The American Heart Association strongly refutes the findings of a May 20, 2016 article in The Lancet by Mente, et al, that suggest low sodium intake is related to a higher risk of heart disease and death. On the contrary, the link between excessive sodium and high blood pressure – as well as higher risks of heart disease, stroke, heart failure and kidney disease – is indisputable. Lowering sodium is more important than ever.
Consider the following:
• One-third of Americans have high blood pressure
• 90% of all American adults will develop hypertension over their lifetime
• Heart disease and stroke are the world’s two leading causes of death (my emphasis)
“The findings in this study are not valid, and you shouldn’t use it to inform yourself about how you’re going to eat,” said Mark A. Creager, M.D., president of the American Heart Association and director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center. “The large body of science clearly shows how excessive amounts of sodium in the American diet can cause high blood pressure, which can lead to heart disease, stroke, and even death.”
“The public should not be confused by the flawed study reported in The Lancet. The American Heart Association and many other reputable organizations urge the vast majority of persons around the globe to consume less sodium. This study offers no credible evidence that lower sodium intake can be harmful. And many other well-done studies support the recommendation of the association to limit daily sodium intake to 1500mg per day,” said Daniel W. Jones, MD. past president, American Heart Association; Sanderson Chair in Obesity, Metabolic Diseases and Nutrition; Director, Clinical Population Science, Mississippi Center for Obesity Research.
Evidence shows there are specific people who should not lower sodium intake including those regularly working in extreme heat, or those with specific, but uncommon, illnesses. But suggesting most Americans don’t need to reduce sodium consumption is off the mark. “Decades of experimental work in the laboratory, where other factors known to affect the cardiovascular system can be closely controlled, have demonstrated the importance of dietary sodium in worsening hypertension. Importantly, that evidence also shows that the impact of dietary sodium can differ greatly from one individual to another,” said Gregory Fink, PhD, past Chair on American Heart Association’s Council on Hypertension.
“Low sodium excretion, based on spot urine collections as done in this study, is a misleading measure of usual dietary intake, particularly over a lifetime,” Dr. Creager added. “Other factors, beyond dietary sodium intake, are present and probably are responsible for the association of lower sodium excretion with cardiovascular disease – factors such as poor appetite and reduced food intake due to a serious concurrent illness.”
The suggestion from The Lancet article that most people are eating the right amount of salt runs counter to established recommendations as well as the recent movement toward limiting sodium in packaged goods and restaurant meals. The AHA is one of numerous health organizations and governmental bodies that encourage sodium limits for health reasons. The U.S. government recommends no more than 2,300 milligrams a day, and the World Health Organization recommends 2,000. Unfortunately, most Americans consume more than twice the American Heart Association’s recommended limit of 1,500 milligrams per day.
Many Americans attempt to reduce their sodium consumption by reducing their use of salt shakers on their dining room table. This is based on ignorance of the source of their dietary sodium. Most Americans overdo their sodium consumption because of their dependence on processed foods. That’s because more than 75 percent of the sodium in the average American diet comes from salt added to processed foods. In other words, we often don’t even know we’re eating it. And while cutting table salt is wise, it may only be putting a tiny dent in your sodium total.
“Sodium shows up in canned soups, salad dressings, and even products that don’t immediately come to mind when we think of ‘salty’ foods, such as pasta, bread and cereals,” said Rachel Johnson, Ph.D., R.D., .a professor of nutrition at the University of Vermont and a volunteer for the American Heart Association. (my emphasis)
The association’s guidelines are based on the expert review of an expansive body of the best-available scientific research over time. While The Lancet article folds into the landscape of available evidence, we must be discerning in the evidence that defines public policy recommendations.
The association is committed to helping Americans achieve better cardiovascular health. Encouraging lower sodium intake is an important part of that commitment, and will ultimately help save lives.