Is a Low Salt Diet Plan Healthy?

High blood pressure is the leading cause of preventable deaths around the world. But did the Institute of Medicine (IOM) really say that lowering salt consumption is not the answer?

“Lowering daily sodium intake below 2,300 milligrams may do more harm than good,” reported CBS News in May 2013. “No benefit in sharply restricting salt, panel finds,” said The New York Times. “Is eating too little salt risky?” asked National Public Radio. “New report raises questions.”

Questions, indeed. But not so much about salt as about what the IOM was asked, what it concluded, and whether it relied on discredited data.

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When the Centers for Disease Control and Prevention asked the Institute of Medicine to quickly review the impact of very low-salt diets on health in 2012, the CDC expected to clear up some confusion. Instead, the report caused more. Here’s what the IOM did—and didn’t—say.

The report wasn’t about whether we eat too much salt.

The question wasn’t whether typical U.S. sodium intakes —at least 3,400 mg a day, not including what we get from the salt shaker—are healthy. They’re not.

Instead, the CDC wanted to know what happens at 1,500 mg to 2,300 mg a day.

While that matters for setting daily sodium targets, it applies to few people, since only about 5 percent of adults get less than 2,300 mg of sodium a day (not counting what comes from the salt shaker).

The report found no harm for most people.

There’s “insufficient and inconsistent” evidence that very low-salt diets cause harm in the “general population,” the IOM concluded.

Why insufficient? Studies that have observed a higher risk of disease or death in people who eat very low-salt diets have weaknesses.

One example: “People who report eating very little sodium are more likely to be ill,” explains Stephen Havas of the Northwestern University Feinberg School of Medicine. Odds are, it’s illness that raises their risk of disease and death and makes them eat so little salt (and food).

Since all the evidence of harm in the general population was based on studies that had that or some other weakness, it added up to “insufficient,” said the IOM.

The report found evidence of harm in people with heart failure, but that’s irrelevant, and the evidence is suspect.

The most persuasive evidence of harm came from a group of Italian researchers who randomly assigned patients with heart failure to normal or very-low-sodium diets. Those restricting sodium were more likely to be readmitted to the hospital or to die.

Alarming? Not quite. First, the researchers restricted not just salt, but also how much water the patients could consume. And they put them on high doses of diuretics. That regimen isn’t used in this country.

“This hyper-aggressive treatment may have caused severe depletion of blood volume,” explains Frank Sacks of the Harvard School of Public Health.

More troubling, in June 2013 the journal Heart retracted a meta-analysis on sodium and heart failure by one of the Italian researchers, Pietro Di Pasquale of the University of Palermo. Each of the six studies in the meta-analysis was done by his research group.

In March 2013 Heart’s editor warned that two of the studies had duplicate data. The editor explained that when its ethics committee asked to see the raw data, the researchers said it was “lost as a result of computer failure.” The IOM didn’t cite the meta-analysis, but it did cite the two studies with duplicate data.

“It’s hard to believe that data can be lost from two trials,” says Lawrence Appel of Johns Hopkins University in Baltimore.

“The editors from the journals that published these papers should ask for the data and conduct an independent analysis of all trials from this research group.”

What’s the bottom line? We should all aim for 1,500 mg of sodium a day, says the American Heart Association. But since at least 95 percent of adults exceed 2,300 mg a day, most of us should be eating less salt.

Sources: www.iom.edu/Reports/2013/Sodium-Intake-in- Populations-Assessment-of-Evidence.aspx; MMWR 60: 1413, 2011; Clin. Sci. 114: 221, 2008; Heart 99: 820, 2013.

This post was originally published in 2013. 

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44 Replies to “Is a Low Salt Diet Plan Healthy?”

  1. Thank you for posting this. I have early renal failure related to systemic lupus and restrict sodium intake. Thank you for clarifying the available data on sodium restriction.

    1. Sarah, sorry for a response literally years later ! ! If you haven’t yet, you should read Super Immunity by Joel Fuhrman, MD. He’s one of the foundering members of the American College of Lifestyle Medicine, and he has saved at least 2, maybe 3 people who were already on Kidney Transplant lists, not only from having to have that surgery and take immune suppressants the rest of their lives, his dietary and nutritional ideas enabled them to get off dialysis and eventually have their creatinine return to normal and their lives return to normal. He’s also the author of the New York Times Bestselling book: Eat To Live, which has over 1,000 peer reviewed journal articles/studies as the factual basis supporting all his recommendations. Enjoy reading one or both of these. (He’s actually coming out in March of 2016 with another new book entitled: The End of Heart Disease.

  2. WOW, The “every day” life of just doing what you have to do, to exist, care for a family , sets you up to be prey
    to an unclassy life. Class being living a very good life
    with health,strength, peace, joy, energy, imagination,enough resoures, adventure, healthy activities…etc.

  3. Dear NA.C : Will my tears come out “SWEETER” if I diminish my avaricious intake of SALT? What would happen two the EARTH without THE SALT that for century has divinely characterize it? Questions to ponder!! PERUCHO 8. ALABAO!!!

  4. Yes, a little knowledge is dangerous. The news is looking for sensation not for sound science, and the public generally does not have the experience to discern what is real. This is why it is so important that we have honest experts to tell the rest of the story. Thanks

  5. Well I happen to be in that 5% so the answer to the question is important to me!

    So I’d still like to know the minimum required for good health.

  6. This was an excellent article in the Nutrition Action Healthletter. The Healthletter is the best investment I have ever made. I also appreciated the article in sustainable fishes to eat. Great Work Nutrition Action!

  7. Is all salt the same? I have switched my salt to Celtic Sea Salt. I was told it had benefits of trade minerals that improve health & longevity as compared to typical table salt.

  8. I’d like to know the sodium levels in diets of different cultures. The recipes I’ve seen for traditional Chinese, Japanese, Thai and Middle Eastern foods, seem to include more sodium than you are recommending.

  9. As if Americans really run the risk of getting too little salt! Exactly what percentage of the population runs that risk?

    1. The ones who are “scratch” cooks, don’t eat manufactured foods and basically avoid all but the healthiest restaurants.

  10. Guess there is nothing conclusive about the harm of a low salt diet. Looking for something conclusive about dark chocolate.

  11. Since limiting my salt intake, from all sources, to less then 1000 mg per day, I don’t have swelling in my feet and ankles any more. Blood tests prove I have adequate sodium in my system.

  12. My granddaughter has swollen knees. She is 9. Not just growing pains. Wondering if she eats too much salt. Eats a lot of pizza and chick fi la

    1. Sounds like she may have an intolerant to something, maybe gluten. Pizza (and fast food) is not a healthy diet for a 9 year old. Whole foods, made from scratch meals would benefit her for the rest of her life and probably make her swelling go away. Good Luck!

  13. I have always had low blood pressure but at a doctors visit my blood pressure was so high the doctor put me on blood pressure medication. I had a pretty severe allergic reaction to the medication so I stopped it and changed my diet to limit my salt intake. I had been on a binge of eating salty items. Voila – no more high blood pressure.

  14. The biggest problem is the hidden sodium in prepare foods! So many Americans rely on package, premade or prepepared. Adding salt while you cook foods from scratch is ok.

  15. NOT MUCH CHANCE OF CONSUMING TOO LITTLE SALT IN THE USA. IF ONE IS CONCERNED ABOUT TOO MUCH SALT, GET RID OF THE SHAKER ON THE TABLE……

  16. Hidden sodium in prepared foods is the big problem. Read the labels,and you’ll see it’s true.

    So then, someone tends to profit from misinformation about salt, don’t they?

    Now I get it.

    Thanks for the information.

  17. I am a healthy 76 year old who has practiced moderation in all things concerning food…given the decades in which I followed “research” on the benefits/dangers of salt, chocolate, fats, supplements, eggs, and so on, I have concluded that there will be no definitive research in my lifetime…so I will continue with moderation as my mantra…good luck to the rest of you…oh, by the way, I’m also without medications for high blood pressure, high cholesterol or weight problems…I go to the gym 3 times a week and I don’t believe genes are an important part of my health because both my sister & brother have multiple problems & medications.

    1. Good to hear from a young person of 76, Always used salt growing up in NYC, I don’t exercise just work around my property most of the day and then relax at night, reading the newspaper about all the people getting killed around the world. & trying to get use to this “CRAZY” 21st. century. WW2 Guy……By the way I’m 86, born in 1927

  18. Why don’t I ever see such discussions include the use of Himalayan salt? Many sources claim it has none of the negative attributes of salt (including sea salt, which is said to be no better than the toxic waste regular salt). It is claimed that it is in fact good for folks. Perhaps using it at home, and encouraging it in prepared food and restaurants, could have a substantial positive impact. Please check it out for us, NA.

  19. This is a fine example of how unreliable research is unless you look at the details of how the research was conducted/manipulated. Headlines and conclusions can be very misleading.

  20. We all would be better off if we just read the Nutrition Action Newsletter and leave the other news to uninformed and stupid people. The network news is for entertainment purposes only.

  21. Sou Nutricionista no Brasil, e creio que a ciência é evolutiva, mas cada um tem seu próprio laboratório de pesquisa ou seja, faça sua experiência, seja seu próprio médico, mas não se torne tão auto confiante que venhas a esquecer que caminhamos sobre ombros de gigantes.

  22. This is a classic example of media spreading such misinformation to the public in order to make a profit. Always do your own research & if all possible, live life to the fullest with clean unadulterated food. God bless.

  23. Marcy -CHC says:

    It is likely due to the fact that the processed food industry has added so much salt to our food that if these standards change, it would upset their bottom line. Once again, the food industry is slowly killing us.

  24. The problem should not be HOW MUCH SALT BUT WHAT KIND OF SALT! According to sources I’ve consulted, MOST TABLE SALT IS BAD! It doesn’t have the necessary nutrient IODINE in it!! Iodine is needed in our diet to help balance our hormones! Without it we are succeptible to all kinds of disorders such as thyroid, prostate, adrenal gland disorders, etc.

    1. The Dietary Guidelines for Americans recommends that younger adults consume no more than 2,300 milligrams of sodium per day. Middle-aged and older people, African Americans, and anyone with high blood pressure should aim for no more than 1,500 mg per day.

  25. Comment: It seems to me that if years of warning about sodium-related risks of heart attacks and strokes, one must NOT assume that people on extremely low NA diets have complicated or chronic conditions. Controlling for these data really must be included before final recommendations can be made.

    Question: Will Pietro Di Pasquale of the University of Palermo be sanctioned for unethical research practice? I fear sometimes that academic misconduct has the potential to create so much confusion, esp. when data are still being parsed for clear conclusions.

  26. I am 86 years old and no longer cook except on rare occasions. I rely on frozen dinners to a great extent, but it is very difficult to find one that has less than 500 mg of sodium. There are still dozens of dinners and soups that have 1,000 or more mg of sodium. I have found that when they lower the sodium chances are they will increase the sugar. When I asked why, I was told it makes the food taste better. No to me! I see very little improvement in both the salt and sugar content of prepared foods.

  27. On Himalayan and Celtic salts (Wayne and Valerie), there’s (surprise!) much misinformation online. When labeled, as few are, they show 97-98% sodium chloride, plain salt. Many of the trace minerals are things you don’t want, like arsenic or aluminum/ium, but lucky you, they are in such tiny doses at a merely outrageous price!
    I’ve heard that folks in Pakistan, where the Himalayan salt is cheap, prefer other types, for what that’s worth.
    The reason for the magic number 1500mg as an upper limit is the DASH diet sequel, which tried limiting salt to that UPPER limit and found good effects on blood pressure. The lower limit is so low (200-250mg) no-one wants to mention it; and since that was the result of older studies, it too may be too high– maybe 125mg?
    Again for what it’s worth, estimates of sodium in a (real, not US 21st century) Paleo diet are quite low too, and my own chosen range is 250-1200mg/day.
    Finally, the sordid fact behind high-salt puffery is that most fast/canned/manufactured ‘foods’ taste awful if you don’t hide their taste under a hefty dose of salt. Bon appetit!

  28. Seems like for the average person with out related health issues to salt, moderation, normal salt use, use Maldon Flakes, a pinch, on top of something to get the “salt Hit” that is kind of nice. All food in restaurant,s is “well” salted , as is , takeout, prepared,frozen dinners, probably not frozen vegetables that are just the vegetable, no sauce. No question, the best food is at home.

  29. Always consult a professional for up to date information and advice. Nutritionists
    study this subject and know a lot about how things work, maybe a groups of friends can get together and hire a nutritionist to talk about their questions.

  30. A Doctor commented ,restaurants are not in the business to make people healthy, they are in the business to make money. So it is , in many ways, bottom line, profit.

  31. Been using organic no salt seasoning in my cooking for a few years when I started to read he labels on canned goods and packaged food. The amount of salt, fat and sugar is astounding! Trying to stay healthy by paying attention to the nutritionist. Walking is also be a constant daily event! Hoping to be a centenarian one day!

  32. It would be ideal if these studies also evaluated the influence of salt-sensitive genes such as ACE and their polymorphisms, which can sway the direction of risk vs. benefit. Additionally, evaluation of intake of the remaining blood pressure quartet – potassium, calcium, and magnesium – could provide a clearer picture. Some of these studies do exist, but adding those factors has not yet become widespread enough to prevent confusing data analyses.

  33. I like salt and go by what tastes good. If I listen to everyone how,what,when, why,how much that would be a full time job and confusing. Let your body tell you , become more mindful about what is good for you and works. We were born with this fabulous working mechanism all we need to start is trusting in it. Just that alone will show every individuals great results. Try it and you will like it.

  34. My blood test always show I am low in sodium so I am told to add more salt to my food and I know if I don’t I do not feel well ,I am 86 years old this has been most of my life ,and I do take blood pressure medication this is very confusing but I do feel very well.

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