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Salt, blood pressure and health: a cautionary tale.

By virtue of its central role in maintaining intravascular and extracellular volume, sodium is essential to human survival. Taste, habit, environment, genes, and behaviour probably all influence sodium intake. In view of the heterogeneity that characterizes humankind, it is remarkable that the vast majority of the world’s citizens, everywhere, given free access to salt, consume between 100 and 200 mmol of sodium per 24 hours. 1 Despite this uniformity of sodium intake across all dietary, cultural, environmental, and hereditary circumstances, and the fact that life spans that are steadily increasing worldwide, many authorities now contend that current salt intake is too high by half. Advocates of universal restriction of sodium intake to ,100 mmol/24-h base their case on the belief that this will produce a population-wide reduction of blood pressure which, in turn, will reduce cardiovascular morbidity and mortality. There is even stronger enthusiasm for strict control of sodium intake for hypertensive people. Indeed, these dogma are often preached with a fervour usually associated with religious zealotry. I will argue here that the available data provides insufficient evidence to justify any universal target for sodium intake for either the whole population or for its hypertensive subset. The Link of Salt to Blood Pressure Recognition of the strong, continuous, independent, and significant relationship of blood pressure to the occurrence of cerebral, cardiac, and renal disease, provided the reasonable stimulus for seeking safe, simple, and effective means for reducing blood pressure on a population-wide basis. Dietary intake of sodium, or salt, both because of its ubiquity in the human diet, and its centrality in determining blood volume, presented an obvious opportunity to intervene on blood pressure. The first indication that differences in dietary sodium might explain variation in blood pressure came from cross-cultural studies. In unacculturated societies, blood pressures tended to be lower, and did not appear to rise with age. This contrasted sharply with the age-related rise in pressure and high levels of ‘hypertension’ common in most industrialized nations. Sodium intake, among many other factors, was found to differ between ‘developed’ and ‘undeveloped’ communities. In fact, people confined to an economy of hunting and gathering, with little access to salt, had daily intakes of sodium often limited to 20‐40 mmol sodium. 2