Guidelines for daily sodium intake: a counterpoint to the current recommendation for low sodium intake

Several health organizations suggest that people should consume less sodium, aiming for an intake below 2.3 g per day on the premise that lowering sodium intake will lower blood pressure and, in turn, reduce the incidence of cardiovascular disease. However, these guidelines were created without effective means of maintaining low-sodium diets in real life, and strong evidence is lacking that shows low sodium intake leads to fewer cardiovascular events compared with average intake levels. This review evaluates whether the advice to consume less sodium is backed by solid evidence. It argues that most people consume a moderate amount of sodium (3 to 5 g per day), which is associated with the lowest risk of cardiovascular disease, and recommends a target below 5 g per day. Results from large randomized controlled trials evaluating the effect of sodium reduction on clinical events and mortality are awaited. This is particularly relevant in clinical practice, where sodium-containing medications such as sodium oxybate (SO), a mainstay in narcolepsy treatment, contribute to daily intake but are not considered by sodium guidelines. Clinicians should evaluate each patient's total sodium intake from both diet and medications and make personalized recommendations based on their cardiovascular and renal risk profile.