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EuSalt Blog

19 November 2013

A recent series of research - from 2010 up to October 2013 - increasingly cast doubt on the way sodium reduction policies are carried out, as well as the WHO recommendation for the daily consumption of sodium, i.e. 2 000 g of sodium / 5 g of salt per day. Indeed, the body of literature questioning the appropriateness of public policies aiming at drastic sodium reduction in the population has swollen further.

Recent research pointed to the following conclusions:

  • Recommendations for sodium intake need to follow nutritionally adequate diets and physiological needs [1];
  • Population-wide sodium reduction policies are not appropriate for it neglects the physiological needs of individuals, as well as of certain groups of patients. For instance, low sodium intakes poses a higher risk for morbidity and mortality to patients with Type 2 Diabetes [2] [3];
  • Evidence backing up those public health policies are inconsistent. Some monitoring studies have revealed inconsistencies in the data associating salt intake and cardiovascular diseases, calling for a more refine analysis and more caution regarding generalisation [4];
  • Scientific uncertainty needs to be acknowledged in order to define better, more accurate policies [5];
  • Both sides of the scale represent a risk: sodium intakes above or below 2.5-6.0 grams per day are associated with increased cardiovascular risks[6].

All those studies cast a reasonable doubt on universal sodium reduction and calls for caution in setting population-wide recommendations for daily intakes. Good dietary habits involve varied and balanced diets. There isn't just one, universal diet. This also means a balanced salt intake: ‘too much’ is detrimental to our health, and so is ‘too little’. Our body needs minimum salt intake in order to maintain its sodium level stable and function properly. Taking into account that we naturally excrete a part of the sodium we take in – this excretion also increases when we do sports or as we are ageing -, we need to replace the sodium lost in the course of the day.

Thus, the WHO recommendation of 5 grams per day might be adapted for a certain group, namely for people with hypertension or at risk of cardiovascular diseases. However, this recommendation is not adapted to the needs of the general population. A public health policy targeting a whole population should not be derived from specific measures designed for a target group. Doing so can only result in reaching another extreme for health issues related to insufficient sodium intake are as those related to excessive sodium consumption.

EuSalt restates its support to the promotion of a varied and balanced diet in association with a healthy lifestyle.



[1] D. A. McCarron, "Physiology, Not Policy, Drives Sodium Intake", American Journal of Hypertension (2013); 26(10),

2] A. Mente, "Population Wide Sodium Guidance 'Makes No Sense' In Most Countries", Intervention at The Heart Congress Society of Cardiology (ESC) 2013 Congress,

    National Research Council, Sodium Intake in Populations: Assessment of Evidence, The National Academies Press, 2013,

[3] E. Ekinci, S. Clarke, M.C. Thomas, et al., "Dietary Salt Intake And Mortality in Patients With Type 2 Diabetes", Diaetes Care, April 2011; 34(4),

[4] M.J. O'Donnell, A. Mente, A. Smyth, and S. Yusuf, "Salt Intake And Cardiovascular Disease: Why Are The Data Inconsistent", European Heart Journal, April 2013; 34(14),

[5] R. Bayer, D. Merritt Johns, and S. Galea, "Salt And Public Health: Contested Science And The Challenge Of Evidence-based Decision-Making", Health Affairs, 2012; 31(12),

[6] M.H. Adelman and H.W. Cohen, "Dietary Sodium Intake and Cardiovascular Mortality: Controversy Resolved?", American Journal of Hypertension, 2012; 25(7).


Additional bibliographical references:

- J.J. DiNicolantorio, A.K. Niazi, C.J. Lavie, and J.H. O'Keefe, "Problems With The American Heart Association Presidential Advisory Advocating Sodium Restriction", American Journal of Hypertension, 2013; 26(10),

- M.H. Adelman and H.W. Cohen, "The IOM Report Fails To Detect Evidence To Support Dietary Sodium Guidelines", American Journal of Hypertension, 2013; 26(10),

- R.P. Heaney, "Sodium: How and How Not To Set A Nutrient Intake Recommendation", American Journal of Hypertension, 2013; 26(10),

- A. Mente, M. O'Donnell, and S. Yusuf, "Extreme Sodium Reductions For The Entire Population: Zealotry or Evidence Based?", American Journal of Hypertension, 2013; 26(10),

- J.J. DiNicolantorio, P. Di Pasquale, R.S. Taylor, D.G. Hackam, "Low Sodium Versus Normal Sodium Diets In Systolic Heart Failure: Systematic Review And Meta-Analysis", Heart, 2012,

- A.S. Todd, R.J. MacGinley, J.B.W. Schollum, S.M. Williams, W. Sutherland, J.I. Mann, and R.J. Walker, "Dietary Sodium Loading In Normotensive Healthy Volunteers Does Not Increase Arterial Vascular Reactivity Or Blood Pressure", Nephrology (17), 2012,

- M. Maillot and A. Drewnowski, "A Conflict Between Nutritionally Adequate Diets and Meeting The 2010 Dietary Guidelines For Sodium", American Journal of Preventive Medicine, 2012; 42(2),

- M.J. O'Donnell, S. Yusuf, A. Mente, P. Gao, J.F. Mann, K. Teo, M. McQueen, et al., "Urinary Sodium And Potassium Excretion And Risk Of Cardiovascular Events", Journal of the American Medical Association, November 2011; 306(20),

- K. Stolarz-Skrzypek, T. Kuznetsova, L. Thijs, et al., "Fatal And Non-Fatal Outcomes, Incidence Of Hypertension, and Blood Pressure Changes In Relation to Urinary Sodium Excretion", Journal of the American Medical Association, 2011; 305(17),

- B. Folkow, "On Bias In Medical Research; Reflections On Present Salt-Cholesterol Controversies",Scandinavian Cardiovascular Journal, 2011; 45.

24 June 2013


In view of the European Union’s ambition to move to a low-carbon economy by 2050, the European salt industry is convinced it can make a positive, meaningful contribution towards that  goal. Engaging further in sustainability provides opportunities for innovation, hence remodelling industrial development and supporting a new type of economic growth. We need to ensure a workable legislative framework by raising awareness about the salt industry’s contribution to a sustainable economy and calling for an integrated vision of industry development in Europe.

On 6th June 2013, the European Salt Producers’ Association (EuSalt) held a roundtable discussion on ‘Visions for a Green Future’ in Cracow, Poland. The debate moderated by Sonja van Renssen (ViEUws) gathered representatives from energy- and environment-focused consultancies and institutes, as well as from the salt and lime industries, and addressed an international audience. It aimed to identify perspectives and viable options to achieve a greener economy, and identify the role of the European salt industry in the EU energy and environment roadmaps.

With regard to the EU Energy 2050 Roadmap, Dr. Felix Matthes (Öko-Institut) stated the importance of a long-term vision to check for the consistency of policy, which speaks for transparency and predictability. The roadmap puts great emphasis on re-organising Europe’s energy mix, increasing the share of renewables (especially solar and wind) and incentives for further energy efficiency. Mr. Amit Gautam (Booz & Company) explained further the many opportunities lying in sustainability, not only environmental but also economic and social.

It is therefore essential for any industry to think through its own long-term future, i.e. draw up a 2050 roadmap, thus clarifying its interests, identifying no-regret options and formulating demands and suggestions to policymakers (Dr. Matthes). It further requires to ensure cross-sector collaboration and proactive work towards favourable legislation (Mr. Gautam).

From an industry perspective, it is clear that there is no alternative to sustainability (Mr. Peter Kuijpers, EuSalt). Even though this aspect has not been so prominent so far, the industry must seek opportunities to innovate. The ‘energy transformation’ debate must be reframed in a positive way.

The participation of China’s salt industry in the debate showed that climate and energy are not only a concern to Europe. In China, the salt sector is not wary of climate policy, which ‘has encouraged us to innovate and reduce emissions’ (Mr. Mao Qingguo, China National Salt Industry Corporation). China sees huge potential in market demand for the many applications of salt. There again, innovation and investments in new technologies is the key to energy savings.