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People’s Pharmacy: Very low-salt diets could be deadly

Years ago, there was a popular book titled “All I Really Need to Know I Learned in Kindergarten,” by Robert Fulghum. It was full of wisdom like share everything, play fair, wash your hands before you eat and clean up your own mess. These are great lessons we all learned (or should have learned) in kindergarten.

One of our favorite parts of kindergarten was the story circle, and we especially loved the story of “Goldilocks and the Three Bears.” You probably remember that Goldilocks was not very prudent when she went waltzing into a house where no one was home. (Papa, Mama and Baby Bear were out for a walk in the woods.) But as Goldilocks went through the house, she tried things out and found the ones that were just right – not too big or too little, not too soft or too hard, not too hot or too cold.

We caution against breaking and entering, but we think that otherwise Goldilocks’ strategy was pretty wise. Medical studies keep demonstrating that for most things, too much and too little are bad for us. We need to get to “just right.”

This was just borne out by a study from Denmark examining the effects of sodium intake on mortality, especially cardiovascular deaths (American Journal of Hypertension online, March 20, 2014). The scientists analyzed 25 studies to find out whether severely limiting salt really results in lower blood pressure and fewer heart attacks, as we have all been assured.

What the investigators found might make the American Heart Association splutter. The data run counter to AHA guidelines.

Usual salt intake was better at preventing premature death and heart-related mortality than low-sodium diets. Usual salt intake also was healthier than high-salt diets. People who consumed moderate amounts of sodium, between 2,645 mg and 4,945 mg daily, were less likely to experience heart attacks or unexpected death compared with those ingesting more or less than those amounts.

The American Heart Association and the Centers for Disease Control and Prevention (CDC) still recommend, as they have for years, that most people should drastically cut sodium intake to 1,500 mg a day or less. At that level, food tastes bland, and there are no obvious benefits. In fact, the accumulating data indicate that there is an increased risk of heart disease and death.

Public health organizations don’t seem open to revising their guidelines based on evolving information. Their recommendations for cutting sodium intake to the bone seem to be based primarily on an assumed effect on blood pressure.

Assumptions are not science. Evidence should trump belief in the world of medicine, but it often takes time for paradigms to shift.

Perhaps it’s time to shift back to a common-sense approach familiar to grandparents: moderation!

To learn more about the long-running salt wars, cholesterol controversies and other debates about healthy living, we offer our book “Best Choices” online at

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer letters from readers. Write to them via their website: