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The recommend that people get no more than 2,300 mg of sodium from their diets daily. If you're in a "special population" -- in this case, all persons over age 50 and African Americans over age 2 -- it is recommended that you cap your dietary sodium at 1,500 mg daily.
The intent is to reduce blood pressure because high blood pressure poses health risks. Too many people are hypertensive and some groups, especially older people and African-Americans, are at higher risk than others, and there's evidence that reducing sodium intake can help lower blood pressure. (I resent that over 50 is considered "older," but that's another topic.)
Of course, no average person, and very few health professionals, can picture what a diet that has 1,500 mg of sodium looks like. Put another way, if you checked into the hospital, and your doctor prescribed a standard low-sodium diet, it was traditionally 2,000 mg of sodium per day.
This 2010 recommendation takes it 25% lower and applies it to everyone over age 50 living in free society and all African-Americans over age 2. Follow these recommendations and you've had your last condiment, your last meal in a restaurant, and the last bowl of your mom's chicken soup, no matter what she said it would cure. Sorry, Mom.
Currently, most of us do eat too much salt. We get about 3,600 mg daily -- more if you eat out a lot as restaurant food is often salty -- so we're not even meeting the 2,300-mg recommendation. Expecting consumers to further take it down to 1,500 mg/day is probably unrealistic. My patients live in the real world, and as a clinician I need to meet them there and talk to them about what is realistic for them.
Not everyone is even salt-sensitive. Their blood pressures may not increase much until salt intake gets extremely high, so reductions below a certain level may not help most people. Perhaps a better strategy is to focus on interventions that can have a better impact not only on blood pressure, but on other measures of health quality -- and that might be more acceptable to most people.
I love . It stands for "Dietary Approaches to Stop Hypertension" and focuses on a moderate reduction to 2,300 mg of sodium (you can go lower but not necessary), with lots of fruits and vegetables (about 4 cups daily) and three servings of low-fat and fat-free dairy foods. It has been widely shown to lower blood pressure as well or better than drugs in persons with mild hypertension. And all you have to do is eat more fruits, vegetables, and low-fat dairy. It's the one diet even the feds endorse. To be sure, just eating more fruits, vegetables, and low-fat dairy foods, especially between meals, would probably lower dietary sodium just by pushing out saltier snack foods.
Weight gain can increase blood pressure, too, and two-thirds of us are overweight or obese. If we lose excess weight -- even just 5% to 10% of body weight -- and got back to having more fruits and veggies and low-fat yogurt and milk every day, it would probably have more impact than pressing our dietary sodium lower than "hospital" thresholds. And since these are very underconsumed food groups, aiming in this direction would fill a lot of dietary gaps as well.
One other thing that would drop blood pressure like a bomb: moving more. Seriously, regular exercise, and regular walking counts here. It tends to dilate blood vessels and lower blood pressure over time.
Making these dietary and activity changes -- which are pretty commonly recommended anyway, for overall health and wellness -- would probably do more to lower our nation's blood pressure than expecting tens of millions of people to gravitate to an extremely low consumption of sodium.
Now, this is anecdotal, but put it into the category of "What are the odds?" Two close family members, not genetically related, and a very close friend, have been told by different cardiologists to eat more salt. Their blood pressures were too low.
One cardiologist even got specific about recommendations: a glass of salted vegetable juice and a bowl of soup every day. Another offered a choice: eat more salt or get medication to increase this person's blood pressure.
Perhaps this is a coincidence, but maybe we should reassess this recommendation for such a low intake of sodium for so many people, especially when there are other -- and much tastier and more enjoyable -- ways to change our diets and lifestyle, perhaps with even better results.
, is an associate professor of pediatrics at Albert Einstein College of Medicine in New York City.