The first Dietary Guidelines for Americans, published in 1980, encouraged Americans to “avoid too much sodium,” and every edition since has included a key recommendation on limiting sodium in the diet.
The American Heart Association recommends everyone consume no more than 1,500 milligrams of sodium per day.
A systematic literature review concluded there is limited evidence that daily sodium intakes greater than 3,400 milligrams and less than 2,900 milligrams increased incidence of cardiovascular disease events, all-cause mortality and hospitalization in the general population. Also that year, authors of a meta-analysis found that individuals with daily sodium intakes of 2,645 milligrams to 4,945 milligrams have the lowest cardiovascular disease and mortality risks — and that plotting sodium and mortality creates a U-shaped curve with significantly increased risks at the highest and lowest intake levels. Some of the more compelling and controversial findings came from a large-scale epidemiologic study following more than 150,000 individuals in 17 countries.
Participants with the lowest mortality and cardiovascular risk consumed between 3,000 milligrams and 6,000 milligrams of sodium per day, and greater than 1,500 milligrams of potassium per day. High sodium intake was only linked with increased risk of death and cardiovascular events when blood pressure was high, while people with normal blood pressure who consumed more than 6,000 milligrams of sodium daily did not experience increased risk of death and cardiovascular events. Additionally, those who consumed less than 3,000 milligrams experienced increased risk when blood pressure was normal.
In 2015 during the American Heart Association’s Scientific Sessions, prominent researchers on either side debated the complexities of this issue. Low-sodium proponents asserted that to protect their health, Americans must limit sodium intake — and that given the majority of Americans’ sodium intake comes from processed food, this effort should focus on industry-wide interventions. The opposing side maintained that for people without elevated blood pressure, there is no benefit to consuming less than 2,500 milligrams of sodium per day, that it actually may be harmful in some cases, and that to base general guidelines on extrapolations of data is unsound.
Currently, the perfect study to settle the sodium controversy does not exist. Large randomized controlled trials with long follow-up periods are difficult and expensive, and an ideal sodium intake assessment tool is yet to be discovered. In the meantime, the DASH diet — which places more emphasis on fruits and vegetables than sodium (DASH trials averaged around 3,000 milligrams of sodium per day) — is the most effective dietary intervention for hypertension.
And for patients and clients with normal blood pressure, practitioners should continue to develop individualized eating patterns based on clinical judgment, guideline recommendations and scientific evidence
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