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Podcast: Salt: One Dash Too Many

By The Paleo Diet Team
February 27, 2014
Podcast: Salt: One Dash Too Many image

Dr. Loren Cordain: I'm Loren Cordain, founder of The Paleo Diet Movement.

Shelley Schlender: And I'm Shelley Schlender. This is The Paleo Diet Podcast for November 2014. Loren Cordain, before I came here to visit you here in Fort Collins last night, I ate some sausage and I ate some sausage because I'm a little afraid you're going to talk me out of eating salt.

Dr. Loren Cordain: One of the things about the Paleo diet concept that I've built into it from day one is I realized that we can't be hunter gatherers. We live in the 21st century and we have temptations and we've eaten certain foods that we enjoy all of our life.
If you enjoy a little bit of bratwurst and beer, go ahead and do it. I've built in to the Paleo diet what I call the 85:15 rule. What that means is if you're about 85% compliant with the Paleo diet, you can accrue many of its health benefits.

What is 85:15 when I say 85%? People eat three meals a day mainly so that's 21 meals per week. If you have three meals out that you don't comply with a Paleo, that's around 15% of your total calories.

Shelley Schlender: So if I have bacon or sausage maybe 15% of my week, maybe that isn't so bad after all.

Dr. Loren Cordain: I think that most people that are 85% compliant with Paleo experience many beneficial health effects. Some people that have serious health issues if you're grossly overweight, you have type 2 diabetes, you've got an autoimmune disease, heart disease or cancer whatever, I think those folks need to be more compliant because I think that the more compliant you are with the concept, the greater the health benefits can be.


Shelley Schlender: Before we go into the science of this, it's worth pointing out that most of the salt in people's diet comes from foods they don't even know what's in like processed breads, processed soups. There's so much salt in those that makes having something where you sprinkle salt on it at a meal pale by comparison.

Dr. Loren Cordain: That's right. The number one source of salt in the US diet according to CDC, the Center for Disease Control, their data comes from bread. Bread and baked goods are the number one source of salt in the US diet.

Paleo dieters, because we don't eat bread, they cannot worry about that, but as I mentioned, processed meats and cheeses are real high source of salt as our processed meats and olives and pickles and pickled items, very high salts sources, processed fish, canned fish.

Shelley Schlender: Look at for those if you want to cut down on your salt and here in this huge thick pile of research papers, the first one, the title is intracellular ionic consequences of dietary salt loading in essential hypertension. I'm going to ask you to translate that.

Dr. Loren Cordain: This is a very cool paper. The lead author on this is Lawrence Resnick who, unfortunately, is no longer with us. The senior author is John Laragh. These guys are just incredible scientists and they've been studying the adverse effects of salt.

Shelley Schlender: They're talking about essential hypertension. That's basically blood pressure that goes high and just gets stuck there.

Dr. Loren Cordain: Right. It's known forever in a day that in some people who are called salt sensitive people, if you eat salt, it elevates your blood pressure. Others who tend not to be salt sensitive, salt seems to have a less effect on blood pressure.
What Resnick and Laragh were interested in was looking at what happens to the intracellular concentration of sodium.

Shelley Schlender: Intracellular. Is that inside of our cells or the fluids flowing between our cells?


Dr. Loren Cordain: It's actually inside the cells themselves. Every cell in our body has a cell wall on it and what we have to do is we're interested in measuring. When you eat something like a high salt diet, it influences every single cell on your body; your nose, your hands, your legs, everything. Your eyes.

Shelley Schlender: When you measure salt in the body with standard blood tests, you're measuring the salt that's flowing around in the blood kind of like sea water. You're not measuring the salt that's inside the cells.

Dr. Loren Cordain: That's a very good point Shelley. The kidney maintains tight control over the salt that's in the blood. Even though if you eat a high salt diet, the salt ends up going inside your cells, you increase your urine output, so the net effect is to maintain homeostasis in the bloodstream.

Shelley Schlender: At the same time, you can't always tell from what the blood readings of salt are what's happening inside your cells with the salt.

Dr. Loren Cordain: Exactly. It was very difficult, because when you think about it, if you take a cell and you want to find out what's inside of it, what do you have to do? You have to poke a hole in the membrane. If you poke a hole in the membrane, everything goes out of it.

That was the real challenge for physiologists in the last 50 or 60 years is how do we accurately measure intracellular salt concentration or sodium concentration after you get people a huge dose of salt.

It was only starting in the late 80s early 90s that the technology became available. They used to call it a nuclear magnetic resonance. We now call it MRIs.

Shelley Schlender: That's a little bit more politically less correct.

Dr. Loren Cordain: More politically correct because we take the nuclear out of it. People were frightened that there's radioactivity, so that's why they changed it to MRIs. The technology became available starting in the late 80s, early 90s to use what are called specific probes.

Shelley Schlender: People think of magnetic resonance imaging, MRIs, is something that you do to someone's brain, but you're talking about doing it to teeny tiny cells.


Dr. Loren Cordain: That's right. These probes then, these MRI probes were developed 20 years ago to be able to analyze the ionic concentration within cells. Salt contains two ions. It contains sodium and chloride. We can measure any specific ions with these various probes within the cell.

Shelley Schlender: You can measure magnesium, calcium.

Dr. Loren Cordain: Exactly. You can measure magnesium and calcium and potassium and you can measure pH as well.

Shelley Schlender: That's your acid balance.

Dr. Loren Cordain: Acid base balance. This was a very cool experiment and it was published in 1994. This is the very first time we're ever able to see ... If you take basically normal people and you give them big load of salt, what happens intracellularly.
We know that in the bloodstream that the kidney and other homeostatic mechanisms seem to clear the salt from the bloodstream, but what's going on within the cells. What we find out is that when you eat salt, anybody is it increases the intracellular sodium concentration and then it characteristically reduces potassium.

It reduces potassium, increase the sodium, and then it characteristically increases calcium and reduces magnesium. Then it also lowers pH.

Shelley Schlender: I'm trying to picture this right now. This poor little cell has too much salt in it and when this happens, it says, "Help, I need to get the salt out," and it has to use magnesium and potassium ions which I think of is the things we need more of to help push the salt out, you think what's going on?

Dr. Loren Cordain: It's a series of events that occurs there what are called ionic channels. There's sodium channels. There's calcium channels. There's what are called antiporters as well. When you stimulate these channels, it stimulates other ions. Then there's also what are called ionic gradients. You stimulate these antiporters and that causes changes in other ions, but the net effect is more important.


We've got a series of mechanisms and I don't want to get in to the details. It's something we teach in my graduate level courses, but there's a series of cellular physiologic events that ultimately change the concentration of these ions within cells. The crucial point here is these changes are characteristic of all cancer cells. All cancer cells have the same ionic changes. The sodium goes up, potassium goes down, calcium goes up, magnesium goes down, and pH goes down.

Shelley Schlender: Loren Cordain, we were talking about a paper about high blood pressure and now you're saying that there are similarities to what happens in cancer patients.

Dr. Loren Cordain: The intent of this paper of Laragh and Resnick, these guys were interested in blood pressure, and so we see these same things occurring in the smooth muscle cells. This happens in every cell in the body.

What causes high blood pressure is the arteries are surrounded by smooth muscle cells. When the smooth muscle cells contract regularly and chronically, that ends up with high blood pressure. The smooth muscle cells, the muscle surrounding arterial hypertrophy and they get thicker and bigger. Now, why is that? What causes that?

It's because calcium is what causes cells to contract. Basic muscle physiology tells us that when you change the calcium concentration intracellularly, then it causes a cell to contract, muscle cells.
Shelley Schlender: That makes me think there's another condition that this might be related to and that's leg cramps.


Dr. Loren Cordain: I hadn't given that much thought, but that certainly is a possibility. What's causing calcium increase is the salt. We're fundamentally disturbing our basic human physiology by eating high levels of salt. This happens over the course of a lifetime because we saw from the time we're waned until we die and it's surprising that 80% or 90% of us by the time we're in our six decade, we have high blood pressure.

What is less well appreciated is that this same process, as I mentioned, that we believe is fundamentally underlying high blood pressure is less well appreciated and then has been known since the early 80s. This paper was published in 1980 and you can read to your audience.

Shelley Schlender: Intracellular concentration of sodium and other elements as related to mitogenesis and oncogenesis in vivo. Now, onco is kind of the word in science for cancer.

Dr. Loren Cordain: Right. Oncogenesis is cancer. Mitogenesis means cell division.

Shelley Schlender: Meaning, how fast were the cells dividing and whether they're getting cancers as they divide. In vivo, does that mean in a test tube or in a body?

Dr. Loren Cordain: That means in body.

Shelley Schlender: This is looking at the inside the cell, concentration of sodium and other minerals as related to how fast the cells are dividing, how often they get cancer inside of a body.

Dr. Loren Cordain: It's concentration gradient driven. Meaning that the higher and the higher the intracellular sodium concentration is at low to medium levels, it stimulates mitogenesis, it stimulates cell division.

Shelley Schlender: If cells are dividing too fast, then they don't get to go through their checklist as well and they're more likely to have mistakes that can be cancerous.

Dr. Loren Cordain: Right. The point that they're making is that there's a threshold here when intracellular sodium switches from mitogenesis to oncogenesis.

Shelley Schlender: Okay, so it's saying that when normal cell division, mitogenesis, switches to cell division, that turns into cancer. That's what it's saying.


Dr. Loren Cordain: Yeah. Once the technology to measure intracellular ions came about in the late 80s or early 90s, this process was shown by a number of groups worldwide to actually happen. That's really the significance of this paper by Resnick and Laragh is that it shows that this is a process that seems to happen to all of us when we eat salt.

Let's go back to the significance of this. As you go to that Ancestral Health Society and you look at this plethora of books that have come out that call themselves Paleo, in virtually every recipe, I should show you some of these. They allow sea salt because they think that sea salt somehow has different properties than regular processed salt.

Shelley Schlender: Really? It does have some different properties. It's more prone to have a mix of minerals and not just salt and processed salt is ... I'm stopping because processed salt, table salt is not just sodium, it's got what else in it.

Dr. Loren Cordain: Anybody that wants to go online can see the difference and I've actually pointed it out in blogs that are available on my website. What sea salt is is you take sea water and you evaporate it. I don't care whether you're in the Pacific Ocean, the Atlantic Ocean or in the Arctic Ocean, it's all basically the same. When it dries out, it has the same percentage of these salts.

Shelley Schlender: It's mostly sodium still.

Dr. Loren Cordain: It's sodium chloride is the number one ingredient. It's about 80% sodium chloride and then the balance comes from these other salts. Now, if you look at processed salt like Morton's, they have a process where they basically take salt that comes from sea salt and they eliminate these other salts, and so it's almost 99% sodium chloride. You're about 15% higher sodium and chloride than you are in sea salt.

However, animal studies as well as human study show that they have the exact same effect in terms of what it does to us physiologically.


Shelley Schlender: And that intracellular issue is that when somebody takes in a lot of salt, any creature, sodium inside the cell goes up, chloride goes up, potassium and magnesium go down.

Dr. Loren Cordain: Yes.

Shelley Schlender: Which is not good.

Dr. Loren Cordain: Calcium goes up and pH goes down as well.

Shelley Schlender: Inside the cell becomes more acidic.

Dr. Loren Cordain: Yes. These are characteristic changes that we see, not just in smooth muscle of arteries that produces high blood pressure, but they're also characteristic of all cancer cells.

Shelley Schlender: The implications of this are worrisome, but I'm ...

Dr. Loren Cordain: They're very worrisome.

Shelley Schlender: I'm going to ask you some tougher questions right now. One is are there studies of this to show whether or not what somebody's eating and their lifestyle affects how much the salt that someone is taking in starts to make these changes inside the cell? Have you seen anything that ...

Dr. Loren Cordain: Early in my career, I worked with a research group, the Green Cancer Institute. There was a guy that devoted his entire life to study in the relationship between sodium and potassium in cancer. He did some of the very, very best work. His name was Berger Jensen.

I had the privilege and pleasure to get to know him through correspondence. In those days, we didn't have email, so we just through letters. He sent me a book that he'd been writing and he never published it. It was kind of a loose leaf book. It was his life's work and he sent me a copy of it.

I feel privileged to have one of the few copies that ever came about, because it was never published, but he did write a number of scientific papers and that was exactly what he said. He didn't understand the mechanisms as well as what the science that came out in the mid-90s because he was approached in the end of his career before he died.

He had epidemiologically made this analysis again and again and again. If you triangulate all of the data with acid base and ionic concentrations and so forth, it's very interesting. The incidence of certain cancers that occur at people living at high altitude is greater than those living at low altitude.


Mechanistically, what's going on here is that when you're at high altitude, you breathe a little bit different, and so it seems to, over the long haul, changed the pH and makes you a little bit more acidic. That was just one argument that he used.

Shelley Schlender: He looked at a number of variations in how people lived and where they lived and how that affected the salt inside their cells.

Dr. Loren Cordain: Let's don't get off on the tangents and that salt is the only cause of cancer. Cancer is caused by a multitude of environmental factors, and salt clearly is what we call a promoter. They are initiators of cancers and then there's promoters of cancers. The two operate together to elicit oncogenesis. It looks like a high salt diet tends to promote all cancers.

Shelley Schlender: Could we say that somebody whose health is compromised, they may be more vulnerable to the effects of a high salt diet and somebody whose healthy, their body clears the salt in a way that it doesn't create this bad formula of too much salt inside the cell, too much calcium inside the cell, too little magnesium?

Dr. Loren Cordain: Shelley, this is a very obscured topic, and you're not going to find this in standard medical textbooks.

Shelley Schlender: You're not. There are some researches who have looked at other aspects of this. Steve Phinney for instance who is a medical doctor who has done a lot of research on low carb diets and especially the Inuit, the Eskimo who believes that if somebody is eating a diet that is more ketogenic, meaning that's so low in carbs that their body is basically mainly burning fat and not burning carbs that somebody in that condition can eat more salt without it raising blood pressure and without some of the side effects for many people of high salt in their diets.


Dr. Loren Cordain: You and I have discussed this, never on the recording, but I think the issue has come up a few times and you're absolutely right is that there is very good data to show that chronically elevated insulin increase intracellular sodium.
High glycemic load carbohydrates which everybody in the Western world eats, we talk about 70% of the calories coming from those four elements; refined sugar, refined grains, refined vegetable oils, and dairy. Three of those elements that we eat on a daily basis tend to promote increases in basal insulin levels. Insulin is a master hormone and when insulin goes up chronically, then it drives more salt intracellularly.

Shelley Schlender: Okay, so you're adding yet another part of the American style of eating or the Western style which is foods that tend to make people have high insulin levels. That adds to the problem of somebody eating a lot of salt, because the insulin means that more salt get stuck inside their cell which is not good.

Dr. Loren Cordain: That's right. When we look at Paleo dieters, I think most of them are on board with the notion that we should eliminate processed foods, we should eliminate refined sugars, refined grains, but they're not on board with the salt. It works together in concert.

Shelley Schlender: It does work together in concert, but I'm thinking if someone had very low insulin levels, meaning that they didn't a lot of carbohydrates or sugars to raise their insulin levels. Could it be that the way that the body handles salt would be somewhat different?

Dr. Loren Cordain: Those experiments have not been conducted since Lawrence Resnick died. He had the funding to do those measurements. There have been very few human studies done since the mid-90s with MRI sodium specific probes. That would be a fascinating experiment to do is to put somebody on a low glycemic load diet versus a high glycemic load and let's see how that influences intracellular sodium.


The other caveat here is you probably need to get people who are sodium sensitive and people who are non-sodium sensitive. That means looking at hypertensives versus non-hypertensives and see how high glycemic load diets influences those two groups. Those experiments haven't been done yet.

Shelley Schlender: Those experiments haven't been done, but you've got two interesting papers here that are obscure, plus the unpublished writings of this colleague who became your friend and you're telling me that those studies need to be done.

Dr. Loren Cordain: I think so. At least in the Paleo community, I don't think that the dangers of salt is closely appreciated as they should be. The medical community has recognized that. If you look at the meta analyses which are epidemiologic studies where you take hundreds or tens of thousands of people, they unequivocally show that a high salt diet has multiple adverse effects. Whether it's sea salt or refined salt, doesn't matter.

Shelley Schlender: Again, on the tougher questions, most of those medical studies are done with the backdrop of people eating the standard Western diet which is promoting of high insulin levels and high inflammatory conditions. There are a few variables here that we're talking about.

Dr. Loren Cordain: Even still, when you get a large enough sample sizes, the conclusions shine through is that salt is not a good thing for humans to put in your food.

Shelley Schlender: Not so many olives, not so much sausage, go with the food that isn't as salty.

Dr. Loren Cordain: I have to laugh because ... I see this just incredibly gorgeous recipe. I should show you some of these recipe books that are Paleo this and Paleo that. They seem to cobble the word Paleo into it, and invariably, every single one of them adds in sea salt. They somehow think that sea salt is different than regular salt in terms of its effects but it isn't.

Shelley Schlender: Loren Cordain, isn't the standard Paleo potato chip bacon?


Dr. Loren Cordain: Bacon is incredibly popular in the Paleo community. Bacon is an enormously high source of salt. Similarly, some people, and I'm not going to name names because a lot of them are close friends and colleagues, but they also advocate dairy products. Cheese is okay for some Paleo diets and I pointed it out, cheese is an enormously high source of salt. It's almost as bad as bacon. Cheese, even though we all love it, it's a huge, huge dietary source of salt.

Shelley Schlender: I don't know what to do about the cheese thing and salt, but for bacon, there is the kind of pork that's called pork belly. The pork belly is not salted.

Dr. Loren Cordain: Well, that's what bacon is made out of is they take the underside of a pig which is the fattiest part of its carcass and they cut it out and then they process it and they soak it in salt and what have you.

Bacon is made from pork bellies and then they slice these pork bellies into these long little strips that we call bacon. You know, there's actually ... In one of my blogs, there's a better form of bacon. You know what it's called? A pork chop.

I contrasted the nutritional qualities in one of my last blogs of a pork chop to standard bacon that you get at the supermarket. It doesn't even hold a candle. It's way more nutritional dense and all of B vitamins, the irons, and zinc and it doesn't have all the added crap that they put into bacon. If you get a hankering to eat pork, go out for breakfast and eat yourself a pork chop with your eggs and you're going to be much, much better off.

We have this addiction to salty sugary foods and bacon is one of them. It's just like bread or candy or ice cream and what have you. Use it in the 85:15 rule. If you enjoy bacon, do what you know sparingly, but don't eat bacon every day because you think it's Paleo.

That's all for this edition of The Paleo Diet Podcast.


Shelley Schlender: Our theme music is by Chapman Stick's soloist, Bob Culbertson.

Dr. Loren Cordain: Visit my website, for past episodes and for hot links to my research studies, books, and latest writings. For questions or comments, the place to go is

Shelley Schlender: For The Paleo Diet Podcast, I'm Shelley Schlender.

Dr. Loren Cordain: And I'm Loren Cordain.

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