Research Finds Current Level of Salt Consumption Safest
The most recent issue of the New England Journal of Medicine (August 14, 2014) highlighted the latest research on the impact of sodium (salt) consumption. The first study by Mente A, O’Donnell MJ, Rangarajan S, et al., entitled, “Association of Urinary Sodium and Potassium Excretion with Blood Pressure” covered more than 100,000 adults sampled from the general population of 17 countries that varied in their economic development and acculturation to an urban lifestyle. The authors concluded from the findings that a very small proportion of the worldwide population consumes a low-sodium diet (less than 2,300 mg per day) and that sodium intake is NOT related to blood pressure in these persons, calling into question the feasibility and usefulness of reducing dietary sodium as a population-based strategy for reducing blood pressure. These results are a strong argument against reduction of dietary sodium as a public health recommendation. The full paper can be found here: http://www.nejm.org/doi/full/10.1056/NEJMoa1311989
A second paper by O’Donnell MJ, Mente A, Rangarajan S, et al., entitled, “Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events” describes a very large study over several countries demonstrating that sodium intakes of between 3 -6 g per day were associated with a lower risk of death and cardiovascular events than were levels below this amount. (This optimal range is far above the government recommendation of 1,500-2,300 mg sodium per day.) This paper can be found here: http://www.nejm.org/doi/full/10.1056/NEJMoa1311889
A third paper by Prof. Susan Oparil, Director of the Vascular Biology and Hypertension Program at the University of Alabama Medical School, entitled, “Low Sodium Intake — Cardiovascular Health Benefit or Risk?” clearly suggest very high and low levels of sodium may increase the risk of heart problems and death, she wrote. “These provocative findings beg for a randomized, controlled outcome trial to compare reduced sodium intake with usual diet. In the absence of such a trial, the results argue against reduction of dietary sodium as an isolated public health recommendation.” http://www.nejm.org/doi/full/10.1056/NEJMe1407695
These three papers were comprehensively covered in the media because their results confirm what the May 14, 2013 Institute of Medicine report stated – there is no evidence to support the current low, unachievable and risk-laden recommendation of 1,500-2,300 mg sodium per day.
The international coalition of salt reduction advocates immediately tried to criticize these three papers published in the New England Journal of Medicine, but the traditional hollowness of their arguments seemed to reach new levels. Without referring to actual numbers they persisted in saying that this only proves that “high levels” of sodium can cause health problems. However, they neglected to mention that the “high levels” refer to above 5,500 mg sodium per day, levels only consumed by one or two countries. The fact is, more than 73 % of the countries in the world consume between 2,800-5,500 mg sodium per day, where the negative health impacts are the least – the Safe Range. The current US consumption is 3,400 mg sodium per day – smack dab in the middle of that safe range! It is the most desirable level of sodium (salt) consumption in the world! So why are the government recommendations trying to drive us to a level of consumption that will result in reduced health?
As a final note, let’s set the record straight. The Salt Institute, backed by the latest published evidence (*) defines sodium consumption levels as follows:
(Sodium mg x 2.54 = Salt mg. Divide mg salt by 5,680 to get teaspoons)
Above 5,500 mg sodium/day (equivalent to above 14,000 mg salt or 2½ teaspoons)
(About 1% of countries in the world consume this level)
From 2,800 – 5,500 mg sodium/day (7,112-13,970 mg salt or 1¼ – 2 ½ teaspoons)
(More than 73% of countries around the world consume this level)
Less than 2,800 mg sodium/day (equivalent to below 7,112 mg salt or 1¼ teaspoons)
(About 25% of countries – all in Africa and Caribbean -consume this level)
Based upon the available morbidity and mortality evidence (†), the Medium Level is the Safe Range
The current recommendations of 1,500 -2,300 mg sodium per day are well below the “Low Level” and outside the “Safe Range.” This level is consumed by less than 10% of countries – amongst the poorest in the world. Kenya, (life expectancy 60 years), is the only country in the world that consumes the American Heart Association (AHA) recommendation of less than 1,500 mg sodium per day.
The US consumption of sodium is 3,400 mg per day or 8,600 mg salt, about 1½ teaspoons, a bit lower than the mid-point of the Safe Range – an ideal level.
PLEASE NOTE THAT THERE ARE CERTAIN INDIVIDUAL WITH UNCONTROLLED HYPERTENSION AND SALT SENSITIVITY THAT MUST CONTROL THE AMOUNT OF SALT THEY CONSUME. THEY SHOULD CONSULT WITH THEIR PHYSICIAN REGARDING SALT AND OTHER ESSENTIAL NUTRIENT INTAKE.
(*) Powles J, Fahimi S, Micha R, et al., Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open 2013;3:e003733. doi:10.1136/bmjopen-2013-003733. Available at: http://bmjopen.bmj.com/content/3/12/e003733.full
(†)O’Donnell MJ, Mente A, Rangarajan S, et al. Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events. N Engl J Med 2014; 371:612-623August 14, 2014DOI: 10.1056/NEJMoa1311889. Available at: http://www.nejm.org/doi/full/10.1056/NEJMoa1311889