#138 Restricting Salt May Be Dangerous For Your Heart

Restricting Salt May Be Dangerous For Your Heart

Salt is something your doctor has always told you to avoid, right?  In this article, I will share with you the latest medical research showing that, in some cases, restricting salt may be dangerous for your heart.

American Heart Association’s Salt Recommendations

The American Heart Association continues to preach that Americans should reduce their 3,400 mg average of sodium each day to just 1,500 mg.  To put this in perspective, 1,500 mg of sodium is a little more than a half teaspoon of salt.  Is it any wonder that only 1% of Americans can actually follow such strict salt restrictions?

Who wants to eat such a low salt diet?  Our ancestors never ate such bland food. I personally enjoy flavorful food.

Salt Restriction and Heart Failure

Since I started my cardiology training nearly 20 years ago, I was taught that heart failure patients must restrict salt.  When it comes to salt, heart failure patients are like the “canary in the coal mine.”

In other words, if anyone is going to get into trouble from too much salt, it is the heart failure patient.  The thinking was that too much salt led to water retention.  Water retention then caused swollen legs and shortness of breath.

Even today, heart failure patients at my hospital are told to restrict salt.  Are there any medical data to support salt restriction in heart failure?

Salt Restriction Worsens Heart Failure Study

Surprisingly, there are no compelling medical studies supporting the recommendation for heart failure patients to restrict salt.  In fact, a new study showed that salt restriction can actually make heart failure worse.

This past week, cardiologist Dr. Rami Doukky and colleagues from Rush University in Chicago, published a study that has cardiologists around the world questioning everything we have been telling our patients for generations about heart failure.

In this study, Rush University researchers recruited 833 people from 10 different hospitals in the Chicago area.  All patients suffered from severe heart failure.

Some of these heart failure patients restricted their salt to less than 2,500 mg of sodium daily and some did not.  I should point out that the 2,500 mg sodium restriction in this study is far higher than what is allowed with the American Heart Association’s recommended 1,500 mg of sodium each day.

After following these heart failure patients for 36 months, the researchers found that those who restricted salt were 85% more likely to die or be hospitalized during the study!  Wow, the very thing these patients were told to do may have caused them to die prematurely or end up in the hospital.

Of course, I should point out that this was just an observational study.  In other words, just the observation that salt restrictors were more likely to die or be hospitalized doesn’t prove at all that salt restriction was the cause.

There could have been other factors at play to explain these results.  For example, perhaps the salt restrictors were much more sedentary, thus they did not need salt to replace sweat losses from exercising.  That is why my conclusion to this study is that restricting salt may be dangerous for your heart.

Certainly, when it comes to heart failure and salt intake, we need more studies to know what we should be recommending to heart patients.  In the meantime, as long as heart failure patients are not eating a lot of processed and fast foods, they are probably fine flavoring their food with salt unless their doctor tells them otherwise.

Salt and High Blood Pressure

When it comes to salt and high blood pressure, the medical data are pretty clear.  Excessive salt from processed and fast foods raises blood pressure.  Where the medical data aren’t so clear is whether salt, by itself, actually causes heart attacks and strokes.

How much salt should you eat?

This new salt and heart failure study adds further confusion to how much salt you should eat.  This study should not be interpreted that processed and fast food is okay.  Rather, if you rarely eat processed or fast foods then flavoring your “real food” with some salt may be just fine.

To help clarify things, the Institute of Medicine recently reviewed all of the medical studies on salt and came up with the following conclusions:

1. You need at least 1,500 mg of sodium each day to cover sweat losses.

2. Eating up to 2,300 mg of sodium daily is safe.

3. There are not enough quality medical data yet to make any firm salt guidelines.

How do you know how much salt you are eating?

People suffering from high blood pressure should consider tracking their salt intake.  This doesn’t have to be for a long period of time.  Even just a few days would be helpful to at least get an idea of how much salt they are consuming and how sensitive their blood pressure is to salt.  How should this be done?

My Fitness Pal and Lose It are both great free apps to track sodium and nutrition.  Personally, I use the Lose It app.

According to the data compiled by the Health app that comes with all iPhones, I have averaged 1,895 mg of sodium daily for the last year.  This is an underestimation, as I generally don’t take the time to add in the amount of salt I use when cooking or preparing food.  I suspect that if everything was included I would probably end up somewhere near 2,300 mg of sodium or one teaspoon of salt each day.

The Big Picture

Most of the salt in the American diet comes from processed and fast foods.  This is definitely not the way to get salt.  For people who eat minimal processed or fast foods, then you are probably fine flavoring your food with some salt unless your doctor tells you otherwise.

In general, the people who get in trouble from salt are those with high blood pressure on a processed and fast food diet.  For the rest of us, there is no reason to restrict salt unless your doctor has told you to limit salt.

Please leave your comments on this article below.  Also, if you have any questions on this article please leave them below as well and I will answer every question.

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.

  1. Is Himilayan SeaSalt a better choice since it has minerals and isn’t so processed? I just found your site from a post on a Facebook Afib site. Thank you for the wealth of information. Time to get serious about losing weight for Afib!

  2. I developed high b/p (hypertension) several years ago but didn’t start medication until around 2009. Went from mild meds to stronger, higher doses and finally HCT-combined with Valsartan. Even with that, I developed T2D, Afib and b/p is still 130/80. I stopped salting my food a couple of years ago because I noticed how much better I felt without it. A few months ago, I tried sprinkling a little into some very tasteless onion-lentil soup and wow! About 20 mins. later, I thought my head would explode. In emergencies, I’ve used apple cider vinegar to reduce inflammation so I downed 2 tbsp and got some relief.
    Following your advice, I changed my diet, started exercising, lost about 40 lbs, got my sugar down (never on meds for that) to about 120 average but so far, the AF and b/p still require meds (metoprolol+aspirin for AF). For what it’s worth, I’d guess zero extra salt for those of us with multiple conditions is the best way to go.

    • Hi Richard,

      Thanks for sharing! So glad to hear about your weight loss and diabetes success!

      Probably the biggest thing I have learned about food is that everyone is different. There is no one right diet for everyone. We all have different genes, different medical challenges, different tastes, etc.

      At the end of the day, you need to find what works for you. What foods allow you to feel your best, keep medical conditions in check, and maintain a healthy weight.

      Salt, like sugar, is one of those hidden ingredients that is in everything. Some people are incredibly salt sensitive and others are not. Most people are getting far more salt than they even realize.

      Thank you so much for sharing your experiences!

      I wish you continued success!


  3. Dear John
    Happy new year I hope it is a very healthy and happy one for you and your family. I have very low blood pressure and salt helps me a lot as there is very little by way of medication to help this problem. I am very strict about only eating healthy foods and a lot of exercise every day but i believe salt was over estimated and given a bad name. What is your opinion on lyme disease causing heart problems and AFib Is there any natural cures for this disease and the best test to get a correct diagnosis? I am interested on your opinion with the connection of lyme disease causing AFib. I look forward to your reply email. God bless and take good care of you and your family.
    Kind Regards

    • There are certainly reported cases of Afib from Lyme Disease. Typically, these are in the setting of carditis from the lyme disease. Unfortunately, antibiotics remain the treatment of choice for acute lyme disease.


  4. I suffer from hyperaldosteronism…take eplerenome which has my BP well under control. It has seemed to me that excess salt leads to fluid retention which in turn eventually leads to dumping (AF and ANP at work, apparently). Controlling salt intake is particularly difficult when eating out. Any thoughts on how to approach this?

    • Hi John,

      I completely agree with you. If excess salt leads to fluid retention then you need to do what works best for your body. I think this is a key message to nutrition and health–you need to listen to your body and find out what works best for you.

      Eating out is definitely another huge problem when it comes to excess salt. The salt can be anywhere–in the dressing, in the sauces, in the bread…

      One way to minimize the salt when eating out is to select the right foods. For example, you could have your vegetables steamed. You could use olive oil and balsamic vinegar for your salad dressing. You could ask for any sauces, glazes, etc. on the side so that you can control the intake.

      Hope this helps and thank you so much for reading!


      • On a completely different topic, I wanted to thank you for an earlier article you had on Multaq that saved me much grief. I had progressed from AF once a month to AF once a week. Dr. put me on Multaq. I then began having AF every 48 hours like clock work. At first I thought it was progression of the AF, and I needed to give Multaq time to work (gave it three weeks!), but after reading your article I realized the Multaq was probably causing the AF. After trying to reach the Dr. unsuccessfully (he was on vacation and staff dropped the ball), I stopped Multaq on my own. Problem self-corrected after about five days.

        • How interesting…every once in a while I see cases just like the one you described where the “anti” arrhythmic actually made the arrhythmias worse. Glad to hear things are now under control again!