International Panel Questions the Wisdom of Strict Sodium Guidelines

A technical paper published in the online version of the European Heart Journal suggested that individuals should strive to keep their sodium intake to less than 5 grams per day. This is in marked contrast to the recommendations of the American Heart Association of 1.5 grams per day and American College of Cardiology recommendations of 2.3 grams per day. The authors of the papers included some of the world’s experts on the topic of hypertension including Giuseppe Mancia, MD, Suzanne Oparil, MD and Paul Whelton, MD.  They agreed that consuming more than five grams per day was associated with an increased cardiovascular risk. They believe there is no firm evidence that lowering the sodium intake to below 2.3 or 1.5 grams per day reduces cardiovascular disease without putting you at risk of developing other health issues from having too little sodium.

The report triggered a firestorm of controversy in the hypertension and cardiovascular field with proponents on each side of the issue. Both sides agreed that we need more meticulous research to determine the best lower end of daily sodium intake because current information makes recommending one level or another a guess at best with little data to back you up. That leaves clinicians and patients scrambling for clarity and the media reporting this paper in a manner threatening to further erode the public’s confidence in the scientific method and physicians in general.

As a practicing physician I will continue to recommend a common sense approach to salt intake. Those patients who have a history of congestive heart failure or hypertension which is volume related will still be encouraged to read the sodium content of the foods they are purchasing and try to avoid cooking with or adding sodium chloride to their food at the table. This will be especially important for patients with cardiomyopathies and kidney disease who are following their daily weights closely. For the rest of my patient population I will ask them to use salt judiciously and in moderation only. I will suggest not adding salt at the table and if they do to please add it in moderation. I will allow more salt intake in those patients who work outside all day and are exposed to our high temperatures and humidity.

Like everyone else, I will wait for the meticulous research studies to be performed over time to determine how low and high our sodium chloride consumption should be without hurting ourselves.

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