Salt Intake Can Be Too High or Too Low

By Gabe Mirkin, M.D.

A study of 130,000 people from 49 countries shows that severely restricting salt may actually increase risk for heart attacks, strokes and death in both people with and without high blood pressure (The Lancet, May 20, 2016). The article recommends against severe salt restriction even in people who already have high blood pressure.

Fewer than 5 percent of North Americans and people around the world consume less than 2.3 grams of salt per day, andthose with salt intake below 2.3 grams per day had higher risk for heart attacks and fatal heart attacks. Only 10 percent of the people in this worldwide study had both high blood pressure and high salt intake (over six grams per day).

Other studies support this study by showing that a moderate salt intake (three to six grams per day) is associated with reduced risk of heart attacks and death compared to an intake of less than 3 grams per day (N Engl J Med, Aug 14, 2014;371(7):612-23). The highest risk for heart attacks occurs in people who take in fewer than three grams or more than six grams/day.

Still Disagreement Among Researchers

Many doctors vehemently disagree with the recommendations of this study and believe that patients should be encouraged to keep salt intake as low as possible. One study estimated that 1.65 million deaths from heart attacks in 2010 could be blamed on a salt intake of more than 2.0 grams per day (N Engl J Med, Aug 14, 2014;371(7):624-34).

What is High Blood Pressure?

You are generally considered to have high blood pressure if your systolic blood pressure is over 120 before you go to bed at night or when you first wake up in the morning, or over 140 during the daytime. Get your own blood pressure cuff so you can monitor your blood pressure when you first wake up or when you are relaxed and ready to go to sleep at night. If it is consistently over 120 at these times, check with your doctor.

Lower Blood Pressure with Diet Changes

Many studies have shown that a plant-based diet controls blood pressure more effectively than salt restriction. I have been recommending this diet to my patients for many years: DASH (High-Plant) Diet for Heart Health, Weight Loss and Diabetes Prevention/Control

Almost all diabetics and people with high blood sugar levels have high blood pressure, and controlling blood sugar can help many of these people to lower their blood pressure. If you are unable to keep your blood pressure under 120 with diet changes, you may need to take medications.

My Recommendations

To achieve the moderate intake of salt (three to six grams per day) recommended in this study,

• Eat a primarily plant-based diet. Plants are very low in salt, while meats contain a lot of salt.
• Limit prepared foods, which usually have both salt and sugars added to make them taste good. Check the labels on packaged foods and the nutrition information on restaurant foods.
• Stay away from the salt shaker and try to avoid adding extra salt to your food.