Health effects of salt

Hypernatremia (high 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.{{cite web |url=http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypernatremia |title=Hypernatremia | work=Merck Manual of Diagnosis and Therapy| vauthors = Lewis JL |publisher = Medical Library Association |date = March 2013|access-date = 25 December 2015}}{{cite web | work = Department of Health & Human Services, State Government of Victoria, Australia | url = https://www.betterhealth.vic.gov.au/health/healthyliving/salt | title = Better Health Channel: Salt | date = May 2014 }} Death can be caused by ingestion of large amounts of salt at a time (about 1 g per kg of body weight).{{cite web | url = http://msds.chem.ox.ac.uk/SO/sodium_chloride.html | title = Safety data for sodium chloride | archive-url = https://web.archive.org/web/20111202084352/http://msds.chem.ox.ac.uk/SO/sodium_chloride.html | archive-date = 2 December 2011 | work = The Physical and Theoretical Chemistry Laboratory of Oxford University | date = 18 November 2005 | access-date = 7 July 2011 }} Deaths have also been caused by the use of salt solutions as emetics, typically after suspected poisoning.{{cite journal | vauthors = Türk EE, Schulz F, Koops E, Gehl A, Tsokos M | title = Fatal hypernatremia after using salt as an emetic--report of three autopsy cases | journal = Legal Medicine | volume = 7 | issue = 1 | pages = 47–50 | date = January 2005 | pmid = 15556015 | doi = 10.1016/j.legalmed.2004.06.005 | url = http://thirdworld.nl/fatal-hypernatremia-after-using-salt-as-an-emetic-report-of-three-autopsy-cases | archive-url = https://web.archive.org/web/20170202112942/http://thirdworld.nl/fatal-hypernatremia-after-using-salt-as-an-emetic-report-of-three-autopsy-cases | archive-date = 2 February 2017 | url-access = subscription }}

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.{{cite web|url=http://www.merckmanuals.com/professional/sec12/ch156/ch156d.html#CIHEIHHA|title=Hyponatremia|date=May 2009| vauthors = Lewis III JL |publisher=Merck Manual of Diagnosis and Therapy|access-date=2016-06-08|archive-date=2011-01-11|archive-url=https://web.archive.org/web/20110111045040/http://www.merckmanuals.com/professional/sec12/ch156/ch156d.html#CIHEIHHA|url-status=dead}}

{{Further|Salt and cardiovascular disease}}

Major health organizations and recent reviews state that high consumption of salt increases the risk of several diseases in children and adults.{{cite web |url=https://www.cdc.gov/salt/potassium.htm |title=Sodium, potassium and health |work=Salt |publisher=US Centers for Disease Control and Prevention|date=23 August 2022 |access-date=10 May 2023}}{{cite web | url=https://www.efsa.europa.eu/en/news/efsa-provides-advice-adverse-effects-sodium | title=EFSA provides advice on adverse effects of sodium | publisher=European Food Safety Authority | date=22 June 2005 | access-date=10 May 2023}}{{Cite web |title=WHO issues new guidance on dietary salt and potassium |url=https://www.who.int/mediacentre/news/notes/2013/salt_potassium_20130131/en/ |archive-url=https://web.archive.org/web/20130203050838/http://www.who.int/mediacentre/news/notes/2013/salt_potassium_20130131/en/ |url-status=dead |archive-date=February 3, 2013 |date=31 January 2013 |publisher=World Health Organization}}{{cite journal | vauthors = He FJ, Li J, Macgregor GA | title = Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials | journal = BMJ | volume = 346 | issue = apr03 3 | pages = f1325 | date = April 2013 | pmid = 23558162 | doi = 10.1136/bmj.f1325 | doi-access = free }}

Excess sodium consumption increases blood pressure. Approximately 15% of adults have inverse salt sensitivity, with blood pressure increasing from eating less salt.{{cite journal |last1=Felder |first1=Robin |last2=Gildea |first2=John |date=2022-06-16 |title=Inverse Salt Sensitivity of Blood Pressure: Mechanisms and Potential Relevance for Prevention of Cardiovascular Disease |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC9728138/ |journal=Current Hypertension Reports |volume=24 |issue= |publisher= |pages=361-374 |doi=10.1007/s11906-022-01201-9 |access-date=2025-04-11|pmc=9728138 }}{{cite web |last=Corliss |first=Julie |date=2024-03-01 |title=Dietary salt and blood pressure: A complex connection |url=https://www.health.harvard.edu/heart-health/dietary-salt-and-blood-pressure-a-complex-connection |website=Harvard Health Publishing |location= |publisher=Harvard University |access-date=2025-04-11}} Some studies suggest a U-shaped association between salt intake and mortality, with increased mortality associated with both excessively low and excessively high salt intake.{{cite journal | vauthors = Asayama K, Stolarz-Skrzypek K, Persu A, Staessen JA | title = Systematic review of health outcomes in relation to salt intake highlights the widening divide between guidelines and the evidence | journal = American Journal of Hypertension | volume = 27 | issue = 9 | pages = 1138–1142 | date = September 2014 | pmid = 25122867 | doi = 10.1093/ajh/hpu126 | doi-access = free | url = https://lirias.kuleuven.be/bitstream/123456789/479618/1/14-39-P.pdf }} Larger reductions in salt intake lead to larger decreases in blood pressure.

Normotensive overweight/obese patients who were salt restricted for six weeks showed an endothelin 1 (ET-1) decrease of 14% associated with a 45% increase in flow-mediated dilation (FMD).{{cite journal | vauthors = Dickinson KM, Clifton PM, Keogh JB| title=A reduction of 3 g/day from a usual 9 g/day salt diet improves endothelial function and decreases endothelin-1 in a randomised cross_over study in normotensive overweight and obese subjects | journal= Atherosclerosis | volume=233 | issue=1 | pages=32–38 | year=2014 | doi= 10.1016/j.atherosclerosis.2013.11.078 | pmid=24529119}} ET-1 has autocrine action on endothelial cells causing the release of nitric oxide. Another study using middle-aged or older adults with moderately elevated blood pressure taking sodium chloride tablets or placebo tablets for a few weeks showed that sodium restriction increased nitric oxide and tetrahydrobiopterin (BH4) resulting in improved FMD without affecting blood pressure.{{cite journal | vauthors = Jablonski KL, Racine ML, Seals DR | title=Dietary sodium restriction reverses vascular endothelial dysfunction in middle-aged/older adults with moderately elevated systolic blood pressure | journal= Journal of the American College of Cardiology | volume=61 | issue=3 | pages=335–343 | year=2013 | doi= 10.1016/j.jacc.2012.09.010 | pmc=3549053 | pmid=23141486}} The suppression of endothelium production of nitric oxide is the result of oxidative stress on the vasculature.{{cite journal | vauthors = Greaney JL, DuPont JJ, Farquhar WS | title=Dietary sodium loading impairs microvascular function independent of blood pressure in humans: role of oxidative stress | journal= The Journal of Physiology | volume=590 | issue=21 | pages=5519–5528 | year=2012 | doi= 10.1113/jphysiol.2012.236992 | pmc=3515835 | pmid=22907057}}

Health effects associated with excessive sodium consumption include:

• Stroke and cardiovascular disease.{{cite journal | vauthors = Strazzullo P, D'Elia L, Kandala NB, Cappuccio FP | title = Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies | journal = BMJ | volume = 339 | pages = b4567 | date = November 2009 | pmid = 19934192 | pmc = 2782060 | doi = 10.1136/bmj.b4567 }}
• High blood pressure: Evidence shows an association between salt intakes and blood pressure among different populations and age ranges in adults.{{cite web | work = Scientific Advisory Committee on Nutrition (SACN) | url = http://www.sacn.gov.uk/pdfs/sacn_salt_final.pdf | title = Salt and Health | archive-url = https://web.archive.org/web/20140211084303/http://www.sacn.gov.uk/pdfs/sacn_salt_final.pdf | archive-date = 11 February 2014 | page = 3 }} Reduced salt intake also results in a small but statistically significant reduction in blood pressure.{{cite journal | vauthors = Hooper L, Bartlett C, Davey SG, Ebrahim S | title = Advice to reduce dietary salt for prevention of cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD003656 | date = 26 January 2004 | volume = 2009 | pmid = 14974027 | doi = 10.1002/14651858.CD003656.pub2 | url = https://researchonline.lshtm.ac.uk/id/eprint/19764/1/19764.pdf }}
• Left ventricular hypertrophy (cardiac enlargement): "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 predicts left ventricular hypertrophy."{{cite web | work = Food Safety Authority of Ireland | url = https://www.fsai.ie/uploadedFiles/Science_and_Health/salt_report-1.pdf | title = Salt and Health: Review of the Scientific Evidence and Recommendations for Public Policy in Ireland | page = 12 | access-date = 2021-01-16 | archive-date = 2021-04-13 | archive-url = https://web.archive.org/web/20210413155618/https://www.fsai.ie/uploadedFiles/Science_and_Health/salt_report-1.pdf | url-status = dead }}
• Edema (fluid retention): A decrease in salt intake has been suggested to treat edema.{{cite web | work = Australia: Better Health Channel | location = Australia, Victoria | url = http://www.betterhealth.vic.gov.au/bhcv2/bhcArticles.nsf/pages/Fluid_retention?OpenDocument | title = Fluid retention | archive-url = https://web.archive.org/web/20150324130939/http://www.betterhealth.vic.gov.au/bhcv2/bhcArticles.nsf/pages/Fluid_retention?OpenDocument | archive-date = 24 March 2015 }}
• Kidney disease: Excessive salt (sodium) intake, combined with an inadequate intake of water, can cause hypernatremia. It can exacerbate renal 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.{{cite book | title=Sodium Intake in Populations: Assessment of Evidence | publisher=National Academies Press; Food and Nutrition Board; Board on Population Health and Public Health Practice; Institute of Medicine | year=2013 | location=Washington, DC | isbn=978-0-309-28295-6| doi=10.17226/18311 | pmid=24851297 | vauthors = Strom BL, Yaktine AL, Oria M | collaboration = Committee on the Consequences of Sodium Reduction in Populations | url = http://www.worldactiononsalt.com/news/saltnews/2013/99714.pdf | archive-url = https://web.archive.org/web/20170202022310/http://www.worldactiononsalt.com/news/saltnews/2013/99714.pdf | archive-date= 2 February 2017 }}

A meta-analysis investigated the association between sodium intake and health outcomes, including all-cause mortality and cardiovascular disease (CVD) events.{{cite journal | vauthors = Graudal N, Jürgens G, Baslund B, Alderman MH | title = Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis | journal = American Journal of Hypertension | volume = 27 | issue = 9 | pages = 1129–1137 | date = September 2014 | pmid = 24651634 | doi = 10.1093/ajh/hpu028 | doi-access = free }} Low sodium intake level was a mean of <115 mmol (2645 mg), usual sodium intake was 115-215 mmol (2645–4945 mg), and a high sodium intake was >215 mmol (4945 mg), 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".

{{excerpt|Salting (food)|Health effects}}

Microplastic contamination in sea salt has been confirmed in all areas of the world, ranging from zero to 1,674 particles per kilogram.{{cite journal | vauthors = Kim JS, Lee HJ, Kim SK, Kim HJ | title = Global Pattern of Microplastics (MPs) in Commercial Food-Grade Salts: Sea Salt as an Indicator of Seawater MP Pollution | journal = Environmental Science & Technology | volume = 52 | issue = 21 | pages = 12819–12828 | date = November 2018 | pmid = 30285421 | doi = 10.1021/acs.est.8b04180 | s2cid = 206582726 | bibcode = 2018EnST...5212819K }} The most common particles are polypropylene, followed by polyethylene and nylon.{{cite journal | vauthors = Selvam S, Manisha A, Venkatramanan S, Chung SY, Paramasivam CR, Singaraja C | title = Microplastic presence in commercial marine sea salts: A baseline study along Tuticorin Coastal salt pan stations, Gulf of Mannar, South India | journal = Marine Pollution Bulletin | volume = 150 | issue = | pages = 110675 | date = January 2020 | pmid = 31669711 | doi = 10.1016/j.marpolbul.2019.110675 | bibcode = 2020MarPB.15010675S | s2cid = 204966981 }} Microplastic particles per kg sea salt tend to be higher when sourced from Asian countries. Salt sourced from India ranged from 115 to 560 particles/kg.{{cite journal | vauthors = Vidyasakar A, Krishnakumar S, Kumar KS, Neelavannan K, Anbalagan S, Kasilingam K, Srinivasalu S, Saravanan P, Kamaraj S, Magesh NS | display-authors = 6 | title = Microplastic contamination in edible sea salt from the largest salt-producing states of India | journal = Marine Pollution Bulletin | volume = 171 | issue = | pages = 112728 | date = October 2021 | pmid = 34303058 | doi = 10.1016/j.marpolbul.2021.112728 | bibcode = 2021MarPB.17112728V }} Sea salt sourced from China reported more than 400/kg.{{cite journal | vauthors = Feng D, Yuan H, Tang J, Cai X, Yang B | title = Preliminary investigation of microplastics in the production process of sea salt sourced from the Bohai Sea, China, using an optimised and consistent approach | journal = Food Additives & Contaminants. Part A, Chemistry, Analysis, Control, Exposure & Risk Assessment | volume = 38 | issue = 12 | pages = 2151–2164 | date = December 2021 | pmid = 34372756 | doi = 10.1080/19440049.2021.1956691 | s2cid = 236967839 }} Microplastics also accrue in shellfish grown or harvested in regions with microplastic contamination of seawater, and are a significant contributor to human exposure.{{cite journal | vauthors = Van Cauwenberghe L, Janssen CR | title = Microplastics in bivalves cultured for human consumption | journal = Environmental Pollution | volume = 193 | issue = | pages = 65–70 | date = October 2014 | pmid = 25005888 | doi = 10.1016/j.envpol.2014.06.010 | bibcode = 2014EPoll.193...65V | s2cid = 6939614 }} The extent to which humans are exposed to microplastics in foods and beverages can be assessed via measuring microplastics content in feces, but the health effects, if any, are poorly understood.{{cite journal | vauthors = Cho YM, Choi KH | title = The current status of studies of human exposure assessment of microplastics and their health effects: a rapid systematic review | journal = Environmental Analysis, Health and Toxicology | volume = 36 | issue = 1 | pages = e2021004–e2021000 | date = March 2021 | pmid = 33730791 | pmc = 8207003 | doi = 10.5620/eaht.2021004 }}

Recommended intakes of salt are usually expressed in terms of sodium intake as an Adequate Intake (AI) and a Tolerable upper intake level (Upper Limit or UL). Salt (as sodium chloride) contains 39.3 percent of sodium by weight.

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.{{cite journal | vauthors = McCarron DA, Geerling JC, Kazaks AG, Stern JS | title = Can dietary sodium intake be modified by public policy? | journal = Clinical Journal of the American Society of Nephrology | volume = 4 | issue = 11 | pages = 1878–1882 | date = November 2009 | pmid = 19833911 | doi = 10.2215/CJN.04660709 | doi-access = free }} 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.{{cite news| vauthors = Kolata G |title=No Benefit Seen in Sharp Limits on Salt in Diet|url=https://www.nytimes.com/2013/05/15/health/panel-finds-no-benefit-in-sharply-restricting-sodium.html?pagewanted=all&_r=0|access-date=3 June 2013|newspaper=New York Times|date=14 May 2013}}

The United States Centers for Disease Control and Prevention (CDC) states that excess sodium can increase blood pressure and the risk for heart disease and stroke in some individuals.{{cite web | url=https://www.cdc.gov/salt/index.htm | title=Salt | publisher=US Centers for Disease Control, Department of Health and Human Services, Atlanta, GA | date=1 June 2016 | access-date=9 June 2016}} Therefore, health authorities recommend limitations on dietary sodium.{{cite web |url= http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/Meeting2/CommentAttachments/AHA-220e.pdf |title=American Heart Association 2010 Dietary Guidelines |date=23 January 2009 |work=2010 Dietary Guidelines |publisher=American Heart Association |access-date=16 May 2010 |url-status=dead |archive-url= https://web.archive.org/web/20110124154830/http://www.cnpp.usda.gov/publications/dietaryguidelines/2010/meeting2/commentattachments/aha-220e.pdf |archive-date=24 January 2011 }}{{cite web |url=http://www.nrv.gov.au/nutrients/sodium.htm |title=Nutrient Reference Values for Australia and New Zealand – Sodium | work = Nutrient Reference Values for Australia and New Zealand |publisher=Australian Government National Health and Medical Research Council/ New Zealand Ministry of Health |access-date=16 May 2010 |url-status=dead |archive-url=https://web.archive.org/web/20090929152401/http://www.nrv.gov.au/nutrients/sodium.htm |archive-date=29 September 2009 }}{{cite web |url=http://www.nhs.uk/Conditions/vitamins-minerals/Pages/Other-vitamins-minerals.aspx#salt |title=Sodium Chloride |work=Eat Well, Be Well |publisher=UK Government Food Standards Agency |access-date=16 May 2010}}{{cite web |url=http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/food-aliment/sodium-eng.php |title=Health Canada, Healthy Living, Sodium |year=2008 |work=Healthy Living |publisher=Health Canada |access-date=16 May 2010 |url-status=dead |archive-url=https://web.archive.org/web/20100304144104/http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/food-aliment/sodium-eng.php |archive-date=4 March 2010 }} The United States Department of Health and Human Services recommends that individuals consume no more than 1500–2300 mg of sodium (3750–5750 mg of salt) per day.{{cite web| url=http://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf| title=Dietary Guidelines for Americans 2010| publisher=US Department of Agriculture and US Department of Health and Human Services| access-date=14 February 2015| archive-date=5 October 2018| archive-url=https://web.archive.org/web/20181005161616/https://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf| url-status=dead}}

Although sea salt is sometimes promoted as being healthier than table salt, both forms have the same sodium content.{{Cite web | vauthors = Zeratsky K | title = Is sea salt better for your health than table salt? | publisher = Mayo Foundation for Medical Education and Research | date = 27 August 2009 | url = http://www.mayoclinic.com/health/sea-salt/AN01142 | access-date =22 April 2011}}

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 (or 0.6 g sodium). Low is 0.3 g salt or less per 100 g (or 0.1 g sodium). 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 (high), amber (medium), or green (low).{{cite web | url = http://www.salt.gov.uk/understanding_labels.html | title = Understanding labels | archive-url = https://web.archive.org/web/20070331030341/http://www.salt.gov.uk/understanding_labels.html | archive-date = 31 March 2007| work = Salt.gov.uk | date = 6 November 2009 | access-date = 7 July 2011 }}

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 (e.g., low in fat, calories, etc.), a disclosure statement is required if the food exceeds 480 mg of sodium per 'serving'.{{cite web | work = U.S. Food and Drug Administration | url = http://www.cfsan.fda.gov/~dms/flg-6a.html | title = A Food Labeling Guide—Appendix A | archive-url = https://web.archive.org/web/20060321031336/http://www.cfsan.fda.gov/~dms/flg-6a.html | archive-date = 2006-03-21 }}

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.{{cite web|title=Drop the Salt! Campaign|url=http://www.saltmatters.org/|access-date=7 March 2013|publisher=Australian Division on World Action on Salt & Health}}

In 2016, South Africa was the first country to legislate the maximum amount of salt in processed food.{{cite journal | vauthors = Charlton K, Ware LJ, Baumgartner J, Cockeran M, Schutte AE, Naidoo N, Kowal P | title = How will South Africa's mandatory salt reduction policy affect its salt iodisation programme? A cross-sectional analysis from the WHO-SAGE Wave 2 Salt & Tobacco study | journal = BMJ Open | volume = 8 | issue = 3 | pages = e020404 | date = March 2018 | pmid = 29602855 | pmc = 5884349 | doi = 10.1136/bmjopen-2017-020404 }} The legislation was aimed at addressing the fact that 60% of salt in the diet was contributed to by processed foods, with 65% of all ethnic groups consuming sodium in excess of 6g/day, and 40% of young adults in excess of 9g/day.{{cite journal | vauthors = Webster J, Crickmore C, Charlton K, Steyn K, Wentzel-Viljoen E, Naidoo P | title = South Africa's salt reduction strategy: Are we on track, and what lies ahead? | journal = South African Medical Journal = Suid-Afrikaanse Tydskrif vir Geneeskunde | volume = 107 | issue = 1 | pages = 20–21 | date = December 2016 | pmid = 28112084 | doi = 10.7196/SAMJ.2017.v107i1.12120 | doi-broken-date = 2024-11-10 | hdl = 10019.1/104738 | hdl-access = free }}

Consensus Action on Salt and Health (CASH){{cite web |url=http://www.actiononsalt.org.uk/ |title=CASH: Consensus Action on Salt and Health |access-date=7 March 2013 | work = Wolfson Institute of Population Health | publisher = Queen Mary University of London }} established in the United Kingdom in 1996, actively campaigns to raise awareness of the negative health effect of high intake of salt. The 2008 focus includes raising awareness of high levels of salt hidden in sweet foods that are marketed towards children.{{cite news| title=Child health fears over high salt levels in sweet foods |url=https://www.theguardian.com/society/2008/jan/28/foodanddrink.healthandwellbeing |date=28 January 2008|work=The Guardian|location=London| vauthors = Rebecca S |access-date=23 May 2010}} In 2004, Britain's Food Standards Agency started a public health campaign called "Salt – Watch it", which recommends no more than 6 g of salt per day; it features a character called Sid the Slug and was criticised by the Salt Manufacturers Association (SMA).{{cite web | work = Salt Manufacturers Association press release | url = http://www.saltsense.co.uk/releases/rel015.htm | title = New salt campaign under attack | archive-url = https://web.archive.org/web/20100325211142/http://www.saltsense.co.uk/releases/rel015.htm | archive-date = 2010-03-25 }} The Advertising Standards Authority did not uphold the SMA complaint in its adjudication.Advertising Standards Authority {{cite web | url = http://www.asa.org.uk/NR/rdonlyres/EFB31ED5-A00D-4AE7-8988-F69B20DF8C6D/0/Broadcast_rulings_20_April_05.pdf | title = Broadcast Advertising Adjudications | date = 20 April 2005 | archive-url = https://web.archive.org/web/20090326202238/http://www.asa.org.uk/NR/rdonlyres/EFB31ED5-A00D-4AE7-8988-F69B20DF8C6D/0/Broadcast_rulings_20_April_05.pdf | archive-date = 2009-03-26 }} 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.{{cite web | url = http://www.salt.gov.uk/tv_ads.html | title = Salt TV ads | archive-url = https://web.archive.org/web/20090124172405/http://www.salt.gov.uk/tv_ads.html | archive-date = 24 January 2009 | work = Salt.gov.uk | date = 6 November 2009 | access-date = 7 July 2011 }}

From around 2010 to 2022, as part of the Sodium Reduction in Communities Program (SRCP), the United States Centers for Disease Control and Prevention funded local communities across the United States to implement a variety of policy, systems, and environmental change strategies focused on increasing access to lower sodium foods in a variety of settings such as hospitals, congregate meal sites, and university settings.{{Cite web|title=Sodium Reduction in Communities Program|url=https://archive.cdc.gov/#/details?url=https://www.cdc.gov/dhdsp/programs/sodium_reduction.htm |date=26 January 2022|access-date=10 February 2025|publisher=United States Centers for Disease Control and Prevention}}

In January 2010, New York City launched the National Salt Reduction Initiative (NSRI). It was 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 had signed on as partners of the NSRI. Together, the NSRI partnership encouraged food manufacturers and chain restaurants to voluntarily commit to NSRI sodium reduction targets for 2012 and 2014. The NSRI aimed 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.{{cite web|url=https://www1.nyc.gov/site/doh/health/health-topics/national-salt-reduction-initiative.page|title=Sodium initiatives|publisher=National Salt Reduction Initiative, City of New York|date=2016}}

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.{{cite journal | vauthors = Wilson N | title = Salt tax could reduce population's salt intake | journal = BMJ | volume = 329 | issue = 7471 | pages = 918 | date = October 2004 | pmid = 15485985 | pmc = 523164 | doi = 10.1136/bmj.329.7471.918-c }} Taking an alternative view, the Salt Institute, a salt industry body based in North America, is active in promoting the use of salt,{{cite web |url=http://www.saltinstitute.org/About-Us|title=About the Salt Institute|year=2009 |publisher=Salt Institute |access-date=5 December 2010}} and questioning or opposing the recommended restrictions on salt intake.{{cite web |url=http://www.saltinstitute.org/Issues-in-focus/Food-salt-health|title=Food salt & health|year=2009 |publisher=Salt Institute |access-date=5 December 2010}}

In 1989 the Swedish Food Agency launched the symbol Nyckelhålet{{Cite web |title=Nyckelhålet |url=https://www.livsmedelsverket.se/matvanor-halsa--miljo/nyckelhalet |access-date=2024-06-05 |website=www.livsmedelsverket.se |language=sv}} (The Green Keyhole). The symbol is a public health campaign that aims to help consumers to find healthier food alternatives, and the requirements for using the symbol differs between food categories. Apart from salt, the requirements include fat content, fat quality, fibre content and sugar. It is voluntary for food manufacturers to apply for the symbol on food items that fulfill the requirements, and the application is usually reviewed by the municipal environment and health protection board. Since June 2009, the symbol is also used in Norway and Denmark.

{{Main|Low sodium diet}}

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 (WHO) 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.{{cite journal | vauthors = McLaren L, Sumar N, Barberio AM, Trieu K, Lorenzetti DL, Tarasuk V, Webster J, Campbell NR | display-authors = 6 | title = Population-level interventions in government jurisdictions for dietary sodium reduction | journal = The Cochrane Database of Systematic Reviews | volume = 9 | issue = 9 | pages = CD010166 | date = September 2016 | pmid = 27633834 | pmc = 6457806 | doi = 10.1002/14651858.CD010166.pub2 }}

Studies found that excessively low sodium intake, below about three grams (3,000 mg) of salt per day, is associated with increased mortality and higher risk for cardiovascular disease.

A 2020 Cochrane systematic review{{cite journal | vauthors = Graudal NA, Hubeck-Graudal T, Jurgens G | title = Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride | journal = The Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | pages = CD004022 | date = December 2020 | pmid = 33314019 | pmc = 8094404 | doi = 10.1002/14651858.CD004022.pub5 }} concludes that for white people with hypertension, reducing salt intake results in a decrease of about 4 mmHg (about 3.5%) of their blood pressure; for people with normal blood pressure, the decrease was negligible. Weak evidence indicated that these effects might be a little greater in black and Asian people. This review also indicates potential negative side effects on hormones and lipid levels, so that decreasing salt intake is not necessarily recommended for people with normal blood pressure.

In people with chronic kidney disease, including those on dialysis, there is high-certainty evidence that dietary salt restriction may help to lower systolic and diastolic blood pressure, as well as albuminuria.{{cite journal | vauthors = McMahon EJ, Campbell KL, Bauer JD, Mudge DW, Kelly JT | title = Altered dietary salt intake for people with chronic kidney disease | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 6 | pages = CD010070 | date = June 2021 | pmid = 34164803 | pmc = 8222708 | doi = 10.1002/14651858.CD010070.pub3 | collaboration = Cochrane Kidney and Transplant Group }} The risk of hypotensive symptoms, such as dizziness, may also increase in some people, with moderate certainty. It is unclear whether this affects the dosage required for anti-hypertensive medications. The effect of salt restriction on extracellular fluid, oedema, and total body weight reduction is also uncertain.

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• {{cite book | title = Guideline: sodium intake for adults and children | url = https://www.who.int/publications/i/item/9789241504836 | access-date = 10 May 2023 | isbn = 978-92-4-150483-6 | year = 2012 | last1 = Organization | first1 = World Health | publisher = World Health Organization }}
• {{cite book | title = Salt Kills | isbn = 978-1938009006 | url = http://www.healthnowbooks.com/books/salt-kills/ | vauthors = Neravetla SR, Neravetla SR | publisher = Health Now Books, LLC | location = Springfield, OH | year = 2012 }}
• {{cite book | title = Strategies to Reduce Sodium Intake in the United States | isbn = 978-0-309-14805-4 | url = http://books.nap.edu/openbook.php?record_id=12818 | author = Committee on Strategies to Reduce Sodium Intake | veditors = Henry JE, Taylor CL | publisher = The National Academies Press | location = Washington, DC | year = 2010 | doi = 10.17226/12818 | pmid = 21210559 }}
• {{cite book | title = Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate | author = Panel on Dietary Reference Intakes for Electrolytes and Water | publisher = The National Academies Press | location = Washington, DC | year = 2005 | isbn = 978-0-309-09158-9 | url = http://www.nap.edu/openbook.php?record_id=10925 | doi = 10.17226/10925 }}

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{{Salt topics}}

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Category:Edible salt

Salt