Pass the salt? IOM warns that low-sodium diet can cause problems

Patients with diabetes do not need to cut sodium intake, report says

Although experts have long urged Americans to reduce their salt intake, a new Institute of Medicine (IOM) report warns that ultra-low sodium diets can have a detrimental effect on heart health. 

The average U.S. resident consumes 3,400 milligrams of sodium per day—well over current U.S. dietary guidelines, which recommend a maximium sodium intake of 2,300 milligrams per day. (Certain high-risk populations, like individuals over age 50, African-Americans, and individuals with hypertension, diabetes, or chronic kidney disease are supposed to limit sodium consumption to 1,500 milligrams per day.) 

The American Heart Association also has urged all Americans to limit their daily salt intake to 1,500 milligrams.

However, IOM suggests there is no evidence to support lower salt thresholds for certain Americans, including those with hypertension. "The evidence on both the benefit and harm is not strong enough to indicate that these subgroups should be treated differently from the general U.S. population," the panel wrote.

In fact, IOM suggests that consuming less than 1,500 milligrams a day may increase risks for some health problems. For example, low-sodium diets may harm individuals with mid- to late-stage heart failure who are receiving aggressive treatment.

The latest data supported reducing sodium "from very high intake levels to moderate levels," according to the University of Pennsylvania’s Brian Strom, chair of the IOM committee. But the data "also suggest that lowering sodium intake too much may actually increase a person's risk of some health problems," Strom added.

Health groups respond

Health experts who support current sodium guidelines were quick to stress that the report's findings do not contradict the growing concern around Americans' salt intake.

Bonnie Liebman, director of Nutrition at the Center for Science in the Public Interest (CSPI), told Reuters that "the bottom line for consumers is still: cut back on sodium," adding, "[v]irtually any meal at any restaurant would give you at least half-a-day's worth of sodium, maybe a whole day's worth, maybe more."

FDA officials also released a statement saying that they were reviewing the IOM report to see if it is consistent with "efforts to work toward achievable and reasonable voluntary reductions in the sodium content of the U.S. food supply."

According to Reuters, U.S. dietary recommendations are slated for review in 2015 (Heavey, Reuters, 5/14; Pugh, Sacramento Bee, 5/15; Corbett Dooren, Wall Street Journal, 5/14; Selvam, Modern Healthcare, 5/14 [subscription required]).

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