On salt and hypertension

Re: Let’s bring salt back to the table, Aug. 10

As the producers of the Hypertension Canada clinical practice guidelines, we are concerned that the recent article is misleading as it disregards the well-studied benefits of reduced salt intake, which are important to reinforce.

First, it is dangerously simplistic to point to nations with historically low rates of heart disease and higher salt intake, such as Japan and Italy. These cultures also encourage whole food consumption and thus have lower intake of processed foods that contain high levels of salt, in stark contrast to the highly processed North American diets. Further, it is incorrect to state that there is little evidence to support the link between salt and heart attacks and strokes. Several large studies with thousands of participants demonstrated that high salt intake is associated with increased risk and the benefits associated with reduced salt intake. In fact, studies show salt reduction may be the single most cost-effective strategy to improving public health.

Second, reducing salt intake to recommended levels will not generate widespread sodium deficiency. In otherwise healthy persons, recommended salt consumption levels by Health Canada for the general adult population (upper limit of 2,300 mg per day) and by Hypertension Canada for people with hypertension (2,000 mg per day) are very well tolerated with no ill-effects.

There are 7.5 million Canadians who live with high blood pressure or hypertension, the world’s leading risk factor for premature death. Of those, 2.5 million have elevated blood pressure from excess dietary salt. In complex science, it is essential to review all of the scientific data and unfortunately, this article ignored these data. Reinforced by a wide body of evidence and adopted by health organizations around the world, dietary salt reduction indeed stands as a wellresearched and beneficial health strategy.

Dr. Nadia Khan, President, Hypertension Canada; Dr. Doreen Rabi, Co-Chair, Hypertension Guidelines Committee