International Experts Call Salt Guidelines Far Too Restrictive

A broad group of international experts are recommending a far more modest and less draconian approach to sodium restriction than current U.S. and international guidelines. In a new paper, published online in the European Heart Journal, they also focused on the broad gaps of knowledge in the field and drew attention to the paucity of high-quality evidence and research. Again, this approach represents a rebuke of current guidelines, which authoritatively assert the benefits of dramatic reductions in salt consumption.

Worldwide, sodium intake is estimated to average about 3.95 g/day, though there are wide geographical and cultural variations. Most guidelines recommend that sodium consumption be reduced to levels below 2.3 g/day, though the American Heart Association goes further and recommends reductions to 1.5 g/day or lower.

By contrast, the authors of the new paper recommended that sodium be reduced to under 5 g/day, since “there is consistent evidence that high sodium intake (> 5 g/day) is associated with increased CV risk.” However, they freely acknowledged that there is no good randomized, controlled trial evidence to support this target. And they explicitly rejected the lower target of other guidelines, explaining that “there is an ongoing scientific debate about the optimal lower level of sodium intake for CVD prevention.”

The new paper also emphasized the potential dangers of lowering sodium too much, as in the WHO and AHA guidelines. “Sodium,” the authors wrote, “is an essential nutrient. This implies that there must be a ‘U’-shaped relationship between dietary sodium intake and cardiovascular events, but there is no consensus of where the minimum risks lies.”

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