium determines the osmotic pressure and ionic strength of a cell, and of the body fluids, like blood and the fluid between the cells. They thus control the movement of water in and out of the cells and tissues and are involved in preventing water retention (such as swelling of the legs) and oedema. A potassium deficiency allows more sodium to enter the cells. The additional sodium increases the water inside the cells, producing oedema and cell damage. These two minerals are also intimately involved in muscle contraction (including the heart muscle) and the conduction of nerve impulses. Sodium is required for the production of hydrochloric acid in the stomach and therefore plays an integral part in digestion.
What then determines the ratio of potassium and sodium in the body? Our diet! Primitive diets of our prehistoric ancestors consisted of only unprocessed foods, such as seeds, fruits, roots (vegetables) and little meat. Such a diet is relatively low in sodium and high in potassium, approximating a ratio of around 1:17. Throughout evolution, the kidney has adapted to actively excrete excess potassium and to carefully conserve supplies of sodium, due to the historical preponderance of potassium in the diet. However, in our modern over-processed Western diet, sodium intake is high and potassium usually very low, equally a ratio of about 9:1. Long term over-use of salt and other salts of sodium upsets the delicate balance between potassium and sodium. It is important to note that deficiency or imbalance of nutrients other than sodium and potassium may further impair the cell’s mechanism for pumping sodium out and potassium in, therefore resulting in an imbalanced state.
Seeing that the delicate balance between sodium and potassium is so important for optimal health, we need to determine what will cause cumulative losses of these minerals. Sodium is well retained by the body, but the following factors will deplete potassium levels over a period of time:
• Diabetic acidosis – body becomes acidic in diabetics
• Diuretic drugs or ‘water pills’
• Alcohol consumption
• Coffee drinking
• Excess sugar intake
• Hypoglycaemia – low blood sugar
• Sodium excess
• Magnesium deficiency
• Aspirins and drugs containing acetyl salicylic acid
We need more potassium in our diet than sodium, but our modern diet provides the contrary. Potassium-rich foods are unprocessed vegetables, fruits, seeds, pulses and wholegrains. In general, natural wholefoods contain little sodium and more potassium. However, we have reversed this balance found out in nature by adding salt (sodium) to our food.
Factors that will lead to excess sodium:
• Milk consumption unfavourably encourages sodium to enter cells. Higher sodium levels in infancy is normal, but not in adulthood. High animal protein diets not only favour sodium entering the cell, but are usually too high in sodium (added salt) and too low in potassium, especially cheese and processed meats.
• Food processing – table salt (sodium chloride) is added to almost all processed food for taste. Initially salt was used as preservative to extend shelf-life, but today mainly for taste reasons, it is driven by consumer demand. It is thus not the food industry that should be blamed for the salt overload in processed food, but us, the consumers! Furthermore, major losses of potassium occur during food processing, such as canning and freezing of vegetables. Potassium is very soluble and will therefore easily be lost through cooking water. See table 1 for examples of the distorted ratio’s of sodium to potassium in processed foods. Not only will table salt add to the sodium load, but other preservatives too, such as sodium nitrite and nitrates (processed meat), sodium bicarbonate (baking powder), MSG (monosodium glutamate), hydrolysed vegetable or animal protein (in stock cubes, savoury pastes, gravy powder, canned and packet soups and many meat products). Even nutritional supplements may contain sodium, such as sodium ascorbate (Vitamin C) and bicarbonate of soda (sodium bicarbonate).
• Lack of fresh and raw fruit, vegetables, seeds and pulses in the diet.
Table 1: Comparing the sodium to potassium ratio of processed food. Sodium and potassium are expressed in mg per 100 dry-matter.
|Food||Sodium||Potassium||Sodium to Potassium ratio|
|Packet soup (Chicken)||6429||284||22.7|
Long before potassium depletion or sodium excess causes any labelled chronic disease, there are usually many warning signs that the ionic ratio of sodium to potassium is out of balance.
Symptoms of potassium depletion:
• Irritability and mental confusion (due to effects on nervous system)
• Oedema (swelling of tissues or organs)
• Muscular weakness (mostly in elderly people)
• Paralysis of small intestine muscles, causing abdominal distension
• Disturbance of heart rhythm
• Bone and joint pains
• Raised blood pressure
Symptoms of sodium excess:
• Pre-menstrual tension
• Headaches over the eyes
• Sinus and chest problems (especially in men)
• Legs tend to swell – alleviated by lying down or putting one’s feet up
• General puffiness and swelling of the lower abdomen
• Aching of muscles and joints
• Difficulty sleeping and poor concentration
• Itchy skin
• Greasy hair and dandruff
• Desire for salt and salty foods – yes, the more sodium in your cells, the more salt you would crave!
• Frequent colds
• Loss of calcium from bone and possible deposition in soft tissues
• Passing water frequently in the morning, prior to 11h00 am.
• Heavy periods or miscarriages
• Acidosis – acidic body
The body’s need for sodium should be met by sodium from organic sources which will normalise, not disrupt, the balance of other minerals in the body. It would dissolve, rather than promote, the out-of-place deposition and solidification of calcium for example. It will aid, rather than disrupt gastric secretions. It would even help the excretion of excess sodium that has been accumulated from excessive intake of inorganic salt (table salt). Good sources of organic sodium would be celery, cauliflower and root vegetables. However, an actively healing and eliminating diet should not offer total sodium values of more than 500mg/day.
Is all salt then bad for us? Yes. We should limit the addition of any salt to our food, since all salt will favour sodium overload. Sea salt and other ‘healthy salt substitutes’, such as Biosalt (sodium chloride combined with salts of potassium), still throw out the sodium to potassium balance, by providing excess sodium to the diet. Nevertheless, if healthy and enjoying a balanced unprocessed wholefood diet, unrefined and additive-free mined or harvested rock, desert or sea salt, could be added to food sparingly. These unrefined salts contain naturally occurring trace minerals, like potassium, magnesium, and calcium, therefore adding nutrient value. Table Salt or “Iodized Salt” is not a healthy naturally occurring rock, crystal or sea salt. It is a manufactured type of sodium called sodium chloride with added iodide. Iodine in salt available at grocery stores, restaurants and in practically all processed foods, have added synthetic chemicals. These chemicals may include manufactured forms of iodide, sodium solo-co-aluminate, fluoride, sodium bicarbonate, toxic amounts of potassium iodide, anti-caking agents and aluminium derivatives. Table salt has also been bleached. Unfortunately, most table salt is not only unhealthy, but is toxic to the body and should never be considered as a source of healthy iodine. Synthetically added iodine leads to an iodine overload in our Western diet, contributing to numerous health problems. Increased iodine intake, especially in supplement or synthetic form, can increase the autoimmune attack on the thyroid. Iodine reduces the activity of an enzyme called thyroid peroxidase (TPO). TPO is required for proper thyroid hormone production. Excess iodine will lead to autoimmune thyroid diseases in the presence of concurrent selenium deficiency. On the contrary, unrefined salts have no added chemicals and contain a more balanced ratio of trace minerals.
Because unrefined artisan and sea salts usually have more dramatic flavour and texture, one can use them in much smaller amounts than white table salt. The following salt varieties are options to enhance your favourite foods, if used sparingly: Kala namak; Fleur de sel; Grey salt; Cyprus black salt; Peruvian and Himalayan pink salt and Hawaiian red alaea sea salt. In choosing unrefined salts you may also be supporting smaller businesses and social enterprises, which makes the choice not only healthy but also ethical, especially if you choose locally sourced salts over those that are produced far away. Make sure the salt is harvested or mined from pristine areas and does not contain heavy metals. The source must be sustainable and renewable. Our best South African local options would be various sea salts and Kalahari desert salt.
A balanced unprocessed wholefood diet would provide the correct ratio of sodium to potassium to ensure optimum health, without the need to add salt in any form. We need more potassium than sodium in the diet. Nonetheless, in our modern diets, the dietary sodium to potassium ratio has been grossly distorted by the 1) omission of high potassium foods, 2) removal of potassium through processing and cooking and 3) lacing food with salt and other high-sodium substances.
Various health organisations and nutritional groups advocate the lowering of salt in the diet and many food manufacturers follow suit. However, health would not be restored by simply omitting or reducing table salt. The ratio between sodium and potassium is more important than the amounts! High blood pressure (hypertension) has been related to high sodium levels. However, the amount of potassium in the diet (or rather the lack thereof) is far more important than sodium levels. The sodium-to-potassium ratio is therefore a far more accurate predictor of blood pressure than the amount of sodium alone. The most important factor to realise is that the more sodium intake rises, the higher the potassium intake should be to balance it!
To restore health, all processed food and snacks should be avoided, not merely a reduction in salt intake. Processed food has added salt, but also contain sodium added in other forms; it is very low in potassium content; and lack other trace minerals essential to restore balance in the system. Yet, a reduction in salt intake is a good start! Be aware of what you are eating from day to day. A range of foods, such as smoked meat and fish, are naturally salty, so you don’t need to add more. When you cook, gradually lower the amount of salt each time you cook, so your palate eventually gets used to less. In due course you will have weaned yourself off the taste for highly salty foods. Pep up a meal’s flavour by using herbs and spices, such as garlic, ginger and lemon grass, creatively.