pile of salt next to a salt shaker low sodium diet, high sodium

Years ago, there was a popular book titled All I Really Need to Know I Learned in Kindergarten by Robert Fulghum. It was full of wisdom like Share everything, Play fair, Wash your hands before you eat and Clean up your own mess. These are great lessons we all learned (or should have learned) in kindergarten.

One of our favorite parts of kindergarten was the story circle, and we especially loved the story of Goldilocks and the Three Bears. You probably remember that Goldilocks was not very prudent when she went waltzing into a house where no one was home. (Papa, Mama and Baby Bear were out for a walk in the woods.) But as Goldilocks went through the house, she tried things out and found the ones that were just right–not too big or too little, not too soft or too hard, not too hot or too cold.

Entering uninvited is a bad idea, but we think that otherwise Goldilocks’ strategy was pretty wise. Medical studies keep demonstrating that for most things, too much and too little are bad for us. We need to get to “just right.”

This was just borne out by a study from Denmark examining the effects of sodium intake on mortality, especially cardiovascular deaths (American Journal of Hypertension, online, March 20, 2014). The scientists analyzed 25 studies to find out whether severely limiting salt really results in lower blood pressure and fewer heart attacks as we have all been assured.

What the investigators found might make the American Heart Association splutter. The data run counter to AHA guidelines.

Usual salt intake was better than low sodium diets at preventing premature death and heart-related mortality. Usual salt intake was also healthier than high salt diets. People who consumed moderate amounts of sodium, between 2,645 mg and 4,945 mg daily, were less likely to experience heart attacks or unexpected death compared to those ingesting more or less than those amounts.

The American Heart Association and the Centers for Disease Control and Prevention (CDC) still recommend, as they have for years, that most people should drastically cut sodium intake to 1,500 mg a day or less. At that level, food tastes bland and there are no obvious benefits. In fact, the accumulating data indicate that there is an increased risk of heart disease and death.

These public health organizations don’t seem open to revising their guidelines on low salt diets based on evolving information. Their recommendations for cutting sodium intake to the bone seem to be based primarily on an assumed effect on blood pressure.

Assumptions are not science. Evidence should trump belief in the world of medicine, but it often takes time for paradigms to shift.

Perhaps it’s time to shift back to a common sense approach familiar to our grandparents: moderation!

Share your story about your experience with a low salt diet below in the comment section.

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  1. EEC

    Since developing very low sodium (now usually 128, once was 123), my cardiologist has changed my Blood Pressure medicine to HCTZ only at 125mg. He also lowered Avapro (150mg) to once a day, not twice. For a month on this, I am increasingly so queasy I can’t sit or stand long, and very weak & dizzy.
    I never ate very high salt, but now I don’t try to eat low salt. BP is down, but I just can’t function! I do any small thing I can. I get out of bed, but then can hardly stay up.
    I’m getting very discouraged. Any suggestions?

  2. Soozi

    I used to work in an office. I was a busy working person. I often ate food prepared by others (tuna sandwiches on white bread…) and the amount of sodium added to my food was probably astronomical. I had no way of knowing. My BP was high and I was on medication for years. If people eat processed food or food prepared by restaurants, their sodium intake is probably very high. As soon as I stopped working, started reading labels and preparing my own food, my blood pressure went back to normal with no medication. I’m sure I stumble on plenty of sodium by accident throughout my days, because every now and then I eat in restaurants or have pizza or other take out.
    I’m convinced that people need to watch what they eat. If the general population cooks their own food, then the 1,500 mg guidelines may be low. If the general population eats fast food periodically, processed food daily and in restaurants once in awhile, then their sodium/salt intake is probably quite high and there is no way to know for sure. If you look at the ingredients in the big salads served in some of the top chain restaurants, it is easy to exceed 1,500 milligrams of sodium, while hoping to eat responsibly.
    Just one small example: Most jars of tomato sauce have hundreds of milligrams of sodium per serving and who really eats only one serving as measured on the jar label? Add that to a few other items throughout the day and whoops!
    i’m just saying, if your goal is 1,500 mg, it is easy to far exceed that without even knowing it.

  3. Donnie

    Remember when they told us butter, red meat, saturated fats, eggs and salt would kill us. Eat the nice transfats and margarine and avoid the other foods they claimed were deadly for us. Well, they sure got it wrong about transfat that actually does harm people, and about the other foods that are not harmful after all. Perhaps we would be much better off not listening to what ‘they’ say, and use our own common sense.

  4. Carolyn Kay / Many Years Young

    Also, most of these studies ignore the importance of the sodium/potassium ratio, which may be more important than the level of sodium intake alone. – http://nyti.ms/12NVuUG

  5. GLP

    I have high blood pressure and medications have been a part of my daily life for quite a while. I moved so I changed to a clinic close by. My first get-to-know-you appointment revealed that my blood sugar was pre-diabetic, but not medication worthy. I started to track my daily glucose count and started to cut back on my sweets and watching carb intake.
    My glucose count lowered, my blood pressure lowered, I lost weight and my taste for salt practically disappeared so I use it sparingly.
    It taught me a great deal about how wonderfully our bodies work together to stay in sync. I sure learn a great deal from your column that lends itself very nicely to staying on top of my health. Thank you so much!

  6. jj

    I’m not surprised at the results, nor at the institutional inaction. We’ve ditched institutional advice for common sense years ago. All salt is not the same. We avoid processed foods and processed white table salt, and we use sea salt freely and we are in pretty good health.

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