A public health mantra — that Americans need to keep their salt intake as low as possible, ideally down to 2,300 milligrams of sodium per day and to 1,500 milligrams if you’re over 50 and have high blood pressure, diabetes or kidney disease — has been questioned with the issuing of a new report from the Institute of Medicine. Based on health outcomes, the report says that “the evidence on direct health outcomes does not support recommendations to lower sodium intake … to or even below 1,500 milligrams per day.”
Brian Strom, a dean and professor of public health at the University of Pennsylvania and the committee chairman for the report, puts it this way to NPR: “The net conclusion is that people who are eating too much sodium should lower their sodium, but it is possible that if you lower it too much you may do harm.”
Plenty of Americans, especially given the amount of processed foods that makes up too much of most people’s diets, still need to reduce their sodium intake. NPR points out a McDonalds burger has about twice as much salt (1,000 milligrams) as the fries; other of the chain’s menu offerings such as the Quarter Pounder have even more (2,000 milligrams). While McDonalds says it will reduce sodium counts in its food by 15 percent by 2015, the truth is that it’s just difficult for most of us not to eat too much salt.
How the IOM Came To Its New Conclusions About Sodium Intake
Nonetheless, the IOM expert committee’s findings bear consideration. The panel looked carefully at research done since a 2005 report about sodium intake and found that, as Strom explains, “as you go below the 2,300 mark, there is an absence of data in terms of benefit and there begin to be suggestions in subgroup populations about potential harms.”
A 2008 study done on 232 Italian patients with aggressively treated moderate to severe congestive heart failure found that those who consumed a diet with 1,840 milligrams of sodium a day had to be readmitted to the hospital more and also hadÂ more than twice as many deaths.
Another study that appeared in 2011 analyzed the sodium consumption of 28,800 subjects (aged 55 and older) with high blood pressure for 4.7 years. Those who consumed either an excessive amount of sodium (7,000 milligrams a day) or a quite low amount (fewer than 3,000 milligrams of sodium a day) were at greater risk of heart attacks, strokes, congestive heart failure and death from heart disease.
Too little sodium intake has physiological consequences that can put someone at greater risk for heart disease, Dr. Michael H. Alderman, a dietary sodium expert at Albert Einstein College of Medicine who was not on the IOM committee, tells the New York Times. Consuming too little salt can increase triglyceride levels, insulin resistance and the activity of the sympathetic nervous system.
Public Health Groups Dispute IOM’s Findings
A number of public health groups including the American Heart Association (AHA) and the World Health Organization have expressed reservations about the IOM’s new report. The AHA says it outright disagrees with the IOM’s findings. Bonnie Liebman, director of nutrition at the Center for Science in the Public Interest, states that “it would be a shame if this report convinced people that salt doesn’t matter.”
In defense of its findings, the IOM cited flaws in previous studies (such as lots of variation in what constitutes high and low sodium consumption). Committee members noted that most earlier studies based their findings on correlations between diet and health without sufficiently considering factors such as the amount of exercise that people get and the difficulty people have recalling how much sodium they have consumed.
Given the excessive amounts of sodium in most foods in the typical American diet, it does seem best not to be too generous with the salt shaker. There are many ways to make food taste good without excessive sodium, through spices, lemon and some oils (such as olive). You can definitely try to include more fresh and unprocessed foods in your diet. Certain cooking methods (searing, sauteing and roasting) can help to make food flavorful without using excessive salt.
It may be well to remember that, a couple hundred years ago, salt was considered so valuable that it was kept in elaborately crafted salt cellars and carefully measured out. The advent of the Industrial Revolution led to salt becoming more widely available to the point that we can sprinkle it with abandon. The IOM’s new report should be weighed with previous recommendations to “hold the salt” in mind: Nothing in excess, right?
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