Healthier Salt Substitutes

As I discuss in my video Shaking the Salt Habit, the two most prominent dietary risks for death and disability in the world are not eating enough fruit and eating too much salt. Eating too little fruit kills nearly five million people every year, and eating too much salt kills four million.

There are three things we can do to lower our salt intake. First, don’t add salt at the table. One third of us add salt to our food before even tasting it! Second, stop adding salt while you’re cooking. At first, the food may taste bland, but within two to four weeks, “as the sensitivity of the salt taste receptors in the mouth become more sensitive to the taste of salt in the usual concentrations”—believe it or not—you may actually prefer the taste of food with less salt. Some of the flavorings you can use in the meanwhile instead of salt include “pepper, onion, garlic, tomato, sweet pepper, basil, parsley, thyme, celery, lime, chilli, nettle, rosemary, smoke flavoring, curry, coriander and lemon.” Even if you did add salt while cooking, though, it’s probably better than eating out, where even at non-fast food restaurants, they tend to pile it on. And, finally, avoid processed foods that have salt added.

In most countries, only about half of sodium intake comes from processed foods, so there’s more personal responsibility. In the United States, however, even if we completely stopped adding salt in the kitchen and dining room, it would only bring down salt intake a small fraction. This has led public health commentators to note how challenging it is for everyone to reduce their salt intake, since so much of our sodium intake is out of our control. But is it? We don’t have to buy all those processed foods. We can choose not to turn over our family’s health to food corporations that may not have our best interests at heart.

If we do buy processed foods, there are two tricks we can use. First, try to only buy foods with fewer milligrams of sodium listed on the label than there are grams in the serving size. So, if it’s a 100-gram serving size, it should have less than 100 mg of sodium. Or, second, shoot for fewer milligrams of sodium than there are calories. For example, if the sodium is listed as 720 and calories are 260, since 720 is greater than 260, the product has too much sodium.

That’s a trick I learned from Jeff Novick, one of my favorite dieticians of all time. The reason it works is that most people get about 2,200 calories a day. So, if everything you ate had more calories than sodium, you’d at least get under 2,300 milligrams of sodium, which is the upper limit for healthy people under age 50. Of course, the healthiest foods have no labels at all. We should try to buy as much fresh food as possible because it is almost impossible to come up with a diet consisting of unprocessed natural foodstuffs that exceeds the strict American Heart Association guidelines for sodium reduction.


Not eating enough fruit as a leading killer? For more, see my video Inhibiting Platelet Aggregation with Berries.

In my latest sodium series, I lay out the evidence and dive into the manufactured controversy to expose salt industry shenanigans. See:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How to Treat Dry Eye Disease Naturally with Diet

One of the most common eye disorders, dry eye disease, causes irritation or discomfort, and can decrease functional vision, sometimes causing a dramatic deterioration in the quality of life. About five million Americans over age 50 suffer from moderate-to-severe dry eyes, and tens of millions more have mild or episodic manifestations of the disease, at a cost of more than $50 billion.

In terms of treatment, there are several drops and drugs that can help. We spend hundreds of millions of dollars on things like artificial tears, but currently there is no therapy available to actually fix the problem. If drugs don’t work, doctors can try plugging up the outflow tear ducts, but that can cause complications, such as plugs migrating and eroding into the face, requiring surgical removal. Alternatively, surgeons can just cauterize or stitch up the ducts in the first place.

There has to be a better way.

What about prevention? Dry eyes can be caused by LASIK surgery, affecting about 20-40% of patients six months after the operation. With a million LASIK procedures performed annually, that’s a lot of people, and sometimes the long-term symptoms can be severe and disabling.

There’s a long list of drugs that can cause it, including antihistamines, decongestants, nearly all the antidepressants, anticonvulsants, antipsychotics, anti-Parkinson’s drugs, beta-blockers, and hormone replacement therapy, as well as a few herbal preparations.

In the developing world, vitamin A deficiency can start out as dry eyes and then progress to becoming the leading cause of preventable childhood blindness. Vitamin A deficiency is almost never seen in the developed world, unless you do it intentionally. There was a report in the 1960s of a guy who deliberately ate a vitamin A-deficient diet, living off of bread and lime juice for five years, and his eyes developed vascularization and ulceration of the cornea, which you can see (if you dare) in my Treating Dry Eye Disease with Diet: Just Add Water? video. That was better than what happened to an unfortunate woman who was the member of a cult and tried to live off of brown rice and herbal tea: Her eyes literally melted and collapsed.

There are also a couple case reports of autistic children who refused to eat anything but French fries or menus exclusively comprised of bacon, blueberry muffins, and Kool-Aid, and became vitamin A deficient. A case in the Bronx was written up as vegan diet and vitamin A deficiency, but it had nothing to do with his vegan diet—the kid refused to eat vegetables, consuming only potato chips, puffed rice cereal with non-fortified soymilk, and juice drinks. “His parents lacked particular skill in overcoming the child’s tendency to avoid fruits and vegetables.”

A plant-based diet may actually be the best thing for patients with dry eye disease, those who wear contact lenses, and those who wish to maximize their tear secretions. People with dry eyes should be advised to lower protein, total fat, and cholesterol intake, and do the following:

  • increase complex carbohydrates;
  • increase vitamin A content (by eating red, orange, yellow, and dark green leafy vegetables);
  • increase zinc and folate intake (by eating whole grains, beans, and raw vegetables, especially spinach);
  • ensure sufficient vitamin B6 and potassium intake (by eating nuts, bananas, and beans);
  • ensure sufficient vitamin C intake (by eating citrus);
  • eliminate alcohol and caffeine;
  • reduce sugar and salt intake; and
  • consume six to eight glasses of water per day.

We know dehydration can cause a dry mouth, but could dehydration cause dry eyes? It may seem kind of obvious, but evidently it was never studied until recently. Is the answer to just drink more water? We know that those suffering from dry eye are comparatively dehydrated, so researchers figured that tear secretion decreases with progressive dehydration just like saliva secretion decreases and gives us a dry mouth. And indeed, as one gets more and more dehydrated, their urine concentrates and so does the tear fluid. But one can reverse that with rehydration, raising the exciting prospect that improving whole-body hydration by getting people to drink more water might bring relief for those with dry eyes. The researchers recommend eight cups of water a day for women and ten cups a day for men.


Find more on the importance of proper hydration in my How Many Glasses of Water Should We Drink a Day?, Does a Drink Of Water Make Children Smarter?, and Can Dehydration Affect Our Mood? videos.

To learn more on other topics related to eye health, check out:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: