It’s no surprise that most Americans consume much more salt than they should. According to the American Heart Association (AHA), the average American takes in more than 3,400 milligrams (mg) of sodium each day. The organization recommends consuming no more than 2,300 mg of sodium per day, equivalent to 1 teaspoon of salt, while working toward an ideal limit of 1,500 mg per day for most adults.
Too much salt in your diet can lead to high blood pressure, heart disease, and stroke.
For people with congestive heart failure, which is when the heart is unable to pump enough blood and oxygen to support the other organs in your body, following a low salt diet can make a difference, but exactly how much salt they should be consuming is still up for debate.
How Salt Affects the Heart
We’ve all heard this before: too much salt can be bad for the heart.
“Sodium attracts water, so a high-salt diet will draw more water into the bloodstream, subsequently raising your blood pressure, congesting your lungs and decreasing oxygen in your blood,” explains Trent Orfanos, MD, director of integrative and functional cardiology at Case Integrative Health in Chicago. “High-blood pressure, or hypertension, is one of the biggest risk factors for developing cardiac disease.”
Excess salt also puts pressure on the blood vessels, which overtime can lead them to stiffen, decreasing blood flow, per the Harvard T.H. Chan School of Public Health. This can result in a heart attack or stroke.
People with heart failure also need to be mindful of their salt intake because it causes the body to hold onto extra salt and water, says Nicholas Hendren, MD, a cardiologist who specializes in heart failure at UT Southwestern in Dallas.
He likens this to a salt shaker on a warm, humid summer day.
“You may recall salt clumping on top of the salt shaker as water is pulled into the salt,” Dr. Hendren explains. “In the same way, as your heart fools your body into holding onto extra sodium, extra water is also retained, leading to swelling and shortness of breath.”
The Debate Over How Much Salt
Researchers still aren’t sure what to recommend for people with heart failure.
“The general consensus is that less sodium is better, but we don’t know what the numerical threshold should be,” says Ahmed Seliem, MD, a heart failure specialist at Loma Linda University International Heart Institute in California. “There are no adequate randomized control trials to support specific numbers of grams for daily sodium intake for people with heart failure.”
Guidelines by medical groups vary, but recommendations tend to fall within a ballpark of 2,000 mg of salt per day.
The Heart Failure Society of America recommends that generally, people with mild heart failure reduce their salt intake to less than 3,000 mg per day, while those with moderate to severe heart failure consume no more than 2,000 mg per day.
The World Health Organization (WHO) advises all individuals to keep salt intake to less than 2,000 mg per day, but notes that people with heart failure should work with their doctor on a diet to fit their specific needs.
Similarly, the AHA does not stipulate a specific amount of sodium for people with heart failure.
According to their latest guidelines published in May 2022 in the journal Circulation, “The AHA currently recommends a reduction of sodium intake to [less than] 2,300 mg [a day] for general cardiovascular health promotion; however, there are no trials to support this level of restriction in patients with [heart failure].”
For example, in a study of more than 800 people with chronic heart failure, adhering to a low-salt diet of less than 1,500 mg per day did not result in fewer cardiovascular related hospitalizations or emergency room visits than a control group consuming 2,000 to 2,500 mg of salt per day, according to research published in April 2022 in The Lancet.
Aggressively restricting salt intake in a person’s diet may inadvertently restrict their overall nutrient consumption, Dr. Seliem cautions.
Such a restrictive diet usually requires someone to eat less overall, which could also cause them to eat less nutritious foods,” explains Seliem.
Bottom line: It’s a balancing act. “The idea is to decrease sodium intake without decreasing the nutritional value of food,” he says. “As an example, the DASH diet reduces sodium intake and is high in antioxidants without compromising the nutritional adequacy of the food.”
So how much salt should people with heart failure eat?
“What I tell all of my patients is that it’s all about common sense: everything in moderation,” Seliem says. “Overall, reduction of daily sodium intake rather than aggressive restriction is the healthiest option for most people, including those with heart failure.”
Work with your doctor to figure out which diet or healthy eating plan works for you.
Add other healthy lifestyle habits like regular physical activity, maintaining a healthy weight, keeping your alcohol intake to a minimum, and avoiding smoking. “All of these efforts taken together can decrease your risk of or help control comorbid conditions,” he says.
