Don’t add too much salt to your food, its bad for you.  Everyone knows this right? Or have we all been misled?

When on a salt restricted diet, the body will use insulin as a tool for preserving and using the sodium it does have. Below I give an overview of a few studies that support the notion that low salt diets can have a negative impact on insulin sensitivity and early death.

In one single-blind crossover trial done on 147 non-obese normotensive subjects aged 19-78 years were randomly assigned to a low salt diet of 20mmol or a high salt diet of 300mmol sodium per day for 7 days each. With dietary salt restriction, serum total- and LDL-cholesterol as well as serum insulin and uric acid concentrations increased significantly. Short-term sodium restriction in normotensive (normal blood pressure) adults had unfavorable effects on lipid and glucose metabolism.

Further studies are needed to determine the effects of more moderate salt reduction for longer periods on the risk factor profile for cardiovascular disease before a low salt diet can be regarded as a safe public health measure for the general population (Ruppert et al. 1991).

Another study looked at a low sat diet and its effect on insulin resistance.  151 healthy individuals were studied after 7 days of a low sat diet (urine sodium <20mmol/day) and 7 days of a high salt diet in a random order.  Insulin resistance was measured after each diet and compared statistically.  Subjects were 39+/-12.5 years, BMI 25.3+/-4.0kg/m2.  HOMA = (plasma glucose (mmol/L)×plasma insulin (µU/mL))/22.5 was used to measure insulin sensitivity. Mean HOMA was significantly higher in the low salt group (2.8 +/- 1.6 vs 2.4 +/-1.7:P<0.01), the low salt group became more insulin resistant than the high salt group.

Aldosterone and norepinephrine were also elevated which may contribute to an increase in insulin resistance on a low salt diet. Angiotensin II levels were also higher on a low salt diet which has been shown interfere in insulin signaling pathways (Garg et al. 2010).

An article in the New England Journal of Medicine studied the sodium levels of 101,945 people from 17 countries.  The scientists examined the association between sodium excretion and the outcome of death and major cardiovascular events over a mean follow up of 3.7 years.  Sodium excretion correlates directly with sodium ingestion.

Authors found that participants with the lowest sodium excretion (less than 3 grams of sodium per day or ½ teaspoon of salt) had the highest rate of death or cardiovascular events – 4.3%.

Participants who excreted 3-4 grams per day (just over ½ teaspoon of salt) had cardiovascular incident rate 28% lower than the lowest salt-ingesting group.

Participants who ingested the most sodium (>7g per day or over 1 teaspoon of salt) had a 24% lower death or cardiovascular group when compared to the lowest group (O’donnell et at. 2014).

Too low of sodium intake may prove to be associated with insulin resistance, elevated triglycerides and cholesterol, increased rate of death or cardiovascular events.  4.5g/day of sodium ~ 5 teaspoons of pink Himalayan sea salt is a good ballpark to be in if you want to avoid the negative effects of a salt restricted diet. If you are an athlete, who trains intensely and sweats a lot, you will want to consume more salt to replace what is lost during exercise.

If you are consuming a low sodium diet and increase your sodium intake you will likely see a temporary increase in water retention and weight gain, your body will acclimate to the increased sodium intake over time.  One could also gradually increase sodium intake overtime to avoid the temporary water retention and weight gain that can occur from rapid sodium increases.

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Garg, R., Williams, G. H., Hurwitz, S., Brown, N. J., Hopkins, P. N., & Adler, G. K. (2011). Low Salt Diet Increases Insulin Resistance in Healthy Subjects. Metabolism: Clinical and Experimental, 60(7), 965–968. http://doi.org/10.1016/j.metabol.2010.09.005

O’Donnell, M., Mente, A., Mente, S., McQueen, M., Wang, X., Liu, L., . . . Yusuf, S. (2014). Urinary sodium and potassium excretion, mortality, and cardiovascular events. [Abstract]. N Engl J Med, 25(371), 1267th ser., 612-623. doi:10.1056/NEJMoa1311889

Ruppert, M., Diehl, J., Kolloch, R., Overlack, A., Kraft, K., Gobel, B., . . . Stumpke, K. (1991). Short-term dietary sodium restriction increases serum lipids and insulin in salt-sensitive and salt-resistant normotensive adults. [Abstract]. Klin Wochenschr., 69(1991), 25th ser. Retrieved July 24, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/1921253.