Salt Intake Restrictions for Seniors, Others
Questioned by Institute of Medicine
Potential harm from too little salt? Lack of evidence
to support current guidelines
Graphic from Mayo Clinic
report, "Sodium: Are you getting too much?" Click to read
May 15, 2013 – Senior citizens have been well
warned by the American Heart Association and a number of other
authoritative sources that they should not consume more than 1,500 mg
per day of sodium. Now, the prestigious Institute of Medicine is
questioning this restriction and even the restriction for younger people
of 2,300 mg per day.
Recent studies that examine links between sodium
consumption and health outcomes support recommendations to lower sodium
intake from the very high levels some Americans consume now, but
evidence from these studies does not support reduction in sodium intake
to below 2,300 mg per day, says this
new report from the Institute of Medicine.
Despite efforts over the past several decades to
reduce dietary intake of sodium, a main component of table salt, the
average American adult still consumes 3,400 mg or more of sodium a day –
equivalent to about 1 ½ teaspoons of salt.
The current Dietary Guidelines for Americans urge
most people ages 14 to 50 to limit their sodium intake to 2,300 mg
daily. People ages 51 or older, African Americans, and people with
hypertension, diabetes, or chronic kidney disease – groups that together
make up more than 50 percent of the U.S. population – are advised to
follow an even stricter limit of 1,500 mg per day.
These recommendations are based largely on a body
of research that links higher sodium intakes to certain “surrogate
markers” such as high blood pressure, an established risk factor for
The expert committee that wrote the new report
reviewed recent studies that in contrast examined how sodium consumption
affects direct health outcomes like heart disease and death.
“These new studies support previous findings that
reducing sodium from very high intake levels to moderate levels improves
health,” said committee chair Brian Strom, George S. Pepper Professor of
Public Health and Preventive Medicine at the University of Pennsylvania
Perelman School of Medicine.
“But they also suggest that lowering sodium intake
too much may actually increase a person’s risk of some health problems.”
While cautioning that the quantity of evidence was
less-than-optimal and that the studies were qualitatively limited by the
methods used to measure sodium intake, the small number of patients with
health outcomes of interest in some of the studies, and other
methodological constraints, the committee concluded that:
● evidence supports a positive relationship
between higher levels of sodium intake and risk of heart disease, which
is consistent with previous research based on sodium’s effects on blood
● studies on health outcomes are inconsistent
in quality and insufficient in quantity to conclude that lowering sodium
intake levels below 2,300 mg/day either increases or decreases the risk
of heart disease, stroke, or all-cause mortality in the general U.S.
● evidence indicates that low sodium intake
may lead to risk of adverse health effects among those with mid- to
late-stage heart failure who are receiving aggressive treatment for
● there is limited evidence addressing the
association between low sodium intake and health outcomes in population
subgroups (i.e., those with diabetes, kidney disease, heart disease,
hypertension or borderline hypertension; those 51 years of age and
older; and African Americans).
While studies on health outcomes provide some
evidence for adverse health effects of low sodium intake (in ranges
approximating 1,500 to 2,300 mg daily) among those with diabetes, kidney
disease, or heart disease, the evidence on both the benefit and harm is
not strong enough to indicate that these subgroups should be treated
differently from the general U.S. population.
Thus, the evidence on direct health outcomes
does not support recommendations to lower sodium intake within these
subgroups to or even below 1,500 mg daily; and
● further research is needed to shed more
light on associations between lower levels of sodium (in the 1,500 to
2,300 mg/day range) and health outcomes, both in the general population
and the subgroups.
The report does not establish a “healthy” intake
range, both because the committee was not tasked with doing so and
because variability in the methodologies used among the studies would
have precluded it.
The recent studies suggest that dietary sodium
intake may affect heart disease risk through pathways in addition to
“These studies make clear that looking at sodium’s
effects on blood pressure is not enough to determine dietary sodium’s
ultimate impact on health,” said Strom. “Changes in diet are more
complex than simply changing a single mineral. More research is needed
to understand these pathways.”
The report was sponsored by the Centers for Disease
Control and Prevention.
The Institute of Medicine, established in 1970
under the charter of the National Academy of Sciences, provides
independent, objective, evidence-based advice to policymakers, health
professionals, the private sector, and the public. The National Academy
of Sciences, National Academy of Engineering, Institute of Medicine, and
National Research Council make up the National Academies. A committee
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