Do You Really Have to Cut Back on Salt?

A new report calls the current sodium guidelines into question

Beth Fontenot, MS, RD, LDN
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Photograph: Shutterstock.com

Things we thought we knew about sodium may need to be taken with a grain of…salt. A new report from the Institute of Medicine (IOM) has health experts shaking their heads and health organizations issuing peppery statements of disagreement.

There is no good reason for Americans to reduce their sodium intake below 2,300 mg/day, and in fact, it could be harmful to health. This is the conclusion of the newly issued report by the IOM. The recommendations stand in stark contrast to the government-issued Dietary Guidelines for Americans, and contradict the recommendations of the American Heart Association and several medical groups.

Let’s take a step back and look at what’s going on.

Sodium Highs and Lows

The health warnings over the years have given salt a bad rap. Sodium is not a harmful substance in and of itself. This mineral is a nutrient essential to the functioning of every cell in your body. Adverse health effects occur with sodium intakes that are too high and too low.

Even with the new recommendations, the average American consumes too much sodium — about 3,400 mg/day or the equivalent of 1½ teaspoons of salt. Sodium causes the body to retain extra fluid, making the heart work harder. High intakes have been associated with an increased risk for heart failure, stroke, stomach cancer, kidney disease, and osteoporosis. It is estimated that high sodium consumption may be linked to a third of the cases of high blood pressure in the US.

Low levels of sodium in the blood can lead to mild symptoms such as headache and a general loss of energy or to more serious symptoms like seizures and coma, and even cause death.

In 2005, the IOM set the minimum amount of sodium required for adequate nutrition at 1,500 milligrams, and 2,300 milligrams as the maximum amount that could be consumed each day without raising blood pressure.

These ranges were behind the 2010 Dietary Guidelines for Americans which recommend people consume no more than 2,300 mg/day, except for those who face greater health risks from excess sodium consumption: adults over 50, African-Americans, and those with high blood pressure, diabetes, or chronic kidney disease. People in these groups, who make up over half the population, were advised to limit their sodium to 1,500 mg/day per day.

Then the American Heart Association weighed in and tightened the rein on sodium intake even further. It said that everyone, regardless of age, race, or ethnicity, should limit their sodium intake to 1,500 mg/day per day. Their thinking was that keeping sodium intake this low would help prevent heart attacks and strokes. The only problem was there were no data on the health benefits of such a sodium restriction.

The New Evidence Behind the New Guidelines

The current IOM report, which was done at the request of the Centers for Disease Control and Prevention (CDC), considers new evidence that has emerged since 2005.

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