Is it safe to increase salt intake on a ketogenic diet?

Dr. Stephen Phinney and the Virta Team

In the setting of a well formulated ketogenic diet, a modest increase in salt intake is safe, and does not raise blood pressure (Hallberg 2018). The only exception to this is for people taking medication for high blood pressure.

Interestingly, a large multi-national analysis in the New England Journal of Medicine showed the lowest overall mortality in people with salt intakes of 4-5 grams per day, which is above current guidelines (O’Donnell, 2014). Another recent study showed higher mortality and hospital readmission rates in patients with congestive heart failure who severely restricted their salt intake (Mente, 2016).

Learn more about sodium in our blog post.

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  1. Hallberg SJ, McKenzie AL, Williams PT, Bhanpuri NH, Peters AL, Campbell WW, Hazbun TL, Volk BM, McCarter JP, Phinney SD, Volek JS.  Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther. 2018 Apr;9(2):583-612.
  2. O'Donnell, Martin, Andrew Mente, Sumathy Rangarajan, Matthew J McQueen, Xingyu Wang, Lisheng Liu, Hou Yan, et al. “Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events..” The New England Journal of Medicine 371, no. 7 (August 14, 2014): 612–23. doi:10.1056/NEJMoa1311889.
  3. Mente, Andrew, Martin O'Donnell, Sumathy Rangarajan, Gilles Dagenais, Scott Lear, Matthew McQueen, Rafael Diaz, et al. “Associations of Urinary Sodium Excretion with Cardiovascular Events in Individuals with and Without Hypertension: a Pooled Analysis of Data From Four Studies..” Lancet (London, England) 388, no. 10043 (May 20, 2016): 465–75. doi:10.1016/S0140-6736(16)30467-6.