Across the United States, roughly 80 million adults are at greater risk for heart disease and stroke because of high blood pressure, also known as hypertension. But while nearly all Americans consume more salt than they should, exacerbating their risk, not everyone should switch to a low-salt diet. A team of researchers from McMaster University’s School of Medicine, found that while lowering salt intake is key to keeping those with high blood pressure in check, cutting out too much salt could put them at greater risk of cardiovascular disease and death.

“These are extremely important findings for those who are suffering from hypertension pressure who also consume high sodium diets,” said the study’s lead author Andrew Mente, researcher and professor of clinical epidemiology and biostatistics at McMaster’s School of Medicine, in a statement. “While our data highlights the importance of reducing high salt intake in people with hypertension, it does not support reducing salt intake to low levels.”

For the new study, published in the journal The Lancet, researchers analyzed the health data of 133,118 participants, 63,559 of whom were diagnosed with hypertension and 69,559 who did not test positive for hypertension. They compared average and high sodium intake to see if there was a link between high sodium intake and heart attack, stroke, and death. Those who were on low-sodium diets were more likely to experience heart attacks, strokes, and death than those who consumed moderate amounts of sodium in their diets.

The findings reveal that the only people who should be worrying about reducing sodium in their diet are salty-food fiends with high blood pressure. It’s important to keep your blood pressure levels in check because in most cases there are no warning signs or symptoms of elevated blood pressure, giving it the name “silent killer.” According to the American Heart Association, high blood pressure signifies blood is being transported through the arteries with a greater force than is normal, which places an unhealthy burden on the heart.

Beneath The Salt Ceiling

Some people’s bodies are more sensitive to the effects of sodium than others. However, consuming too much sodium leads to fluid retention and high blood pressure. Those who are sodium sensitive or who have a history of heart problems or hypertension in their family, may want to reduce the amount of salt, but also need to make sure they’re consuming the right amount.

Mente said. “Low sodium intake reduces blood pressure modestly, compared to average intake, but low sodium intake also has other effects, including adverse elevations of certain hormones which may outweigh any benefits.”

Once you go below 2,300 milligrams of sodium per day, there are no benefits to the heart, but instead the potential for harm. When the body is cut off from a sufficient supply of sodium, it struggles to regulate the water consumption of its cells, causing them to swell up. Eventually fatigue will set in, followed by nausea, confusion, muscle weakness, and cramps.

According to the Mayo Clinic, many people aren’t aware of how much sodium they consume each day. A single teaspoon of table salt, which is a blend of sodium and chloride, has 2,325 milligrams of sodium. Meanwhile, the Dietary Guidelines for Americans recommends keeping sodium intake to 2,300 milligrams a day or less. Sodium and chloride are two electrolytes that help maintain fluid balance, nerve impulses, and help the body absorb glucose, amino acids, and water, ultimately regulating the body’s blood pressure.

“This study adds to our understanding of the relationship between salt intake and health, and questions the appropriateness of current guidelines that recommend low sodium intake in the entire population,” said the study’s co-author Dr. Martin O’Donnell, a clinical professor at McMaster University, in the statement. “An approach that recommends salt in moderation, particularly focused on those with hypertension, appears more in-line with current evidence.”

Source: Yusuf S, Teo K, and Mente A, et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. The Lancet. 2016.