Salt has long been seen as enemy number one for people with heart problems, with doctors telling patients to cut down on the amount of sodium they consume.
But new research suggests that restricting salt too much may actually raise the risk of an early death in heart failure patients.
Their work builds upon a growing body of research that posits the benefits of cutting out salt to this subset of patients may be overblown.
And the findings could mean a more exciting diet for the more than six million Americans with heart failure.
Cardiologists found that patients following a diet with a sodium intake target below 2.5 grams per day were 80 percent more likely to die than those following a diet with a target of at least 2.5 grams per day (file photo)
Excess sodium has long been linked with high blood pressure, which increases the risk of developing heart failure and can worsen existing heart failure.
The Heart Failure Society of America recommends two to three grams of sodium per day for healthy people.
But, those with moderate or severe heart failure should stay below two grams daily, which is slightly less than a single teaspoon.
Yet, the average American consumes over 3.4grams per day, according to the Food and Drug Administration.
Sodium is in just about every food, making it hard to keep track of and even harder to avoid.
It is especially prominent in some of America’s most popular snacks.
A five-ounce bag of Kettle Brand Potato Chips contains 25 percent of your daily value of sodium, while a small bag of Chex Mix packs 35 percent of your daily value.
Canned and pre-packaged goods are likely to have sky-high amounts of sodium as well as sodium-rich flavor additives, such as monosodium glutamate.
A serving of canned soup, for instance, has around 700 mg of sodium – nearly a third of a person’s daily allowance.
Many people with heart failure have to severely restrict their diet and avoid these foods out of fear of excess sodium intake.
In a new study presented at the American College of Cardiology’s annual summit Thursday, doctors reported that restricting dietary sodium intake to less than the usual recommendation was counterproductive.
Researchers gathered data from nine previous clinical trials, each assessed the effectiveness of different levels of sodium restrictions for heart failure patients.
Combined, the studies gathered data from nearly 3,500 heart failure patients.
In their analysis, the researchers found that heart failure patients following a diet with a sodium intake target below 2.5grams per day were 80 percent more likely to die than those following a diet with a target above that threshold.
In the more restrictive arms of the study, sodium limits varied from about 1.2 to 1.8 grams per day.
The analysis did not show a trend toward increased hospitalizations among patients following more restrictive diets.
Dr Anirudh Palicherla, from the Creighton University School of Medicine in Omaha, Nebraska and led the study, said: ‘Limiting sodium is still the way to go to help manage heart failure, but the amount of restriction has been up for debate.
‘This study shows that the focus should be on establishing a safe level of sodium consumption instead of overly restricting sodium.’
It is not uncommon for medical professionals to advise patients presenting with symptoms of heart disease to cut back on salt intake.
Too much of it increases fluid retention in the body, which increases blood volume inside the blood vessels.
When more blood flows through the blood vessels, blood pressure increases, forcing the heart to work harder to pump blood throughout the body.
But many doctors have acknowledged that the recommendation to keep sodium intake below 2,000 grams is based on assumptions.
A 2018 review of nine studies conducted by doctors at the University of Oxford found that evidence pointing the benefits of a low salt diet in non-hospitalized heart failure patients was inconclusive.
The Oxford team led by Dr Kamal Mahtani, said: ‘We found no clinically relevant data on whether reduced dietary salt intake affected outcomes such as cardiovascular-associated or all-cause mortality, cardiovascular-associated events, hospitalization, or length of hospital stay.’
Authors of the latest study are urging the scientific community to further discuss optimal targets for dietary sodium in people with healthy hearts, and with potentially deadly conditions.
Until then, they recommended that people looking to limit their sodium intake by eating more fresh fruits and vegetables and cooking with basic ingredients.
They want people to avoid processed, boxed and canned foods and sauces that often contain high amounts of sodium.