Alderman in JAMA: universal sodium reductions are a “rash route”

In the absence of “definitive evidence,” universal dietary sodium reductions are a “rash route,”  writes Michael Alderman in a JAMA commentary. Although measures to cut salt have been gaining widespread support– see the recent study and editorial in the NEJM, as well as a detailed discussion of US efforts to cut salt in heartwireAlderman says these measures have not been validated, and he calls for “large-scale, population-based randomized clinical trials.”

Alderman rejects the arguments of salt reduction advocates that “sodium restriction has been convincingly proven to lower blood pressure and that this will surely prevent stroke and myocardial infarction.” Blood pressure, he notes, is a surrogate endpoint, and he points out that “reduction of sodium intake sufficient to lower blood pressure also increases sympathetic nerve activity, decreases insulin sensitivity, activates the renin-angiotensin system, and stimulates aldosterone secretion.” In the absence of clinically relevant randomized trials, the only basis for sodium reductions is observational studies: “The real issue relates to the inherent limitations of observational studies.”

Previous CardioBrief coverage of the salt controversy:


  1. Two points about this editorial that need to be stressed whenever Dr. Alderman offers his opinion. Firstly, that he has received and continues to receive large amount of money from the lobbyist organizations that support junk food and salty foods, such as The Salt Intitute (think Tobacco Institute) and the like. Secondly, the only reason you see this guy’s name come up as an editorialist on this particular subject again and again, is that no self-respecting physician would offer up smokescreens for these industries that support him. No one would be willing to say that the “evidence is not yet there” and invoke silly and incorrect physiological explainations (that are quite untrue) why salt in excess (as we consume in developed countries) is “good” for us! Tsk, tsk, Mr. Alderman. Can’t believe that JAMA fell for this. They should have known better.

  2. For the record, here is Alderman’s full disclosure that accompanies his comment:

    Financial Disclosures: Dr Alderman reported that he has been a member of the Diet and Cardiovascular Risk Advisory Committee of the Salt Institute since 1996. This has involved participation in an annual scientific consultants meeting for which he received honorarium but has not been compensated in any way since, either by the Salt Institute, its member companies, or any organization or agency connected with it, including the related food industry. Dr Alderman reported that he has not served as a speaker (paid or otherwise) for the Salt Institute or any associated institution, and that he has not received research funding from the Salt Institute or any connected organization.

    FWIW, I believe that Alderman is sincere in his beliefs, and that his views should be evaluated on their own merits.

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