In popular thought, disputing sodium's link to high blood pressure is equivalent to questioning whether the earth is round. However, some experts now believe that salt will not raise blood pressure in everyone, just in people who are "salt sensitive." Only 10 percent of the population is salt sensitive, according to BioMarkers by Professor William Evans and Dr. Irwin H. Rosenberg.

Of course, far more than 10 percent of us suffer from hypertension, meaning that if these experts are correct, salt intake cannot be the only factor contributing to America's high blood pressure epidemic. In fact, according to Gayle Reichler's book, Active Wellness, only half the people with hypertension have high blood pressure because of their salt intake, making cutting down on the amount of salt you eat a good step toward lower blood pressure, but not a cure-all.

Scientists are still unsure why some people's bodies respond to salt more drastically than others; however, most theories focus on sodium's in vivo interaction with potassium, magnesium and calcium. In fact, some experts believe that these nutrients play more of a role in these individuals' salt sensitivity than sodium itself. Deficiencies in these complementary minerals may actually be the larger culprit in hypertension.

"The problem is just as likely to be too little potassium, calcium and magnesium," emphasizes Alice Feinstein in Healing with Vitamins. Most experts agree that you would do well to consume sodium in balance with potassium in order to maintain healthy blood pressure, but they are still unsure about how this potassium mechanism works. Some experts believe that potassium lowers blood pressure by relaxing small blood vessels, while others think that it works by helping the body expel excess sodium and water.

Another interesting theory asserts that these people actually have hypertension because of calcium deficiency, rather than an excess of sodium. However, as Jean Carper explains in Food: Your Miracle Medicine, proponents of this theory have multiple theories about how it might operate:

"One theory is that such individuals retain water when they eat too much sodium, and that calcium acts like a natural diuretic to help kidneys release sodium and water, thus reducing blood pressure. Another, more complex explanation is that calcium works by preventing release of the parathyroid hormone that can raise blood pressure."

As is often the case with uncharted health territory, when it comes to the salt sensitivity explanation for hypertension, theories often pile upon theories. This isn't a bad thing; rather, it makes the intellectual environment ripe for new discoveries. On the other hand, it's important to remember that not all experts agree with the salt-sensitivity theory.

"There's no question about it: A great number of comparative studies of people who use no salt and those who use great quantities have proved that high salt equals high blood pressure," writes Gary Null in his Complete Guide to Health and Nutrition.

Dr. William Castelli, director of the famous Framingham Heart Study, also cites demographic studies as support for the mainstream medical viewpoint that consuming excess sodium leads to hypertension, a perspective that some naturopaths also share. Furthermore, in Food Politics, Marion Nestle questions the ethical roots of some of the salt-sensitivity theory's proponents, pointing out some objectionable financial backing:

"'There is reason to be concerned that lowering NaCl [salt] intake may have long-term metabolic risks that have not been fully identified . . . we do not have solid evidence that lower NaCl intake prospectively will prevent or control high blood pressure."

However, the review in which this appears was funded in part by The Salt Institute, a trade association for the salt industry. This isn't to say that all experts who believe in salt sensitivity are funded by the salt industry. Like any theory, the salt sensitivity explanation for why some people have high blood pressure and others don't has both its proponents and opponents.

A simple test to determine if you are low in the enzyme renin will show you whether you are salt sensitive, according to Reichler. Of course, an even simpler way is to cut down on your sodium intake for a few months – under the care of a doctor, or preferably a naturopath – and see if your blood pressure goes down. If your numbers go down, then you are salt sensitive; if not, you and your naturopath must then take extra steps to learn the cause of your hypertension.

The point is, as Dr. Bernard Lamport emphasizes in Food: Your Miracle Medicine, "Everyone cannot count on sodium restriction to be a panacea for high blood pressure." In other words, as we all know, obtaining good health requires taking a holistic approach to your body, not just making one change and hoping that it will be a cure-all.

The experts speak on salt and high blood pressure:

Not everyone is "salt sensitive" Now salt doesn't raise blood pressure in everyone, only in those whom doctors describe as "salt-sensitive." But if you have high blood pressure, chances are that you are salt-sensitive. Even if you're not, reducing your salt intake is a good idea.

Anti-Aging Prescriptions by James Duke PhD, page 402 Conversely, if an individual is salt sensitive, sodium restriction will have a profound effect upon modulating blood pressure. This is an example of matching an appropriate dietary program with the right genotype. Disease Prevention And Treatment by Life Extension Foundation, page 473

Also, if you have high blood pressure, restricting salt may help curb it especially if you are one of the one-third to one-half of those who are particularly sensitive to blood pressure boosts from sodium. Such "salt responders" are most apt to benefit from sodium cutbacks, say most experts. But you usually only know if you try it. There's even evidence that restricting sodium can depress normal blood pressure. Food Miracle Medicine by Jean Carper, page 93

Use salt judiciously. In most people, eating salt does not increase the risk of high blood pressure, says Dr. Katz. But for some reason, it may affect a few. So if you have high blood pressure, it doesn't hurt to use salt judiciously -- don't add it to foods at the table, and limit super-salty foods like chips to a once-in-a-while indulgence. The Doctors Book of Home Remedies for Women, page 609

Too much salt is even more problematic for overweight people, says Dr. Kenney. "If you eat a lot of sugar and fat and you gain weight, your insulin levels go up, and it's hard for the body to get rid of salt when insulin levels are high," he explains. "That's probably one reason that overweight people are more likely to have high blood pressure: They may eat the same amount of salt as anyone else, but they have more trouble getting rid of it." The Complete Book Of Alternative Nutrition by Selene Y Craig, page 151

Lowering sodium is important because this mineral can raise blood pressure in those who are sensitive to it. Unlike many physicians, though, Dr. Whitaker doesn't tell patients to go on low-sodium diets. Alternative Cures by Bill Gottlieb, page 353

"Some people can tolerate more salt than others, but everybody is sensitive to too much in the diet," he says. "Populations like the Eskimos and Masai, who eat a high-fat diet but have no access to salt, just don't get high blood pressure. Their pressures are virtually the same at age 60 as they were at age 20." Populations like the New Guinea Highlanders and Yanomamo Indians of South America eat a low-fat, high-carbohydrate diet -- and no salt. In these groups, too, there's no sign of essential hypertension, notes Dr. Kenney. The Complete Book Of Alternative Nutrition by Selene Y Craig, page 151

Part of the answer is that putting people on low-salt diets has not had the extensive impact on reducing the health consequences of high blood pressure that scientists had expected. Healing With Vitamins by Alice Feinstein, page 299

That doesn't mean you should immediately suck on a salt shaker or pig out on pretzels, pickles, and potato chips. Many people with mild high blood pressure can indeed control their hypertension by restricting sodium intake. But if you don't suffer from high blood pressure, or if you are not salt sensitive, there is little reason to deprive yourself of some of life's little pleasures -- like a delicious cup of chicken soup and a saltine cracker. Graedons Best Medicine by Joe Graedon & Dr Terasa Graedon, page 57

For most people who are on the Reversal Diet, moderate salt won't raise blood pressure, according to Dr. Ornish. He says it's acceptable to use a small amount of salt when you're cooking dishes that could use a little lift. This can even help some people stick to a very low fat diet, Dr. Ornish notes, since a little salt can make a lean entree a lot more palatable. That's why many of the recipes in Dr. Ornish's books call for a small amount of salt. The Complete Book Of Alternative Nutrition by Selene Y Craig, page 131

Too much sodium can cause high blood pressure in salt-sensitive individuals. (Most people excrete excess salt in urine, however some people may retain salt and excess fluid. The body must work harder to pump excess fluid, resulting in a rise in blood pressure.) sodium is found in table salt and occurs naturally in food, and is often added to processed foods. The American Heart Association recommends that you limit your sodium intake to 2,400 milligrams daily. Earl Mindells Soy Miracle Earl Mindel RPH PHD, page 123

In the West, the connection between salt and hypertension has been convincing enough that many patients with high blood pressure have been forbidden to eat any but the smallest amounts of salt. This implied that salt was somehow an enemy. Now it is known that such restrictions were too severe -- normal person can eat all the salt he wants without harm to his blood pressure. Perfect Health by Deepak Chopra MD, page 238

Cutting sodium intake by half will lead to a drop of 5 points (or more) in blood pressure in about half the people with high blood pressure, according to Dr. Kaplan. New Foods For Healing by Selene Yeager, page 84

Salt is basically safe when used in modest amounts. Some people with salt-sensitive, high blood pressure must avoid it. As a factor in causing high blood pressure, it is implicated in heart disease, as well as in kidney disease. Though salt is safe, it is unwise to consume high-salt-content foods. Staying Healthy With Nutrition by Elson M Haas MD, page 80

Theories on salt sensitivity

You've probably heard that consuming too much sodium can raise your blood pressure. But you may not realize that consuming too little vitamin C, potassium, magnesium, or calcium can have the same effect. Blended Medicine by Michael Castleman, page 10

"Blood pressure control is no longer a single-nutrient issue," says David McCarron, M.D., director of the National Institute of Diabetes, Digestive and Kidney Disease clinical nutrition research unit at Oregon Health Sciences University in Portland. "For some people, salt may not be the real issue at all." The Complete Book of Alternative Nutrition by Selene Y Craig, page 376

Just as too much salt can raise blood pressure in some people, too little of certain minerals seems to be associated with an increase in blood pressure. Home Remedies What Works by Gale Maleskey and Brian Kaufman, page 271

Because they provide potassium and calcium, experts recommend figs for people with high blood pressure. Both minerals, in combination with eating less sodium, keep your blood pressure under control. Eat and Heal by the Editors of FC&A Medical Publishing, page 159

How do these nutrients regulate blood pressure? The exact mechanisms continue to evade researchers. But scientists suspect that they help the body slough off excess sodium and assist in controlling the workings of the vascular system. Everyday Health Tips by Prevention Magazine, page 70

No one really knows exactly how potassium lowers blood pressure, reports Frederick L. Brancati, M.D., assistant professor of medicine and epidemiology at Johns Hopkins, who led the study. One theory suggests that potassium relaxes small blood vessels, while another holds that it helps the body eliminate water and salt. Healing With Vitamins by Alice Feinstein, page 302

Like sodium and potassium, calcium and magnesium are bodily partners in the battle against high blood pressure. Some researchers even contend that calcium and magnesium are more important than sodium and potassium in controlling blood pressure. Calcium plays an important role in regulating heartbeat; magnesium helps to control how blood vessels dilate. Off The Shelf Natural Health How to Use Herbs and Nutrients to Stay Well by Mark Mayell, page 209

Potassium does a balancing act with sodium, which is one reason that it's so vital in maintaining proper blood pressure, Dr. Tobian explains. It works with sodium but also helps to keep it in check. During nerve transmission and muscle contraction, potassium and sodium briefly trade places across the cell membrane. Then they swap again, returning to their original positions ready for action. Natures Medicines by Gale Maleskey, page 277

The sodium-to-Potassium Ratio Just as important as the total potassium content of food, sodium and potassium should be consumed in the proper balance. Too much sodium in the diet can lead to disruption of this balance. Numerous studies have demonstrated that a low-potassium, high-sodium diet plays a major role in the development of cancer and cardiovascular disease (heart disease, high blood pressure, strokes, etc.) Conversely, a diet high in potassium and low in sodium is protective against these diseases and, in the case of high blood pressure, it can be therapeutic. Encyclopedia of Natural Medicine by Michael T Murray MD Joseph L Pizzorno ND, page 529

The body uses potassium to help eliminate excess sodium, which in large amounts can cause blood pressure to rise, says Dr. Webb. The more potassium you eat, the more sodium you lose -- and the lower your blood pressure is likely to be. This is particularly true in people who are sensitive to salt, he says. New Foods For Healing by Selene Yeager, page 56 Unfortunately, most people get too much sodium and barely enough potassium. This can raise your blood pressure and your potential for fluid retention, Dr. Young says. Natures Medicines by Gale Maleskey, page 659

Ideally, potassium intake should be greater than sodium intake and, considering that people in North America may consume as much as 18,000 mg. of sodium daily and as little as 1,500 mg. of potassium, it is easy to see that the great amount of sodium compared to potassium could have an adverse effect on blood pressure. Earl Mindell's Secret Remedies by Earl Mindell RPh PhD, page 160

Today, we've reversed the ratio, consuming much more sodium and a lot less potassium. We average 2,300 to 6,900 milligrams of sodium daily, and some people nibble on enough salty processed foods to boost sodium intake above 20,000 milligrams a day. We are the only nonmarine animal to eat diets so high in salt. Primitive cultures today, where people consume diets similar to our ancient ancestors' with ten times the potassium to sodium, have low blood pressure rates, almost no incidence of hypertension, and their blood pressures don't rise with age as ours do. The Origin Diet by Elizabeth Somer, page 51

Unbalanced sodium and potassium consumption. Those who can reduce their intake of sodium compounds, including table salt, while increasing their consumption of potassium are likely to reduce their high blood pressure. Off The Shelf Natural Health How to Use Herbs and Nutrients to Stay Well by Mark Mayell, page 190

The balance of potassium and sodium is extremely important to human health. Numerous studies have demonstrated that a diet low in potassium and high in sodium plays a major role in the development of cardiovascular disease (heart disease, high blood pressure, strokes) and cancer. Conversely, a diet high in potassium and low in sodium can help prevent these diseases; and in the case of high blood pressure, it can be therapeutic. Natural Alternatives To Drugs by Michael T Murray ND, page 112

In order to reduce blood pressure, sodium intake must be restricted while potassium intake is increased. Individuals with high blood pressure should be aware of "hidden" salt in processed foods. Although their salt intake is comparable, vegetarians generally have less hypertension and cardiovascular disease than non-vegetarians because their diet contains more potassium, complex carbohydrates, polyunsaturated fat, fiber, calcium, magnesium, and vitamins A and C. According to Dr. Cowden, regular consumption of potassium-rich fruits such as avocados, bananas, cantaloupe, honeydew melon, grapefruit, nectarines, oranges, and vegetables such as asparagus, broccoli, cabbage, cauliflower, green peas, potatoes, and squash can lower high blood pressure. Steaming rather than boiling vegetables helps prevent vital nutrient loss. Alternative Medicine by Burton Goldberg, page 777

Most blood pressure pills deplete body potassium, thus exacerbating the problem they are designed to solve. By eating three servings of potatoes, oranges, or bananas per day, you can lower sodium intake about ten percent and elevate potassium levels. Ancient Healing Secrets by Dian Dincin Buchman PHD, page 107

Excessive salt (sodium chloride) consumption, coupled with diminished dietary potassium, greatly stresses the kidney's ability to maintain proper fluid volume. As a result some people are "salt-sensitive", in that high salt intake increases blood pressure and/or water retention. Patients who experience more water retention during the mid-luteal phase may be especially sensitive to salt intake. However, it is simply not a matter of reducing salt intake, as potassium intake must be simultaneously increased. This is easily done by increasing the intake of high-potassium foods (i.e. fruits and vegetables) and decreasing high-sodium foods (most processed foods). Total daily sodium intake should be below 1,800 mg. Textbook of Natural Medicine Volumes 1-2 by Joseph E Pizzorno and Michael T Murray, page 1507

Potassium, especially in conjunction with a low sodium intake, helps keep your blood pressure under control. It also lessens your chances of having a stroke. Add all that fiber, which lowers your cholesterol and reduces your risk of heart disease and stroke, and you have a tiny but potent heart helper. Eat and Heal by the Editors of FC&A Medical Publishing, page 141

Magnesium helps maintain the potassium in the cells, but the sodium and potassium balance is as finely tuned as those of calcium and phosphorus or calcium and magnesium. Research has found that a high-sodium diet with low potassium intake influences vascular volume and tends to elevate the blood pressure. Then doctors may prescribe diuretics that can cause even more potassium loss, aggravating the underlying problems. The appropriate course is to shift to natural, potassium foods and away from high-salt foods, lose weight if needed, and follow an exercise program to improve cardiovascular tone and physical stamina. The natural diet high in fruits, vegetables, and whole grains is rich in potassium and low in sodium, helping to maintain normal blood pressure and sometimes lowering elevated blood pressure. Staying Healthy With Nutrition by Elson M Haas MD, page 176

One of the most powerful methods of producing less stress and more energy in the body is diaphragm breathing. A recent study has shed some light on the effect of breathing in hypertension.Volunteers with normal blood pressure were taught how to breath very shallow. Measurement of the amount of sodium and potassium excreted in the urine indicated that shallow breathing led to the retention of sodium in the body. It was suggested that this breathing pattern may play a causative role in some cases of hypertension due to the retention of sodium. Textbook of Natural Medicine Volumes 1-2 by Joseph E Pizzorno and Michael T Murray, page 1307

Opponents of the salt-sensitivity theory / Proponents of traditional view that excessive sodium intake leads to hypertension The first cure most people think of for high blood pressure is to cut down on salt. It may or may not work, depending on your individual biological makeup. Scientists have been arguing for years over the impact of salt on high blood pressure and the debate goes on. It's unlikely that salt is a major cause of high blood pressure, concluded a recent Harvard report. Still, Dr. William Castelli, director of the famed Framingham Heart Study, notes that in the few areas of the world where salt intake is low, high blood pressure is rare and does not rise with age as it does among Americans. Food Miracle Medicine by Jean Carper, page 92

If you have high blood pressure, the best way to reduce or eliminate your need for medication is by improving your diet, losing weight, exercising, and decreasing your salt and alcohol intake. Mild hypertension can be controlled by proper nutrition and exercise. If these measures do not lower your blood pressure enough and you need medication, hydrochlorothiazide, a water pill (see thi-azide diuretics, p. 100), is the drug of choice starting with a low dose of 12.5 milligrams daily. It also costs less than other blood pressure drugs. Worst Pills Best Pills by Sidney M Wolfe MD and Larry D Sasich PharmD MPH, page 144

Excess salt is known to be a cause of high blood pressure, ulcers and cancer of the stomach, edema, fear, cravings, kidney damage, diminished absorption of nutrients, and calcium deficiency, resulting in weakened bones, nerves, muscles, and heart. Early signs of excess salt intake are unusual thirst, dark urine and complexion, clenched teeth, and bloodshot eyes. Healing With Whole Foods by Paul Pitchford, page 164

No matter what its size, the "tank" of your circulatory system can become "overfilled." This can occur when a high-salt diet causes the body to retain excess water, so that the blood volume exceeds the amount the vessels can safely hold. The resulting "too full" tank can create excess pressure on the entire circulatory system. When the "tank" becomes too full or too small or both, the blood pressure rises. If the imbalance between the size of the tank and the volume that fills it becomes too extreme, hypertension results, and the life-giving pulsation of blood pressure turns into a relentless pummeling of blood vessels everywhere in the body. Healing Moves by Carol Krucoff and Mitchell Krucoff MD, page 210

Most processed foods contain sugar or salt. Although moderate amounts of either of these substances are not particularly harmful for most people, the amounts of sugar and salt in your everyday diet can add up quickly if your diet is composed primarily of packaged foods. People with high blood pressure need to be particularly cautious about their intake of salt, and may find that a diet of processed foods goes beyond the level of salt intake recommended by their doctors. Home Safe Home by Debra Lynn Dadd, page 226

If you have high blood pressure, cut down on your sodium intake by reading the labels on the foods you buy. Look for salt, sodium, or the chemical symbol Na. Vitamin Bible by Earl Mindell, page 92

Not all experts agree on the exact role of sodium, particularly sodium chloride. Some believe that only a quarter of those with high blood pressure are sensitive to sodium. But others, including Dr. Kenney, think that too much sodium is dangerous for everybody, especially when it's in combination with chloride, as in salt. The Complete Book Of Alternative Nutrition by Selene Y Craig, page 151

Cut way back on salt. It's well known that sodium -- found in table salt and many processed foods -- can damage the heart by raising blood pressure. Yet the average American still consumes 6,000 mg a day -- far more than the recommended 2,400 mg. Bottom Line Yearbook 2002 by Bottom Line Personnel, page 10

The resulting epidemic of high blood pressure should be no surprise. All this extra sodium can damage the kidneys. Your kidneys filter waste materials from your blood and control blood pressure. They need the right level of sodium to function well. Complete Guide Health Nutrition by Gary Null, page 13

Yes, we all need sodium, but most of us get too much. Too much sodium results in potassium deficiency and even more serious problems, such as stress, hypertension, muscular weakness and fatigue, liver damage, and pancreas disease. Of these, hypertension is the most dangerous and is in fact one of the leading killer diseases in our country today. One out of every ten Americans may be predisposed to high blood pressure, which is rearing its ugly head even in the lives of our children. Complete Guide Health Nutrition by Gary Null, page 497

Unless your blood pressure is very high, you may be able to control it with a low-salt diet, exercise, weight loss and other lifestyle factors. Try this approach before considering drug therapy. Bottom Line Yearbook 2004 by Bottom Line Personnel, page 25

Most people are aware that lowering sodium intake can help reduce blood pressure. It is by no means all that you can do, but it is nonetheless important. Sodium draws water into the blood vessels, and too much water in the artery can lead to too much pressure. Reducing salt intake is really quite easy, and we will go into that in more detail in chapter 9. Eat Right Live Longer by Neal Barnard MD, page 142

Too much salt at the expense of potassium results in high blood pressure. It also leads to edema and water retention, especially in women during the last half of their menstrual cycle. Excessive salt intake causes kidney stress, once again deregulating the body's natural alkaline-to-acid balance. Salt also disturbs digestion, and has been linked to stomach cancer. Food Swings by Barnet Meltzer MD, page 56

We know that anyone with hypertension (high blood pressure) should avoid salt. They should also avoid refined sugar. Animal studies suggest that high blood pressure may even lead to blood-sugar disorders. Get Healthy Now by Gary Null, page 31

Because sodium usually is in excess, potassium has a curative role. For example, if blood pressure is high because of excessive salt intake, one of the first remedies in Western allopathic medicine is to use potassium supplements while restricting salt. Healing With Whole Foods by Paul Pitchford, page 162

If you're sodium-savvy and watching your blood pressure, you already know to say no thanks to foods such as chips and salty pickles. Yet sodium appears in many foods in which you might not expect it. Baking soda and baking powder, for instance are both sodium bicarbonate. Dried fruit contains sodium sulfite, and ice cream often has sodium caseinate and sodium alginate. New Foods For Healing by Selene Yeager, page 83

Innumerable scientific studies have connected fat intake to heart disease and cancer, and sodium intake to high blood pressure. Nearly 3 million children between ages six and seventeen suffer from high blood pressure. Many children of the new millennium are overweight, hyperactive, and deficient in the nutrients they need to grow into healthy adults. Prescription For Dietary Wellness by Phyllis A Balch, page 247

The usual symptoms of high blood pressure are dizziness, headaches, and noises or ringing in the ears. Along with any remedy used for hypertension, the following regime is generally recommended: sufficient rest; regular exercise; abstinence from tobacco, coffee, and alcoholic beverages; a low-salt diet; minimization or, if possible, avoidance of stress-provoking situations; and control of the cholesterol count by correct diet or other means. Secrets of the Chinese Herbalists by Richard Lucas, page 196

High blood pressure is not an inevitable part of aging as often thought. There are some populations in which older people have the same blood pressure as the younger ones. Diet appears to be a big factor. Diets of these non-acculturated societies differ from acculturated societies -- containing less sodium, simple sugars and saturated fats (meat, butter, whole milk) and containing more complex carbohydrates, fibers and potassium. Exercise also plays an essential role since indigenous cultures tend to live a more rigorous and active lifestyle. Syndrome X and SX-Fraction by Mark Kaylor PhD and Ken Babal C.N., page 12

Determining whether or not you are salt sensitive Have your pressure taken again. You can do the opposite if you've been avoiding salt: Try two weeks of a diet that does include salt and see what effect, if any, it has on your blood pressure reading. Natural Prescriptions by Dr Robert M Giller, page 199

Sodium restriction "not a panacea" The researchers stated that "the higher the oats intake, the lower the blood pressure," regardless of other factors such as age and weight, or alcohol, sodium, or potassium intake, which are known to affect blood pressure. According to chief researcher Michael Klag, M.D., it is oatmeal's high content of water-soluble fiber (beta glu-can) that produces the heart benefits. A six-year study involving 22,000 middle-aged Finnish males showed that consuming as little as 3 g daily of soluble fiber (from the beta glucan fiber component of oats, barley, or rye) reduced the risk of death from heart disease by 27%. Alternative Medicine by Burton Goldberg, page 777

Not every one, therefore, should follow the recommendation of the American Heart Association and reduce their intake of salt. Everyone needs to have some salt in their diet, especially those with low blood pressure. When salt is restricted or eliminated from the diet, people tend to have more infections and bone disorders. Feed Your Body Right by Lendon H Smith MD, page 163

News Target
Originally published December 14 2005

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