The Relationship Between Diabetes and Salt

Growing up, I was wary of the salt shaker. My father, like most of the men in his family, had heart problems from a young age. My mother cooked low-fat, farm-to-table cuisine before it was popular, and she made sure to keep sodium out of the food as well. The only time salt appeared on our table was for company, when she'd warn them that they'd need to add their own.

Later, as a food critic, I became much more enamored of salt. Much of the fare in restaurants is overly salted, and boy, did I get used to it.

I'm also one of those people whose blood pressure is so low at times that my doctor tells me to go snack on some pretzels. And hey, what can I say: I'm a very compliant patient. I'll have the whole bag. (Let's be frank: I also don't need an excuse.)

Eventually, though, I noticed an odd pattern emerge. Whenever I had a particularly heavy workload and/or salt binge, my blood sugar spiked into pre-diabetic zones, where it stayed for months at a time. I always thought it was because I ate too much candy or drank too much wine. But after interviewing Tricia Pingel, NMD, an Arizona-based naturopathic physician and the author of Total Health Turnaround, I believe that sodium was the more likely culprit.

Does Salt Affect Type 2 Diabetes Risk?

"Studies have shown that consuming a salt-rich diet can actually lead to the development of type 2 diabetes in the future," Dr. Pingel says. "In fact, one study found that there is a 43 percent increase in the risk of diabetes development for each extra gram of sodium consumed in a day. It also found that those who ate above 3.15 grams of sodium had a 58 percent chance of developing diabetes."

These are some serious numbers, of which the U.S. Food and Drug Administration (FDA) has also been keeping track. The agency's research shows that "people consume 50 percent more sodium than recommended. This includes our youngest and most vulnerable populations, with more than 95 percent of children aged 2 to 13 years old exceeding recommended limits of sodium for their age groups."

As a result, the FDA recently released new guidelines regarding how much sodium Americans should be consuming daily, and it's 1,100 less milligrams than we take in on a daily average now. It suggests that Americans 14 and up keep their salt intake to 2,300 milligrams per day. That's 1,100 less than we do now.

Salt and the Cardiovascular System

If Americans kept their salt intake at or below recommended levels, we might, on the average, live longer.

"Studies have shown that high salt intake is associated with a 17 percent greater chance of cardiovascular disease and a 23 percent greater risk of stroke," Dr. Pingel says. "Reducing daily salt intake can decrease blood pressure by about four points."

Of course, this is true for everyone, no matter your health status. Given that cardiovascular disease remains our number one cause of death, even during a pandemic, it makes sense for us all to reduce salt consumption.

For a person with prediabetes or one with existing diabetes, however, the amount of salt in our food is a real concern for several reasons. Essentially, diabetes is an inflammatory disease, and one of those areas that's most at risk for inflammation is the cardiovascular system. Dr. Pingel says that in diabetics, this peril is often compounded by co-morbidities like obesity.

The Role of Potassium

Compounding the problem, people with diabetes typically have chronically low potassium. "Sodium and potassium have a very intricate relationship and are intended to balance each other out for proper cellular functioning," she says. "The more sodium you eat, the less relative potassium your body has."

So a person with diabetes who eats a lot of salt loses even more essential potassium. And very low potassium levels mess with the regulation of blood sugar and the insulin cycle even more.

"Low potassium leads to impaired glucose tolerance by reducing the secretion of insulin in response to the intake of sugar," Dr. Pingel says.

Think of salt consumption, then, as a trickle-down theory. Too much blood sugar gets deposited in already inflamed nerves and vessels, plugging them up more. In turn, this leads to atherosclerosis and hypertension. The cascading effect is why people with diabetes are twice as likely to have a heart attack or stroke than non-diabetics.

How to Reduce Salt in Your Diet

It's easy to say, "Just stop salting your food." And that's good advice whether you're dining out or taking out, as restaurant-prepared fare is already over-salted. In fact, the FDA found that "more than 70 percent of [our] total sodium intake is from sodium added during food manufacturing and commercial food preparation." This is why the FDA wants producers to voluntarily reduce the sodium in processed, packaged, and prepared foods.

People with diabetes need to be especially careful of all processed foods, sidestepping deli meats, anything pickled or fermented, even mustard and ketchup. Dr. Pingel says to avoid "anything in a box, most frozen, quick-heat meals, fast food, and many quick-serve restaurants. The focus needs to be on whole foods, cooked and prepared fresh, without the use of processed sauces and condiments."

1. Cook instead of ordering in.

We've all gotten used to pick-up, take-out, and delivery during the pandemic. Certainly even the most enthusiastic cooks among us suffer from kitchen fatigue, let alone those of us who barely get by on scrambling an egg. But people with diabetes need to travel one step further in the mise en place direction when it comes to the culinary side of things.

If you set yourself up with anti-inflammatory spices instead of the salt shaker, you kill two chickens with one stone. Dr. Pingel recommends turmeric, cumin, cinnamon, cayenne, sage, peppermint, ginger, fenugreek, and garlic for flavor as well as health.

2. Flush salt from the body.

Meanwhile, if you already have too much sodium in your system, try getting rid of some it by consuming "potassium-rich foods, such as leafy greens, legumes, avocado, nuts and seeds, coconut water, wild-caught salmon, broccoli, and beet greens," Dr. Pingel says. "Drink plenty of water — at least half your body weight in ounces. Support your adrenal glands with a nutrient-rich diet, mediations, and daily exercise. Take a well-formulated trace mineral supplement."

3. Get unstressed.

Finally, she recommends what everyone does, but what is the hardest of all to implement: "Reduce stress."

This is because when we're stressed, the body releases cortisol, a hormone, into the bloodstream. Cortisol impacts how your body manages — or mismanages –— blood sugar.

Additionally, Dr. Pingel says the adrenal glands will release aldosterone, which she says has "an impact on sodium and potassium levels — favoring sodium retention and potassium depletion. This can further increase your risk of developing diabetes and worsen insulin resistance."

Add the overconsumption of salt to this chain-reaction, and you can see how diabetes is such a threat.

More Than a Diet

You might be wondering what happens if you eliminate all the salt from your diet. The truth is, you can't. Sodium is naturally occurring in food. Some items have more than others, of course.

For instance, a medium-size sweet potato has 70 milligrams. An average stalk of celery has 30 milligrams. Dr. Pingel says limiting your intake to what's already there is appropriate and should not be "supplemented in addition."

Does this sound Draconian? Maybe. But at the end of the day, diabetes is already an epidemic. By 2035, 592 million (1 in 10) people worldwide will have diabetes. Making both diet and lifestyle changes can break sodium's chain of command in your body and reverse the trend.

As for myself, I've gone back to my childish ways. And for the first time since the pandemic began, my blood sugar has tested normally.

Related:

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• 6 Common Eating Habits That Are Problematic for People With Diabetes
• The Worst Fruits for People With Diabetes (and the Best)