Sodium and Health: Old Myths and a Controversy Based on Denial

Francesco P Cappuccio¹, Norm R C Campbell², Feng J He³, Michael F Jacobson⁴, Graham A MacGregor³, Elliott Antman⁵, Lawrence J Appel⁶, JoAnne Arcand⁷, Adriana Blanco-Metzler⁸, Nancy R Cook⁵, Juliet R Guichon², Mary R L'Abbè⁹, Daniel T Lackland¹⁰, Tim Lang¹¹, Rachael M McLean¹², Marius Miglinas¹³, Ian Mitchell², Frank M Sacks¹⁴, Peter S Sever¹⁵, Meir Stampfer¹⁴, Pasquale Strazzullo¹⁶, Wayne Sunman¹⁷, Jacqui Webster¹⁸, Paul K Whelton¹⁹, Walter Willett¹⁴

Affiliations

¹ University of Warwick, W.H.O. Collaborating Centre for Nutrition†, Warwick Medical School, Gibbett Hill Road, CV4 7AL, Coventry, UK. f.p.cappuccio@warwick.ac.uk.
² University of Calgary, Calgary, Canada.
³ Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
⁴ Author, 'Salt Wars, The Battle Over the Biggest Killer in the American Diet', Washington, DC, USA.
⁵ Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
⁶ Johns Hopkins University, Baltimore, USA.
⁷ Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada.
⁸ Costa Rican Institute of Research and Teaching in Nutrition and Health, San José, Costa Rica.
⁹ Temerty Faculty of Medicine, University of Toronto, W.H.O. Collaborating Centre On Nutrition Policy for Chronic Disease Prevention, Toronto, Canada.
¹⁰ Medical University of South Carolina, Charleston, USA.
¹¹ Centre for Food Policy, City, University of London, London, UK.
¹² Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
¹³ Santaros Klinikos Hospital, Vilnius University, Vilnius, Lithuania.
¹⁴ Harvard T.H. Chan School of Public Health, Boston, USA.
¹⁵ Imperial College School of Medicine, London, UK.
¹⁶ Federico II University of Naples, Naples, Italy.
¹⁷ Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁸ The George Institute for Global Health, W.H.O. Collaborating Centre On Salt Reduction†, Sydney, Australia.
¹⁹ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.

PMID: 35165869
PMCID: PMC9174123
DOI: 10.1007/s13668-021-00383-z

Review

Sodium and Health: Old Myths and a Controversy Based on Denial

Francesco P Cappuccio et al. Curr Nutr Rep. 2022 Jun.

. 2022 Jun;11(2):172-184.

doi: 10.1007/s13668-021-00383-z. Epub 2022 Feb 14.

Authors

Affiliations

¹ University of Warwick, W.H.O. Collaborating Centre for Nutrition†, Warwick Medical School, Gibbett Hill Road, CV4 7AL, Coventry, UK. f.p.cappuccio@warwick.ac.uk.
² University of Calgary, Calgary, Canada.
³ Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
⁴ Author, 'Salt Wars, The Battle Over the Biggest Killer in the American Diet', Washington, DC, USA.
⁵ Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
⁶ Johns Hopkins University, Baltimore, USA.
⁷ Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada.
⁸ Costa Rican Institute of Research and Teaching in Nutrition and Health, San José, Costa Rica.
⁹ Temerty Faculty of Medicine, University of Toronto, W.H.O. Collaborating Centre On Nutrition Policy for Chronic Disease Prevention, Toronto, Canada.
¹⁰ Medical University of South Carolina, Charleston, USA.
¹¹ Centre for Food Policy, City, University of London, London, UK.
¹² Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
¹³ Santaros Klinikos Hospital, Vilnius University, Vilnius, Lithuania.
¹⁴ Harvard T.H. Chan School of Public Health, Boston, USA.
¹⁵ Imperial College School of Medicine, London, UK.
¹⁶ Federico II University of Naples, Naples, Italy.
¹⁷ Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁸ The George Institute for Global Health, W.H.O. Collaborating Centre On Salt Reduction†, Sydney, Australia.
¹⁹ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.

PMID: 35165869
PMCID: PMC9174123
DOI: 10.1007/s13668-021-00383-z

Abstract

Purpose of review: The scientific consensus on which global health organizations base public health policies is that high sodium intake increases blood pressure (BP) in a linear fashion contributing to cardiovascular disease (CVD). A moderate reduction in sodium intake to 2000 mg per day helps ensure that BP remains at a healthy level to reduce the burden of CVD.

Recent findings: Yet, since as long ago as 1988, and more recently in eight articles published in the European Heart Journal in 2020 and 2021, some researchers have propagated a myth that reducing sodium does not consistently reduce CVD but rather that lower sodium might increase the risk of CVD. These claims are not well-founded and support some food and beverage industry's vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst. Nevertheless, some researchers, often with funding from the food industry, continue to publish such claims without addressing the numerous objections. This article analyzes the eight articles as a case study, summarizes misleading claims, their objections, and it offers possible reasons for such claims. Our study calls upon journal editors to ensure that unfounded claims about sodium intake be rigorously challenged by independent reviewers before publication; to avoid editorial writers who have been co-authors with the subject paper's authors; to require statements of conflict of interest; and to ensure that their pages are used only by those who seek to advance knowledge by engaging in the scientific method and its collegial pursuit. The public interest in the prevention and treatment of disease requires no less.

Keywords: Cardiovascular prevention; Conflict of interest; Ethics; Population sodium reduction; Public health policy; Sodium (salt) intake.

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Conflict of interest statement

FPC: Past-President, British & Irish Hypertension Society (2017–2019) (unpaid); Member, Action on Salt and World Action on Salt, Sugar and Health (unpaid); Head, World Health Organization (WHO) Collaborating Centre for Nutrition (unpaid); Senior Advisor, WHO (received travel, accommodation, per-diem, refund of expenses); OMRON Academy (received speaker fees, travel, accommodation, expenses); Annual Royalties from Oxford University Press (OUP) for 2 books on topics unrelated to salt. NRCC: Personal fees from Resolve to Save Lives (RTSL) and the World Bank, outside the submitted work; Member, World Action on Salt and Health, unpaid; Consultant on dietary sodium and hypertension control to numerous governmental and non-governmental organizations, unpaid; Chairman, International Consortium for Quality Research on Dietary Sodium/Salt (TRUE), unpaid. FJH: Member, Action on Salt and World Action on Salt, Sugar and Health (unpaid); partially funded by the National Institute for Health Research and the Medical Research Council. GAM: Chairman, Action on Salt, Sugar and Health, World Action on Salt, Sugar and Health and Blood Pressure UK (unpaid); partially funded by the National Institute for Health Research and the Medical Research Council. EA: Past President, American Heart Association (2014–5). LJA: Receives payments from Wolters Kluwer for chapters in UpToDate on the relation of blood pressure with lifestyle factors, including sodium intake. NRC: Member, 2019 Committee to Review the Dietary Reference Intakes for Sodium and Potassium for The National Academies of Sciences, Engineering, and Medicine. Member, Expert Panel for Minimum Standards for Dietary Sodium/Salt Research, Systematic Reviews and Dietary Guidance for the World Hypertension League. MRL’A: Chair, Pan American Health Organization Technical Advisory Group on Sodium (received travel, accommodation, refund of expenses); Member, WHO Nutrition Advisory Group on Nutrition (received travel, accommodation, refund of expenses); Past Chair/Co-Chair, Sodium Working Group, Canada (received travel, accommodation, refund of expenses); Director, WHO Collaborating Centre on Nutrition Policy for Chronic Disease Prevention (unpaid). TL & PSS: Member and Trustee, Action on Salt (unpaid). PS: Member, World Action on Salt, Sugar and Health (unpaid). President, Italian Society of Human Nutrition (unpaid). WS: Member, Action on Salt (unpaid). JW: Head, WHO Collaborating Centre for Salt reduction (unpaid). MFJ, JA, AB-M, JRG, DTL, RMcL, MM, IM, FMS, MS, PKW, WW: nothing to declare.

References

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Sodium and Health: Old Myths and a Controversy Based on Denial

Affiliations

Sodium and Health: Old Myths and a Controversy Based on Denial

Authors

Affiliations

Abstract

Conflict of interest statement

References

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LinkOut - more resources

Full Text Sources

Research Materials