Why substitute salt?

Health Concerns – The Controversy around Salt and Health – The 2013 WHO Initiative

Why substitute salt? – Health Concerns

Several health organizations recommend low sodium intake (below 2.3 g/day of sodium equivalent to 5.8 g/day of salt) for entire populations. The recommendations are based on the premise that lowering of sodium intake, irrespective of its level of intake, will lower blood pressure and, in turn, will result in a lower incidence of cardiovascular disease.

The controversy around salt and health

Three recent reviews conclude that the recommendations to reduce sodium intake in whole populations to low levels is premature. The expert teams suggest that the optimal sodium intake should be in the range between 3 and 5 g/day, until new data from clinical trials emerge 1,2,3.

  1. Mente, A.; O’Donnell, M.; Yusuf, S. Sodium Intake and Health: What Should We Recommend Based on the Current Evidence? Nutrients 2021, 13, 3232.
  2. Mancia, G.; Oparil, S.; Whelton, P.K.; McKee, M.; Dominiczak, A.; Luft, F.C.; Alhabib, K.; Lanas, F.; Damasceno, A.; Prabhakaran, D.; et al. The technical report on sodium intake and cardiovascular disease in low- and middle-income countries by the joint working group of the World Heart Federation, the European Society of Hypertension and the European Public Health Association. Eur. Hear. J. 2017, 38, 712–719.
  3. O’Donnell, M.; Mente, A.; Alderman, M.H.; Brady, A.J.B.; Diaz, R.; Gupta, R.; López-Jaramillo, P.; Luft, F.C.; Lüscher, T.F.; Mancia, G.; et al. Salt and cardiovascular disease: Insufficient evidence to recommend low sodium intake. Eur. Hear. J. 2020, 41, 3363–3373.

The 2013 WHO salt reduction initiative

Despite the ongoing controversy, salt reduction initiatives are launched around the world, following the recommendation of the WHO in 2013 to reduce population salt intake by 30% by 2025. The most recent review and evaluation of salt reduction initiatives around the world dates from 2021 . The review counts 96 national ongoing salt reduction initiatives with an additional 16 countries in their planning stages4.

The initiatives target different areas of salt consumption:

  • Salt added by individuals during cooking and at the table.
  • Salt use in processed food.
  • Salt in food eaten out of the home, i.e. restaurants, food outlets, hospitals, schools and the workplace.

Importance of areas of salt consumption differ markedly with countries and regions, and are shown below:

National initiatives tend to focus on the most important sources of salt intake, and vary for different countries.

[4] Santos JA, Tekle D, Rosewarne E, Flexner N, Cobb L, Al-Jawaldeh A, Kim WJ, Breda J, Whiting S, Campbell N, Neal B, Webster J, Trieu K. A Systematic Review of Salt Reduction Initiatives Around the World: A Midterm Evaluation of Progress Towards the 2025 Global Non-Communicable Diseases Salt Reduction Target. Adv Nutr. 2021 Oct 1;12(5):1768-1780.


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