Hold the salt? Not so fast, says the Institute of Medicine (and ACSH)

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As is so often the case, the science of dietary sodium/salt restriction seems to be catching up to ACSH s oft-expressed viewpoint: while too much of anything is not good for you, so is too much restriction. The Institute of Medicine has just published a review of the good and evil linked to sodium, or salt, restriction. Appearing in the current JAMA Internal Medicine, the key message is as follows:

The IOM committee s conclusions have 2 important implications for practice. First, the lack of evidence of benefit and concerns for harm suggest that low sodium intake (<2300 mg/d) should not be recommended. This finding has particular implications for high-risk subpopulations (including those with heart failure) for whom many guidelines had recommended targets as low as or lower than 1500 mg/d. Second, the evidence of cardiovascular benefit (both from studies of direct cardiovascular effects and from trials on blood pressure) does support a decrease in sodium consumption for most Americans because most are consuming considerably more than 2300 mg/d.

These new data are especially cogent regarding the draconian advice long emanating from health nonprofits such as The American Heart Association, who counsel limiting sodium to a daily intake of less than 1,500 mg a day.

ACSH s Dr. Gilbert Ross had this perspective: As an internist with over 20 years experience treating hypertension and heart failure, I can say that it s devilishly hard to keep people on such a low-salt regimen for long. Anyone who has tried will tell you: That [food product, beverage, etc.] tastes like clay, ugh when describing the pleasures of a severely salt restricted diet. Anthropological studies have demonstrated that humans through the eons are hard-wired to ingest between 3.5 and 4.0 grams (3500-4000 mg) of sodium daily. To try to cut that in half, or less as per the AHA, is both fruitless and more likely to harm than benefit, except in highly unusual populations.