High Sodium Consumption Takes a Toll on Health

April 27, 2015|2:53 p.m.| Katie Potestio

Recent scientific studies and media messages have questioned the need to reduce population sodium intake, but the public health recommendations remain crystal clear: Americans are consuming too much sodium each day, and it’s raising their risks for high blood pressure and cardiovascular disease.

Most scientific and professional health organizations say sodium reduction is an urgent public health priority. However, despite many scientific experts calling for sodium intake reductions based on the evidence base, some argue that most Americans are eating a healthy amount of salt and that lowering salt intake may increase the risk of disease.

Sodium infographic from the American Heart Association

The 2010 Dietary Guidelines for Americans, World Health Organization, Institute of Medicine, American Heart Association and other health organizations have varying guidelines for sodium intake, but all consistently recommend the general public consume no more than 2,400 milligrams of sodium per day. These recommendations are made after weighing all of the evidence, including studies of greater and lesser strength of design and some with conflicting results. Americans on average eat more than 3,400 milligrams of sodium per day—at least 1,000 milligrams (mg) more than they need. Almost 80 percent of that sodium comes from packaged and restaurant foods.

Scientists who question the current sodium guidelines point to research studies suggesting that too little salt causes more risk for early death and disease, but these studies often have methodological limitations. The American Heart Association has documented its concerns about the validity of these studies in a science advisory, and addressed the state of the science in a commentary in Nutrition Today (also see its blog post on “Making Sense of the Science of Sodium”).

To support the current public health recommendations, more than 30 nutrition scientists signed a Consensus Statement on Sodium Reduction in June 2014, concluding “Population-wide reduction of sodium intake is an integral approach to reducing cardiovascular disease events and mortality in the United States.”

Known health risks

The causal link between sodium intake and high blood pressure levels is well-established, but lowering sodium is helpful even for people who don’t have high blood pressure. Eating less salt can mitigate the rise in blood pressure that occurs with age, as well as reduce the risk of cardiovascular disease. This is important because 90 percent of American adults are expected to have high blood pressure in their lifetimes.

Earlier this year a committee of nutrition experts maintained the current recommendations from the federal government to limit sodium reduction to less than 2,300 mg/day for the general population in the Dietary Guidelines Advisory Committee Report. Additionally, the report emphasized expanding industry efforts to reduce the sodium content of foods, and the importance of policies and programs at local, state, and national levels to support reduction efforts.

Reducing sodium intake to levels consistent with the Dietary Guidelines for Americans is also a priority for CDC. At the national level, the Million Hearts initiative has set a goal for 20 percent reduction in average sodium by 2017. Million Hearts is a national initiative co-led by CDC and CMS to prevent 1 million heart attacks and strokes in the United States by 2017.

CDC funds state and local communities to increase access to and accessibility of lower sodium food options, and continues to build practice-based evidence around effective population-based strategies to reduce sodium consumption through the Sodium Reduction in Communities Program. Additionally, the New York City Department of Health and Mental Hygiene is coordinating the National Salt Reduction Initiative, an unprecedented public-private partnership to reduce the amount of salt in packaged and restaurant foods through voluntary targets for salt levels.

State health agencies can lead sodium reduction efforts in their jurisdictions by prioritizing healthy eating initiatives such as implementation of food service guidelines, sending a clear message to partners and policymakers, and helping to address the challenge of messaging for consumers (What does 2,300mg/day look like, and which foods does it come from?). ASTHO has been working with CDC’s Division of Heart Disease and Stroke to engage state health officials in addressing sodium as an important component of dietary change strategies through a collaborative effort of public health leaders and other stakeholders.  

State efforts to reduce sodium levels in foods and beverages

To reduce the sodium content in the food supply, states are using innovative approaches focused on government food procurement to improve the nutritional quality of food for state employees and state programs’ clients. Within their own agencies, states like Arkansas are leveraging worksite wellness efforts by implementing food service guidelines that include sodium restrictions for vending machines, meetings and events, and cafeterias. These policies can serve as models for other governmental agencies and for the business community.

Other sectors ripe for partnership around sodium reduction include food service providers, food suppliers and manufacturers, school food service, and hospitals. In Iowa, the Department of Public Health successfully worked with the Department of Administrative Services to include healthier eating standards in the food service contracts for cafeterias, and it developed a memorandum of understanding with the Department for the Blind to provide healthy selections in the vending machines.

Washington State’s governor issued an executive order in October 2013 requiring all executive state agencies to adopt healthy nutrition guidelines, and Connecticut is actively pursuing a statewide food procurement policy setting nutrition standards, including sodium standards, on all food purchased by state agencies, similar to Massachusetts.

National, state, and local sodium reduction efforts are laying an important groundwork for future sodium reduction initiatives and policies. However, further education and awareness on the sodium reduction science is necessary to keep the public and policymakers informed about the role of reducing sodium intake in overall efforts to improve dietary patterns and health.

For more information about common challenges and lessons learned from states working on sodium reduction, see ASTHO’s Salt and Your State Project Summary

Katie Potestio

Katie Potestio, MPH, RD, is an analyst for health promotion and disease prevention at ASTHO. She is a registered dietitian and received a Master of Public Health degree from the University of Washington with a focus in public health nutrition. Katie supports ASTHO projects related to nutrition, chronic disease prevention, worksite wellness, and breastfeeding promotion.