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44 Serious Disorders Caused by Salt Deficiency

The long-standing recommendation to restrict salt intake for people with high blood pressure, heart disease, or diabetes has been mainstreamed for two generations. But no one was told that reducing salt damages the stomach, colon, kidneys, heart, brain, muscles, bones, joints, and mental health faster than alcohol damages the liver or smoking destroys the lungs.

This publication identifies 44 entirely avoidable but otherwise life-altering serious disorders caused directly by a low-salt diet and/or deficiency. And they’re just the tip of the iceberg, considering the cascade of treatments, medications, and side effects that follow.

The most maddening thing about it is that numerous researchers with strong academic credentials have rebutted the link between dietary salt and hypertension, and their findings have been published in leading peer-reviewed medical journals for quite some time.

Adding insult to injury, the effect of low-salt diets on high blood pressure was less than a 1% reduction after evaluating 23 clinical trials (#3 below). In practical terms, it means that if your blood pressure was 160/90, on a low-salt diet, it has changed to 158/89, a totally irrelevant difference.

And that's even before mentioning that "BP measurement is often suboptimally performed in clinical practice, which can lead to errors that inappropriately alter management decisions in 20% to 45% of cases."

Wrap your head around it — up to 45% of patients may be diagnosed with hypertension and prescribed medication simply because their blood pressure wasn't measured properly. And this quote didn't come from a fringe conspiracy lunatic, but from the venerable American Medical Association in the article titled 4 big ways BP measurement goes wrong, and how to tackle them.

The Truth Is There for Anyone Who Wants to Know

Here are five examples of academic publications that refute the effectiveness of low-salt diets and highlight their possible harms. I added my commentaries and "translations" into plain English from academic jargon where necessary:

  1. Alderman MH. "Dietary sodium and cardiovascular disease: the 'J'-shaped relation." Journal of Hypertension. 2007;25(5):903-907. JAMA Network

    "Skeptics argue that modification of this single surrogate end point does not guarantee a health benefit as measured by morbidity or mortality [Improving blood pressure has no effect on health outcomes — KM]. Instead, they note that salt restriction capable of reducing blood pressure also unfavorably affects other cardiovascular disease surrogates. [Salt restriction may improve blood pressure but worsen lipid profiles, insulin resistance, or hormone balance, and doesn't reduce mortality — KM].

    In medical research and clinical trials, the term "surrogate endpoint" is a substitute measure used to see how well a treatment works. In this particular case, a surrogate endpoint meant that researchers used blood pressure readings to predict the risk of heart disease, rather than waiting to see if someone actually develops it (morbidity) or dies from it (mortality).

    Dr. Michael H. Alderman is a Professor Emeritus of Medicine and Population Health, Albert Einstein College of Medicine, and a former President of the American Society of Hypertension. He is known for challenging the blanket salt-restriction guidelines, emphasizing that low sodium intake may have unintended harms.

  2. McCarron DA. "Normal range of human dietary sodium intake: a perspective based on 24-hour urinary sodium excretion worldwide." American Journal of Hypertension. 2013;26(10):1218-1223. [Link]

    "The recent Institute of Medicine (IOM) report Sodium Intake in Populations—Assessment of Evidence found “no evidence for benefit and some evidence suggesting risk of adverse health outcomes associated with sodium intake levels in ranges approximating 1,500–2,300mg per day,” a range well below the lower limit of normal that our data defines"

    Dr. David A. McCarron is a Former professor of medicine at UC Davis. He has argued that mineral balance (e.g., potassium, calcium, magnesium) and overall diet quality matter more than sodium alone in determining cardiovascular risk. Co-authored opinion pieces and studies critical of low-salt guidelines.

  3. Graudal N, Jürgens G, Baslund B, Alderman MH. "Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis." American Journal of Hypertension. 2014;27(9):1129-1137. PubMed

    This particular study, a meta-analysis of 23 clinical trials and, by all counts, an elephant in the room, found that low-salt diets reduced blood pressure by less than 1%, a negligible change. It also reported that in patients with metabolic syndrome (prediabetes, diabetes, or obesity), salt restriction could paradoxically raise blood pressure. In other words, the entire campaign to reduce salt intake as a strategy to prevent hypertension was based on a deeply flawed premise.

    For context, the authors defined "excessive" salt intake as approximately 12.4 grams per day, or nearly 2.5 times the U.S. recommended daily allowance. I'm not suggesting you consume this much either.

    Dr. Niels Graudal is a Clinical Professor, Rigshospitalet, Copenhagen University Hospital, Denmark. He is the lead author of major meta-analyses showing that both low and high sodium intakes are associated with increased mortality risk along the U-shaped curve. 

  4. Mente A, O'Donnell M, Rangarajan S, et al. "Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies." The Lancet. 2016;388(10043):465-475. The Aga Khan University

    "Compared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations (no association in normotensive population), while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension." [If you already have high blood pressure, too much salt is bad for you. If you don't have high blood pressure, a low-salt diet increases your risk of death — KM.]

    Dr. Andrew Mente is an Epidemiologist at the Population Health Research Institute, McMaster University, Canada. He is the co-author of the large international PURE study, which found no increased cardiovascular risk at moderate salt intake levels.

  5. Dr. James DiNicolantonio. The Salt Fix: Why the Experts Got It All Wrong—and How Eating More Might Save Your Life, August 4, 2020. Amazon.com

    "For more than forty years, our doctors, the government, and the nation’s leading health associations have told us that consuming salt increases blood pressure and thus causes chronic high blood pressure. Here’s the truth: there was never any sound scientific evidence to support this idea. Even back in 1977, when the government’s Dietary Goals for the United States recommended that Americans restrict their salt intake, a report from the U.S. Surgeon General admitted there was no evidence that a low-salt diet would prevent the increases in blood pressure that often occur with advancing age." p. 7

    James J. DiNicolantonio is a cardiovascular research scientist and doctor of pharmacy at Saint Luke's Mid-America Heart Institute in Kansas City, Missouri. He serves as the Associate Editor of Nutrition and the British Medical Journal's (BMJ) Open Heart, a journal published in partnership with the British Cardiovascular Society.

These experts differ in methodology and tone, but they all share a willingness to challenge the entrenched anti-salt orthodoxy with physiological facts, epidemiological data, and clinical insights.

Why Bother?

I've chosen to revisit this topic because, aside from Dr. DiNicolantonio, most of their work has focused on hypertension and kidney function and was limited to academic press, and none have my depth of experience with functional gastrointestinal disorders, a critical area that remains overlooked in the salt debate.

My goal in this article is to help you understand the true role of salt in gut health and digestion so that you can protect one of the most critical parts of your body from preventable harm.

Also, I'm not suggesting that you binge on salt. Like anything else, excessive salt is harmful, and above a certain amount, outright toxic. For a 70 kg person, the lethal range is approximately 14 to 35 grams of salt taken at once, depending on age, kidney function, hydration status, and rate of absorption. Death typically results from hypernatremia, which causes brain shrinkage, seizures, coma, and ultimately respiratory failure or cardiac arrest. But that doesn't mean too little salt, or none at all, is somehow "healthy."

Any extreme is equally deadly. Drinking six or more liters (1.5 gallons) of water within a few hours, for example, has been documented to cause death from dilutional hyponatremia, especially when water isn't accompanied by salt or the person is already salt-depleted. 

The terms hyponatremia and hypochloremia refer to acute deficiencies of sodium and chloride, respectively. The term -natremia is derived from the Latin name for sodium. Functionally, both terms describe the same condition — an acute deficiency of sodium chloride (NaCl) in the body because table salt is the primary source of both sodium (Na) and chloride (Cl) in the human diet. Hyper-anything refers to the opposite end of the spectrum.

A Note of Caution to Vegans and Vegetarians

Both sodium and chloride are essential electrolytes, but in plant-based foods, they are present only in trace amounts. Even so-called “high-sodium” vegetables like spinach, celery, kale, lettuce, or cabbage contain too little sodium to meet your physiological needs. I put “high-sodium” in quotes because its actual amount is modest, typically around 20 to 40 mg per serving, too small to move the needle.

And to get even that meager amount, you need to eat these vegetables raw, because boiling depletes much of the mineral content in plants. The same goes for chloride, which is also water-soluble and lost during cooking, further reducing your intake of this critical electrolyte.

For most people, the overwhelming source of both sodium and chloride in the diet is table salt. Without it, meeting the body's daily requirement for these two essential electrolytes on a plant-based diet is virtually impossible.

If Being Right Is Crazy, So Be it!

Now, let's address my claims that "reducing salt consumption damages stomachs, colons, kidneys, hearts, brains, muscles, bones, joints, and mental health faster than alcohol damages the liver or smoking damages the lungs?"

Reading this, some people may say, "How dare you make these crazy claims?"

I hear you! Let me explain, organ by organ, what happens when the body doesn't get enough salt from your diet. I’ve added numbers in parentheses (1, 2, 3...) next to each related disorder to show how many total complications can arise from what, at first glance, may seem like a trivial issue.

Some of the explanations you'll read below are relatively technical. It isn't because I want to impress you with my knowledge, but because this text will be read and ruthlessly scrutinized by skeptics, critics, naysayers, lawyers, and medical professionals. If I simplify it too much, it will be dismissed as inconsequential, and rightfully so.

To assure you that I don't have an ax to grind or, somehow, am crazy, I used ChatGPT to verify whether all of my claims are accurate and supported with mainstream medical references.

If you’re thinking that ChatGPT might be hallucinating or just telling me what I want to hear, it’s not. The latest versions of this tool actively search and verify information against real academic sources online, much like Google used to, only faster, with more context, and without favoring big advertisers who push their own agendas on top of the searches. 

Tap the "Is it true?" link at the end of each paragraph to read ChatGPT's reply and review the sources:

Even after twenty-five years of debunking the nastiness of the 'low-salt is good for you' propaganda, I still find these results shocking—and they’re just the tip of the iceberg.

Let's Go Under the Water to See the Rest of the Iceberg

I intentionally led with the most controversial conditions first to get your attention. Here's the list of other well-documented and widely recognized complications and side effects caused by low-salt diets and salt restrictions:

I Still Have Doubts! Show Me Real Proof…

Sure. Japan has some of the highest salt intakes in the world, often exceeding 10 grams per day, and yet far lower rates of heart disease, obesity, dementia, and digestive disorders than the United States. Life expectancy in Japan is the highest in the world at 85 years. In the U.S., it's dropped to around 77.

That's an eight-year gap, despite the fact that most older men in Japan still smoke like there's no tomorrow and, by Western standards, many middle-aged working men are functional alcoholics. And don't write this off as Japanese genetics—the rates of obesity, diabetes, cardiovascular disease, and cancer in Japanese Americans begin to resemble U.S. averages within one or two generations.

0.9% Sodium Chloride 1L IV bag

If Japan's example isn't enough for you, wrap your head around another salt-related paradox. When a victim of a heart attack or stroke is transported to the hospital, they're immediately hooked up to an intravenous drip (IV) with 0.9% Sodium Chloride (NaCl) solution. It has the same concentration of salt as in the blood.

To non-doctors, using salt while treating a heart attack or stroke doesn't make sense, considering mainstream medical advice to protect yourself from both conditions by avoiding salt.

But it's a different story for the doctors because their highest priority is to keep the heart, brain, and all other organs perfused (supplied with fluids and essential electrolytes). Without it, blood pressure can crash, the kidneys can shut down, and the patient can quickly deteriorate (move toward a critical state).

So while most medical professionals preach to avoid salt in theory, in practice, they reach for it the moment the situation gets serious.

And, incidentally, a lot of it — a 1-liter bag of IV solution (like the one above) contains 9 grams of salt, or 55% more than the 5.8 grams recommended daily ((9.0 - 5.8) / 5.8 = 0.55) And all of that salt goes into the patient's body in just 1 to 2 hours, not over 24.

A Little White Lie on Behalf of the Big 'White Death'

The U.S. Daily Recommended Allowance (DRA) for salt is currently set at 2,300 mg (2.3 g) of sodium per day for healthy adults.

When most people read this recommendation, they naturally assume it means limiting salt intake to 2.3 grams per day. In reality, 2.3 grams of sodium equals 5.8 grams of table salt, or just slightly over one teaspoon.

Here's what's going on:

Salt's chemical formula is NaCl, a combination of sodium (Na) and chloride (Cl). Sodium makes up about 39% of salt's weight; the other 61% is chloride. So:

5.8 grams of salt × 39% = 2.3 grams of sodium

This deliberate misrepresentation is rooted in U.S. food labeling laws and public health policy. On one hand, it allows manufacturers to underreport the actual salt content of packaged foods by listing "sodium" instead of "salt."

Nutrition Facts

You can see an example in the Nutrition Facts label on the left: the 440 mg of "sodium" listed here actually represents 1,128 mg (1.1 g) of table salt, or 61% more than what you think it is.

On the other hand, this trick encourages consumers to underconsume salt in order to comply with public health recommendations aimed at reducing salt intake, regardless of individual need or context.

So, if you are watching your salt intake either way — not enough or too much — don't get fooled by this 'sleight of hand' because an even bigger victim here was the 'baby' that got thrown out with the bathwater.

By the baby, I meant the less famous second part of the sodium chloride. Low-salt diets reduce chloride (Cl) intake just as much as sodium (Na), even though it's chloride, not sodium, that plays the more critical role in salt deficiency dysfunctions that affect digestion, breathing, brain function, and kidneys. From a strictly physiological standpoint, chloride is critical for:

As you can see, reducing salt deprives the body of chloride, an essential electrolyte with far-reaching roles in digestion, respiration, brain function, and fluid balance. From producing stomach acid and regulating breathing chemistry to calming the nervous system and supporting kidney function, chloride is central to basic physiological stability. When salt intake drops, all of these systems can become destabilized.

With that in mind, let's turn to practical recommendations for how to consume salt and support your health safely.

How the Salt Is Stored and Lost from the Body

When salt (NaCl) is dissolved in water, it separates into ions of sodium (Na⁺) and chloride (Cl⁻). Accordingly, when the body needs to remove excess salt, it doesn’t flush out table salt per se, but excretes sodium and chloride ions separately.

This distinction matters because the body regulates sodium and chloride independently, and losing too much of either can disrupt blood volume, acid-base balance, and nerve function—even if you're technically “just losing salt.”

So when I talk about “salt loss in urine or sweat,” what’s really leaving the body are salt ions, not actual table salt. When sweat dries on your skin, the white residue you see is sodium and chloride ions that have recrystallized into salt.

Throughout this text, I use the words salt and sodium interchangeably. Technically, this isn’t correct for academic publications written for scientists, but it’s perfectly appropriate here to avoid confusion.

You'll also hear the term “turnover.” It refers to the continuous cycle of fluids entering the body, moving through tissues and systems, and then being lost through sweat, urine, and breathing. It’s not just about how much water the body stores, but how quickly it moves through the system and how often it needs to be replaced along with the electrolytes, like sodium and chloride, that go with it.  

Watching for Salt Deficiency Is Just as Important as Watching for its Excess

The actual requirement for maintaining blood volume, acid production, enzyme activation, and cellular function varies widely depending on factors such as age, gender, weight, race, occupation, physical activity, elevation, climate, diet composition, medication, and overall health. So, giving all people the same baseline of 5.8 grams is just as dumb as giving every newborn the same name.

The right approach to determining optimal salt intake is based on compensating for your daily losses. These losses come in two forms:

Let's review both in greater detail:

Obligatory losses of salt

Salt losses shift constantly based on your age, gender, surroundings, activity level, and health status. The body loses both through urine, stool, sweat, breath, and skin, and these losses can rise dramatically in heat, during exercise, illness, or after time in a sauna. The table below outlines typical daily losses under common conditions. These values are averages, but they make it clear that your salt and hydration needs can easily double or triple without you noticing, especially if you're physically active, live in a warm climate, or are recovering from illness.

Condition

Salt Loss (NaCl)

Water Loss

Notes

Basal (rest, mild climate)

3–4 grams

1.5–2.5 liters

Standard urine, minor sweat, normal breathing

Dry indoor air (heated / cooled)

4–5 grams

2.0–3.0 liters

Increased respiratory and insensible loss due to low humidity

Hot weather / Beach day

6–9 grams

3.0–4.5 liters

Continuous sweating and fluid evaporation

Moderate physical work

8–12 grams

4.0–6.0 liters

Repetitive or sustained muscular activity, outdoor labor

High-intensity sport (1–2 hrs)

10–14 grams

3.5–5.0 liters

Includes heavy sweating from team sports or intense training

Fever (moderate)

6–8 grams

2.5–4.0 liters

Elevated temperature increases fluid loss through the skin and lungs

Sauna (20–40 minutes)

6–10 grams

1.0–2.5 liters

Rapid sweating and salt loss; varies by duration, temperature, and body size

Severe fluid loss (vomiting, diarrhea)

10–20+ grams

3.0–7.0+ liters

Water and salt loss depend on severity and duration.

The amount of salt lost each day varies widely depending on the environment, physical activity, health status, and body size. While the basal losses in a temperate climate are relatively modest, even a brief exposure to heat, exercise, fever, or illness can double or triple both salt and water losses. In such cases, failure to adequately replace both can lead to dehydration, fatigue, digestive issues, and circulatory stress.

Gender and ethnicity can influence salt loss, primarily due to differences in sweat rate, sweat composition, body size, and hormonal regulation, though the variations are generally moderate and become more relevant under extreme or prolonged conditions.

Gender Differences in Salt Loss and Retention

Biological sex plays a measurable role in how salt is lost, conserved, and distributed throughout the body. These differences are driven by physiology, hormones, and body composition, not just behavior or diet.

Understanding these gender-based physiological differences can help explain why salt needs and responses to low-salt diets may vary significantly between men and women. What’s considered “high” or “low” salt intake on paper doesn’t mean the same thing in different bodies. Context matters.

Ethnic Differences in Salt Metabolism

Salt needs and sensitivity aren't the same for everyone. Genetics, environment, and evolutionary history all shape how different populations handle sodium and chloride. These differences help explain why some groups are more salt-sensitive, retain sodium more easily, or face higher risks of hypertension on low- and high-salt diets:  

These differences matter most when interpreting salt needs for individuals, especially in contexts like heat exposure, athletic training, or recovery from illness. But day-to-day, environment, activity level, and diet remain the dominant factors.

Daytime Losses

Yes, there is a clear difference in salt and water loss between day and night, driven by changes in activity level, body temperature, hormonal rhythms, and environmental exposure. 

Most salt loss occurs during the day, especially during physical activity and exposure to heat, which raises body temperature and increases sweating. Here are the main contributors:

The only real defense against these daytime losses is adding salt back in. Indigenous people who live in high-altitude regions with dry air often drink tea with salt, not sugar—a habit shaped by necessity, not taste.

Nighttime Losses

At night, the body enters a fluid-conservation mode, reducing urine output and slowing electrolyte loss. But water is still lost through breathing, sweating, and metabolic activity, including tissue repair and detoxification.

By morning, most digestive fluids have been reabsorbed, and plasma sodium chloride may become more concentrated. So waking up thirsty is often the result of overnight metabolic demands, extra sweating in dry or warm climates, and the increased concentration of reabsorbed salt.

Salt Loss in Children

Before puberty, children have significantly fewer active sweat glands, and their thermoregulatory systems are not yet operating at full adult capacity. This is why children may tolerate heat differently and are less prone to the same degree of salt depletion, though their smaller fluid reserves make them more vulnerable to dehydration overall if vomiting or diarrhea is involved.

Induced (Lifestyle-Related) Losses

The induced losses of salt result from the choices you make. My goal here isn't to make you change your lifestyle, but to make you aware of which of them may negatively impact your health. If any factor listed below is present in your life, make sure to offset it with an extra bit of salt:

This list is far from complete, but with everything you have already learn, sufficiently representative.

Digestive and Systemic Signs of Salt Deficiency

As you can see from everything said above, the number of factors that influence salt deficiency is immensely varied. Even a super-duper A.I. would have a hard time handling personalized recommendations day after day, month after month, year after year. In a pickle like this, just fall back on the time-tested approach: listen to your body and adjust accordingly. Two or more of the following symptoms will usually tell you with a reasonable degree of certainty that your salt levels are too low:

In severe cases, such as in hospitalized patients or endurance athletes, salt deficiency can lead to seizures, coma, or death due to cerebral edema. But even mild chronic deficiency can quietly undermine digestion, energy, and hormonal stability.

So, by now, you know what to watch for when salt levels drop too low. Now let’s flip to the opposite side of the dark moon and look at the equally serious risks of getting too much salt.

Warning Signs of Excessive Salt Intake

Symptoms of excess salt intake are less straightforward because, in healthy individuals with normal kidney function, the body efficiently excretes excess sodium through urine and sweat. However, when intake consistently exceeds the body's capacity to regulate, or in the presence of underlying health conditions, certain signs may emerge.

Here's a list of the most common functional and clinical signs of salt excess. These conditions aren't exclusive to salt, so you should only consider them after knowingly consuming significantly more salt than recommended:

Boxers and jockeys use saunas or hot baths to shed excess water and salt before weigh-ins. The heat drives fluid out through sweat, which pulls sodium and other electrolytes with it. It’s a quick and effective way to drop 'water' weight fast. While not sustainable or even entirely safe, this technique shows just how responsive the body is to salt-driven fluid shifts. So, if you find yourself bloated after a night of binging on beer and pretzels, it is a reliable way to get back into 'fighting' shape quickly.

Most of the symptoms listed above result from chronic salt excess in people who have compromised kidney function. In contrast, acute salt overload from consuming large quantities of salt in a short period can trigger vomiting, diarrhea, or confusion as the body tries to expel the excess and restore balance rapidly. These reactions are protective but can lead to dangerous fluid and electrolyte imbalances if not corrected quickly. I wrote extensively about this situation in the Why Do People Throw Up When They Are Too Happy, Too Angry, or Too Scared? essay.

For healthy individuals with balanced hydration and normal kidney function, the body is remarkably efficient at managing salt fluctuations through thirst, urine output, and hormonal regulation.

What about me?

So, how much salt should you actually consume? That's the question everyone wants answered, and the one I can't answer with a one-size-fits-all number or formula because:

Salt needs vary widely from person to person depending on body size, age, diet, activity level, health status, medications, and dozens of other factors I've already described above.

Just as important, they also vary from day to day. You might need twice as much salt on a hot, stressful, active day as you do working from home in an air-conditioned room. Travel throws things off. Weekends throw things off. Changes in sleep, diet, exercise, alcohol, and caffeine—all of them shift your needs.

So no, I can't give you a magic number. And if I did, it wouldn't serve you well. The only way to get this number right is to listen to your body and adjust accordingly. That's why I outlined the signs of salt deficiency and excess above, so that you can observe and recognize them early, before any problems, too much or too little, set in.

If you pay attention to your body's signaling, it will tell you exactly when it needs more salt or less. You just have to stop ignoring the signals or living in fear of "overdosing."

Let's Wrap it Up!

If you've made it this far, one thing should be clear: salt is not a ‘white death’ toxin, but an essential nutrient. Like all essentials, the real harm comes not from occasional excess but from continuous deficiency. The symptoms of too little or too much salt are clear when you know what to look for. And, by now, you do!

I am not asking you to go wild on salt, but reminding you to stop fearing what your body needs. Listen to it. Watch for the signals. And don't allow obsolete guidelines to ruin your health.

Author's note

Just like with low-salt diets, the history of public healthcare in the United States is littered with sacred cows: low-fat diets, cholesterol phobia, dietary fiber, eight glasses of water, an apple a day, and others. These ideas persist not because they’re right, but because they’re profitable:

And who benefits from the low-salt craze? Considering the cascade of disorders it sets in motion, it isn't difficult to figure out either.

Thanks for listening!


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Thank you!

Konstantin Monastyrsky