Should You Obsess About Salt?

Understanding the link between salt intake, heart disease
If You're Healthy, Don't Obsess About Salt

By: Steven Nissen, MD

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If you’re thinking about cutting back on the amount of salt you eat, make sure you’re doing it for the right reasons – and talk with your doctor. While a recent study finds no link between salt consumption and risk of death or developing heart disease in healthy older adults, people with certain medical conditions still need to modify their salt intake.

In the study, published in the journal JAMA Internal Medicine, researchers at Emory University studied the effect of salt intake on more than 2,600 healthy people between the ages of 71 and 80. The study followed the participants, who filled out questionnaires about the types of food they ate, for 10 years.

The researchers then split the participants into three groups: those who consumed less than 1,500 milligrams of salt a day; those who ate 1,500 to 2,300 milligrams a day; and those who took in more than 2,300 milligrams a day. The results show no association between salt intake and risk of heart disease, heart failure or death.

The Dietary Guidelines for Americans, written in 2010 by the U.S Department of Agriculture and the U.S. Department of Health and Human Services, recommends everyone older than age 2 consume less than 2,300 milligrams of salt each day. One teaspoon of table salt contains about 5,687 milligrams.

The Dietary Guidelines limit salt intake to 1,500 milligrams daily for some people, such as adults older than age 51, African-Americans and those with high blood pressurediabetes or chronic kidney disease. About half of the entire U.S. population and the majority of adults would qualify for the 1,500 milligram recommendation.

Emerging evidence

A number of recent studies are challenging the long-held notion that suggest restricting salt intake for everyone. Recent research suggests that if you’re healthy, you probably don’t need to be extraordinarily cautious about salt, says cardiologist Steven Nissen, MD.

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“There’s emerging evidence that salt is not as evil as many people have suggested,” says Dr. Nissen, who did not participate in the Emory study.

While the study is not definitive, Dr. Nissen says, “several recent studies seem to show that in otherwise healthy people, fanatical measures are not necessary to control their salt intake.”

The study also indicates that older, healthy adults are not going to live longer or avoid a heart attack by eating a low-salt diet, Dr. Nissen says.

When to monitor your salt

Some individuals, however, do need to monitor their salt consumption, Dr. Nissen says. For example, if you have high blood pressure or are borderline for the condition, or have congestive heart failure, a low-salt diet should be part of your overall health plan. He recommends the DASH diet, which is low in salt and total fat from animal products and high in fruits, vegetables and low-fat dairy foods.

“Research supports that the DASH diet lowers blood pressure, so that’s clearly an intervention worth considering for these patients,” Dr. Nissen says.

If you have other medical conditions, a diet high in salt could put you at higher risk for cardiovascular disease or heart failure. Be sure to talk with your doctor and follow his or her recommendations.

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To lower salt in your diet:

  • Choose fresh meats, fruits and vegetables.
  • Do not add salt to food before or after cooking.
  • Avoid salty foods such as bacon, sausage, lunch meat, cheese, pretzels, chips and most packaged or prepared food.
  • When reading labels, look for “low sodium” or “no salt added” foods. Look for levels less than 140 mg/serving.
  • When selecting from frozen or packaged entrees, choose those with fewer than 600 mg of sodium per serving.
  • Use salad dressings and condiments — such as sauces, pickles, olives, mustard, and ketchup — sparingly, as they are high in sodium.
  • When eating out, request that your food be prepared without salt or high-sodium ingredients.

More research needed

The Emory University researchers say more studies are needed, with stronger evidence, before changing the current daily sodium recommendations for older adults, or the general adult population.

“This is a gray area where the research right now is not definitive enough to answer the question,” Dr. Nissen says, adding that the latest data must be interpreted with caution. Dietary salt and the impact on health is a complex area and more needs to be known, he says.

The amount of sodium in your diet is just one piece of a complex puzzle, he says. Focusing on salt isn’t the entire answer to preventing heart disease and living longer.

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