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Experts question the emphasis on a low-salt diet

By GINA KOLATA The New York Times
Published: Wednesday, May 15, 2013 at 1:00 a.m.
Last Modified: Tuesday, May 14, 2013 at 7:50 p.m.

In a report that undercuts years of public health warnings, a prestigious group convened by the government says there is no good reason based on health outcomes for many Americans to drive their sodium consumption down to the very low levels recommended in national dietary guidelines.

Those levels, 1,500 milligrams of sodium a day, or a little more than half a teaspoon of salt, were supposed to prevent heart attacks and strokes in people at risk, including anyone older than 50, blacks and people with high blood pressure, diabetes or chronic kidney disease — a group that makes up more than half of the U.S. population.

But the new expert committee, commissioned by the Institute of Medicine at the behest of the Centers for Disease Control and Prevention, said there was no rationale for anyone to aim for sodium levels lower than 2,300 milligrams a day.

“As you go below the 2,300 mark, there is an absence of data in terms of benefit and there begin to be suggestions in subgroup populations about potential harms,” said Dr. Brian L. Strom, chairman of the committee and a professor of public health at the University of Pennsylvania.

The committee was not asked to specify an optimal amount of sodium and did not make any recommendations about how much people should consume.

There are physiological consequences of consuming little sodium, said Dr. Michael H. Alderman, a dietary sodium expert at Albert Einstein College of Medicine who was not a member of the committee. As sodium levels plunge, triglyceride levels increase, insulin resistance increases, and the activity of the sympathetic nervous system increases. Each of these factors can increase the risk of heart disease.

Medical and public health experts responded to the new assessment of the evidence with elation or concern, depending on where they stand in the salt debates.

“What they have done is earth-shattering,” Alderman said. “They have changed the paradigm of this issue. Until now it was all about blood pressure. Now they say it is more complicated.”

But Bonnie Liebman, director of nutrition at the Center for Science in the Public Interest, said “it would be a shame if this report convinced people that salt doesn’t matter.”

Source: New York Times