There has long been a consensus that eating less salt is healthier for your heart. But just how seriously you should monitor your salt consumption may depend on your current heart health and other cardiovascular risk factors, says Kainat Khalid, MD, a cardiologist at Jamaica Hospital Medical Center and a specialist in hypertension management in Queens, New York. Limiting salt intake will benefit some people more than others.Expert guidelines recommend consuming no more than 2,300 milligrams (mg) a day with an optimal goal of no more than 1,500 mg. According to the American Heart Association, the body needs less than 500 mg of sodium each day to do its job.

The salt we put on our food is a combination of sodium and chloride. Salt is present in certain foods naturally, and it is often added in unhealthy quantities to ultra-processed foods, like processed meats, prepared foods, and condiments.“Sodium is the part that affects blood pressure and heart health,” says Dr. Khalid. “When we talk about salt intake, what really matters is the sodium content.The body requires some sodium to aid nerve and muscle function, but there’s a limit to how much it needs before it starts putting your blood pressure in jeopardy. The main way that happens is through its impact on fluid balance.

“Excess sodium makes the body hold onto more water. This raises blood volume, which can increase blood pressure,” says Khalid. “Over time, high blood pressure puts stress on the arteries, the heart, and other organs like the kidneys.”

It’s critical for people to stay on top of blood pressure health. High blood pressure can increase risk for outcomes like stroke, heart attack, heart failure, and kidney failure.

There is some conflicting information in the medical literature about how much salt impacts heart health. It seems probable that some people may be more greatly harmed by excessive salt consumption than others.

A recent narrative review supports the idea that decreasing salt intake can help lower blood pressure. High sodium intake may also increase risk for a heart condition called left ventricular hypertrophy, when the heart’s main pumping chamber becomes thicker and enlarged. However, the review does acknowledge that there is a lack of long-term randomized controlled trials on salt intake and cardiovascular outcomes.Other evidence suggests decreasing salt intake doesn’t make much of a difference. One umbrella review, a comprehensive review of reviews, suggests that following a low-salt diet does not significantly decrease risk for cardiovascular disease.Expert opinions continue to differ. Another review concluded that the cardiovascular risk from too much salt occurs when people consume more than 5 grams (g) a day, which is more than twice the current recommended amount. In addition, the study authors wrote that existing high blood pressure can impact how much high sodium intake is healthy. For about one-third of people, salt has a more exaggerated effect on blood pressure.“Some people, particularly older women, seem to be more sensitive to the impact of salt on blood pressure,” says Heather A. Trivedi, MD, a cardiologist at Montefiore Einstein Advanced Care in Elmsford, New York. On the flip side, about 15 percent of the population actually experiences an increase in blood pressure when sodium intake is low.For people with chronic kidney disease, consuming more sodium may increase risk for cardiovascular events. The same is true for those who are overweight.

“In general, most people benefit from avoiding excessive salt intake in the diet. Those individuals with salt sensitive hypertension, heart failure, or kidney disease may see the most benefit,” says Dr. Trivedi.

However, there aren’t many serious downsides for anyone to stop reaching for the salt shaker. Trivedi says, “limiting salt intake is part of a recommended diet for everyone as part of reducing the risk for developing these in the future.”

Current U.S. dietary guidelines recommend people should have less than 2.3 g of sodium daily. The British National Health Service recommends that people consume less than 1 teaspoon of salt each day, which is about 6 g. For people with heart failure, the European Society of Cardiology suggests less than 5 g of salt daily.

Sean Heffron, MD, a preventive cardiologist at the center for the prevention of cardiovascular disease at NYU Langone in New York City, says reducing salt intake is beneficial for many U.S. residents, since “the average American is overweight or obese and has a number of cardiovascular risk factors.” He adds that the most benefit is likely in people who are consuming the highest amounts of salt and those who have high blood pressure.

Having too little sodium in the blood can be life-threatening; people do need some sodium. So, it is worth asking: Is it possible to not eat enough salt?

“Too little sodium can lead to low blood sodium levels (hyponatremia),” says Khalid. “This usually only happens with very restrictive diets, certain medical conditions, or heavy fluid loss (like athletes who drink large amounts of water without replacing electrolytes).”

To avoid possible risks, make sure you’re eating regularly. Trivedi says that it’s “unlikely to consume dangerously little salt as long as you are eating regular meals.”

The science suggests that salt substitutes are safe and may help to decrease blood pressure. Their use may also decrease risk for death from cardiovascular events, according to a systematic review and meta-analysis.

“Reduced-sodium salts usually replace some of the sodium with potassium chloride,” says Khaldi.

However, some people should be careful with using salt substitutes. People with kidney disease should read product labels and avoid salt substitutes that contain potassium chloride, which can be more harmful to this population than salt itself. Khalid adds that those on certain medications, like ACE inhibitors, ARBs, or potassium-sparing diuretics, should also be cautious.Much of the sodium in the U.S. diet comes from foods prepared in restaurants, as well as prepared and packaged foods. “It's typically the hidden salt that is the problem,” says Trivedi.

The best way to avoid consuming too much sodium is to know where it lurks. High-sodium foods include:

• Processed meats such as cold cuts, bacon, and sausage

• Savory snacks like chips and crackers

• Bread and other dishes that focus on grains like pasta dishes

• Dairy products such as cheese

• Meat-based dishes

Focusing on fresh foods when grocery shopping and cooking more at home allows you to know how much salt is in the foods you’re eating. Khalid says says seasonings to try beyond salt are herbs, spices, lemon, or vinegar. She also recommends knowing how to read nutrition labels — “low sodium” means 140 mg or less per serving.”

• Most science supports the idea that reducing salt intake can help keep your heart healthy by reducing the risk for high blood pressure. However, not all studies agree on the specifics of who should be eating less of it.

• People with certain health conditions, such as high blood pressure and chronic kidney disease, should be cautious with both regular salt and salt substitutes. Low-sodium salt products that contain potassium chloride may be harmful to the kidneys.

• Focusing on fresh, home-cooked meals can help control sodium intake, and using herbs, spices, lemon, or vinegar instead of table salt for flavor can promote healthier eating habits.