Sodium and Health: Old Myths and a Controversy Based on Denial

Abstract

Purpose of Review The scientific consensus on which global health organizations base public health policies is that high sodium intake increases blood pressure (BP) in a linear fashion contributing to cardiovascular disease (CVD). A moderate reduction in sodium intake to 2000 mg per day helps ensure that BP remains at a healthy level to reduce the burden of CVD. Recent Findings Yet, since as long ago as 1988, and more recently in eight articles published in the European Heart Journal in 2020 and 2021, some researchers have propagated a myth that reducing sodium does not consistently reduce CVD but rather that lower sodium might increase the risk of CVD. These claims are not well-founded and support some food and beverage industry’s vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst. Nevertheless, some researchers, often with funding from the food industry, continue to publish such claims without addressing the numerous objections. This article analyzes the eight articles as a case study, summarizes misleading claims, their objections, and it offers possible reasons for such claims. Summary Our study calls upon journal editors to ensure that unfounded claims about sodium intake be rigorously challenged by independent reviewers before publication; to avoid editorial writers who have been co-authors with the subject paper’s authors; to require statements of conflict of interest; and to ensure that their pages are used only by those who seek to advance knowledge by engaging in the scientific method and its collegial pursuit. The public interest in the prevention and treatment of disease requires no less.

A Method for Estimating 24 h Urinary Sodium and Potassium Excretion by Spot Urine Specimen in Stroke Patients

“…Stroke is the second leading cause of death and the third leading cause of disability worldwide [ 1 ], and is a major health threat in China [ 2 , 3 ]. Many studies have shown that the risk of stroke is associated with high sodium intake and low potassium intake [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Estimating sodium and potassium intake among stroke patients is an important strategy for improving the intake of both electrolytes and reducing the risk of stroke.…”

Salt: the forgotten foe in UK public health policy

“…Most of this is based on a few prospective cohort studies suggesting a J or U shaped association between salt intake and cardiovascular events—that is, both lower (<7.5 g/day) and higher (>15 g/day) salt intakes were associated with increased risk of disease. However, the US National Academies of Sciences, Engineering, and Medicine and others describe methodological limitations (such as inaccurate estimates of individual salt intakes from single spot urine samples) and point to a high risk of bias in these cohort studies, alongside researcher conflicts of interest 67…”

“…These studies continue to be used to support the food and beverage industry’s vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst,6 but the totality of evidence shows that the relationship between salt intake and blood pressure is one of the most robust causal associations we know 8. The causal association between blood pressure and cardiovascular disease is similarly robust 9.…”

Information available on consumer‐facing websites may affect adherence to important public health measures such as reducing sodium consumption

“…Sodium consumption, among the determinants of hypertension, plays a fundamental role by contributing to the increase in blood pressure in a dose‐dependent manner, in both sexes, in all ethnicities, from infancy to old age, and according to basal pressure. 7 Scientific evidence has undoubtedly demonstrated that sodium reduction is a global priority and is one of the main objectives of world health policies helping to prevent and treat hypertension and cardiovascular disease 8 , 9 , 10 , 11 and the most important scientific societies and health institutions such as WHO advised reducing the consumption of sodium to low than 2300 mg/day. 8 Despite a reduction in sodium intake has been recommended by health practitioners, 12 public health institutions such as the FDA and CDC 13 and main scientific hypertension societies, 9 , 10 a quality guidance according to these recommendations should be readily available on websites for all people seeking online information, otherwise there is a risk of limiting its effectiveness.…”

“…In a recent paper published by Cappuccio et al. 7 this topic was extensively treated and discussed. Starting from the analysis of eight articles published between 2020 and 2021 in which the importance of the low‐sodium diet on cardiovascular risk was questioned, Cappuccio et al.…”