Less salt (sodium) for better health

Children are exposed to a large amount of salt (sodium chloride) in their diets from many forms of processed foods such as chips, hot dogs, pizza, and many others. In general, the more sodium in an individual’s diet, the higher an individual’s blood pressure is and the higher their risk for heart attacks and stroke.

Establish Good Food Habits in Childhood

Because food habits established in childhood are likely to persist long term, it is important to learn to enjoy foods that are low in sodium. There is good evidence that over time, people can retrain their preferences so that they grow to enjoy and prefer low salt and salt-free foods that may have initially been unpalatable.

Studies such as the Trials of Hypertension Prevention (TOHP), showed
a linear 17% increase in cardiovascular disease risk per 1000 mg per day increase in sodium from levels starting at 1,500 mg per day. The average of 3,500-4,000 mg of sodium a day in the typical American's diet far exceeds the American Heart Association (AHA) recommendation of a limit of 2,400 mg (5.8 gm salt), or even better a 1,500 mg of sodium (3.6 gm salt) per day for everyone, including children.

Wide Individual Variation

There is considerable individual variation in if and how much salt increases blood pressure. Some people are "salt resistant," and the sodium content of their diet has little or no effect on their blood pressure. Some research suggests that very low sodium consumption will increase the risks of death from CVDs and all causes, but most research supports the current recommendations to limit sodium.

The Institute of Medicine (IOM) examined research on dietary sodium intake and health outcomes in the general U.S. population and among individuals with hypertension; prehypertension; those 51 years of age and older; Black Americans; and those with diabetes, chronic kidney disease, and congestive heart failure. The 2013 report from the Institute of Medicine concluded that existing evidence suggests that:

• Consuming more than 2300 mg of sodium a day increases the risk of high blood pressure.
• There is not enough evidence to say that eating less than 2,300 mg of sodium a day benefits cardiovascular disease outcomes for the general population.
• Practice handwriting and grammar by writing letters to family members. This is a great way to connect and limit face-to-face contact.
• In people with known cardiovascular disease, diabetes, or chronic kidney disease, there is some evidence that a diet of 1,500 to 2,300 mg of sodium a day may have negative health effects compared with higher-sodium diets.

However, this evidence is not strong enough to say that these individuals should be treated differently than the general population. Since the release of the report, a study among individuals with chronic kidney disease (about 11% of U.S. population) suggests that reductions in sodium intake to the 2,300 mg/day level would have considerable benefit in preventing heart failure, myocardial infarction, and stroke.

Confusion over IOM Report

The IOM report led to confusing news reports with headlines like “Doubts About Restricting Salt" and "Study finds Low-Salt Diet Poses Health Hazard" that inaccurately suggest there is no health benefit from decreasing salt intake. Because most Americans consume far more than 2300 mg of sodium a day, a decrease in sodium intake to an average of 2,300 mg per day would be beneficial to most people. Some observers would say that there is not enough evidence that further decreasing sodium intake to 1500 mg a day has an additional benefit for the prevention of cardiovascular disease—or is harmful. However, a very careful analysis published in the New England Journal of Medicine in 2016 concluded that there is strong evidence that there is a strong linear dose-response effect of sodium reduction on blood pressure and CVD risk down to 1,000 mg/day.

Salt is added to many processed foods

Because salt is added to so many processed foods, including canned foods, bakery goods, soups, snack foods such as chips, and fast foods such as pizza, it is difficult to limit the intake of sodium. As a result, 90% of Americans exceed the 2,400 mg/day recommendation. Note that 1 gram (gm) of table salt contains 413.19 milligrams (mg) of sodium.

According to the AHA, reducing daily sodium intake to less than 1,500 mg per day is particularly important for persons who are age 51 and older and those of any age who are Black or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children and the majority of adults.

For most people, there is little need to worry about not getting enough sodium. Even in the probably unlikely instance that it did turn out to be harmful, the CDC estimates that fewer than 1% of Americans reach the 1,500 mg daily limit—our food supply is just too loaded with sodium. In fact, one large international study of 17 countries found that, as measured by sodium excretion, only 4% of study subjects ingested sodium in the U.S. recommended ranges. Only 3.3% of those studied consumed sodium as low as 2,300 mg per day, and just 0.6% of those studied reached 1,500 mg per day.

Low sodium diet effective in lowering blood pressure

A low sodium diet is even more effective in lowering blood pressure when it is combined with measures to increase fitness through appropriate levels of physical activity, attaining and maintaining a healthy weight, and managing stress. Adolescents should be aware that alcohol and cigarettes also contribute to hypertension. More than one drink of alcohol a day can raise blood pressure, and the chemicals in cigarette smoke raise blood pressure and damage blood vessels.

This report presents opinions and ideas and is intended to provide helpful general information. Catalyst for Children is not engaged in rendering advice or services to the individual reader. The ideas, procedures, and suggestions that are presented are not in any way a substitute for the advice and care of the reader's own physician or other medical professional based on the reader's own individual conditions, symptoms, or concerns. If the reader needs personal medical, health, dietary, exercise, or other assistance or advice, the reader should consult a physician and/or other qualified health professionals. Catalyst for Children specifically disclaims all responsibility for any injury, damage, or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this report or participating in any programs described in this report.

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