In the case of salt vs. pepper, salt could be accused of contributing to the preventable deaths of thousands of Americans.  Pepper, on the other hand, might make you sneeze.  If you will forgive a bit of tongue-in-cheek humor, a brief taste of the evidence examining the pros and cons of these popular condiments may make you thirsty for more knowledge.

We need salt to survive, and, historically, it has been a highly valued commodity. The idea that salt is a threat to human health for its impact on blood pressure is only about 50 years old.  In fact, in 1930, Gandhi led more than 100,000 people in a march in India to protest the salt tax imposed by the British government. "Next to air and water, salt is perhaps the greatest necessity of life," he declared.

In a study in the New England Journal of Medicine published in 2014, it was suggested that 1.65 million deaths a year from cardiovascular causes were caused by high salt intake.

The DASH trial (Dietary Approaches to Stop Hypertension) showed that eating a diet rich in fruits and vegetables and low in saturated fats and salt led to decreasing blood pressure by as much as 11 points.  As a result, both diet changes and salt restriction are recommended if you have high blood pressure.

The salt that we add at home is the least of our problems.  A recent study showed that Americans get just 5 percent of their salt intake from the table salt shaker, but 71 percent from processed foods and restaurant meals. Older people and African Americans tended to salt their food more at home, the study found, and younger people get even more of their salt outside the home, eating even more processed foods.

Pepper is a different story.  Americans use 6.5 million tons of salt a year, and only 27,000 tons of pepper.  The spice became popular hundreds of years ago when Europeans realized pepper could disguise the taste of semi-rotten meat, which was quite common at the time. But medically speaking, pepper isn't necessary to life, as moderate salt intake is.

But cutting salt is notoriously difficult. Here are some suggestions that may help:

  1. Take the salt shaker off the table. Do not substitute sea salt and kosher salt in the belief that they are better for you, as they contain just as much sodium.  It is best to avoid salt substitutes and expose your palate to new flavors using other spices. Give it some time; your tastes will adjust to the reduction, and eventually your old salt intake will seem overpowering to you.
  2. The more that you can eliminate salt-laden processed foods from you diet, and replace them with fruits and vegetables, the healthier you and your blood pressure will be.
  3. The biologic need for salt is about 2 grams per day – that's less than a half-teaspoon. Most people in America consume at least triple this.
  4. If you have been diagnosed with hypertension, evidence is overwhelming that reducing salt, adding potassium-containing foods, losing weight, and exercising regularly will work, and is the best treatment to try before going on medication.
  5. Pepper is safe – it may even help with gastric upsets and nutrient absorption. But in very large amounts, black pepper may affect the way the liver breaks down certain medicines, possibly increasing the chances of side effects.

The bottom line: The real guilt in this case lies with the makers of many processed foods for dumping so much salt in our diets and increasing the risk of premature cardiac death.

David Becker, M.D., is a board certified cardiologist at Chestnut Hill Temple Cardiology, and associate director of preventive cardiology at the Temple Heart and Vascular Institute.