Dietary sodium intake and its relation to human health: a summary of the evidence

Sodium and Health: Old Myths and a Controversy Based on Denial

Purpose of Review

The scientific consensus on which global health organizations base public health policies is that high sodium intake increases blood pressure (BP) in a linear fashion contributing to cardiovascular disease (CVD). A moderate reduction in sodium intake to 2000 mg per day helps ensure that BP remains at a healthy level to reduce the burden of CVD.

Recent Findings

Yet, since as long ago as 1988, and more recently in eight articles published in the European Heart Journal in 2020 and 2021, some researchers have propagated a myth that reducing sodium does not consistently reduce CVD but rather that lower sodium might increase the risk of CVD. These claims are not well-founded and support some food and beverage industry’s vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst. Nevertheless, some researchers, often with funding from the food industry, continue to publish such claims without addressing the numerous objections. This article analyzes the eight articles as a case study, summarizes misleading claims, their objections, and it offers possible reasons for such claims.

Summary

Our study calls upon journal editors to ensure that unfounded claims about sodium intake be rigorously challenged by independent reviewers before publication; to avoid editorial writers who have been co-authors with the subject paper’s authors; to require statements of conflict of interest; and to ensure that their pages are used only by those who seek to advance knowledge by engaging in the scientific method and its collegial pursuit. The public interest in the prevention and treatment of disease requires no less.

Effect of reducing sodium chloride based on the sensory properties of meat products and the improvement strategies employed: a review

Many consumers are concerned about the high levels of salt intake owing to the accompanied risk of chronic diseases. Due to this dietary concern, the food industry has recommended the reduction of salt content in many products. However, the addition of salt to meat products improves their quality and sensory properties, including saltiness, color, juiciness, and texture. Because quality deteriorations could induce decreased sensory scores owing to salt reductions, the challenges involved in improving the quality of reduced-salt meat products have been addressed. During the development of low-salt meat products, it is important to reduce sodium content and address the problems that arise with this reduction. Modified salt, organic acids, amino acids, nucleotides, hydrocolloids, high-pressure, ultrasound, electric pulsed field, and irradiation have been suggested as strategies to replace or reduce sodium content, and sensory scores could be improved by these strategies. Therefore, when developing a low-salt meat product, several perspectives must be considered and the latest technologies that could resolve this problem should be adopted.

Dietary Sodium 'Controversy'-Issues and Potential Solutions

PURPOSE OF REVIEW

High dietary sodium is estimated to be the leading dietary risk for death attributed to 1.8 million deaths in 2019. There are uniform recommendations to reduce sodium consumption based on evidence that increased dietary sodium is responsible for approximately a third of the prevalence of hypertension, and meta-analyses of randomized controlled trials show that sodium reduction lowers blood pressure, cardiovascular disease, and total mortality. Nevertheless, there is a perception that the beneficial effect of reducing dietary sodium is controversial. We provide experiential evidence relating to some sources of the controversy and propose potential solutions.

RECENT FINDINGS

Inappropriate research methodology, lack of rigor in research, conflicts of interest and commercial bias, questions of professional conduct, and lack of policies to protect public interests are likely to contribute to the controversy about reducing dietary sodium. There is a failure to protect policies to reduce dietary sodium from nonscientific threats. Significant efforts need to be made to ensure the integrity of nutritional research and maintain public trust.

Sodium in feline nutrition

High sodium levels in cat food have been controversial for a long time. Nonetheless, high sodium levels are used to enhance water intake and urine volume, with the main objective of reducing the risk of urolithiasis. This article is a review of current evidence of the putative risks and benefits of high dietary sodium levels. Its secondary aim is to report a possible safe upper limit (SUL) for sodium intake. The first part of the manuscript is dedicated to sodium physiology, with a focus on the mechanisms of sodium homeostasis. In this respect, there is only few information regarding possible interactions with other minerals. Next, the authors address how sodium intake affects sodium balance; knowledge of these effects is critical to establish recommendations for sodium feed content. The authors then review the consequences of changes in sodium intake on feline health, including urolithiasis, blood pressure changes, cardiovascular alterations and kidney disease. According to recent, long-term studies, there is no evidence of any deleterious effect of dietary sodium levels as high as 740 mg/MJ metabolizable energy, which can therefore be considered the SUL based on current knowledge.

The influence of high versus low sodium intake on blood pressure and haemodynamics in patients with morbid obesity

BACKGROUND

Many patients with morbid obesity (BMI > 40 kg/m) have hypertension. The complex pathophysiological abnormalities linking hypertension to obesity have not been fully clarified, but abnormal sodium handling could be an important mechanism.

METHOD

Therefore, we examined changes in body fluid compartments and haemodynamic responses (at rest and during exercise) after 5 days of a low-sodium diet (90 mmol/day) and 5 days of a high-sodium diet (250 mmol/day) in 12 morbidly obese, hypertensive patients; 12 morbidly obese, normotensive patients and 12 nonobese controls.

RESULTS

High sodium intake as compared to low sodium intake was associated with an increase in plasma volume (obese, hypertensive patients: 5 ± 4%; obese, normotensive patients: 10 ± 11%; nonobese controls: 7 ± 6%), cardiac output (CO) (obese, hypertensive patients: 17 ± 12%; obese, normotensive patients: 20 ± 16%; nonobese controls: 13 ± 14%) and stroke volume (SV) (obese, hypertensive patients: 27 ± 26%; obese, normotensive patients: 27 ± 24%; nonobese controls: 18 ± 27%) in all three groups with no differences between the groups. Despite an increase in CO during high salt intake, 24-h blood pressure (BP) was unchanged in patients and controls as a result of a reduction in total peripheral resistance (obese, hypertensive patients: -11 ± 11%; obese, normotensive patients: -10 ± 12%; nonobese controls: -5 ± 14%). Similar changes were observed during an incremental bicycle exercise test wherein CO and SV were higher, whereas mean arterial BP was unchanged at each exercise level during high sodium intake.

CONCLUSION

Despite substantial increases in CO and SV, we did not observe any significant change in BP during high sodium intake, neither in morbid obese patients nor in lean individuals.

Selective activation of hTRPV1 by N-geranyl cyclopropylcarboxamide, an amiloride-insensitive salt taste enhancer

TRPV1t, a variant of the transient receptor potential vanilloid-1 (TRPV1) has been proposed as a constitutively active, non-selective cation channel as a putative amiloride-insensitive salt taste receptor and shares many properties with TRPV1. Based on our previous chorda tympani taste nerve recordings in rodents and human sensory evaluations, we proposed that N-geranylcyclopropylcarboxamide (NGCC), a novel synthetic compound, acts as a salt taste enhancer by modulating the amiloride/benzamil-insensitive Na⁺ entry pathways. As an extension of this work, we investigated NGCC-induced human TRPV1 (hTRPV1) activation using a Ca²⁺-flux signaling assay in cultured cells. NGCC enhanced Ca²⁺ influx in hTRPV1-expressing cells in a dose-dependent manner (EC₅₀ = 115 µM). NGCC-induced Ca²⁺ influx was significantly attenuated by ruthenium red (RR; 30 µM), a non-specific blocker of TRP channels and capsazepine (CZP; 5 µM), a specific antagonist of TRPV1, implying that NGCC directly activates hTRPV1. TRPA1 is often co-expressed with TRPV1 in sensory neurons. Therefore, we also investigated the effects of NGCC on hTRPA1-expressing cells. Similar to hTRPV1, NGCC enhanced Ca²⁺ influx in hTRPA1-expressing cells (EC₅₀ = 83.65 µM). The NGCC-induced Ca²⁺ influx in hTRPA1-expressing cells was blocked by RR (30 µM) and HC-030031 (100 µM), a specific antagonist of TRPA1. These results suggested that NGCC selectively activates TRPV1 and TRPA1 in cultured cells. These data may provide additional support for our previous hypothesis that NGCC interacts with TRPV1 variant cation channel, a putative amiloride/benzamil-insensitive salt taste pathway in the anterior taste receptive field.

High-salt diets during pregnancy affected fetal and offspring renal renin-angiotensin system

Intrauterine environments are related to fetal renal development and postnatal health. Influence of salty diets during pregnancy on renal functions and renin-angiotensin system (RAS) was determined in the ovine fetuses and offspring. Pregnant ewes were fed high-salt diet (HSD) or normal-salt diet (NSD) for 2 months during middle-to-late gestation. Fetal renal functions, plasma hormones, and mRNA and protein expressions of the key elements of renal RAS were measured in the fetuses and offspring. Fetal renal excretion of sodium was increased while urine volume decreased in the HSD group. Fetal blood urea nitrogen was increased, while kidney weight:body weight ratio decreased in the HSD group. The altered ratio was also observed in the offspring aged 15 and 90 days. Maternal and fetal plasma antidiuretic hormone was elevated without changes in plasma renin activity and Ang I levels, while plasma Ang II was decreased. The key elements of local renal RAS, including angiotensinogen, angiotensin converting enzyme (ACE), ACE2, AT1, and AT2 receptor expression in both mRNA and protein, except renin, were altered following maternal high salt intake. The results suggest that high intake of salt during pregnancy affected fetal renal development associated with an altered expression of the renal key elements of RAS, some alterations of fetal origins remained after birth as possible risks in developing renal or cardiovascular diseases.

Effects of dietary sodium chloride on health parameters in mature cats

High sodium diets have been shown to enhance water intake and urine output, a potential benefit in the management of lower urinary tract diseases. However, one study suggested that high salt (sodium chloride) diets might have adverse effects on the kidneys [Kirk CA, Jewell DE, Lowry SR. Effects of sodium chloride on selected parameters in cats. Vet Ther 2006; 7: 333–46]. Therefore, the objective of this controlled, prospective study was to evaluate the effects of diets with different salt content (1.11% sodium and 1.78% chloride versus 0.55% sodium and 1.02% chloride, dry matter (dm)) when fed to mature cats (mean age 7.0 years; 12 cats per group) over a 6-month period. Food intake, body weight, bone mineral content, total body hydration status, blood pressure, and markers of renal function were unaffected by salt intake, and no adverse effects were observed. When a subset of cats ( n=9) with an initial serum creatinine ≥1.6 mg/dl was evaluated separately, there remained no evidence of adverse effects associated with increased salt intake. These results are consistent with the majority of other studies evaluating sodium intake in cats, as well as with the National Research Council's assessment, all of which indicate that sodium at 1.5% of the diet dm is not harmful to healthy cats.

Hungarian national dietary survey, 2003–2004

In the course of the 3 rd national nutritional survey data were collected in 2003, and the paper on the energy and nutrition intake of a sample group consisting of 1179 people all aged above 19, was published in the Hungarian Medical Journal (Vol. 146, No. 34, 2005). The present paper focuses on one group of micronutrients, namely the minerals’ intake. The authors evaluated the results mainly in comparison with the data of the two previous Hungarian national surveys, and the international and national recommendations. The average magnesium intake was considered adequate in both sexes, while iron, zinc and copper intakes also met the recommended level in men. On the other hand, the insufficient calcium and the excessive phosphorus intakes, as well as the disproportionate calcium-phosphorus ratio in both sexes are unfavourable facts. The adverse results include insufficient iron, zinc and copper intake in women and the excessive sodium intake in both sexes, as well. The authors emphasize the importance of spreading the principles of healthy nutrition as well as co-operating with the food industry in order to prevent the occurrence of mineral nutrients deficiency.