This is a guest article by Silvio Aladjem MD

It has been standard of practice for many years for physicians to advise their patients to limit salt intake. Publicly, the USDA, FDA, the NIH and other organizations, have consistently encouraged limiting salt intake. If you have ever been hospitalized for high blood pressure or cardiac problems, your diet has strictly been “salt free.” If you were diagnosed with high blood pressure, the first step was to limit your salt, since salt  increases fluid retention, and therefore worsens the high blood pressure as well as, eventually, cardiac conditions.

Over the years, I myself, stressed the importance of limiting salt intake to my patients, and as a patient I was instructed, in no uncertain terms, to limit my salt intake.

As a rule, for healthy people, the “safe” level of salt intake in 24 hours is considered to be 2,300 mgs, equivalent to 1 small teaspoon. With hypertension or cardiac problems, the amount goes down to 1,000 mgs daily, roughly half a teaspoon daily.

This is the current gospel. Nobody questioned whether you were individual or Professional Organizations (Heart Association and others). Everybody “knew” the advantages and beneficial effects of “Low salt diet”. Period.

But science is never static. Historically, “everybody” knew the beneficial effects of “bloodletting” to purge the sick patient’s body of “evil toxins” and cure whatever. “Everybody knew” that a pregnant patient with toxemia (preeclampsia) should be in a dark room with the head of the bed towards North! Same with salt intake, “everybody knows”.

Recently, four articles were published in the August 14, 2014 issue of the prestigious New England Journal of Medicine, telling us that we may have been all wrong!

These papers, which included over 100,000 patients from 17 countries, show that a low salt diet can actually increase your risk of death by 27%!  Very high levels, over 6,000 mgs daily, are also bad.  The conclusions of these investigators are that an intake between 3,000 and 6,000 mgs daily is probably your best bet.

An editorial in the Journal, which accompanies the publication of these papers, warns about some short comings of these studies, which are well taken.

In any event, don’t expect that changes in salt advisories to change overnight. Nor should they. Medicine is slow to change, which, in more ways than one, is good. No study is ever “definitive”. Most certainly, when it comes to changing a pattern that has been in effect for years and years, physicians will take their time. Further studies will have to confirm, or dismiss, this new information before it makes its way into the practice and displaces an old pattern.

In addition, the FDA USDA and Professional Organizations will take their time before accepting, or dismissing, this new information. It can’t be any other way. You may wonder why? Simply because, if it’s not confirmed, we may be doing a lot of damage.  Public health is a commodity where we should be as close to 100% sure as possible.  It is estimated that there are over 1 billion people with high blood pressure, worldwide, and about 9 million people die each year as a consequences of hypertension. This is not exactly a “headache”.  It would be a major change in the practice of medicine all over the world with significant consequences. We have to be sure, or as sure as humanly possible.

SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI.  He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached through his website,

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