Story at-a-glance

"Conventional wisdom" states that a high-sodium diet will increase your blood pressure, thereby raising your risk for a cardiac event. However, this claim is largely based on uncontrolled case reports from the early 1900s

A 2018 systematic review found no evidence of benefit from a low-sodium diet for those with heart failure

The randomized controlled SODIUM-HF trial, published in April 2022, also found no benefit for patients with Class 2 or 3 heart failure, as lower sodium intake had no statistically significant impact on clinical events

Contrary to popular belief, it's actually hard to consume harmful amounts of sodium, but it's easy to end up with too little. Symptoms of sodium deficiency include muscle fatigue, muscle spasm, cramps, heart palpitations, lethargy and confusion

Low-salt recommendations rarely take coffee intake into account, even though coffee consumption is extremely common and will rapidly deplete your salt stores. Sweating will also eliminate salt from your body, so if you sweat a lot, you may get rid of more than you add back in if you're on a low-salt diet

"Conventional wisdom" states that a high-sodium diet will increase your blood pressure, thereby raising your risk for a cardiac event. This claim is largely based on uncontrolled case reports from the early 1900s,1 and despite more rigorous studies finding no support for the low-sodium recommendation, the dogma around it has been hard to break through.

No Evidence to Support Low-Sodium Diet

For example, in December 2018, a systematic review2 of nine studies concluded there was no robust high-quality evidence available to either support or refute the use of a low-sodium diet for people with heart failure. Then, in April 2022, the results of the SODIUM-HF trial3 were published.4 As reported by Medscape:5

"SODIUM-HF is a pragmatic randomized controlled trial that tested general advice on dietary sodium against a low-sodium diet of 1,500 mg daily ... Patients in SODIUM-HF had class II-III New York Heart Association heart failure ... average age 66 years, average left ventricular ejection fraction of 36%, good medical therapy.

The study was carried out in 26 sites in six countries over six years ... The primary endpoint was a composite of all-cause death and hospitalization or emergency department visit for cardiovascular (CV) reasons."

Between baseline and the first 12 months of treatment, the median sodium intake decreased from 2,286 mg per day to 1,658 mg in the low sodium group, and from 2,119 mg per day to 2,073 mg among controls.

At the end of the six-year study, 15% of the low-sodium arm and 17% of controls had experienced cardiovascular-related admission to hospital, a cardiovascular-related emergency department visit, or died — a difference in incidence that did not meet statistical significance.