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

For decades, public health experts have been exhorting Americans to eat less salt. This is supposed to reduce their risk of high blood pressure and heart disease. Have food manufacturers succeeded in cutting back on salt in packaged food? Are Americans buying low-sodium products?

New research shows that packaged food purchased in 2014 had significantly less sodium than that in the grocery bags in 2000 (JAMA Internal Medicine, online June 5, 2017). The scientists used data from the Nielsen Homescan Consumer Panel. Approximately 170,000 households participated nationwide during this time, scanning every package of food they bought. The bar codes allowed the investigators to calculate how much sodium was in each food per person it was serving.

They concluded that there has been a 12 percent decline in sodium content during this time, dropping per capita sodium by almost 400 mg per person per day. We think that is actually pretty impressive. The authors of the article noted:

“Moreover, the sodium content of households’ purchases decreased significantly for all top food sources of sodium between 2000 and 2014, including declines of more than 100 mg/100 g for condiments, sauces, and dips and salty snacks.”

Raining on the Cutting Back on Salt Parade:

The authors seemed less thrilled with their results:

“Although a significant 15-year reduction in the median sodium density of households’ packaged food and beverage purchases was achieved, almost all US households had purchases exceeding optimal sodium density levels. In summary, sodium in US households’ packaged food purchases decreased significantly and consistently for all 3 measures examined (mg/d, mg/100 g, and mg/1000 kcal), but further reductions are needed.”

The authors go on to suggest that most US households are still getting more sodium than experts consider healthy and further reductions are needed.

The Sodium Controversy Continues:

Franz Messerli, MD, is one of the world’s foremost researchers in the field of hypertension. He graduated from Bern Medical School in Switzerland and has spent decades in the United States as a highly regarded investigator. He is professor of medicine at the Icahn School of Medicine at Mount Sinai Health System and directed the hypertension program at St. Luke’s Roosevelt Hospital.

In a commentary published in the American Journal of Medicine (April, 2017) titled “Salt, Tomato Soup, and the Hypocrisy of the American Heart Association,” Dr. Messerli and his colleagues point out that a controversial study by Mente, et al concluded:

“that a reduction of dietary sodium is beneficial in high salt eaters who also have high blood pressure. However, in people with normal blood pressure, lowering salt intake has little if any effect and may even be harmful when becoming too severe.”

Dr. Messerli goes on to criticize the American Heart Association:

“This is the same AHA that for years has accepted fees to uncritically endorse as ‘heart healthy’ scores of products by the Campbell Soup Company (Camden, NJ), products that contain far more salt than the AHA itself recommends for a heart-healthy diet. Specifically, the AHA recommended that consumers shouldn’t eat more than 1500 mg of sodium per day, and also preferentially choose low-sodium foods defined as having <140 mg of sodium per serving. Campbell’s AHA-certified products contained around 400 mg per serving, or between 600 and 1000 mg per unit, far from the AHA’s suggestions.”

Finally, Dr. Messerli and his co-authors summarize, in our opinion, the salt issue quite thoughtfully:

“Understandably, the AHA, despite its hypocritical endorsing policy, is unwilling to acknowledge that universal salt restriction may be controversial, that indeed the relationship between salt intake and heart disease may be far more complex than we originally thought. Perhaps, then, the AHA should take to heart the dictum of H. L. Mencken:

‘For every complex problem there is an answer that is clear, simple, and wrong.'”

Want to learn more about the controversy swirling around cutting back on salt? Here is a link to the complexity of this seemingly “simple” story:

What Do European Experts Think About Salt?

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  1. Evelyn
    NC
    Reply

    Sodium intake appears to affect some people more than others. My husband’s BP has a history of being strongly affected by his sodium intake while mine has been minimally affected.

    I was out of town for a couple of months and hubby ate whatever he wanted – canned corned beef, hot dogs, and such with mustard, chili, etc. A few evenings after I returned, we had to take him to the ER as his BP was in excess of 220/180. They kept him overnight, gave him meds but there was no significant improvement when he was discharged the next morning nor during the following day.

    After viewing the pantry and seeing his food choices, I chose to put him on an extremely restricted sodium diet (harder to do than one might think – just check the nutritional data). In 3 days, his BP dropped drastically to 135/80.

    He had been on moderate BP meds for years so no change in meds. The sodium restriction was so low as not to be realistically sustainable over a long period but had the desired short term effect. He finally learned what I had been aware of for years. His body just can’t handle a lot of sodium. It’s definitely not a case of “one size fits all.”

  2. Alex
    MA
    Reply

    You mention Campbells Soup, I automatically bypass them because of high sodium.

  3. Evelyn M
    TX
    Reply

    The relationship between salt intake and potassium levels in the blood should be part of the discussion. My partner was diagnosed with moderate to severe congestive heart failure twenty years ago, and was advised to eliminate added salt from her diet. She has been a lifelong “saltaholic,” adding salt to almost everything she eats, so this was a devastating blow. She found it nearly impossible to eat food without salt.

    After various treatments she finally received a biventricular pacemaker, which, along with drug therapy, has restored her heart function to nearly normal. She gradually returned to her “bad” salt habits with no apparently ill effects.

    Her only experience with high blood pressure happened during treatment after a near-fatal auto accident, after which the CHF [congestive heart failure] occurred. While she was in the trauma ICU, it was discovered that her potassium levels run on the high side of normal, so much so that her daily 40 mg of Lasix does not require a potassium supplement.

    We have since read that potassium tends to moderate the effects of salt on blood pressure. It would be interesting to find out if other patients have had similar experiences, and if potassium supplementation could benefit those who are most negatively affected by salt intake.

  4. dzrlib
    Reply

    One problem with using salt substitutes is the chance of developing hyponatremia.
    The normal concentration of sodium in the blood plasma is 136-145 mM. Hyponatremia occurs when sodium falls below 130 mM. Plasma sodium levels of 125 mM or less are dangerous and can result in seizures and coma.

  5. S Scaggs
    Illinois
    Reply

    When one gets blood tests from doctor look at the sodium and chlorine to see if one is eating too much salt. Sodium Cloride is table salt. Every cell
    needs a balance of salt and potassium . they are the electrolites in each cell.
    I don’t always write a note so I guess that is why you cancelled to send
    People’s Pharmacy in email. I always listen on SuNDAY and watch emails..
    Sue S

  6. dee
    WA
    Reply

    as a caregiver for over 20 years to very elderly people, most with heart disease, i have seen what a low-salt diet does to people who already have very little quality of life.

    many people lose interest in eating altogether, as salt-free food has no taste! (imho; and i am a person of 77 without heart disease and i love salt in moderation). i saw my mother deprive herself of salt (and thus, taste), and she still died at 77. yes, of heart disease.

    each person needs to weigh the pros and cons of this controversial issue, and try to not take as “gospel”, the pronouncements of cardiologists or primary care practitioners. they are often just parroting what they have read in studies many many years out of date.

  7. Beverly
    Reply

    I agree it is a complex issue, and I hate simple answers to complex problems, whether in health or politics, usually given for corporate financial gain. For example, I am allergic to fish and fish oil may be healthful to most, but not me. The mass current use of sea salt in chips, etc may have less sodium, but lack iodine and possibly other nutritive essentials. I agree with Dr. Messerli, simple answers are “clear, simple and wrong”. Thanks for a thoughtful article.

  8. Helen
    CA.
    Reply

    I controlled my salt intake just because salty foods made my joints ache. (from fluid retention I guess) Not to a drastic degree but I just avoided packaged or canned foods that listed very high sodium content. Didn’t lower my BP. I had a couple of UTI infections and landed in the hospital in ICU because of low sodium numbers. Drs. seemed overly concerned and I wasn’t released until the sodium level increased. I had no idea it could be such a serious problem.

  9. Karen C
    New Braunfels, Texas
    Reply

    Here’s my experience regarding salt intake. I was told by a cardiologist to reduce salt intake. Although it did not seem to lower my bp, it helped my arthritic knee immensely. I could barely walk when first standing up and now it hardly bothers me at all. I did lose a few pounds also but if I consume more salt my knee gets worse again. I was contemplating knee replacement. Not anymore!

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