Problems With the American Heart Association Presidential Advisory Advocating Sodium Restriction

The American Heart Association (AHA) Presidential Advisory Committee recently published a recommendation supporting population-wide sodium reduction. The advisory concluded that the available data included in studies published since 2011 support the AHA guidelines to reduce sodium intake to <1.5 g/d in all Americans. However, no systematic review of the literature was performed to obtain all appropriate meta-analyses and studies on topics of sodium reduction prior to 2011. Moreover, the severe limitation for the trials that suggest benefit for a " lowered-sodium intake " is that patients were not given the exact same diets. Rather, they were given a diet that lowers sodium (among many other variations that come along with this type of diet), for example, increased intake of fruits, vegetables, and spices and decreased intake of processed foods. Thus, trials testing a " low-sodium diet " cannot prove causation unless the exact same diets are given, with the only difference being that of a lowered sodium intake, which has not occurred. Because of the potential adverse cardiometabolic effects of a very low-sodium diet, such as increased lipids, insulin resistance, and subsequent diabetes, the AHA should reconsider the other side of this story and soften its recommendations for a population wide dietary sodium restriction of <1.5 g/d. The American Heart Association (AHA) Presidential Advisory Committee recently published further evi dence to support its previous recommendation of reduction in sodium intake, with what we believe is a biased interpretation of the literature. 1 Many authors of the AHA report are members of the World Action on Salt and Health (WASH), which is an advocacy group with an agenda to " improve the health of populations throughout the world by achieving a gradual reduction in salt intake. " 2 The Centers of Disease Control and Prevention publicly funded a parallel Institute of Medicine (IOM) project, titled " Consequences of Sodium Reduction in Populations, " that was designed to mirror the efforts of the presidential advisory. Although we applaud these groups' efforts to improve the health of the global population , we believe that both groups have underemphasized considerable evidence that does not support their recommendations. The article authors claim that reports suggest harmful effects of a reduced-sodium diet are based on observational studies and a single meta-analysis. The authors' guidelines state that these reports have been misinterpreted; however , they fail to give any scientific basis to support their statement. In addition, …