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.

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  1. Penelope

    The other issue, is that if we only cut out table salt, we are depriving ourselves of iodine. Limit the sodium from prepared foods, and sprinkle a very little on your food on your plate.

  2. laura j.
    Boca Raton Florida

    I have wondering about the salt issue for some time so am glad to receive this discussion.
    thank you.

  3. LJI

    Way back in 1986 an elderly friend of mine had been put on a low sodium diet. Prior to his adhering to diet, at age 82 he was in reasonably good health. Within a couple of years he had to hold on to walls to get around the house due to dizziness and instability. This confounded his doctors. They chose to ignore the fact that his blood tests revealed extremely low sodium levels and only encouraged his continuance to avoid Salt from any and all sources.
    His condition worsened up to the point he remained stationary most of the time. Finally, His eldest daughter, a cardiatric care nurse flew into town and took him to her physician 500 miles away who was alarmed at his lack of salt . . . put him back on it.
    Within days, he was up and about, shocked at just how unreliable most medical advise is. Pass me the Salt, Please !

  4. Paul C. G.

    Hi, This data fits perfectly with heart chloride ion levels. Remember Cl- ions allow the heart to beat when maintained in the narrow range. It is not potassium as everyone thinks it is, but chloride ions controlling things. Remember, in the Bible it says we come from the salt of the earth, Sodium/Potassium Chloride. pg o&o

  5. JTD

    My husband’s grandfather always told us “all things in moderation”. He lived to be almost 102 and could still could beat most of his grandkids and great grandkids at cribbage and blackjack.
    Although I have been told my my Dr. I am mildly hypertensive and am on a mild diruretic Rx, that along with regular excercise and a diet that contains adequate fruits and vegetables and not a lot of sugar controls my mild hypertension very well.
    My father was on a very strict no-salt diet with congestive heart failure before he died of renal failure, and he suffered and craved salt. I wish we would have known then what we know now.
    I have also noticed that in the summer if I don’t eat enough salty foods when I am working hard in the garden or cleaning the barn and sweating a lot, my body tells me very quickly when I need more salt and other minerals. I get weak. Eating some salty chips and drinking some water or Gatoraide and cooling off indoors a few minutes cures the wooziness quickly. It is one of the only times I eat salty chips or drink Gatoraide.
    I know I can’t go to excess, either, but simply observing our sheep, animals that pretty much self-regulate on salt intake, tells me other mammals need adequate salt/mineral intake, too. Most people don’t know that sheep sweat, and they also eat more salt in the summer!

  6. TEF

    I eat a small amount of salt after spinning class. I work hard in class and sweat just pours off me for about 40 minutes. Without the salt I was Mr. Cramp. Muscles, particularly my leg muscles, would cramp at random times in the day or at night. The salt got rid of the cramps. I don’t know if it is the salt itself or just the fact that salt allows replenishment of fluids. Whatever the mechanism, salt works.

  7. jj

    All salt is not the same, just as all fats are not the same. I wouldn’t touch table salt with a ten foot pole. Sea salt is fine. We use it liberally, but we don’t eat processed foods or use processed salt. We buy the coarsest sea salt, and I grind it myself by hand. I’m not having any health problems, but I stay away from the medical profession like I stay away from white sugar, tobacco, alcohol and caffeine.

  8. irene

    A dear friend was ordered by his doctor to cut out salt. My friend became paranoid about ingesting anything with salt in it. He died of heart failure a few short months later. Coincidence? I think not. He was strong as an ox, good East European constitution.

  9. Donnie

    I have to make sure to keep my sodium levels up, by eating extra salt. My lab tests usually shows my readings are below normal.

  10. JY

    I totally agree with this article after reading other similar articles as well. It just makes sense. I do have to watch salt intake however, because of osteoporosis. I have read that excessive salt intake leaches calcium from bones. However, I wonder how much salt I can safely consume to avoid this problem.

  11. plm

    Like I have said before, “Everything in Moderation” including drink. This was told to me by my Mother. It works.

  12. Soozi

    I was on blood pressure medication for 15 years!! No doc ever explained the low salt/sodium solution to me, because writing a prescription is good business. Then I attended a program that served whole foods. When I arrived I had high blood pressure while on medication for 15 years with doctors saying they would increase my medication. Over night, after eating food at the program, low in added sodium, my bp was NORMAL! It has been normal ever since. I am very thankful that I am no longer pumping prescription drugs into my body every day, for years, with no resolution to my high BP.
    I think there is plenty of salt/sodium all over the place. It is naturally occurring in food. It is added in huge amounts to processed food. Look at the back of any tomato sauce container. You would think tomatoes are healthy, but the sodium numbers are often quite high. Bread is another surprising culprit. Restaurants give you no idea how much they add to your tasty meal.
    As some have said here, it’s difficult to get and keep the salt/sodium levels down in our current day diets. Yes some of our grandmothers lived long lives, but they often ate whole, natural foods and exercised more than we do, now that we drive everywhere.
    Everything in moderation, yes!
    I for one have excellent experience keeping my BP normal by carefully regulating my salt/sodium intake.
    I wonder who those people are that can keep their salt/sodium levels so low that they are in harms way. That’s a major challenge to me.

  13. TA

    This answers my question of why my cardiologist says 2200 mg while my friends are told it is should be 1500. Could my cardiologist perhaps be compromising with the studies and going for moderation? Still I have to tell you it is a challenge to stay under 2200 and still have tasty foods. However, I do feel a little better although a bit light headed.

  14. Rodika

    Absolutely right, everything in moderation and kept in balance is the key to a healthy life.

  15. Mary V.

    I was taught by my mother who was taught by her mother that all things in moderation is a good policy as well.

  16. Mary T.

    I was taught by my Grandmother that moderation in all things is a good policy. I agree!

  17. JRC

    My understanding is that salt doesn’t stand alone, that the problem is an imbalance of the minerals, especially potassium and the other electrolytes. Tell me if I am wrong! Eating sea salt or, even better, Hymalian salt contributes to this balance. My lab tests sometimes shows low on salt, at other times, low on potassium. Each time, the doctor insists that I fix one, then the other.

  18. Carole

    I knew the saying “everything in moderation” was right. It seems we keep hearing new information about things like chocolate, fats, and now salt intake can be okay in moderate doses. I feel exonerated! However, I will take all this new info with “a grain of salt”.

  19. Pat

    I read somewhere that you can become dehydrated no matter how much water you drink, if you don’t have enough salt in your system. The reasoning was that salt is what allows your cells to retain water and if there isn’t enough, your cells can’t hold on to the water that is available to them. That could definitely cause health problems.

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