What does a 2 g per day sodium diet entail for an asymptomatic adult with hypertension, diabetes, and a mildly elevated albumin‑creatinine ratio?

What is a 2g/day Sodium Diet?

A 2 g/day sodium diet means limiting total sodium intake to 2,000 mg (2 grams) per day, which is equivalent to approximately 5 grams (about one teaspoon) of table salt per day, including all sodium from processed foods, added salt during cooking, and salt added at the table. 1

Understanding the Sodium-to-Salt Conversion

• 2 grams of sodium = approximately 5 grams of salt (sodium chloride) 1
• This is a critical distinction because food labels list sodium content, not total salt content 1
• Most dietary sodium (approximately 75%) comes from processed and restaurant foods, not from the salt shaker 2

Specific Recommendations for Your Clinical Context

For an adult with hypertension, diabetes, and elevated albumin-creatinine ratio (indicating early kidney disease), the sodium restriction is particularly important:

Primary Target

• Limit sodium to less than 2,300 mg/day as the general recommendation 1
• Further restriction toward 2,000 mg/day (2 g/day) is appropriate given the combination of hypertension and kidney involvement 1

Why This Matters for This Patient

• Hypertension: Sodium reduction of even 1,000 mg/day produces measurable blood pressure lowering 1, 3
• Diabetes: The American Diabetes Association recommends <2,300 mg/day for people with diabetes, with further individualized restriction for those with concurrent hypertension 1
• Kidney disease (elevated albumin-creatinine ratio): This indicates early diabetic kidney disease, making sodium restriction even more critical 1

Practical Implementation

What to Avoid or Limit

• Processed and packaged foods (contribute ~75% of dietary sodium) 2
• Restaurant and fast food meals 2
• Canned soups, vegetables, and beans (unless labeled "no salt added") 2
• Deli meats, bacon, sausage, and cured meats 2
• Salty snacks (chips, pretzels, crackers) 2
• Condiments high in sodium (soy sauce, teriyaki sauce, salad dressings) 2

What to Emphasize

• Fresh fruits and vegetables (naturally low in sodium and high in potassium) 1, 3
• Home-cooked meals where sodium content can be controlled 2
• Reading nutrition labels to track sodium content 2
• Using herbs, spices, lemon, and vinegar for flavoring instead of salt 1

Important Caveats

The Evidence Debate

While guidelines consistently recommend <2,300 mg/day, some observational research suggests a J-shaped curve where very low sodium intake (<3 g/day) may be associated with increased cardiovascular events 1, 4, 5. However, the most recent 2024 ESC guidelines acknowledge this controversy but maintain that the causal trial evidence (particularly from the SSaSS trial) supports sodium restriction to approximately 2 g/day for patients with hypertension 1.

Potassium Considerations

• Increasing dietary potassium intake (through fruits and vegetables) enhances the blood pressure-lowering effect of sodium restriction 1, 3
• However, potassium supplementation or salt substitutes should be avoided if the patient develops advanced kidney disease or takes certain medications (ACE inhibitors, ARBs, potassium-sparing diuretics) 1, 3

Protein Intake

• Do not restrict protein below 0.8 g/kg/day even with early kidney disease, as this does not improve outcomes and may cause malnutrition 1

Monitoring and Adjustment

• Recheck blood pressure every 6 months to assess response to sodium restriction 1
• Monitor kidney function (eGFR and albumin-creatinine ratio) regularly 1
• The sodium restriction should be balanced with overall dietary quality, emphasizing a Mediterranean-style eating pattern rich in vegetables, fruits, whole grains, and healthy fats 1