Salt: another public health hazard

Closely following the news that sugary beverages may be responsible for 180,000 deaths per year, the same group of scientists has reported an estimate of the number of deaths due to excess salt consumption.

Salt shaker. Flickr: TooFarNorth

High sodium intake is associated with poor health outcomes, including elevated blood pressure, heart attack and stroke (even in the absence of high blood pressure), kidney disease, ulcers, gastric cancer, osteoporosis, and now autoimmune inflammation.1,2  Elevated blood pressure, a consequence of excess sodium intake, is a significant threat to one’s health, and its prevalence is rising. Hypertension is one of the leading causes of death in the U.S., contributes to heart attack and stroke risk, and is associated with dementia.3

Using data gathered from the World Health Organization, the average worldwide daily sodium intake was found to be more than double the American Heart Association’s recommended limit of 1500 mg/day. Average worldwide sodium intake was 3,950 mg, and American adults came in just under that average at 3,600 mg.  Most of the world – 119 of the 187 countries studied, or 88% of all adults – consumed more than 3,000 mg sodium a day. Out of the 187 countries, only one (Kenya) had an average sodium intake meeting the American Heart Association’s guideline of 1,500 mg a day. Excess sodium has clearly become a global issue.

With excess sodium consumption now common throughout the entire world, are more people dying from heart attacks and strokes?

Higher sodium intake is consistently associated with greater risk of heart attack, stroke, and cardiovascular death in healthy populations.1 The scientists gathered data on deaths in 50 different countries and concluded that 2.3 million deaths per year worldwide may be due to excess salt consumption, and 40% of those deaths occurred in individuals under the age of 70 – suggesting that excess sodium is needlessly cutting many lives short. They estimated that excess salt contributes to one in 10 deaths of American adults, and that 15 percent of all deaths from cardiovascular disease were a consequence of excess salt intake.4-6

Could reducing sodium intake really prevent some of these deaths?

Clinical trials have clearly shown that reducing sodium intake reduces blood pressure in both healthy and hypertensive subjects.1  Additional clinical trials have shown that cardiovascular events could be  reduced by 20% with sodium reduction.7 A recent publication in the New England Journal of Medicine used mathematical models to estimate that a 1200 mg reduction in daily sodium intake population-wide in the U.S. could result in 60,000 fewer cases of CHD, 32,000 fewer strokes, and 54,000 fewer heart attacks every year.8 The effort to reduce sodium intake is substantially worthwhile.

Added salt is ubiquitous in processed foods and restaurant meals, and is contributing to the rampant cardiovascular disease in the modern world. Since most of the added sodium in the American diet comes from these foods, it is simple to avoid added salt by preparing most of your meals at home.  Sodium is an essential mineral that becomes dangerous in excess; by consuming only the sodium present in natural foods, we get adequate but not disease-causing levels of sodium. 


1. Whelton PK, Appel LJ, Sacco RL, et al: Sodium, blood pressure, and cardiovascular disease: further evidence supporting the American Heart Association sodium reduction recommendations. Circulation 2012;126:2880-2889.
2. Tsugane S, Sasazuki S: Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric Cancer 2007;10:75-83.
3. Murphy SL, Xu J, Kochanek KD: Deaths: Preliminary Data for 2010. Natl Vital Stat Rep 2012;60.
4. Phend C: Whole World Uses Too Much Salt, Study Finds. 2013. MedPage Today. Accessed
5. Armour S: High Salt Consumption Tied to 2.3 Million Heart Deaths. 2013. Bloomberg. Accessed
6. Gray N: High salt intake causes 2.3 million deaths per year. 2013. Food Navigator. Accessed
7. He FJ, MacGregor GA: Salt reduction lowers cardiovascular risk: meta-analysis of outcome trials. Lancet 2011;378:380-382.
8. Bibbins-Domingo K, Chertow GM, Coxson PG, et al: Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010;362:590-599.

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Comments (3) Read through and enter the discussion with the form at the end
Daisy Anne - April 3, 2013 1:22 PM

Thank you for this informative article. Is rock salt healthy to eat and can replace processed salt?

Per Haug - April 4, 2013 5:08 AM

It could have been interesting to know how much salt a nutritarian, adding no salt to anything, would end up consuming in its natural form, compared to the AHA's recommedned limit of 1500mg/day or the average of more than 3000mg/day. I know, and so do other nutritarians, that the natural sodium in plants, is not to be avoided.

The basis in all my meals are the jewels of foods-the G in G-BOMBS: dark greens such as kale, spinage and/or collards-everything else in the plant world is supplementing these. My blood pressure is 98/56 and my resting heart beat is 49. My body is thus having a holiday every day.

I will not, and I do not, let anyone but me decide what to put in my body, be it at home or any place away from home. My health is my single most valuable investment. Nothing else even come close. Without your health, you have nothing.

I should know, because I lost my mom to strokes in April of 2012 and she lost her life as she had come to know it 21/2 years before that, as she became totally helpless without the ability for meaningful communication.

Thank you Joel Fuhrman for scrutinizing those 50.000 research papers and referencing 1.500 of them in Eat to Live. Your hard work has made it much easier to know how to achieve one's maximum potential health and longevity. Everything before that were just pieces of a non-finishable puzzle, as we were continually bombarded with conflicting research. No wonder many took up the quote: "Eat carrots while they are still healthy."

Deana Ferreri, Ph.D. - April 4, 2013 4:10 PM

A Nutritarian diet with no added sodium generally provides less than 1000 mg/day sodium.

All salt is almost totally sodium chloride, so it is generally all the same when it comes to health.

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