How Much Dietary Salt Should You Consume? Is the Salt Debate More Spicy than Healthy?

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According to “Salt-Blood Pressure Hypothesis" increasing consumption of sodium results in increased risk for hypertension and consequently higher risk for cardiovascular disease. However, this has never conclusively proven with proponents on both sides of importance of salt restriction being passionate about their sides

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Conflicting results from recent studies have accentuated the controversy especially in defining the ideal limits of sodium consumption. As such, ideal amount of sodium consumption has become increasingly contentious in this era of evidence-based medicine.

The “Prospective Urban Rural Epidemiology (PURE)” observational study from 17 countries suggested an optimal sodium intake between 3–6 g daily, with higher risk for cardiovascular events both above and below these levels.

A 2016 citation network analysis found a strong polarization in scientific literature. Roughly 60% of published reports support salt reduction whereas 40% oppose it. Both sides of cite papers supporting their own position.

Alderman from the Albert Einstein College of Medicine, Bronx, NY recommends that effect of sodium restriction on blood pressure “can no longer be accepted as a surrogate for health outcomes associated with sodium intake.”

On the other hand, Campbell and colleagues from the University of Calgary, Calgary and University of Toronto believe that “controversy concerning dietary sodium results primarily from low-quality studies and their commercial marketing and promotion”. They go as far as to say that publication low quality studies “leveraged by the private sector, has created a false aura of scientific controversy around dietary salt”.

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Part of the explanation may lie in two different sets of populations—sodium sensitive and sodium insensitive.

In addition, sodium demonstrates pleiotropic effects (one gene affecting multiple unrelated or opposing actions) on cardiovascular sickness and health, emphasizing that the relationship between sodium consumption may not be intake and cardiovascular outcomes cannot be grounded on its effect on blood pressure alone.

A 2014 Meta-analysis of medical literature concluded that both low sodium intakes and high sodium intakes are associated with increased mortality.

Alternate option suggested:
Rather than sodium intake, Aaron and Sanders from the University of Alabama at Birmingham suggest that a diet comprising of “modest salt restriction while increasing potassium intake” may be a better approach to reduce blood pressure and risk of cardiovascular disease.

Nonpartisan US Institute of Medicine (2013) renamed as National Academy of Medicine has been concerned about quality of research especially relating to how much sodium should be consumed per day. It concluded:

• Higher levels of sodium intake increase risk of cardiovascular disease.
• It remains unclear how sodium intake below 2300 mg/day affects risk or benefit for CV outcomes.
• Research does not support recommendations for a lower sodium intake in high-risk patients with diabetes, chronic kidney disease or cardiovascular disease to 1500 mg/day or less.

Dr. Minocha's recommendation
Regardless of the controversy, follow the official guidelines! At the same time, clinicians should be cognizant of expansive array of reputable expert opinions related to dietary sodium intake and its correlation with high blood pressure and cardiovascular risk.

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