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Blog Food-Feed

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.