Dr. Day is a cardiologist and Medical Director of Heart Rhythm Services at his practice in Salt Lake City, Utah. He graduated from Johns Hopkins Medical School and completed his residency and fellowship in cardiology at Stanford University. He is board certified in Cardiology and Cardiac Electrophysiology.
More than half of us here in America have high blood pressure. In fact, 56% of us are above the ideal blood pressure of 120/80 mmHg, as established by the American Heart Association (AHA). High blood pressure leads to heart attacks, heart failure, atrial fibrillation, strokes, and kidney failure.
For years, we have been told to eat a low sodium diet. The American Heart Association (AHA) has recommended 1,500 mg, which is substantially less than one teaspoon per day. One teaspoon of salt has 2,300mg of sodium.
Despite these recommendations, the average American kept on eating an average of 3,400 mg of sodium each day. In fact, less than 1% of Americans could ever achieve the AHA goal.
Based on emerging new medical studies, it appears that following these AHA guidelines would not have helped us reduce our blood pressure as much as one might think. Also, new data indicates that perhaps this ultra low sodium diet is not the best for our long-term health either.
Sodium and High Blood Pressure
While medical studies do support that we can reduce our blood pressure with a low sodium diet, the results are not that impressive. The average person can drop their blood pressure only by about 5 mmHg with a low sodium diet.
As one who has suffered from high blood pressure and wanted to get off the medications, I thought the answer to lowering my blood pressure was to dramatically reduce my sodium. I reduced my sodium so much that all of my food tasted incredibly bland. In fact, it just was not pleasurable anymore.
Over time, I found that the answer to reducing my blood pressure came through significant weight loss, eating real food rather than processed food, reducing and managing my stress, and moving throughout the day. By doing these things, I was able to dramatically drop my blood pressure to 110/70 mmHg without medications.
Having been taught that a low sodium diet was critical to good cardiovascular health, I was always amazed at how many Asian cultures, such as Japan or China, could eat high salt diets, yet have much lower rates of heart disease. From my perspective, it did not add up.
Having spent time in Asia nearly every year of my adult life, I have made it a point to learn more about what they eat. On our last trip to China, my wife, Jane, spent the day with Mrs. Huang and her daughter-in-law cooking meals.
According to Mrs. Huang, the secret to making Chinese food taste great involved three simple ingredients: the right cooking oil, fresh garlic, and salt in one form or another.
Although I have preached a low sodium diet to my cardiology patients for years, I could never reconcile how the Japanese and Chinese can take in so much sodium through soy sauce and salt, in one form or another, but yet seem to avoid heart disease. I knew from medical studies that after Asians immigrate to the U.S., their rates of heart disease gradually approach those of other Americans.
Could it be possible that their diets, high in fruits, vegetables, legumes, nuts, seeds, and fish, in their native countries protect them from heart disease? Could it be possible that salt is not so harmful if it is added to real foods rather than eaten with processed foods?
I suspect that the real problem is not salt but rather processed foods. Interestingly, as more and more Asians are adopting the Western diet with processed foods, their rates of obesity, diabetes, and heart disease are now dramatically increasing.
Medical Societies Can’t Agree on Daily Sodium Intake
The salt controversy really heated up in May of 2013 when the prestigious Institute of Medicine published their daily sodium intake recommendation. They specifically stated the following:
1. There was no compelling data to recommend less than 2,300 mg daily of sodium even in higher risk patients (those patients with diabetes, high blood pressure, or heart disease).
2. They even raised the question that the AHA’s ultra low sodium recommendations may even cause harm.
The 2014 Sodium Controversy
The August 14,2014 issue of the most prestigious medical journal, the New England Journal of Medicine, there were three published articles all questioning the optimal daily sodium intake.
It is interesting to note that all three articles came to different conclusions. Amongst these data, I believe there is a middle ground when it comes to how much sodium per day is optimal. Moderation, not dramatic reduction, is the answer when it comes to daily sodium intake.
Take Home Message on Daily Sodium Intake
1. The ultra low sodium diet is out.
Most experts now recommend a more moderate approach to daily sodium intake. Even though the data seems to be mounting against the AHA’s ultra low sodium recommendations of 1,500 mg/day, the AHA holds strong to their current guidelines. I project that, in time, they will adjust their sodium guidelines, as they did with their ultra low-fat, high-carb diet recommendations.
2. The right amount of daily sodium seems to be about 2,300 mg
Approximately 2,300 mg per day seems to provide the right balance between health and good tasting food. I have carefully tracked my own daily sodium intake. As long as I steer clear of processed foods, fast foods, or most restaurant foods, I find that I can add the desired amount of salt to real food and stay at about 2,300 mg per day.
3. Minimize eating out and processed foods
For most Americans, achieving the moderate sodium recommendations will require significantly cutting back on eating out and processed foods, as 50% of what we eat is processed or restaurant-prepared. The problem is not the saltshaker itself, but rather, who is adding the salt to the food you eat.
Indeed, 80% of the sodium we consume each day is from eating out or from processed foods. Only 20% of our daily sodium intake comes from the salt shaker.
Do you know how much sodium you are getting?
Take back your control. Start today and for one week, do these two things:
1) Read food labels.
It is easy to verify the appropriate sodium percentages, as 2,300 mg is the recommended daily allowance listed on the food labels.
2) Return to real foods.
Make it a point to eat out less and prepare real food at home more. Preparing your own simple, real foods could easily drop your average daily sodium intake of 3,400 mg to 2,300 mg, improving your overall health.
What has worked for you in maintaining a healthy blood pressure? We’d love to hear from you.
Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.