When it comes to salt and your health, science seems to point left, right, up and down at the same time…

  • The American Heart Association wants every healthy adult to restrict sodium.
  • The FDA wants food companies to cut sodium in their products.
  • The goal—to cut the average adult’s intake of sodium from 3,400 mg to 2,300 mg per day.
  • And yet…research has found that people who consume less than 2,500 mg of sodium per day are at higher risk for heart disease—and now a new study reports that in healthy people without high blood pressure, there’s no heart risk until they consume twice as much sodium as the average—7,000 mg per day!

Who’s right? Should healthy people restrict sodium to prevent high blood pressure and heart disease? Can you believe the studies that point to a different conclusion? What if your blood pressure is high or edging up—should you watch your sodium?

For commonsense grounded in science, we turned to one of the top heart specialists in the world, Steven Nissen, MD, chairman of the department of cardiovascular medicine at the Cleveland Clinic.

THE SCIENCE PROBLEM: WE’RE ACTING OUT OF IGNORANCE

Oddly enough, Dr. Nissen doesn’t put much faith in either the government’s public health campaign to get us to consume less sodium—or in the conflicting studies that suggest that a low-sodium lifestyle won’t help and might harm.

Here’s why: Bad studies. Or rather, the lack of good studies. “The science is extraordinarily murky,” Dr. Nissen said. “The estimates used to come up with recommendations come not from clinical trials but from dietary recall studies, which are terribly unreliable, and from computer estimates that simulate what the effects might be.”

In contrast, he pointed to Mediterranean diet studies. These are based on randomized double-blind clinical trials in which one group ate the diet for years and another group ate a different diet. These well-designed trials have proved that the Mediterranean diet can prevent heart disease.

There’s no such research that shows that cutting sodium consumption in healthy people without high blood pressure will lead to any health benefit, Dr. Nissen said. “We’re not all the same—biology doesn’t work that way. We have unique genetics and environments. If you’re a construction worker in Houston in the summer, for example, I’m not sure that salt restriction is a good idea for you.

“I don’t think we should make societal decisions without real data. I have trouble with people who want to say, as a public policy, ‘Whether you like it or not, and whether you have high blood pressure or not, we’re taking the salt out of your diet.’”

COMMON SENSE ABOUT SODIUM, SALT, A HEALTHY HEART…AND CORN ON THE COB

Here are Dr. Nissen’s recommendations based on what is known scientifically…

  • If you have high blood pressure, defined as a reading of 140/90 or higher, go on the sodium-restricted DASH diet, which includes dairy and plenty of fruits and vegetables—along with any medication you are prescribed. The combo of plenty of potassium and calcium and reduced sodium (a daily maximum of 2,300 mg) has been proven to reduce high blood pressure.
  • If your blood pressure is borderline—with a systolic (upper) number between 120 and 139, for example—same advice. “If you want to avoid needing meds, it’s prudent to restrict salt and go on a DASH diet,” Dr. Nissen said.
  • If your blood pressure is normal—stop worrying about sodium and salt! “I wouldn’t give it a lot of attention,” he said. Instead, pay attention to eating a healthy Mediterranean-style diet, with lots of vegetables, fruits, beans, nuts and whole grains, olive oil as the primary fat, regular consumption of seafood, moderate amounts of dairy and eggs, with less frequent, smaller servings of red meat—and, if you drink, a glass of wine with dinner.

Ironically, by eating in this style, you might actually take in less sodium than you do now—without resorting to low-sodium and salt-free products. That’s because about three-quarters of the sodium in our diet comes from processed foods, not whole foods that we cook at home—even if we salt them.

“I don’t eat a lot of processed foods—I don’t eat my dinner out of cans,” said Dr. Nissen. He’ll regularly make an omelet with eggs, which, in spite of earlier concerns about cholesterol, are very healthy foods, he said. He eats dairy products—and is also fond of almond milk. “I have apples and pears sitting in a great big bowl, and when I’m hungry in between meals, I’ll have one. If you eat like that, you won’t overload on salt.”

“I love corn on the cob,” he added, “and I don’t feel guilty if I eat a couple of ears of corn with a little butter—sprinkled with salt.”