A comprehensive guide to salt – the evidence

 
This guide is based on scientific evidence, following our policy for evidence-based guides.

It’s written by Franziska Spritzler, RD, with the latest major update on September 23, 2019. The guide was medically reviewed by Dr. Bret Scher, MD, on September 23, 2019.

The guide contains scientific references. You can find these in the notes throughout the text, and click the links to read the peer-reviewed scientific papers. When appropriate we include a grading of the strength of the evidence, with a link to our policy on this. Our evidence-based guides are updated at least once per year to reflect and reference the latest science on the topic.

All our evidence-based health guides are written or reviewed by medical doctors who are experts on the topic. To stay unbiased we show no ads, sell no products and take no money from industry.1 We’re fully funded by the people, via an optional membership.2

Read more about our policies and work with evidence-based guides, nutritional controversies, our editorial team and our medical review board.

Disclaimer: Most health authorities currently recommend limiting salt intake. However, it is not clear if the evidence applies equally to most individuals. Most of the supporting trial evidence shows a small blood pressure lowering effect without clear evidence of improved overall health.3
Of note, people who eat a low-carb or keto diet may have an increased need of salt (). At the same time these diets may lower blood pressure, likely reducing any benefit of salt restriction.4 It is thus possible that people eating a low-carb diet may benefit from a higher salt intake than other people, although we don’t yet have conclusive supporting data.

This guide is written for adults eating a low-carb diet and who are concerned about salt intake and health.

Discuss any lifestyle changes with your doctor. Full disclaimer

 
Should you find any inaccuracy in this guide, please email andreas@dietdoctor.com.

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  3. A Cochrane meta-analysis of RCTs show no clear benefit:

    Cochrane 2014: Reduced dietary salt for the prevention of cardiovascular disease [strong evidence]

    An earlier Cochrane review found a significantly increased risk of death from salt restriction in people with heart failure:

    American Journal of Hypertension 2011: Reduced dietary salt for the prevention of cardiovascular disease: a meta-analysis of randomized controlled trials (Cochrane review) [strong evidence]

  4. Obesity Reviews 2009: Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities [strong evidence]