Is it sodium or is it salt? Is it grams, millimoles, ounces, milligrams or teaspoons? There are so many variations in the terms used in the ongoing salt debate, it’s no wonder that consumers are totally confused. It’s time to set the record straight.
Salt is a molecule called Sodium Chloride. It is an Essential Nutrient because both sodium and chloride parts of the molecule have critical physiological functions in the body, but the body is incapable of producing either of them. Hence, it is ‘essential’ that we consume sodium chloride in our diet.
The only way to determine what is the best level of sodium chloride or salt consumption is by looking at its effects on health outcomes – the combination of ALL health impacts (not just hypertension) for most people. We don’t want consumers to become victim to the myopic focus on a single measure while losing sight of all the others. The old joke, “The operation was a success, but the patient died!” is really not a joke and was seen very tragically in recent clinical trials where LDL cholesterol levels were aggressively reduced (ILLUMINATE) and in trials where blood sugar was aggressively reduced to cut the risk of diabetes (ADVANCE and ACCORD), but in all cases, researchers eventually found that patients taking treatment were dying in greater numbers from other causes! An editorial in the New England Journal of Medicine highlighted the extreme folly of focusing on one health measure while ignoring the others – which is why the Salt Institute has always considered overall health outcomes as the only valid measure.
The Salt Institute, backed by the latest published medical evidence (*, †) on sodium intakes and health outcomes around the world defines sodium consumption levels as follows:
The Ground Rules
Multiply Sodium milligrams (mg) x 2.54 to get mg of Salt.
Divide mg of Salt by 5,680 to get teaspoons of Salt.
Divide mg by 1,000 to get grams (g).
If you are a bear for punishment, you can divide mg by 28,350 to get ounces (oz).
Levels of Sodium Consumption
Above 5,500 mg sodium/day (equivalent to above 14,000 mg salt or 2½ teaspoons)
(About 1% of countries in the world consume this level)
From 2,800 – 5,500 mg sodium/day (7,112-13,970 mg salt or 1¼ – 2 ½ teaspoons)
(More than 73% of countries around the world consume this level)
Less than 2,800 mg sodium/day (equivalent to below 7,112 mg salt or 1¼ teaspoons)
(About 25% of countries – all in Africa and Caribbean -consume this level)
Based upon the available morbidity and mortality evidence (†), the Medium Level is the Safe Range
The current recommendations of 1,500 -2,300 mg sodium per day are well below the “Low Level” and outside the “Safe Range.” This level is consumed by less than 10% of countries – amongst the poorest in the world. Kenya, (life expectancy 60 years), is the only country in the world that consumes the American Heart Association (AHA) recommendation of less than 1,500 mg sodium per day.
The US consumption of sodium is 3,400 mg per day or 8,600 mg salt, about 1½ teaspoons, a bit lower than the mid-point of the Safe Range – an ideal level.
PLEASE NOTE THAT THERE ARE CERTAIN INDIVIDUAL WITH UNCONTROLLED HYPERTENSION AND SALT SENSITIVITY THAT MUST CONTROL THE AMOUNT OF SALT THEY CONSUME. THEY SHOULD CONSULT WITH THEIR PHYSICIAN REGARDING SALT AND OTHER ESSENTIAL NUTRIENT INTAKE.
(*) Powles J, Fahimi S, Micha R, et al. Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open 2013;3:e003733. doi:10.1136/bmjopen-2013-003733. Available at: http://bmjopen.bmj.com/content/3/12/e003733.full
(†)O’Donnell MJ, Mente A, Rangarajan S, et al. Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events. N Engl J Med 2014; 371:612-623August 14, 2014DOI: 10.1056/NEJMoa1311889. Available at: http://www.nejm.org/doi/full/10.1056/NEJMoa1311889