SODIUM: How Much Do We Really Need?

Many of us have been told that too much salt is not good for us, kind of like how we’ve been told saturated fat isn’t good for us (but that’s a topic for another day). Well, I’m here to let you know that much of what you’ve heard about sodium isn’t quite true for a lot of us. If you’ve ever talked to anyone in the health world, you know that as with most things the answer to, “How much sodium do I need?” is, “It depends” on the situation and the individual. 

Most people have a serious NEED for salt. Our bodies can’t survive without it. Salt (sodium) is an electrolyte that helps with proper hydration. We need a proper electrolyte balance to keep your heart pumping and our cells communicating. Other things sodium helps us with:

• Regulates fluid levels to maintain the correct plasma volume in your blood

• Keeps your brain functioning - moving your muscles on command and thinking straight 

• Also helps support normal stomach acid levels for better digestion in your stomach

Some Background Information Behind the “Reduce Your Sodium Intake” Advice: 

There has been a push by health agencies all over the world to encourage people to reduce their sodium intake. This is because many people ingest a lot of salt. It didn’t take health professionals very long to notice two things: there is an increase in the incidence of chronic diseases and there is also an increase in the amount of sodium people are ingesting.

This has led government and health agencies to issue guidance about appropriate levels of sodium with the goal of reducing overall sodium intake. According to Dietary Guidelines for Americans published by the Department of Health and Human Services (HHS) and the US Department of Agriculture (USDA), we should ingest 2300mg (2.3g) or less sodium per day- about 6g of table salt (table salt is roughly 50% sodium by weight). The World Health Organization recommends 2g or less, the American Heart Association recommends 2.5g as a maximum but says 1.5g is ideal.

The rationale behind these numbers is simply that people eat too much salt and that leads to a variety of health problems- bloating, spikes in blood pressure, eventually leading to damage to your cardiovascular system (hypertension, stroke, coronary heart attacks, cardiovascular disease). However, many of the studies looking at the relationship between high blood pressure and high sodium intake are not conclusive. A recent study (Ameri J Hypertens, 2015) has concluded that salt intake had a “statistically insignificant” impact on blood pressure levels in individuals without pre-existing hypertension. Another analysis by the National Health and Nutrition Examination Survey found “no link between sodium intake and blood pressure”.

Many of the symptoms blamed on high sodium could be the result of overeating in one sitting, consumption of excessive calories, hyperinsulinemia, too much or too little potassium intake, or lack of proper hydration. All of these factors can contribute to sodium retention. 

In America, 70-80% of sodium intake comes from processed foods and restaurants (fast food). Salt acts as a preservative, preventing harmful bacteria from growing so foods become shelf-stable. Salt is also a flavor enhancer-it makes food taste more like itself- which has led to criticisms that heavily salted foods can lead to overeating. Many highly processed foods happen to be loaded with salt. Many are also loaded with refined carbohydrates, sugars, and fats.  

The correlation between high sodium and high incidence of chronic diseases could also be explained by observing that a poor overall diet-one high in highly processed foods, high in calories, and low in nutrient density-will almost always be high in sodium. So sodium levels could be an indicator of diet quality. In fact, the dietary recommendations for reducing sodium intake sound familiar, because they are similar to every other dietary recommendation meant to curb chronic diseases (cardiovascular disease, hyperinsulinemia, Type II Diabetes, etc.)-which includes portion control, limiting processed foods and refined carbohydrates, eating more fresh fruits and vegetables, low-fat dairy and lean meats. So in this case, reducing processed/packaged foods that are hyper-palatable, is actually a good thing to reduce overconsumption of food in general, and consuming poor quality foods/ingredients that are harmful to our health.

For the majority of our population, too low of salt intake will actually seriously harm us by leading to many of the same conditions blamed on high sodium-increased blood pressure, increased risk of heart disease and heart failure, increased insulin resistance, increased levels of LDL cholesterol and triglycerides, as well as increased risk plaques and blockages in the arteries. Too low sodium can cause hyponatremia- a condition where sodium levels in the blood drop to dangerously low levels and can cause brain fog, nausea, and loss of balance. Severe cases result in kidney failure, liver failure, and heart failure. Hypernatremia caused by profuse sweating and drinking too much water (without replacing electrolytes) in an attempt to prevent dehydration is the most common reason visitors to the Grand Canyon end up needing medical attention. 

Many people fear too much salt causes bloating or water retention. It can, but that usually happens if you’re also eating a fair amount of sugar or carbs too. The body converts the carbs into glycogen, which requires a lot of water. It can also spike insulin, which can cause sodium retention. This is why real and whole foods are so important - to maintain healthy blood sugar and sodium balance. 

So how much sodium is optimal? 

It depends on your activity levels, the current state of health, what kind of macro percentages you eat, and if you have specific symptoms. 

Some guidelines for how much sodium intake is optimal: according to Robb Wolf and his studies and research on the subject, he recommends this:

• Average person with mixed diet and some movement: 4-5g’s of sodium per day

• Those living in hotter or more humid environments, or highly active and/or low carb: could be more like 8-10g/day

Out of all the electrolytes, sodium tends to be the hardest one to get enough in, if you're not paying attention. Other electrolytes to consider, but tend to be addressed via a whole foods diet are magnesium, potassium, calcium, phosphate, and chloride. If you ingest salt, you will get your sodium and your chloride, since salt is sodium chloride. It is common to find people with magnesium deficiencies who are also deficient in sodium, so supplementing with a chelated form of magnesium such as magnesium glycinate can be helpful. 

So, who is salt especially good for?

Most people who tend to need more salt will fall in one or more of these categories:

• People who don’t get enough sodium might show symptoms that could be misinterpreted for illnesses. The most common symptoms are: feeling run down, achy, experience frequent muscle cramping, sit-to-stand lightheadedness, problems falling asleep or staying asleep**, and even HPA axis dysregulation (or “adrenal fatigue/dysregulation) symptoms

• Additional symptoms where sodium deficiency can be at play are anxiety, flu-like symptoms, digestive issues, confusion or brain fog, joint pain, and dizziness.

• You're eating a higher fat, lower carb diet*

• Athletes, especially those who sweat a lot, or are in humid or hot environments. The powerlifter/bodybuilder Stan Efferding calls salt one of the most potent performance enhancers in the world due to its positive effects on muscle contraction and helping athletic populations stay properly hydrated. 

• Many pregnant women, as sodium needs to go up during pregnancy

• If you show symptoms of low magnesium (crave chocolate a lot, PMS symptoms, headaches, poor recovery from exercise) - when we are low in sodium, our body secretes more magnesium. 

*When you reduce carbohydrate intake, insulin levels drop. This reduces the hormone aldosterone, which causes the kidneys to excrete sodium at a higher rate. This leaves us needing more sodium to maintain electrolyte balance and proper hydration. 

**"Subjects on low-sodium diets (around 500 milligrams a day) woke up during the night almost twice as often and got about 10 percent less sleep than those on a normal diet (2,000 milligrams of sodium a day). A high-sodium diet (5,000 milligrams a day) led to even longer sleep than the normal diet with fewer nighttime wakings." (study explained https://draxe.com/nutrition/pink-himalayan-salt/)

Who extra salt may not be good for:

• A small percentage of people (various estimates say 5-25% of the population) who are salt sensitive - “sodium hyper responders” or have metabolic syndrome, had historically had an issue with chronic high blood pressure (who actually may benefit from a lower-carb diet, in which you still need a certain level of sodium) - Even when those who have been put on a low sodium diet though, it hasn’t helped balance blood pressure very much, according to recent studies. 

• Those with impaired kidney function.

Take away:

• Unless you have been diagnosed with hypersensitivity to salt (sodium hyper-responder), have renal/kidney disease or malfunctioning of any kind, or are under the care of a physician for relative issues, you can feel free to salt your food to taste, or add a pinch to your water or drinks - sea salt, or at least one that has not had the beneficial minerals are taken out of it (Like table salt). My favorite is Redmond’s Real Salt for everyday use.

• Consider electrolyte supplements like Nuun or LMNT - ones without a load of added sugar or fake sugar. LMNT has the highest amounts and best quality ingredients (in my opinion). 

• Foods like olives, salami, soup/bouillon cubes are also great ways to get more salt in.

• If you eat a lower-carb diet, or sweat more in a day, or experience any of those listed symptoms consistently, consider upping your sodium levels past 5g - or at least experiment with it.

• If you do have high blood pressure and are wondering if you can increase sodium, of course, consult with your doctor, but you can also watch this video for a better idea on the subject: https://robbwolf.com/2019/02/27/is-there-a-thing-as-too-much-sodium/

If you want more information on the studies surrounding this subject, please check out these resources:

https://drinklmnt.com/pages/the-science
https://lilynicholsrdn.com/top-5-myths-about-salt/
https://drruscio.com/health-benefits-of-salt/
https://robbwolf.com/2019/02/27/is-there-a-thing-as-too-much-sodium/
https://robbwolf.com/2019/07/30/electrolyte-imbalance-symptoms-how-to-fix-it/
https://chriskresser.com/shaking-up-the-salt-myth-healthy-salt-recommendations/
https://lilynicholsrdn.com/salt-baby-food-infant-sodium-requirements/

Written By: Emily Rodela