Electrolyte minerals animate your cells. Are yours out of whack? 

 

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Executive Summary

• The human body relies on electrolyte minerals (e.g., sodium, chloride, potassium, magnesium) for muscle contractions, nerve impulses, acid-base balance, and hydration. 
• Deficiencies in minerals result in dysfunction, disease and even death. 
• Electrolytes balance each other and are balanced by other systems in the body. 
• Chronic excess consumption of any has the potential to cause harm. 
• Salt (sodium chloride) is an essential mineral; we must get it from the diet.
• Due to sodium’s role in hypertension, salt is the only essential nutrient that has been vilified. 
• We have a rich history with salt; it’s central to traditions and cultures across the world. 
• UK estimates equal about 8 grams of salt consumed daily.
• Ranges between 5.1 g/d in Samoa and 17.7 g/d in China.
• 75% of a developed country's salt consumption comes from processed foods. 
• In the UK, 61% comes from processed foods. 
• The Salt Wars have been raging for 120 years. 
• Scientists cannot agree on all the variables affecting blood pressure, so they single out sodium.
• Only a third of people’s blood pressure increases with their salt intake. 
• This is known as salt sensitivity.  
• Salt sensitivity is caused by potassium deficiency, obesity, insulin resistance, specific genes and kidney disease. Excessive fructose consumption also plays a role. 
• There is a J-shaped curve (a sweet spot) of salt consumption. 
• Many researchers using more accurate data-gathering techniques have found a sweet spot between about 4 and 6 g/d of sodium. That’s 10 - 15 grams of salt daily, twice the recommended amounts. 
• The causes of salt sensitivity are the real issue, not salt (within reason). 
• Reduce or eliminate junk foods to lower your chances of becoming salt-sensitive and increase your intake of nutrients, including potassium, which is essential for maintaining homeostasis by preventing or reversing salt sensitivity. 
• Reducing junk foods, especially sugar, reduces body fat %, improves kidney function, insulin resistance and helps manage ‘bad genes’. 
• Heavy sweaters (intense and endurance exercisers), low-carb and keto dieters, and people who make their meals from scratch may need to increase their salt intake and the other balancing minerals, especially potassium. 

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Introduction

Electrolytes, such as sodium, potassium, calcium, and magnesium, help generate and transmit electrical impulses throughout the body and brain. These impulses are essential for myriad cellular activities, including muscle contractions, nerve impulse transmission, acid-base balance, and hydration. Minerals must stay balanced. Salt (sodium chloride) is a life-giving mineral with a rich history intertwined with the story of us. For over 120 years, scientists have been fighting over salt’s role in human health based on the simple truth that retained sodium increases blood pressure. However, healthy people with balanced electrolyte minerals can efficiently excrete salt to maintain homeostasis. Obesity, kidney disease, insulin resistance and potassium deficiency can all induce a condition called salt sensitivity. About a third of people are salt-sensitive, meaning their blood levels increase with the amount they eat. Public health advice omits these nuances. Their advice is to reduce salt intake without knowing how much an individual consumes. Take control of your health by choosing nutrient-dense foods and using a balanced electrolyte supplement when appropriate. Read the full article to learn more.

 

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We are electrical beings.
Tiny electrical impulses spark communication signals throughout our bodies. Electrolyte minerals provide us with the ions that shoot between cells to animate us from head to toe. They regulate fluid balance, support nerve and muscle function, and help maintain acid-base balance. Without them, we would cease to be. One primary electrolyte mineral, sodium chloride, united as salt, has become infamous for its contribution to increasing blood pressure. Salt’s status as an essential nutrient has all but been forgotten, as health authorities tell the world to reduce, reduce, reduce. As always, public health advice has been simplified to its lowest common denominator, leaving people with the false notion that salt is toxic. But, as always, there are vital nuances for a health-seeking individual to grasp. 

Electrolyte 101

What are electrolytes?

Electrolytes are minerals that have an electrical charge.

They include sodium, potassium, chloride, calcium, magnesium, phosphate, and bicarbonate. This article will cover sodium, chloride, potassium, calcium and magnesium. Electrolyte minerals transmit messages through our complex nervous systems. Muscle contractions and relaxations, including our beating hearts and the ebb and flow of blood, require electrical signals. That’s why electric shocks tense our muscles and can make our heart stop or restart. When athletes become depleted in electrolytes, their legs stop working. Water moving in and out of our cells depends on these tiny electrical signals facilitated by those electrolyte minerals. This makes hydration much more complex than just the amount of liquids we drink. Hydration is the story of electrolyte mineral and water balance. If you miss this notion, you can run short of electrolytes when you need them the most. Electrolytes are essential to run your electric body.

Sodium

At the heart of any article on electrolytes will be salt, this one included. Ninety per cent of our sodium comes from salt, which is why the two words have almost become synonymous.[1] Sodium is the most abundant mineral outside of our cells. Without sufficient blood sodium levels, brain cells begin to swell with water. The pressure inside the skull builds, becoming a headache. Nausea sweeps through the body. Without adding sodium, the cells begin to balloon. The afflicted starts to vomit. They become confused before collapsing. If their sodium levels are not increased quickly, they’ll drop into a coma and maybe even die. People die like this every year. Ignorance and fear push them towards the precise thing they’re trying to avoid. People might over-hydrate like this before and during a marathon, often on a sweltering day when their anxiety about dehydration peaks.[2] The irony is that they mistake the early symptoms of overhydration for dehydration and do the opposite of what they should; they drink more water. They’re suffering from hyponatremia, low sodium, a condition that comes about with disease or by drinking too much water in a short space of time, thereby lowering the blood levels of sodium beyond a safe level. Simple equations applied to us all, black-and-white guidelines, underlying conditions and fear have combined to make sodium, from salt, public enemy number one. 

Chloride

Chloride works hard to balance sodium, potassium and water within our cells, making it a major player in hydration. Approximately 75% to 80% of our dietary chloride intake comes from salt, particularly in Western countries.[3] This often-forgotten electrolyte mineral helps to keep acid-base balance in our blood. In this role, chloride helps transport carbon dioxide through the blood for exhalation by the lungs. Chloride synthesises stomach acid, an essential first-line defence system and critical digestive cog. Similar to the other electrolytes, chloride also plays a part in nerve impulse transmission and muscle contraction.[4] A deficiency in chloride is rare, usually only seen during prolonged illnesses. It brings about fatigue, muscle cramps, cognitive issues, and difficulties with digestion and breathing before culminating in serious cardiovascular events.[5] Babies became seriously underweight and ill because of a chloride deficiency.[6] 

Potassium

Potassium is the most abundant mineral inside our cells, involved in over 600 enzymatic reactions.[7] Without sufficient potassium, muscles begin to weaken and cramp. Heartbeats become irregular and frightening, something called arrhythmia. Fatigue sweeps through the body as it runs out of this electrical substrate. High blood pressure manifests and can become dangerous. Gut muscle contractions slow, and constipation results. Severe potassium deficiency, known as hypokalaemia, eventually leads to paralysis and, if left untreated, to cardiac arrest. Good whole food sources include green leafy veg, salmon, avocado, dairy milk (not the chocolate!), potatoes, bananas, mushrooms, halibut, tuna, shellfish, squash and others. 

Magnesium

Without sufficient magnesium, myriad symptoms arise.
Runner up to potassium, magnesium is the second most abundant mineral inside our cells. Magnesium is involved in over 600 enzymatic reactions and counting.[8] A mild deficiency can trigger minute muscle ticks, fatigue and headaches, to name a few.[9] As a deficiency worsens, symptom severity increases. Ticks become cramps; fatigue becomes debilitating; headaches become splitting, ushering in crushing anxiety, insomnia, and emotions that roller coaster up and down at random. Chronic stress, often normalised these days, drains people of their magnesium, trapping them in a vicious cycle of using more at the same time as needing more.[10] If we don’t get bogged down with the bioavailability issues, good sources include nuts, seeds, legumes, green leafy vegetables, yoghurt, halibut, salmon and other whole foods.  

Calcium

Calcium plays critical roles both inside and outside of cells.
Without sufficient calcium, symptoms similar to magnesium deficiency start cropping up. Muscle cramps, tingling in the fingers and lethargy can go unnoticed, ignored or covered with cups of sugary coffee. As the deficiency progresses, symptoms become more pronounced, leading to muscle spasms, difficulty swallowing, and heart palpitations. Chronic calcium deficiency eats away at bones and teeth as the body seizes it from those places to more immediately life-threatening areas, including the heart, brain and nervous system.[11] Irritability, depression, confusion, and abnormal heart rhythms begin to manifest. When it comes to electrolyte minerals, balance is life. Good sources include all dairy products, canned fish with bones, leafy green vegetables, nuts, seeds and other whole foods.

The delicate interplay between electrolyte minerals

The body is constantly seeking homeostasis, the scientific term for balance.
Our amazing bodies endlessly monitor our systems and adjust to keep everything in homeostasis. Minerals are instrumental to achieving this balance but must themselves be in balance. In other words, you can’t just take loads of one or two minerals without upsetting the equilibrium of the others, like worsening the sound quality when amping up a single frequency on a '90s Hi-Fi system. Eating natural whole foods alone makes reaching harmful levels of minerals almost impossible, but supplements need a little know-how and, therefore, come with directions. In theory, if you consume too many electrolyte minerals, which dissolve in water, your kidneys can remove them in urine, provided you're well-hydrated and don't have any health conditions that could hinder this process. In reality, the chronic excessive consumption of any electrolyte upsets the delicate mineral balance and can potentially cause harm.

For example, high sodium intake can lead to potassium depletion and vice versa. Excess magnesium can decrease calcium levels.[12] The reverse is also true.[13] High sodium levels can also increase the excretion of calcium.[14] Potassium can shield calcium from excess sodium.[15] Low magnesium levels also drag potassium levels down with them.[16] Sodium and chloride (salt) work closely to balance minerals and water. The point is minerals are constantly jockeying with each other as the body tries to maintain homeostasis.

Doctors received a stark reminder of this balancing act after a new enteral (tube feeding) nutrition product turned out to be deficient in chloride. Unaware, doctors gave 59 severely disabled patients the new enteral food product. After about eight weeks, patients became deficient in not only chloride but also sodium and potassium, despite them being within the product.[17]

Now, let’s take a deep dive into salt.

 

Salt & the real issue

‘Salt is one of the cornerstones on which the mammalian biochemical structure is built. Total exclusion of salt from the diet leads to disaster, namely death. Still, salt is considered by some authorities to be toxic on a level comparable with alcohol and tobacco. Why is salt the only essential component of mammals to have obtained this unattractive status?’ [18]

Niels Graudal MD; Salt Research Scientist.

 Salt’s appeal as a condiment is its ability to cancel out bitterness whilst simultaneously allowing sweet and sour flavours to pop. By decreasing water activity, salt concentrates flavour and heightens our pleasure from food.  People added salt to their food at least 40,000 years ago and have used it to ferment plants and preserve meat ever since.[19] In China, 8000 years ago, salt farmers would scoop it from shallow pools at the end of a sunny day before it trundled off across the vast countryside.[20] Salt mining is an ancient industry, the oldest mine yet discovered, in Hallstatt, Austria, dates back 6000 years.[21] Salted and fermented seafood and meat were favourites among the Ancient Egyptians, immortalised along with the Pharaohs in their tomb murals.[22] Roman legionaries spent a part of their salaries on salt. Indeed, the Latin word for salt is ‘sal’, the root of the word salary.[23] Pliny the Elder, an ancient Roman author, remarked that ‘Civilised life cannot proceed without salt: it is so necessary an ingredient that it has become a metaphor for intense mental pleasure.’[24] The Romans were not unique; salt and their famous salty fermented fish sauce, Garum, were traded all over the ancient world.[25] In Venice, a busy port between the 14th and 16th centuries, 30-60% of the import cargo was salt.[26] Certainly, salt has been a sought-after commodity, like sugar, but it has a life-giving role to play. 

How much salt did we eat?

There is a current trend to look back at what pre-humans ate during their evolution towards becoming modern humans about 300,000 years ago. The idea is that those things we ate in abundance all those millennia ago are an excellent evolutionary fit for us today, which makes sense. For example, there are vast amounts of archaeological data showing that red meat, indeed anything that moved large and small, fell foul of our ancestors' flinty attacks and made up a large proportion of their diets.[27] However, whether they ate salt similarly is infinitely more challenging to prove. Two researchers attempted to work out how much sodium our Palaeolithic ancestors ate.

The paper, published in the New England Journal of Medicine back in 1985, stated that ancient humans between 2 million years ago and 10,000 years ago ate about 700 mg of sodium per day.[28]

That’s about 1780 mg of salt, or about a third of a teaspoon of typical table salt. That’s low compared to today. James DiNicolantonio, a cardiovascular research scientist, writes about where the researchers' palaeolithic estimates went wrong in his book ‘The Salt Fix: Why the Experts Got it All Wrong and How Eating More Might Save Your Life’.[29] They calculated this low number using only muscle meat from land animals and certain plants, DiNicolantonio explains. They missed all of the aquatic animals.[30] Shellfish are very high in sodium[31], and our early ancestors ate a lot of them if the piles of archaeological evidence still in existence are anything to go by.[32] Other food sources, especially organs and blood, were also omitted in their calculations. Meat only contains a little sodium, but blood is an excellent source. To this day, the Maasai tribe in Kenya drink their cattle’s blood. Perhaps this sacred and completely normalised tribal tradition began as a salt-seeking behaviour.[33]

However, a look at existing hunter-gatherers shows a relatively low intake of salt, with the Yanomamo Indians (Brazil) eating just 0.1 grams daily—if this is accurate, that means they’re not consuming enough sodium to live—compared to the Alaskan Eskimos at the other end of the scale eating 3.91 grams daily.[34] Across groups, the average is just 1000 mg of sodium per day.

There is isotopic evidence of an increase in salt consumption during ancient Greece and Roman times, but whether this affected their health is impossible to prove.[35] In Mark Kurlansky’s best-seller, Salt: A World History, he writes, ‘The salt intake of Europeans, much of it in the form of salted fish, rose from forty grams a day per person in the sixteenth century to seventy grams in the eighteenth century’ (emphasis added).[36] In The Salt Fix, DiNicolantonio makes the case that heart disease was virtually unheard of until the early 20th century, yet people were eating much more salt.[37] While hunting high and low during the research for this article, we didn't find any supporting evidence to equal this kind of salt intake and asked Kurlansky’s publisher for their source. We’re waiting for a response. Suffice it to say we don’t know how much salt our ancestors ate, and from an evolutionary standpoint, what they ate a few hundred or even a few thousand years ago makes no difference to us.

How much salt are we eating nowadays?

Today, in the UK, we eat between about 7 and 8 grams of salt daily, depending on the data you look at.[38] That’s between 1.2 and 1.4 teaspoons. Globally, the range of salt eating is broad, ranging from 5.1 grams per day in Samoa to 17.7 in China.[39] There are accuracy issues with this data because estimates are dependent on substantial observational studies that use food frequency questionnaires (FFQs).[40] People receive an FFQ through the post and tick boxes about their diet and lifestyle.[41] But our memories are deeply flawed; we forget the fudge sundae we ate five minutes ago, exaggerate, and lie all the time, often without knowing it.[42] These perfectly normal human behaviours would suggest that recorded intakes are probably lower than actual consumption because we underreport the processed foods we eat.[43] In developed countries, 75% of salt consumption comes from packaged processed foods, we add 15% at home during cooking, and 10% is the natural sodium content in foods.[44] In the UK, we get 61% of our salt from processed foods (see the pie chart below).

Any discussion about excessive salt consumption should focus on packaged processed foods. Cereal and cereal products add the most salt to the Great British diet, with bread leading the way.[46] Surprised?

Suppose someone is eating 8 grams of salt per day. In that case, 61% comes from processed foods, 21% of the sodium is present in the food, and 18% of the salt is added during cooking or at the table (discretionary salt). It’s not hard to think of an effective intervention to lower their salt intake. If they stop eating processed foods, that number drops to a smidge over 3 grams of salt per day; 1.3 grams of sodium. In reality, those numbers don’t work like that because eliminated processed meals will be replaced with something else with natural sodium and discretionary salt added at a rate of approximately 21% and 18%, respectively. But, the point is if people really are overeating salt, which is highly individualised and contentious, they can quickly lower it by kicking processed foods to the curb. We’ll discuss who might need to eat more salt later in the article.

The problem with public health advice

Health authorities around the globe advise we all keep our sodium between 1.5 - 2.3 grams per day. That’s about four to six grams of salt; six is about a teaspoon. [47] That’s a 53% difference in range. This lack of consensus tells us that a sweet spot still eludes us, at least from the perspective of public health advice. H.L. Mencken, an American journalist in the early 20th century, well-known for his sharp wit and scathing social commentary, said, ‘For every complex problem, there is an answer that is clear, simple, and wrong.’ The statement, ‘salt increases blood pressure,’ is beautifully clear and simple. It’s also wrong. Salt only increases blood pressure in salt-sensitive people. This message is central to this article. But, when it comes to public health messaging, you can forget nuances of any kind. Directions to the masses have to be black and white. Grey areas are confusing, and confused people stop doing as they’re told. Eat less; move more. Salt is bad; lower it.

Why are we so frightened of salt?

Why has salt obtained an ‘unattractive status’?
After all, our blood, sweat and tears are full of salt. Without salt, we sicken and die. In healthy people, about 0.4% of their weight is salt. That means the average person carries around 43 teaspoons of salt mainly in their blood.[48] Salt has an unattractive status because of sodium's controversial role in hypertension. Higher levels of retained sodium in the blood pull more water into the circulatory system, increasing its volume and, therefore, the pressure.[49] Hypertension, commonly known as high blood pressure, is a chronic medical condition where the force exerted by blood against artery walls is consistently too high. This condition can lead to serious health issues, including heart disease, stroke, and kidney problems. Blood pressure is measured in millimetres of mercury (mmHg) and appears as two numbers: systolic pressure (the first number) over diastolic pressure. A normal blood pressure reading is within this range of 120 - 90 / 80 - 60.[50] Deeply rooted in our collective consciousness is the link between salt consumption and elevated blood pressure, leading to frightening diseases.
Hypertension is a primary component of cardiovascular disease and, as such, is the leading cause of preventable deaths.[51] ‘Preventable’ because drug and lifestyle interventions are available to lower blood pressure. Between 1990 - 2019 global rates of hypertension have doubled.[52] However, in the UK, hypertension has dropped steadily since 1975, making it the least affected country in Europe and 195th out of 200 countries assessed in 2015.[53] Using the same ranking data, the countries with the highest prevalence of hypertension, starting with the leader and descending, are Croatia, Latvia, Lithuania, Hungary, Slovenia, Romania, Poland, Czech Republic, Montenegro and Slovakia. That makes Eastern Europe the global hub of hypertension. Have a look at the chart below: 

Notice that 6/10 of the countries (in red on the chart) that consume the most salt are also in the Top 10 Hypertension column. These rankings aren’t proof of anything because the studies used to gather these data simply can’t show a single dietary factor as causative, not even close, but this aligns nicely with the belief that salt drives hypertension. A quick look at the smoking rates in each of the Top 10 Hypertension countries is revealing…[57] The Chinese consume the most salt per day and are 181st out of 200 on the hypertension chart. There must be more to the story.

Niels Graudal MD, a salt research scientist, quoted at the beginning of this Salt section, reminds us how odd it is to label an essential mineral as toxic. But it’s vital to remember that anything becomes toxic beyond a certain level. When did it all start?

When did we all become so scared of salt?

You may not know, but a war has raged for 120 years.
In 1904, the Salt Wars started after two French scientists theorised that salt raises blood pressure. Ambard and Beauchard showed an association between salt consumption and raised blood pressure in six patients.[58] A few years later, a German scientist contradicted those results with his own.[59] Over the next few decades, two armies of scientists faced off, each side slinging research of various quality. The sceptics, unwilling to be wooed by the simplicity of the idea and demanding more proof that the body is incapable of balancing its blood salt levels, against the supporters, those who believed the theory to be sound science because of the observational data and because it made sense to them.

Just before the debacle of the US Dietary Goals (1977), two scientists, George R. Meneely and Harold D. Battarbee from the Louisiana State University Medical Center, published a paper entitled ‘High sodium-low potassium environment and hypertension’.[60] They were supporters of the salt raises blood pressure hypothesis but had added some complexity, saying the real issue was a combination of high salt, specific genetics and low potassium levels. At the time, nutrition was a hot topic, and newspapers and magazines often featured the world’s first governmental dietary guidelines on the front pages. Meneely and Battarbee’s nuanced approach didn’t translate well into headlines, so the media ran with something akin to Salt Causes Hypertension! Even that could have been forgiven, but governmental advice did precisely the same. That year, the dietary advice from the US government, which echoed across the world, was that all Americans should restrict their salt intake to 3 grams of salt (1.2 grams of sodium) per day.[61] Accepting that this number was too low, the committee revised it to 5 grams of salt per day, which is about 2 grams of sodium.[62] After seeing the government’s advice to reduce dietary salt, the American Medical Association (AMA) publicly stated, ‘[the committee] fail to support the hypothesis that salt consumption is a major factor in causing hypertension’. However, the US Dietary Goals, which became the US Dietary Guidelines (1980), had too much inertia.

In 1991, researchers published the first review of low salt trials. Sixty-eight trials, 10 of which were randomised, found that by reducing salt by about 3 grams per day, individuals aged 50-59 could decrease their blood pressure by an average of 5/3 mm Hg (systolic/diastolic) or by 7 mm Hg in those with hypertension.[63] The authors decided that if everyone could reduce their salt consumption by 3 grams per day, they could reduce stroke incidence by 22% and ischemic heart disease by 16%. And, by reducing it further, 75,000 lives per year in Britain could be saved. Impressive projections. However, in true Salt Wars style, more published research cast doubt on those data.

Gradual and two other researchers included only data from randomised trials to raise the standard of the research used for their systematic review and meta-analysis.[64] The 58 RCTs assessed could not match the results from the 1991 review mentioned above. In patients with hypertension, a low-sodium diet reduced their blood pressure by