cutting the salt, pouring salt from a salt shaker

American and European experts on cardiovascular disease disagree about salt. An article in the European Heart Journal recently pointed out that there is little or no evidence supporting the extremely stringent guidelines put forth by the American Heart Association. The main source of sodium in our diets is salt, sodium chloride.

How Much Sodium Is Too Much?

The authors acknowledge that  sodium intake above 5 grams a day is clearly linked to more cardiovascular disease and death in populations. That’s why they “support interventions to reduce sodium intake in populations who consume …> 5g/day.”  This amount of sodium is roughly three times higher than the AHA guidelines, which urge people to get their sodium intake down to 1.5 g/day or lower.

European Heart Journal, Jan. 20, 2017 

Such disagreements between American and European experts, and even among the Americans, are not new. Seven years ago we received this question from a reader:

Restricting Salt to Control Blood Pressure:

Q. My blood pressure is slightly elevated. I take a water pill to control it, and my doctor suggested that I restrict salt.

My adult-ed science teacher claims that only half the adult population is sensitive to salt so that it makes their blood pressure rise.

I went on an extremely salt-restricted diet for a month and had no change in my blood pressure. My doctor now says I can eat normally.

Please tell people that they should run this experiment themselves before spending the rest of their lives hunting for low-salt foods. Life is complicated on a restricted diet, and it would be a shame to do this if it isn’t needed.

A. The link between salt (sodium chloride) and high blood pressure has been controversial for decades. Studies suggest that cutting back on salt can lower blood pressure modestly. A carefully run, long-term trial found that substantial sodium reduction only lowers blood pressure two or thee points (Journal of Human Hypertension, Jan. 2005).

People Are Different with Respect to Salt Sensitivity:

Some people are especially salt sensitive and benefit from a sodium-restricted diet. Others, like you, don’t see any improvement.

A comprehensive study in the British Medical Journal (April 28, 2007) found that sodium restriction led to a 25 percent decline in heart attacks and strokes. Even though cutting back on salt may not make a big difference for everyone, it clearly can help some people delay death from cardiovascular disease.

More Controversy Over Salt:

Japanese experts have also found a link between higher sodium intake and an increased risk of hypertension (Takase et al, Journal of the American Heart Association, July 29, 2015; Murai et al, Journal of Hypertension, June, 2015, Supplement 1). A meta-analysis of 34 randomized trials found that modest salt reduction, to around 3 g/day, for at least a month lowered blood pressure significantly (He et al, BMJ, April 3, 2013).

Just to underscore that not everyone benefits from cutting salt, however, is a study of nearly 7,000 American adults. It found no connection between sodium or potassium intake and elevated blood pressure (Sharma et al, Journal of Clinical Hypertension, April 11, 2014).

What Are the Risks of Cutting Out Salt?

We have written previously about disagreements between experts with respect to sodium. We think people should be warned that following strict AHA guidelines and eliminating salt from the diet to achieve a very low sodium intake may have risks.

Using a salt substitute can sometimes be a good choice for people trying to reduce their sodium intake. But this too may be dangerous, especially if people are taking blood pressure medicines that push the body to hang onto potassium. Excess potassium can become deadly.

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  1. Victoria-nola
    Greater New Orleans Area
    Reply

    Use whole, unrefined salt. That retains the balance of all the minerals as nature intended it, the mineral balance that matches that of our blood. Mineral balance is more important than vitamins, because without minerals we can’t utilize vitamins. What is commonly called “sea salt” is simply refined salt with no iodine added back in. It must be labeled “unrefined” to be whole. I could go on and on…

  2. banne
    USA
    Reply

    For the first time in my 80 plus year, I am having blood pressure issues – found this out after I ate a small bag of potato chips on the day before my yearly physical. In the past few months, I have been taking my blood pressure daily and have found that the day after I have salty food (chips, salty cheese, french fries, etc) that my systolic number will be up at least 10 and sometimes 20 points. My diastolic goes up a bit but stays below 80. While I am not attempting to count the salt in every morsel of food, I am staying away for the most part from chips, etc.

  3. Martha
    Reply

    I do not see much information about the ratio of sodium to potassium and its relationship to blood pressure issues. Since electrolytes need to be in balance, this ratio would seem to be far more important in overall health and blood pressure.

    As to sodium reduction, our current desires and intake of high sodium snacks definitely needs to be reduced but even one slice of multigrain bread can contain as much as 300 mg. of sodium! It’s the prepackaged products out there creating most of our problems and the same would hold true for sugars. Just take a walk down the cereal aisle and see what our children are being fed.

  4. Molly
    Reply

    Salt apparently causes fluid retention, which can lead to CHF. My husband and I both have CHF – it’s not pleasant to not be able to breath due to “water” pressing on our heart and lungs. I can definitely tell the difference if our evening meal contains excessive sodium. We wake up with weight gain, difficulty breathing and discomfort in our mid section. Whether it raises our blood pressure significantly or not is not an issue when we’re drowning in fluid caused by sodium/salt intake.

  5. Angela
    St. Louis, MO
    Reply

    Is the amount of water people drink (or more likely, don’t drink) taken into account when salt studies are done? My uneducated guess is that a hidden culprit to health and heart problems could be not that people are consuming too much salt, but not enough water.

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