The FDA has issued guidance about dietary salt intake. Their advice needs to be taken with a grain of salt – sorry, I couldn’t resist. The summary below conveys their intent and message. The whole report is below and can be downloaded.
This guidance supports the goal of reducing sodium intake as recommended by scientific consensus groups, by focusing on short-term reduction to 3,000 mg/day as a gradual approach to sodium reduction in the food supply. The guidance reflects the broad consensus among experts regarding the direct relationship between sodium and blood pressure, as well as the relationship between blood pressure and cardiovascular disease events. With average sodium intake in the U.S. over 3,400 mg/day, there is considerable work to do to reduce intake to the recommended limit of 2,300 mg/day in order to reduce the risk of hypertension and cardiovascular disease. Thus, the overall goal of this guidance is to support reduction of average sodium intake to 3,000 mg/day as we continue the dialogue on sodium reduction.
I’ve written on this subject before but, as the experts continue to offer advice devoid of nuance, it needs further amplification. The report knowingly lumps sodium in all its forms together when it’s salt (NaCl) that’s the issue. It views a sodium intake of 3 grams/day as a temporary waystation on a final destination to 2300 mg/day. It hopes manufacturers of processed food will decrease the sodium content of their products. Fine, let’s hope they do so without sacrificing flavor. But does everyone need to be on a restricted salt diet? The answer is a firm No! A reality that the experts ignore.
If you do not have hypertension or any edematous disease there is no benefit gained by restricting dietary salt. If your blood pressure rises to a level felt to be unhealthy by your physician or you develop heart, kidney, or liver disease then salt restriction is a good idea. At least half the population can tolerate an unrestricted sodium diet. There’s no reason to put the country on a diet that won’t benefit a lot of them. To keep things simple, I’ve avoided the issue of what constitutes treatable high blood pressure as there’s some disagreement as to the optimum level.
Every medical student is told early in his training that treatment regimens should be individualized. Blanket recommendations should not be proffered because those dispensing them think the public is incapable of understanding the details and exceptions to such advice. There are no data showing that an individual who will develop hypertension when he’s 50 benefits from a low sodium diet when he’s 20.
You now have enough evidence to make an informed decision about your sodium intake. If you fall into one of the categories mentioned above, go easy on the salt. Otherwise, shake away.
As a layperson I don’t know when the first medications for controlling high blood pressure were made available to physicians, but I have a distinct memory of the remedy my father, then 43, was given by his physician brother in 1950: a salt-free diet for three weeks. I can still see my mother mixing what looked like Plaster of Paris into a jug of water, a mixture which passed for milk on this diet. Potassium chloride replaced salt in our salt shakers. Dad was allowed a special cereal over which he poured the plaster-milk. Dinner consisted mainly of boiled rice. At the end of the three weeks, my father had lost nearly 30 lbs. Because the end of the diet coincided with Thanksgiving, he and my mother and sister joined his siblings at his physician-brother’s home, where my Dad couldn’t wait to eat turkey with dressing and gravy. In his eagerness he ignored his brother’s caution that all of the food had been prepared with salt, and that he would do best to try a few bites and then concentrate on one of the pies that had no salt in it. Instead, Dad took full helpings of the main dishes, and instantly winced when he tasted them. My father’s moderately high blood pressure was eventually treated with medication. Sadly, his physician-brother, then chief of staff at a major hospital, had to retire at age 53 because his blood pressure became so elevated that it would not register on a sphygmomanometer. I remember visiting him at his home and hearing him tell my mother, “I have the arteries of an old man. There’s nothing worse than being a doctor and knowing exactly what will happen to you. I’ll have a stroke, and I can only hope it’s a fatal one and that I don’t die by inches from a series of small ones.” In the summer of 1953, he had two strokes and died at age 56 in the hospital he had served as chief of staff.
I don’t like salt and have to force myself to have some as too little has caused some problems.