The Medical Evidence Against (Or For) Salt: Where Is It?

Picture Stolen From Harvard Med School Page Promoting Salt Substitutes

Picture Stolen From Harvard Med School Page Promoting Salt Substitutes

The New York Times has a great article on the current state of scientific evidence linking salt intake with heart failure. There isn't much. Yet it is one of the great medical dogmas of modern medicine: too much sodium gets blamed for heart attack, stroke and hypertension.

The article cites this month's JAMA's commentary by Northwestern University Medical School cardiologist Dr. Clyde Yancey says, "...like many other dogmatic statements that were fully embedded in cardiovascular medicine...the time has now come for sodium restriction in heart failure to be critically reevaluated. There is simply too much uncertainty for a conviction we hold as truth."

There is also an exhaustive review of the literature in this month's JAMA. Biblios to both articles are below. Unless you have a subscription to JAMA, you can only see the abstracts. Ask your MD to read them and make copies for you. Especially if you are being counseled to lower your sodium.

Spoiler Alert: "Limited evidence of clinical improvement was available among outpatients who reduced dietary salt intake, and evidence was inconclusive for inpatients. Overall, a paucity of robust high-quality evidence to support or refute current guidance was available. This review suggests that well-designed, adequately powered studies are needed to reduce uncertainty about the use of this intervention." (Mahtani KR, Heneghan C, Onakpoya I, & et al, 2018)

Yancy CW. (2018). Sodium restriction in heart failure: Too much uncertainty—do the trials. JAMA Internal Medicine, 178(12), 1700–1701. https://doi.org/10.1001/jamainternmed.2018.4653

Mahtani KR, Heneghan C, Onakpoya I, & et al. (2018). Reduced salt intake for heart failure: A systematic review. JAMA Internal Medicine, 178(12), 1693–1700. https://doi.org/10.1001/jamainternmed.2018.4673

Randy Hauer