Diet low in salt
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Benefits and Challenges of a Low-Salt Diet
Introduction to Low-Salt Diets and Health Implications
A diet low in salt, primarily sodium chloride, is often recommended to mitigate various health risks. Excessive sodium intake is linked to several non-communicable diseases, including hypertension, obesity, and stomach cancer. The World Health Organization (WHO) advises that adults should consume less than 5 grams of salt per day, equivalent to 2 grams of sodium, yet average consumption often exceeds this recommendation1.
Major Dietary Sources of Salt
In low- and middle-income countries (LMICs), rapid urbanization has shifted dietary patterns towards foods high in salt, such as breads, meat products, bakery items, instant noodles, and condiments. Identifying these major sources is crucial for developing strategies to reduce salt intake, which include consumer education and product reformulation2.
Health Benefits of Reducing Salt Intake
Hypertension and Cardiovascular Health
Reducing salt intake is particularly beneficial for individuals with hypertension. Studies show that a low-salt diet can help control blood pressure and reduce the risk of cardiovascular events. For instance, a systematic review and meta-analysis found that a low-salt diet reduced the risk of renal composite outcome events in patients with chronic kidney disease (CKD) by 28%4. Additionally, salt reduction has been shown to improve endothelium-dependent vasodilation, suggesting cardioprotective effects beyond blood pressure reduction7.
Insulin Resistance and Metabolic Health
However, there are some concerns regarding the impact of a low-salt diet on insulin resistance. Research indicates that a low-salt diet can activate the renin-angiotensin-aldosterone and sympathetic nervous systems, potentially increasing insulin resistance in healthy individuals6. This finding suggests that while a low-salt diet has cardiovascular benefits, it may have adverse metabolic effects that need further investigation.
Challenges and Controversies
Adherence and Public Health Recommendations
Adherence to a low-salt diet can be challenging. Factors such as knowledge, attitude, family support, and self-awareness significantly influence adherence among hypertensive patients8. Moreover, there is ongoing debate about the overall benefits of a low-salt diet for the general population. Some studies suggest that extremely low sodium intake may not significantly reduce cardiovascular events compared to moderate intake and could potentially be harmful5 9.
Low-Sodium Salt Substitutes
One proposed solution is the use of low-sodium salt substitutes (LSSS), which replace sodium with potassium. These substitutes have been shown to reduce blood pressure and cardiovascular mortality slightly. However, they also increase blood potassium levels, which could be problematic for individuals with conditions like CKD10.
Conclusion
A low-salt diet offers significant health benefits, particularly for individuals with hypertension and CKD. However, the potential increase in insulin resistance and the challenges in adherence highlight the need for balanced and individualized dietary recommendations. Further research is necessary to fully understand the long-term effects of low-salt diets and to develop effective public health strategies that can be widely adopted.
Sources and full results
Most relevant research papers on this topic
Initiatives to Reduce the Content of Sodium in Food Products and Meals and Improve the Population’s Health
Reducing salt content in food products, particularly in baked goods, can significantly improve population health and reduce the risk of non-communicable diseases like hypertension, obesity, and stomach cancer.
Dietary Sources of Salt in Low- and Middle-Income Countries: A Systematic Literature Review
Major dietary salt sources in low- and middle-income countries are breads, meat, bakery products, instant noodles, salted preserved foods, milk, dairy products, and condiments.
Systematic Review
Rigorous JournalLong-term reduction in dietary sodium alters the taste of salt.
Long-term reduction in sodium intake alters the taste of salt, with subjects' preferred level of salt in food decreasing after reducing sodium intake.
Highly CitedEffect of a low-salt diet on chronic kidney disease outcomes: a systematic review and meta-analysis
A low-salt diet reduces the risk of renal composite outcome events in patients with chronic kidney disease, but does not significantly impact eGFR decline rate, proteinuria, all-cause mortality, or cardiovascular events.
Meta-AnalysisRigorous JournalShould we now abandon the low-salt diet?
A low-salt diet may be harmful in normal people, with no increased mortality in those with high salt intake.
Low-salt diet increases insulin resistance in healthy subjects.
A low-salt diet is associated with an increase in insulin resistance in healthy individuals, potentially impacting diabetes and cardiovascular disease risk.
Non-RCTHighly CitedEffects of a low-salt diet on flow-mediated dilatation in humans.
A low-salt diet improves endothelium-dependant vasodilation in normotensive subjects, suggesting additional cardioprotective effects beyond blood pressure reduction.
RCT
Very Rigorous JournalHighly CitedLITERATURE REVIEW: LOW SALT DIET IN PATIENT WITH HYPERTENSION
A low-salt diet can effectively control blood pressure in hypertensive patients when they have knowledge, attitude, and good family support.
Systematic ReviewSalt and cardiovascular disease: insufficient evidence to recommend low sodium intake.
Current guidelines recommending low sodium intake for individuals may be unfeasible, uncertain, and unproven effective in reducing cardiovascular disease.
Literature ReviewRigorous JournalHighly CitedReplacing salt with low‐sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women
Replacing salt with low-sodium salt substitutes (LSSS) can potentially lower blood pressure and increase potassium intake, but potential adverse effects like hyperkalaemia must be considered.
Systematic ReviewVery Rigorous Journal