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May 22, 2013

Institute of Medicine Expresses Concerns About Sodium Guidelines

Despite doubts, the IOM still advises that Americans limit salt intake to previously recommended levels for heart health.

Recently, the Institute of Medicine—a nonprofit organization that provides advice to public health decision makers—was asked by the U.S. government to review the latest evidence on sodium intake and health outcomes. Consuming high levels of salt has been shown to increase blood pressure, a major risk factor for heart disease, heart attack and stroke, and experts have long advised against high sodium intake.

As such, the 2010 Dietary Guidelines for Americans recommend that the general population limit salt intake to less than 2,300 milligrams per day, while those with hypertension or at higher risk for high blood pressure, like African Americans, anyone 51 years of age and older, or anyone with diabetes or chronic kidney disease, should reduce sodium intake to 1,500 milligrams per day. The American Heart Association recommends that all Americans try to limit sodium intake to 1,500mg per day—equivalent to less than one teaspoon of salt. But after conducting a review of recent research, the Institute of Medicine was not convinced that there was enough evidence to support limiting sodium to these levels. In fact, they found some studies showing that too little salt could actually be harmful for certain individuals, leaving many confused. Should we continue to limit salt intake or just ignore current guidelines, given the IOM's recent report?

Most importantly, everyone—including the IOM—agrees that lowering sodium intake is a major public health objective in the United States. Most Americans consume about 3,400mg of sodium a day, and there’s no question that these levels are too high. Evidence continues to show that too much salt—especially beyond 2,300mg a day—can cause high blood pressure, increasing risk for heart disease. Thus, most Americans still need to cut back on their sodium intake to promote better health.

As for concerns regarding too little salt, experts believe that this is a moot point. With restaurants and processed foods, very few Americans are actually able to consume the suggested 1,500mg of sodium a day, despite their best efforts. Also, the IOM admits that we still need more research to really understand how different limits on sodium intake may benefit our health. It’s clear that limiting our salt intake is essential to better health—they would just like more research comparing the benefits of consuming 1,500mg vs. 2,300mg of sodium a day. In the meantime, patients concerned about their sodium intake should consult with their health care providers to determine exactly what’s right for them.

Questions for You to Consider

  • How can too much salt be harmful to your health?

  • While some salt is necessary to maintain the proper balance of fluids in the body, too much salt causes the kidneys to retain water, which increases blood volume and pressure and puts a strain on the heart. These effects can cause hypertension and significantly harm those with pre-existing heart problems.
  • What foods should I avoid when trying to limit sodium intake?

  • While many foods naturally contain small amounts of sodium, it is estimated that 75 percent of dietary sodium comes from processed foods. When limiting salt intake, try to avoid prepared meals and limit consumption of condiments, canned and frozen foods, and packaged snacks, which contain some of the highest concentrations of sodium. Always read food labels when possible to help accurately measure your salt intake each day.

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