Is too much salt harmful? Yes

• Published in: Pediatric nephrology (Berlin, West) West), 2020-09, Vol.35 (9), p.1777-1785
• Main Authors: Agócs, Róbert, Sugár, Dániel, Szabó, Attila J.
• Format: Article
• Language: English
• Subjects: Autoimmune diseases; Blood pressure; Clinical trials; Health aspects; Homeostasis; Medicine; Medicine & Public Health; Nephrology; Nutrient deficiency; Pediatrics; Pro/Con Debate; Risk groups; Salt; Salt in the body; Sodium; Sodium in the body; Urology
• ISSN: 0931-041X; 1432-198X; 1432-198X
• DOI: 10.1007/s00467-019-04387-4

The contribution of high sodium intake to hypertension and to the severity of immune-mediated diseases is still being heatedly debated in medical literature and in the lay media. This review aims to demonstrate two conflicting views on the topic, with the first part citing the detrimental effects of excessive salt consumption. Sodium plays a central role in volume and blood pressure homeostasis, and the positive correlation between sodium intake and blood pressure has been extensively researched. Despite the fact that the average of global daily salt consumption exceeds recommendations of international associations, health damage from excessive salt intake is still controversial. Individual differences in salt sensitivity are in great part attributed to this contradiction. Patients suffering from certain diseases as well as other vulnerable groups—either minors or individuals of full age—exhibit more pronounced blood pressure reduction when consuming a low-sodium diet. Furthermore, findings from the last two decades give insight into the concept of extrarenal sodium storage; however, the long-term consequences of this phenomenon are lesser known. Evidence of the relationship between sodium and autoimmune diseases are cited in the review, too. Nevertheless, further clinical trials are needed to clarify their interplay. In conclusion, for salt-sensitive risk groups in the population, even stricter limits of sodium consumption should be set than for young, healthy individuals. Therefore, the question raised in the title should be rephrased as follows: “how much salt is harmful” and “for whom is elevated salt intake harmful?”