Sodium (found in salt) intake recommendations have traditionally been highly controversial with a large variation in recommendations from expert committees throughout the world. In the US, guidelines are to limit sodium to no more than 2,300 mg among healthy adults and to no more than 1,500 mg for those at risk of cardiovascular disease. Recommendations in the United Kingdom are far more relaxed, restricting sodium intake to 6,000 mg. Germany is among the most unrestrictive in their sodium guidelines, allowing up to 10,000 mg daily. The US isn’t alone in strictly recommending limited sodium intakes; Sweden recommends a maximum of 2,000 mg daily.
With such a large variation in salt recommendations, is there really a risk from excessive salt intake? A recent review of studies on salt intake published in the American Journal of Hypertension may provide some direction. Researchers performed a thorough analysis of available studies and identified 25 that were high quality and measured the risk of both cardiovascular disease and death from sodium intake. In total, the studies included nearly 275,000 participants, some healthy and others with preexisting cardiovascular disease. Using robust statistical analysis to control for common risk factors of cardiovascular disease, the researchers were able to estimate how different intakes of sodium contribute to an individual’s risk of cardiovascular disease and death.
The results of the review not only didn’t support any benefit from a low sodium diet, they found evidence that it may be harmful. The researchers found evidence of harm from both high as well as low intakes of salt. A suggested healthy sodium intake range offered in the study is 2,645 – 4,945 mg per day. The researchers also found that this recommendation was consistent for both healthy individuals as well as those with cardiovascular disease, suggesting that there is no need to recommend a reduced sodium diet for those with hypertension or other risk factors of cardiovascular disease. This conclusion is aligned with a consensus statement from the Institute of Medicine published in 2013 but not in agreement with a Cochrane review published that same year. The Cochrane review recommended restricting sodium intake to no more than 3,000 mg daily. However, this review used blood pressure rather than cardiovascular disease and death as endpoints in their analysis. The results, therefore, may not reflect an accurate risk assessment.
In the US, the average sodium intake is approximately 3,400 mg daily, right in the middle of the healthy range put forth in the review in the American Journal of Hypertension. This review is part of a larger shift in the scientific community away from the low-sodium diet to a more moderate recommendation of sodium intake. With backing from the Institute of Medicine, look for significant changes to salt recommendations in the upcoming edition of Dietary Guidelines for Americans which is scheduled to be released in 2015. Before reintroducing salt into your diet, consider the current recommended guidelines and always consult with your health care provider regarding questions and concerns about dietary changes and what the best option may be with your personal and family medical history and lifestyle. Also, sea salt is not processed and retains trace amounts of minerals like magnesium, calcium, and potassium.
By Ron Beckstrom, MS, RD, HFS
This article is for nutrition information purposes only and does not constitute medical advice. Always seek the advice of a qualified health provider with any health concerns you may have. The information in this article is not intended to promote any specific product, or for the prevention or treatment of any disease.