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Salt shake-up? Too much or too little sodium may be dangerous

The average American consumes about 3,400 milligrams of sodium every day. That amount — almost a teaspoon and a half of salt a day — has long been considered to be too much to maintain good health. But a surprising new study concludes that amount may be just about right.

The typical American sodium intake is well within the realm of “healthy” for most Americans, according to research published Wednesday in the American Journal of Hypertension. The study is a collaboration between Albert Einstein College of Medicine and the Copenhagen University Hospital. The researchers reported that a range of sodium intake between around 2,600 milligrams to 5,000 milligrams daily — higher than existing guidelines — is associated with a decreased rate of both mortality and cardiovascular disease. 

The American College of Cardiology recommends adults consume below 1,500 milligrams of salt a day. The Centers for Disease Control (CDC) suggest an intake below 2,300 milligrams, still 50 percent lower than what the typical American eats every day.

The low end of “healthy” in this new study is fairly close to that of the CDC recommendation for most people. But by raising the upper limit — 5,000 milligrams, or more than 2 teaspoons — doesn't mean it's OK to consume as much salt as you want without risk: population data cannot be automatically translated to an individual. It simply means there appears to be a larger range of sodium intake that sustains good health, depending on individual health and lifestyle. 

Dietary sodium is a nutrient requirement; the body needs about one teaspoon daily to support body needs. Solid evidence has been published linking a reduced sodium diet with improved cardiovascular outcomes, including a drop in blood pressure. 

A recent study by the Institute of Medicine (IOM) found evidence to support sodium intake of 2,300 milligrams a day, but did not find benefit for cutting intake as low as 1,500 milligrams. The new study indicates that dietary sodium intake as high as 5,000 milligrams did not impact cardiovascular risk.

Studies to examine long term dietary sodium intake are hard to design and implement — and many studies are limited by single measurements and incomplete collection, making interpretation challenging from the complex analyses used when combining many studies. This study looked at 25 individual studies, examining 275,000 participants from around the world. The lack of an association between sodium intake and cardiovascular health in this new study supported the results of the IOM report.

But according to the American Heart Association, “there is a significant body of scientific research that proves a very dangerous association between sodium intake and significant health problems.” 

These groups are particularly vulnerable to the impact of excess sodium on health:

  • Over age 50
  • African-American
  • Diabetic
  • Have high blood pressure or relatives with high blood pressure
  • Have chronic kidney disease (CDC recommends the lower limit of 1,500 milligrams of sodium daily).

The new research isn't about how much salt you shake onto your food, which contributes only about 10 percent of daily sodium. Most of the sodium in the diet comes from prepared and processed foods — nearly 75 percent. The remaining 15 percent comes from occurring naturally in foods.