A Radical Sodium Reduction Policy Is Not Supported by Randomized Controlled Trials or Observational Studies: Grading the Evidence

Abstract

Several health institutions recommend sodium intake be reduced to below 2,300mg, which means that 6-7 billion individuals should alter their diet to accommodate. Such a radical recommendation should be based on solid evidence. However, this review reveals that (i) there are no randomized controlled trials (RCTs) allocating individuals to below 2,300mg and measuring health outcomes; (ii) RCTs allocating risk groups such as obese prehypertensive individuals and hypertensive individuals down to (but not below) 2,300mg show no effect of sodium reduction on all-cause mortality; (iii) RCTs allocating individuals to below 2,300mg show a minimal effect on blood pressure in the healthy population (less than 1mm Hg) and significant increases in renin, aldosterone, noradrenalin cholesterol, and triglyceride; and (iv) observational studies show that sodium intakes below 2,645 and above 4,945mg are associated with increased mortality. Given that 90% of the worlds' population currently consumes sodium within the optimal range of 2,645-4,945mg, there is no scientific basis for a public health recommendation to alter sodium intake.