What is the definition of a low sodium diet?

Definition of Low Sodium Diet

A low sodium diet is defined as consuming no more than 2,300 mg of sodium per day (approximately 5.8 g of salt), with further reduction to 1,500 mg per day recommended for those who would benefit from greater blood pressure lowering. 1

General Sodium Intake Guidelines

• The American Heart Association/American College of Cardiology (AHA/ACC) guidelines recommend limiting sodium intake to no more than 2,300 mg per day (100 mmol/day) for the general population 1
• Further reduction to 1,500 mg per day is recommended for enhanced blood pressure lowering effects, particularly for those with hypertension, prehypertension, or cardiovascular risk factors 1
• Even without achieving these goals, reducing sodium intake by at least 1,000 mg per day has been shown to lower blood pressure 1
• For patients with acute decompensated heart failure, sodium should not be restricted to less than 120 mmol/day (2,800 mg/day) as more severe restriction may worsen outcomes 1

Specific Recommendations by Population

• For individuals with hypertension or acute decompensated heart failure, sodium chloride (salt) intake should be no more than 6 g per day (approximately 2,400 mg of sodium) 1
• For patients with diabetes, the recommendation aligns with the general population guideline of limiting sodium to less than 2,300 mg per day 1
• For patients with cirrhosis and ascites, dietary salt should be restricted to a no-added salt diet of 90 mmol salt/day (5.2 g salt/day) 1

Clinical Context and Implementation

• Most Americans consume more than 3,400 mg of sodium daily, far exceeding the recommended limits 1
• Reducing sodium intake has been consistently shown to lower blood pressure in adults with hypertension and prehypertension, regardless of gender, race, or age 1
• The DASH (Dietary Approaches to Stop Hypertension) dietary pattern combined with sodium reduction is more effective for blood pressure lowering than either intervention alone 1
• Sodium reduction is most easily achieved by:
  • Limiting consumption of processed and ultra-processed foods, which are major contributors to sodium intake 1
  • Avoiding adding salt to foods during cooking or at the table 1
  • Following dietary patterns such as DASH, USDA Food Pattern, or AHA Diet 1

Important Considerations and Caveats

• While guidelines recommend low sodium intake, some research suggests that sodium intake between 3-5 g/day may be associated with the lowest risk of cardiovascular disease and mortality 2, 3
• Very low sodium diets (<1,500 mg/day) may be difficult to achieve and maintain in free-living individuals 4
• Some evidence suggests that extremely low sodium intake may activate the renin-angiotensin-aldosterone system and potentially have adverse effects in certain populations 5, 6
• The benefits of sodium reduction are most pronounced in those with hypertension, African Americans, and older adults 1

Practical Implementation

• Reading food labels to identify sodium content is essential for adherence to a low sodium diet 1
• Consuming more fresh fruits, vegetables, and unprocessed foods naturally helps reduce sodium intake 1
• When using salt substitutes, be aware that many contain potassium chloride which may be contraindicated in patients with kidney disease 7
• Sodium recommendations should consider palatability, availability, affordability, and clinical appropriateness 1