LAUSR

The overall prevalence of hypertension in Turkey’s adult population is 21.4% and reaches a maximum of 43.3% in patients aged >65 years (1). The SALTURK study reported that Turkey’s salt consumption averages between 14.8 and 18.1 g per day (2, 3). This leads to a simple question, how much salt is too much salt? Guideline recommendations The American Heart Association (AHA) recommends a daily salt intake of <3.75 g for the general population (4). This indicates that the average Turkish citizen’s salt consumption is more than five times higher than the amount AHA recommends. Therefore, salt consumption is high in Turkey by any standards. However, before we embark on a massive anti-salt campaign, we need to verify the evidence regarding the AHA recommendations, i.e., what is the scientific evidence that healthy people, young and old, men, women, and children should consume less than 3.75 g salt or 1.5 g sodium per day? The AHA’s recommendations regarding salt restriction are based on multiple well-established observations such as salt increases blood pressure (BP), and high BP is known to cause cardiovascular disease. However, the AHA’s recommendation of 3.75 g per day is arbitrary, as are most dietary recommendations. Other institutions, such as WHO and European Society of Cardiology, recommend sodium intake of 2.0-2.5 g per day (5, 6). However, it does not necessarily mean that lowering BP by eating less salt will consistently decrease the risk of heart disease, regardless of whether you are hypertensive or have normal BP, whether your salt consumption is excessive, moderate, or even low. In the US, we have observed a drastic reduction in cardiovascular disease over the past decades (7). However, the average American continues to consume about 9 g of salt daily, (approximately half of that an average Turk’s salt intake) an amount that has not changed in years despite the reduction in heart disease. Conceivably, a reduction in dietary sodium may prove beneficial in high salt eaters who also have high BP. However, in people with normal BP, lowering salt intake has little, if any, effect and may even be harmful when becoming too severe (8).