Health effects of salt
The health effects of salt are the conditions associated with the consumption of either too much or too little salt. Salt is a mineral composed primarily of sodium chloride and is used in food for both preservation and flavor. Sodium ions are needed in small quantities by most living things, as are chloride ions. Salt is involved in regulating the water content of the body. The sodium ion itself is used for electrical signaling in the nervous system.
The World Health Organization recommends that adults consume no more than 5 g of salt per day. The WHO further recommends that salt intake be adjusted for children aged 2 to 15 years old based on their energy requirements relative to those of adults. High sodium consumption and insufficient potassium intake have been linked to high blood pressure and increased risk of heart disease and stroke.
As an essential nutrient, sodium is involved in numerous cellular and organ functions. Salt intake that is too low, below 3 g per day, may also increase risk for cardiovascular disease and early death.
Acute effects
, a blood sodium level above 145 mEq/L, causes thirst, and due to brain cell shrinkage may cause confusion, muscle twitching or spasms. With severe elevation, seizures and comas may occur. Death can be caused by ingestion of large amounts of salt at a time. Deaths have also been caused by use of salt solutions as emetics, typically after suspected poisoning.Hyponatremia, or blood sodium levels below 135 mEq/L, causes brain cells to swell; the symptoms can be subtle and may include altered personality, lethargy, and confusion. In severe cases, when blood sodium falls below 115 mEq/L, stupor, muscle twitching or spasms, seizures, coma, and death can result.
Long-term effects
About 95% of the world's populations have a mean intake of salt that is between 6 g and 12 g daily. Widespread advice that salt intake be restricted below this range is not supported by evidence from randomized controlled trials nor is it supported by evidence from prospective observational studies. In fact, intake of less than 5.8 g of salt per day typically results in activation of the renin-angiotensin-aldosterone system, which leads to an increase in plasma lipids and increased mortality.Although many health organizations and recent reviews state that high consumption of salt increases the risk of several diseases in children and adults, the effect of high salt consumption on long-term health is controversial. Some suggest that the effects of high salt consumption are insignificant.
Excess sodium consumption can increase blood pressure. Most studies suggest a "U" shaped association between salt intake and health, with increased mortality associated with both excessively low and excessively high salt intake.
Health effects associated with excessive sodium consumption include:
- Stroke and cardiovascular disease.
- High blood pressure: Evidence shows an association between salt intakes and blood pressure among different populations and age range in adults. Reduced salt intake also results in a small but statistically significant reduction in blood pressure.
- Left ventricular hypertrophy : "Evidence suggests that high salt intake causes left ventricular hypertrophy. This is a strong risk factor for cardiovascular disease, independently of blood pressure effects." "...there is accumulating evidence that high salt intake can predicts left ventricular hypertrophy." Excessive salt intake, combined with an inadequate intake of water, can cause hypernatremia. It can exacerbate renal disease.
- Edema: A decrease in salt intake has been suggested to treat edema.
- Kidney disease: A US expert committee reported in 2013 the common recommendation by several authorities "to reduce daily sodium intake to less than 2,300 milligrams and further reduce intake to 1,500 mg among persons who are 51 years of age and older and those of any age who are African-American or have hypertension, diabetes, or chronic kidney disease", but concluded that there was no health-outcome-based rationale for reducing intake below 2,300 mg, and did not have a recommendation for an upper limit.
Another meta-analysis investigated the association between sodium intake and health outcomes, including all-cause mortality and cardiovascular disease events. Sodium intake level was a mean of <115 mmol, usual sodium intake was 115-215 mmol, and a high sodium intake was >215 mmol, concluding: "Both low sodium intakes and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes".
Possible effects of microplastic contamination
Studies have found some microplastic contamination in sea salt from the US, Europe and China. The health effects of this contamination are unknown because, as of 2017, no studies on the question had been performed.Dietary recommendations
Recommended intakes of salt are usually expressed in terms of sodium intake as an Adequate Intake and a Tolerable upper intake level. Salt contains 39.3 percent of sodium by weight.| Country | Description | Sodium intake mg per day | Salt intake mg per day | Authority | Remarks |
| United Kingdom | The Reference Nutrient Intake defined for a typical adult | RNI: 1600 | RNI: 4000 | Scientific Advisory Committee on Nutrition | However, average adult intake is two and a half times the RNI. SACN states, "The target salt intakes set for adults and children do not represent ideal or optimum consumption levels, but achievable population goals." The Food Safety Authority of Ireland endorses the UK targets. |
| Canada | An Adequate Intake and Upper Limit recommended for persons aged 9 years or more. | AI: 1200–1500 UL: 2200–2300 | AI: 3000–3750 UL: 5500–5750 | Health Canada | |
| Australia and New Zealand | An Adequate Intake and an Upper Level of intake defined for adults | AI: 460–920 UL: 2300 | AI: 1150–2300 UL: 5750 | NHMRC | Not able to define a recommended dietary intake |
| United States | An Adequate Intake and Upper Limit defined for adults. A different UL defined for the special group comprising people over 51 years of age, African Americans and people with hypertension, diabetes, or chronic kidney disease. | UL: 2300 UL for special group: 1500 | UL: 5750 UL for special group: 3750 | Department of Agriculture and Department of Health and Human Services | The Food and Drug Administration itself does not make a recommendation, but refers readers to the dietary guidelines given by this authority. |
As of 2009 the average sodium consumption in 33 countries was in the range of 2,700 to 4,900 mg/day. This ranged across many cultures, and together with animal studies, this suggests that sodium intake is tightly controlled by feedback loops in the body. This makes recommendations to reduce sodium consumption below 2,700 mg/day potentially futile. Upon review, an expert committee that was commissioned by the Institute of Medicine and the Centers for Disease Control and Prevention reported that there was no health outcome-based rationale for reducing daily sodium intake levels below 2,300 milligrams, as had been recommended by previous dietary guidelines; the report did not have a recommendation for an upper limit of daily sodium intake.
The United States Centers for Disease Control and Prevention states that excess sodium can increase blood pressure and the risk for heart disease and stroke in some individuals. Therefore, health authorities recommend limitations on dietary sodium. The United States Department of Health and Human Services recommends that individuals consume no more than 1500–2300 mg of sodium per day.
Although sea salt is sometimes promoted as being healthier than table salt, both forms have the same sodium content.
Labeling
UK: The Food Standards Agency defines the level of salt in foods as follows: "High is more than 1.5 g salt per 100 g. Low is 0.3 g salt or less per 100 g. If the amount of salt per 100 g is in between these figures, then that is a medium level of salt." In the UK, foods produced by some supermarkets and manufacturers have 'traffic light' colors on the front of the packet: red, amber, or green.USA: The FDA Food Labeling Guide stipulates whether a food can be labeled as "free" "low," or "reduced/less" in respect of sodium. When other health claims are made about a food, a disclosure statement is required if the food exceeds 480 mg of sodium per 'serving'.
Campaigns
Consensus Action on Salt and Health established in the United Kingdom in 1996, actively campaigns to raise awareness of the alleged harmful health effects of salt. The 2008 focus includes raising awareness of high levels of salt hidden in sweet foods that are marketed towards children. In 2004, Britain's Food Standards Agency started a public health campaign called "Salt – Watch it", which recommends no more than 6g of salt per day; it features a character called Sid the Slug and was criticised by the Salt Manufacturers Association. The Advertising Standards Authority did not uphold the SMA complaint in its adjudication. In March 2007, the FSA launched the third phase of their campaign with the slogan "Salt. Is your food full of it?" fronted by comedian Jenny Eclair.The University of Tasmania's Menzies Research Institute maintains a website to educate people about the problems of a salt-laden diet. In Australia, the "Drop the Salt! Campaign" aimed to reduce the consumption of salt by Australians to 6g per day over the course of five years ending in 2012.
In January 2010, New York City launched the National Salt Reduction Initiative. It is the only coordinated, voluntary effort to reduce sodium in the United States, an effort supported by the Institute of Medicine as an interim goal in advance of federal action on sodium reduction.
As of 2013, over 90 state and local health authorities and health organizations have signed on as partners of the NSRI. Together, the NSRI partnership encourages food manufacturers and chain restaurants to voluntarily commit to NSRI sodium reduction targets for 2012 and 2014. The NSRI aims to reduce sodium in the food supply by 25 percent in five years and reduce population sodium intake by 20 percent in the same time, thereby reducing risk for heart attacks and strokes.
Twenty-one companies met their 2012 NSRI commitment. Notable reductions include: 15 percent reduction of sodium in Heinz ketchup; 32 percent reduction of sodium in the Subway’s Subway Club sandwich; 33 percent reduction of sodium in Nabisco’s Honey Teddy Grahams; 18 percent reduction of sodium in Kraft Single American Slices; and 20 percent reduction of Ragu Old World Style Traditional Tomato Sauce.
Separate from the NSRI, a number of major food producers have pledged to reduce the sodium content of their food. Pepsi is developing a "designer salt" that's slightly more powdery than the salt it regularly uses. The company hopes this new form of salt will cut sodium levels by 25 percent in its Lay's potato chips.
Nestlé's prepared foods company, which produces frozen meals, announced that it will reduce sodium in its foods by 10 percent by 2015.
General Mills announced that it will reduce the sodium content of 40 percent of its foods by about 20 percent by 2015. A number of chain restaurants have made pledges to lower sodium over time. MenuStat, a free online database of past and current nutrition data from chain restaurants developed by the NYC Health Department, is available to monitor and evaluate these pledges.
In the United States, taxation of sodium has been proposed as a method of decreasing sodium intake and thereby improving health in countries where typical salt consumption is high. Taking an alternative view, the Salt Institute, a salt industry body based in North America, is active in promoting the use of salt, and questioning or opposing the recommended restrictions on salt intake.
Dietary reduction
A low sodium diet reduces the intake of sodium by the careful selection of food. The use of a salt substitute can provide a taste offsetting the perceived blandness of low-salt food; potassium chloride is widely used for this purpose. The World Health Organization recommends daily potassium intake of not less than 3,510 mg. Government interventions such as food product reformulation and food procurement policy have the potential to reduce the population salt intake.A 2017 Cochrane systematic review of randomized controlled trials reported that lowered dietary salt intake lowered blood pressure in people with hypertension by about 3.5%, indicating that it might be a useful supplementary treatment for hypertension. In people with normal blood pressure, the decrease after lowering dietary salt intake was less than 1%. The effects in Asians and blacks with hypertension were greater than in whites, but more studies are needed to confirm conclusions. Effects of lowered salt intake on hormones and lipids were similar in normotensive and hypertensive individuals.
Studies found that excessively low sodium intake, below about three grams of salt per day, is associated with increased mortality and higher risk for cardiovascular disease.