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Open for Discussion: Just How Much Salt Do We Need

By Chris Eboch  February 2016

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Some scientists and doctors say we should limit our salt intake. Other experts believe a higher salt intake is fine, and maybe even healthier. Why is there so much debate about how much salt we need in our diet? The main reason is that it is difficult to conduct long-term studies of diet.

Randomized controlled trials

Ideally, participants are randomly divided into two groups. An experimental group receives treatment; a control group does not. This type of study, called a randomized controlled trial, is considered the most reliable and accurate.

Short-term randomized controlled trials, involving a few hundred patients studied over several weeks, have shown a link between high salt intake and high blood pressure. But such studies have not directly linked high salt intake to health problems, such as heart attacks and strokes.

A better diet study might randomly assign test subjects meals with different amounts of sodium and then record their rate of health problems, such as heart attacks and strokes. But to get definite results, such a study would have to use thousands of patients over several years, which is impossible in a clinical setting.

Observational studies

In an observational study, scientists track normal behavior rather than trying to control it. For example, starting in 2003, scientists studied the sodium intake of over 100,000 people from 17 countries. The test subjects each provided a urine sample. These showed how much sodium and potassium were eliminated by their bodies, a good estimate of sodium intake. The test subjects then ate their usual diet, and the study recorded major cardiovascular events, such as heart attacks and strokes, as well as death rates, over the course of 10 years.

The study found that people with the highest levels of sodium had a 15% increase in the risk of death or major cardiovascular event. The highest risk was for people with unusual high blood pressure, or hypertension. However, the study also found that people with the lowest sodium intake had a 27% increase in risk. People who met the low U.S. recommended limits for salt (2,300 milligrams (mg) of sodium per day) had more heart trouble than those consuming moderate amounts of salt. But the test subjects may have other behaviors that would cause health problems, making it difficult to identify what is causing the problem.

In the end, the two different types of studies—randomized controlled trials and observational studies—have produced contradictory results.

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What can be done?

To lift the uncertainty over how much salt we need in our diet, more studies of both types, clinical and observational, are needed. Long-term clinical studies would be ideal but are difficult to conduct. Observational studies that follow large populations for years may provide more data. Ideally these would also study how changing sodium intake affects health, and how sodium intake affects people with different health conditions.

What will you do?

For now, expert opinions are divided. However, you still need to make informed choices about your own sodiium consumption. How will you decide how much salt you need? What information will you use to make that choice?

Looks Can Be Deceiving

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Thinkstock

You can see the salt on potato chips, but breakfast cereals, spaghetti sauce, and frozen dinners also contain salt.

Also in the February 2016 Issue...

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Mike Ciesielski

Most people in the United States consume more salt than they should. So is it time to cut back on salt?