Should all diabetes patients limit their salt intake to less than 5 grams per day?

Sodium Intake Recommendations for Diabetes Patients

People with diabetes should limit their sodium consumption to less than 2,300 mg/day (approximately 5 g of salt), which is the same recommendation as for the general population. 1

Evidence-Based Recommendations

Current Guidelines on Sodium Intake for Diabetes

• The American Diabetes Association consistently recommends that people with diabetes limit sodium consumption to less than 2,300 mg/day (approximately 5 g of salt), which aligns with recommendations for the general population 1
• This recommendation has remained consistent across multiple updates of the Standards of Medical Care in Diabetes (2018-2021) 1
• The evidence rating for this recommendation is "B" in all guidelines, indicating moderate-quality evidence 1

Impact of Sodium Restriction on Health Outcomes

• Salt restriction has been shown to significantly reduce blood pressure in people with diabetes 2, 3
• In type 2 diabetes, salt restriction reduced systolic blood pressure by 5.57 mmHg and diastolic blood pressure by 1.68 mmHg 4
• These reductions in blood pressure are comparable to those achieved with single drug therapy for hypertension 2, 3
• Effective blood pressure control in people with diabetes lowers the risk of strokes, heart attacks, heart failure, and slows the progression of diabetic kidney disease 3

Special Considerations

Hypertension and Diabetes

• For individuals with both diabetes and hypertension, further sodium restriction may be indicated, but guidelines generally do not recommend going below 1,500 mg/day 1
• Meta-analyses have shown that achieving lower blood pressure through salt restriction reduces the risk of stroke without increasing myocardial infarction risk 1

Practical Implementation

• Sodium intake recommendations should take into account:
  • Palatability of food 1
  • Availability and affordability of low-sodium options 1
  • The difficulty of achieving low-sodium recommendations in a nutritionally adequate diet 1

Potential Risks and Controversies

• One study reported a paradoxical association between lower sodium excretion and increased mortality in patients with type 2 diabetes, suggesting the need for further research 5
• However, this observational finding contradicts the results from interventional studies and meta-analyses that demonstrate clear benefits of sodium restriction 2, 3, 4

Conclusion

The current evidence supports limiting sodium intake to less than 2,300 mg/day (5 g salt) for all people with diabetes, consistent with recommendations for the general population. This recommendation is based on demonstrated benefits for blood pressure reduction and cardiovascular risk management. While some individuals may benefit from further restriction, especially those with hypertension, the general recommendation of less than 5 g salt per day applies to the diabetes population as a whole.