For decades public health officials have been preaching a low-salt diet. Ask the experts at the Centers for Disease Control & Prevention (CDC) and they would probably say that you can’t have too low a golf score or salt intake. They preach that anyone over 50 should keep sodium intake under 1,500 mg daily. The American Heart Association (AHA) also recommends that “all Americans reduce the amount of sodium in their diet to less than 1500 mg a day.”
What if these prestigious organizations were not just wrong, but dangerously so?
A study published in the American Journal of Hypertension on April 2, 2014, analyzed data from 25 previous research papers. This meta-analysis concluded that a low-salt dietary strategy is associated with a higher risk of death. You read right. In observational studies, the preponderance of the data links the sodium recommendations of the CDC and the AHA to increased mortality. Ouch! This kind of evidence undermines the credibility of our most prestigious public health organizations.
This isn’t the first time we have heard that a low-sodium diet might be hazardous to your health. The Institute of Medicine (IOM) issued a report that was published in JAMA Internal Medicine (online, Oct. 28, 2013) that found there are no data demonstrating benefit from the CDC or AHA low-sodium guidelines. Even worse, the report noted that when people with diabetes, hypertension, kidney and cardiovascular disease achieve the goals set out by the CDC and AHA, they may actually experience harm. Studies have suggested that a low-sodium diet may stimulate a hormonally-induced stress reaction that could lead to an increased risk of type 2 diabetes, heart failure complilcations, worsening thyroid disease and death.
Keep in mind that the health professionals who are nominated to the Institute of Medicine are among the smartest and most respected scientists in the world. But wait, it gets worse still. Another review of the low-sodium recommendations published in The American Journal of Medicine titled “Dietary Sodium Restriction: Take It with a Grain of Salt” came to the following conclusions:
“There is no conclusive evidence that a low sodium diet reduces cardiovascular events in normotensive and pre-hypertensive or hypertensive individuals. On the contrary, there is sound evidence that a low sodium diet leads to a worse cardiovascular prognosis in patients with systolic congestive heart failure or type 2 diabetes mellitus…Advising low sodium diets seems misguided and potentially dangerous and illustrates the problem of guidelines based on flawed studies using surrogate measures.”
Despite the growing evidence that its low-salt guidelines are just plain wrong, neither the CDC nor the AHA seems likely to reverse gears any time soon. Perhaps they fear that their credibility will be damaged if they change direction after all this time. How very sad! Revising views on the basis of evidence seems only rational.
Now, no one is saying that pigging out on salt is a good thing. Too much can be at least as dangerous as too little. The new research makes it clear that the sodium situation is a little like the story of Goldilocks and the porridge. It shouldn’t be too hot or too cold. There is a sweet spot in the middle. The conclusion:
“Both low sodium and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes.”
The new study suggests that the sweet spot for sodium is between 2,645 and 4,945 mg per day. That is substantially above the recommendations by the American Heart association and the CDC and probably is more in line with what your grandmother was consuming. We continue to believe that grandmothers the world over probably had more common sense about such matters than some of our prestigious public health organizations. We leave it to you and your health care professional to determine what would be optimal for you.
In the meantime, here is a link to another People’s Pharmacy Alert titled: “Is a Low Salt Diet Dangerous for Your Health” should you wish to read more.
We welcome your comments about this controversial topic below.