Does salt affect cholesterol?

Hardly at all, and eating less salt will not lower your cholesterol. A meta-analysis commissioned by the WHO pooled 11 randomized trials in 2339 adults and found that cutting sodium changed total cholesterol by 0.77 mg/dL (95% CI −1.2 to 2.7; metric: 0.02 mmol/L, −0.03 to 0.07), which is no significant effect. Its authors rated that evidence high quality. The only rise anyone has measured runs the other way: very deep, mostly short salt cuts nudged total cholesterol up by 5.19 mg/dL.

Established. Modest salt reduction of the kind health advice asks for leaves blood lipids where they were. A Cochrane review of 34 trials in 3230 people, each lasting at least 4 weeks and cutting about 4.4 g of salt a day, found total cholesterol changed by 1.9 mg/dL (95% CI −0.77 to 4.3; metric: 0.05 mmol/L, −0.02 to 0.11). LDL, HDL and triglycerides did not change significantly either.

Change after a very deep sodium cut, mg/dL

The two lipid changes that reached significance in the 2020 Cochrane review, where sodium was cut from about 200 to 65 mmol a day, mostly in short trials. LDL rose 2.46 mg/dL with an interval that crosses zero, and HDL did not change, so neither is drawn. Source: card ev-nachol-01 below.

What the trials found

The question has been asked from two directions, and the answers differ for a reason that is easy to name.

A Cochrane review led by Graudal, updated in 2020, pooled trials where sodium was cut from about 200 to 65 mmol a day. That is a far deeper cut than most diets reach. Total cholesterol rose 5.19 mg/dL (95% CI 2.1 to 8.3) across 27 trials in 917 people, and triglycerides rose 7.10 mg/dL (3.1 to 11.1). LDL tended up by 2.46 mg/dL with an interval from −1 to 5.9, and HDL did not move. The 2017 version of the same review put the cholesterol rise at 5.59 mg/dL, which it expressed as 2.9 percent, and the triglyceride rise at 7.04 mg/dL, or 6.3 percent. The hormone and lipid changes were similar in people with normal and with high blood pressure.

A second Cochrane team, led by He, kept only trials of modest reduction that lasted at least four weeks and found no lipid change at all. Its authors argue that the Graudal result comes from many very short trials with a very large change in salt intake. In their words, such studies are irrelevant to public health advice for a longer modest reduction.

Unsettled. Whether a very deep salt cut raises cholesterol slightly is the one live disagreement here. Both reviews are Cochrane reviews, and they differ because one counts short trials of large cuts and the other leaves them out. Neither suggests that eating more salt lowers cholesterol, and the review limited to the moderate, longer cuts people actually make found no rise.

Single trials point the same way as the longer reviews. In the DASH-Sodium feeding trial, 390 adults with blood pressure between 120 and 159 over 80 to 95 ate three sodium levels, 50, 100 and 150 mmol a day, for 30 days each. Within each diet, sodium did not significantly change total, LDL or HDL cholesterol or triglycerides. One secondary number moved: on a typical American diet, the ratio of total to HDL cholesterol rose 2 percent at lower sodium, from 4.53 to 4.63 (P=0.04). On the DASH diet it did not change. That is a single ratio with a borderline P value.

A 2019 meta-analysis of 21 trials of low-sodium salt substitutes found no significant difference in total cholesterol or triglycerides against ordinary salt. A 2025 umbrella review of 21 meta-analyses on salt and heart health found no adverse effect of lower sodium on lipid profiles, though its lipid estimate reuses the same 2013 trials. The US AHRQ review of 2018 reached the same conclusion from 3 trials, on what it called a low strength of evidence.

Myth. Salt is not a cholesterol food, and cutting it is not a way to bring cholesterol down. In the WHO-commissioned review the evidence for no effect on blood lipids was rated high quality by GRADE.

Who should be careful

Cutting salt has a measurable hormonal side. In the 2020 Graudal review, sodium reduction raised renin by 1.56 ng/mL/hour (95% CI 1.39 to 1.73) across 82 trials in 2904 people, and aldosterone by 104 pg/mL (88.4 to 119.7) across 66 trials. These are the body's expected responses to less sodium, and the two review teams disagree about whether they matter clinically.

People with chronic kidney disease were studied separately. A Cochrane review of salt restriction in kidney disease found no significant change in total cholesterol, −8.9 mg/dL (95% CI −22 to 3.9; metric: −0.23 mmol/L, −0.57 to 0.10), but that rests on 3 small studies in 105 people.

Not for everyone. Potassium salt substitutes are the usual way people cut sodium, and they are not for everyone. The WHO 2025 guideline that suggests them excludes people with kidney impairment and people whose potassium excretion may be compromised, for example those taking potassium-sparing diuretics or potassium supplements. If that is you, ask whoever treats you before switching.

What expert bodies say

The WHO 2012 sodium guideline reviewed lipid outcomes in trials lasting 1 to 2 months and found little or no adverse effect of reduced sodium on blood lipid concentrations. It recommends that adults eat less than 2 g of sodium a day, which is 5 g of salt. That target was set for blood pressure and cardiovascular risk, not for cholesterol. The AHRQ evidence review of 2018 concluded that sodium reduction does not appear to affect blood lipids, with low strength of evidence.

How we searched

Searched: a local copy of PubMed, across all study types, for sodium or salt with cholesterol, lipids, LDL or triglycerides (1431 records), for named forms of salt reduction with the same lipid terms (381 records). A search for sodium with lipids in DASH or crossover feeding trials returned 133 records and no further lipid-specific trial. We also searched agency reports from the WHO and AHRQ, Europe PMC, the open web for newer meta-analyses, the trial registry and the retraction database. Search run on 7 October 2026.

Included: three Cochrane reviews on sodium reduction and lipids, one on salt restriction in kidney disease, the WHO-commissioned meta-analysis, a meta-analysis of salt substitutes, a 2025 umbrella review, the DASH-Sodium lipid analysis, the AHRQ review and two WHO guidelines. None of the papers is retracted.

Excluded: two earlier versions of the Graudal review, superseded by the 2020 update. A DASH-Sodium paper on blood pressure only. Meta-analyses of the DASH diet as a whole, which change much more than sodium. Cohort studies of salt intake and cholesterol, because randomized trials answer this question directly.

What we read: the full text of the WHO-commissioned meta-analysis, sections of the AHRQ review and WHO guidelines, and abstracts for everything else.

What we could not get: full texts of the three Cochrane reviews on sodium and lipids. The DASH-Sodium lipid paper is not in PubMed Central, and we read its abstract through Europe PMC.

What would change this answer

A long trial of modest sodium reduction, six months or more, with LDL cholesterol as its main outcome. We found none registered. Every lipid number above comes from trials built to measure blood pressure.
A review that settles the Graudal and He disagreement by analyzing the same trials by duration and size of the sodium cut. If the small rise holds in longer trials, the deep cut would carry a small lipid cost.

More on salt itself, including the claims made for pink and sea salt: Salt.

The rest of the nutrient, in one place. Sodium: what lowering it actually does to blood pressure and to death rates → What it does, how much you need, who runs short, and what too much does, with the evidence level shown on every line.

The food behind this question

Pink salt, sea salt and the iodine you lose — numbers, evidence and safety

The full guide

The same question for other foods (cholesterol)

Sources

ev-nachol-01 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials, GRADE · n = 917
cholesterol increased 5.19 mg/dL (95%CI:2.1, 8.3) in 917 participants (27 trials); triglyceride increased 7.10 mg/dL (95%CI: 3.1,11.1) in 712 participants (20 trials); LDL tended to increase 2.46 mg/dl (95%CI: -1, 5.9) in 696 participants (18 trials); HDL was unchanged -0.3 mg/dl (95%CI: -1.66,1.05) in 738 participants (20 trials) (All high-quality evidence except the evidence for adrenalin).
Who: people randomized to low-sodium vs high-sodium diets; sodium cut from about 203 to 65 mmol/day in white participants
Effect: total cholesterol +5.19 mg/dL (95% CI 2.1 to 8.3), 27 trials; triglycerides +7.10 mg/dL (3.1 to 11.1), 20 trials; LDL +2.46 mg/dL (-1 to 5.9); HDL -0.3 mg/dL (-1.66 to 1.05); high-quality evidence
Certainty: Includes many very short trials with large sodium cuts (He 2013 criticism); the direction is salt reduction raising lipids slightly, not salt raising them.
Cochrane Database Syst Rev, 2020 · checked 2026-10-07 · we read the abstract
ev-nachol-02 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials · n = —
Renin increased 1.60 ng/mL/hour (55%); aldosterone increased 97.81 pg/mL (127%); adrenalin increased 7.55 pg/mL (14%); noradrenalin increased 63.56 pg/mL: (27%); cholesterol increased 5.59 mg/dL (2.9%); triglyceride increased 7.04 mg/dL (6.3%).
Who: people randomized to low-sodium vs high-sodium diets; average sodium 201 vs 66 mmol/day
Effect: cholesterol +5.59 mg/dL (2.9%); triglyceride +7.04 mg/dL (6.3%)
Certainty: Percent changes are small; sodium cut far deeper than most diets achieve.
Cochrane Database Syst Rev, 2017 · checked 2026-10-07 · we read the abstract
ev-nachol-03 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials, subgroup analysis · n = —
The effects on hormones and lipids were similar in people with normotension and hypertension.
Who: normotensive and hypertensive participants in low vs high sodium trials
Effect: lipid and hormone response similar in normotension and hypertension
Certainty: Subgroup comparison across trials.
Cochrane Database Syst Rev, 2017 · checked 2026-10-07 · we read the abstract
ev-nachol-04 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials · n = 3230
0.05 mmol/l (95% CI: -0.02 to 0.11, I (2)=0%) for cholesterol, 0.05 mmol/l (95% CI: -0.01 to 0.12, I (2)=0%) for LDL, -0.02 mmol/l (95% CI: -0.06 to 0.01, I (2)=16%) for HDL, and 0.04 mmol/l (95% CI: -0.02 to 0.09, I (2)=0%) for triglycerides.
Who: adults in randomized trials of modest salt reduction lasting at least 4 weeks; urinary sodium -75 mmol/24 h (about 4.4 g/day salt)
Effect: cholesterol +1.9 mg/dL (95% CI -0.77 to 4.3; metric: 0.05 mmol/L, -0.02 to 0.11); LDL +0.05 (-0.01 to 0.12); HDL -0.02 (-0.06 to 0.01); triglycerides +0.04 (-0.02 to 0.09)
Certainty: Not all 34 trials reported lipids; numbers of trials per lipid outcome not in the abstract.
Cochrane Database Syst Rev, 2013 · checked 2026-10-07 · we read the abstract
ev-nachol-05 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials · n = —
However, Graudal's meta-analysis included a large number of very short-term trials with a large change in salt intake, and such studies are irrelevant to the public health recommendations for a longer-term modest reduction in salt intake.
Who: trials pooled by Graudal vs trials of modest salt reduction for at least 4 weeks
Effect: disagreement between reviews explained by trial duration and size of sodium cut
Certainty: Methodological dispute between review teams; both reviews are Cochrane.
Cochrane Database Syst Rev, 2013 · checked 2026-10-07 · we read the abstract
ev-nachol-06 · Meta-analysis or systematic review · systematic review and meta-analysis of randomized controlled trials · n = 2339
In the meta-analyses of 11 studies (2339 participants) reporting changes in blood lipids, reduced sodium intake had no significant adverse effect on total cholesterol (mean difference 0.02 mmol/L, 95% confidence interval −0.03 to 0.07 mmol/L), low density lipoprotein cholesterol (0.03 mmol/L, −0.02 to 0.08 mmol/L), high density lipoprotein cholesterol (−0.01 mmol/L, −0.03 to 0.00 mmol/L), or triglyceride levels (0.04 mmol/L, −0.04 to 0.09 mmol/L, table 2).
Who: non-acutely ill adults in randomized controlled trials of reduced sodium intake
Effect: total cholesterol +0.77 mg/dL (95% CI -1.2 to 2.7; metric: 0.02 mmol/L, -0.03 to 0.07); LDL +0.03 (-0.02 to 0.08); HDL -0.01 (-0.03 to 0.00); triglycerides +0.04 (-0.04 to 0.09)
Certainty: Lipid trials lasted 1 to 2 months (WHO 2012 guideline text).
BMJ, 2013 · checked 2026-10-07 · we read the fulltext
ev-nachol-07 · Meta-analysis or systematic review · systematic review and meta-analysis of randomized controlled trials, GRADE · n = —
The evidence for no effect of reduced sodium intake on blood lipids, catecholamine levels, and renal function was also high quality.
Who: adults in randomized trials of reduced sodium intake
Effect: GRADE high quality for no effect on blood lipids
Certainty: GRADE rating by the review authors.
BMJ, 2013 · checked 2026-10-07 · we read the fulltext
ev-nachol-08 · Meta-analysis or systematic review · umbrella review of meta-analyses · n = —
No adverse effects on lipid profiles were observed.
Who: meta-analyses of randomized and observational studies of dietary salt, searched to August 2024
Effect: no adverse effects on lipid profiles; lower sodium linked to lower CVD mortality (RR 0.83, 0.73 to 0.95)
Certainty: Lipid estimate reuses the 2013 BMJ meta-analysis; no new lipid trials.
Ann Med, 2025 · checked 2026-10-07 · we read the abstract
ev-nachol-09 · Meta-analysis or systematic review · agency systematic review · n = —
Based on a low strength of evidence, sodium reduction does not appear to affect blood lipids (triglycerides, total cholesterol, low density lipoprotein [LDL] cholesterol, and HDL cholesterol; based on three RCTs); however, evidence is insufficient to draw a conclusion regarding the effects of sodium reduction on dizziness, headache, insulin sensitivity, and muscle cramping (based on one to two studies per outcome).
Who: adults in RCTs of sodium reduction, AHRQ comparative effectiveness review
Effect: no apparent effect on triglycerides, total cholesterol, LDL or HDL; low strength of evidence (3 RCTs)
Certainty: Agency systematic review (T2, level A by standard); only 3 RCTs met its stricter criteria.
AHRQ, 2018, Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks (Comparative Effectiveness Review 206) · checked 2026-10-07 · we read the section
ev-nachol-10 · Randomized controlled trial(s) · randomized controlled feeding trial with crossover of sodium levels · n = 390
Within each diet, sodium intake did not significantly affect serum total cholesterol, LDL cholesterol, HDL cholesterol, or triglycerides.
Who: adults aged 22 or older with blood pressure 120 to 159/80 to 95 mm Hg, fed control or DASH diet at 3 sodium levels for 30 days each
Effect: no significant effect of sodium on total, LDL, HDL cholesterol or triglycerides; no dose-response
Certainty: Controlled feeding, 30 days per level; outside the local corpus, abstract via Europe PMC.
Hypertension, 2004, 43(2):393-398 (Harsha et al.) · checked 2026-10-07 · we read the abstract
ev-nachol-11 · Randomized controlled trial(s) · randomized controlled feeding trial with crossover of sodium levels · n = 390
On the control diet, the ratio of total cholesterol-to-HDL cholesterol increased by 2% from 4.53 on higher sodium to 4.63 on lower sodium intake (P=0.04).
Who: adults with pre- or stage 1 hypertension on the control diet
Effect: TC/HDL ratio 4.53 (higher sodium) vs 4.63 (lower sodium), +2%, P=0.04; no change on DASH diet
Certainty: Single secondary ratio, borderline P value.
Hypertension, 2004, 43(2):393-398 (Harsha et al.) · checked 2026-10-07 · we read the abstract
ev-nachol-12 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials · n = 105
There was no significant change in total cholesterol in relation to salt restriction (3 studies, 105 participants: MD -0.23 mmol/L, 95% CI -0.57 to 0.10; I(2) = 0%) or symptomatic hypotension (2 studies, 72 participants: RR 6.60, 95% CI 0.77 to 56.55; I(2) = 0%).
Who: people with chronic kidney disease in randomized trials of altered salt intake
Effect: total cholesterol MD -8.9 mg/dL (95% CI -22 to 3.9; metric: -0.23 mmol/L, -0.57 to 0.10)
Certainty: Small and short studies (1 to 26 weeks).
Cochrane Database Syst Rev, 2015 · checked 2026-10-07 · we read the abstract
ev-nachol-13 · Meta-analysis or systematic review · systematic review and meta-analysis of randomized controlled trials, GRADE · n = —
Differences in detected hypertension, overall mortality, total cholesterol, triglycerides, glucose or BMI were not significant.
Who: adults in hypertensive, normotensive and mixed populations using low-sodium salt substitutes vs regular salt
Effect: total cholesterol and triglycerides: no significant difference; SBP -7.81 mm Hg
Certainty: Heterogeneous substitute formulations; low to very low quality.
Heart, 2019 · checked 2026-10-07 · we read the abstract
ev-nachol-14 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials · n = 2904
During sodium reduction renin increased 1.56 ng/mL/hour (95%CI:1.39, 1.73) in 2904 participants (82 trials); aldosterone increased 104 pg/mL (95%CI:88.4,119.7) in 2506 participants (66 trials)
Who: people randomized to low-sodium vs high-sodium diets
Effect: renin +1.56 ng/mL/h (1.39 to 1.73); aldosterone +104 pg/mL (88.4 to 119.7)
Certainty: Hormone changes are expected physiology; their clinical meaning is debated (He 2013 calls them small).
Cochrane Database Syst Rev, 2020 · checked 2026-10-07 · we read the abstract
ev-nachol-15 · Position of an expert body · WHO guideline (NUGAG, GRADE) · n = —
The results showed little or no adverse effect of reduced sodium on blood lipid concentrations.
Who: adults, WHO systematic review of RCTs lasting 1 to 2 months
Effect: little or no adverse effect on blood lipids
Certainty: Rests on the same trials as the 2013 BMJ meta-analysis.
WHO, 2012, Guideline: sodium intake for adults and children · checked 2026-10-07 · we read the section
ev-nachol-16 · Position of an expert body · WHO guideline (NUGAG, GRADE) · n = —
WHO recommends a reduction to <2 g/day sodium (5 g/day salt) in adults (strong recommendation).
Who: adults
Effect: <2 g/day sodium (5 g/day salt), strong recommendation
Certainty: Set for blood pressure and cardiovascular risk, not for cholesterol.
WHO, 2012, Guideline: sodium intake for adults and children · checked 2026-10-07 · we read the section
ev-nachol-17 · Position of an expert body · WHO guideline (GRADE) · n = —
The recommendation in this guideline is intended for adults in the general population and excludes individuals with kidney impairments or with other circumstances or conditions that might compromise potassium excretion (e.g. those taking potassium-sparing diuretics and potassium supplements).
Who: adults in the general population; excludes kidney impairment, potassium-sparing diuretics, potassium supplements
Effect: conditional recommendation for lower-sodium salt substitutes, with exclusions
Certainty: Relevant to people with high cholesterol who also take heart or kidney medicines.
WHO, 2025, Use of lower-sodium salt substitutes: WHO guideline summary · checked 2026-10-07 · we read the section

How this page was made. Evidence was extracted from primary sources into cards, every number was re-checked against the source, and the text was written from those cards. Bioma Learn has no human medical reviewer at this time, and we say so rather than invent one. Methodology. This is information, not medical advice.