Dr. Zorba Paster: Average sodium intake not linked to heart risk, study finds

August 24, 2018

David Stluka Portrait of Dr. Zorba Paster on Tuesday, January 15, 2013 in Oregon, Wis. (Photo by David Stluka)

Guess what? For those who are on a low-salt diet, you probably can use more salt than you thought, according to a new study. For many of us, that is good news.

Now first off, I’m not recommending you pour on the salt, eat all of those prepared foods that are loaded with sodium, have salt-laden pretzels and chips like the good old days — not at all. The issue is what’s the threshold for too much salt?

The World Health Organization says 5 grams of salt, or a little over one teaspoon, is all you should have per day. Many health care professionals, dietitians and most cardiologists have agreed with this, even though this recommendation has scant evidence to back it up. Where did the 1 teaspoon idea come from?

I’ve done some research and I can’t find exactly where it started but I do know it was when Americans were accustomed to loading their plates with all sorts of salty snacks. That was when the epidemic of heart disease and stroke was happening. And so we have thought, for years and years, that salt is the culprit.

We were right in one way — salt is the culprit when consumed in copious amounts. But it may be all right in lesser quantities.

That’s where this study comes in. Research published in the prestigious journal The Lancet looked at 95,000 people in more than 18 countries over an 89-year period to see exactly what the association was between salt intake and heart attacks and stroke.

They found that once a person exceeded 2½ teaspoons of salt intake a day, they were at risk. Stay below that number and it was just fine. Lo and behold as it turned out, most people in most of the countries, with the exception of China, were below that 2½ teaspoon number.

What the researchers also found was that the most important factor was the intake of potassium. In communities where people ate more potassium-rich foods such as nuts, berries, vegetables, potatoes and milk, the numbers showed a lower risk of heart disease and stroke.

Bottom line for the researchers was this summary: “There is no convincing evidence that people with average or moderate sodium intake need to reduce their sodium intake to prevent heart attack and stroke.”

Now, before you go out and buy more salt, we need some caveats — people with congestive heart failure have to watch their salt intake, as do people with kidney disease. There also are other medical problems that require salt restrictions. But for the vast majority, you can consume more salt — especially if you also add more potassium-rich foods to your diet.

Two years ago, a published study of 130,000 people from 50 countries concluded that restricting salt could be harmful if it caused salt intake to be too low. The reaction of the scientific community to this was swift — they called it bad science, and the American Heart Association refuted the entire study.

But those denouncements fly in the face of evidence that women in Hong Kong have the highest rate of longevity in the world, topping out at an average of 87 years, despite the fact they consume enormous amounts of salt, about 8 grams per day.

The other issue is that curtailing salt is a very difficult proposition. A study on reducing salt intake among those in the federal prison population, where there is nearly complete control over dietary offerings, was a dismal failure.

Sir George Pickering, a renowned medical doctor in Britain once said, “The rigid low-sodium diet is insipid, unappetizing, monotonous, unacceptable and intolerable. Staying on it requires the asceticism of a religious zealot.”

My spin: I recommend focusing more on how you use salt, rather than on simply eliminating it. Cook salt-free and then put some salt, lightly, on the top of your food for flavor.

The best kind to use is kosher salt or sea salt that has large crystals. It tastes “saltier” because the larger crystals give a bigger “pop” to the salt receptors on your tongue.

And make sure you increase your potassium through eating more fruits and veggies — that is critically important. And as for prepared food — still look at the salt in it. Lots of it has way too much. Stay well.

This column provides general health information. Always consult your personal health care provider about concerns. No ongoing relationship of any sort is implied or offered by Dr. Paster to people submitting questions. Any opinions expressed by Dr. Paster in his columns are personal and are not meant to represent or reflect the views of SSM Health.

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