Reduce Dietary Salt and Sodium for Good Health

Sodium, a component of table salt, is one of the most important minerals in the body. Regulating the amount of sodium in the body is absolutely critical to life and health. Research indicates that between 20% and 40% of an adult’s resting energy goes toward regulating sodium. A major failure of sodium regulatory mechanisms would lead to cell death in the body.

Essential in small amounts, sodium exists as the ion Na+, affects every cell in the body, is carefully controlled by the kidneys, endocrine glands, and brain, and plays a major role in regulating and maintaining:

• The proper balance of fluid in and around cells of the body (Potassium is also essential for this regulation)
• Blood pressure and blood volume
• An electrical gradient that allows transmission of nerve impulses (nerve function)
• The contraction and relaxation of muscles, and therefore muscle strength
• Waste removal from cells
• The acidity (pH) of the blood

A system of checks and balances exists to control sodium levels in the bloodstream and cellular fluid for optimal health, regardless of sodium intake. When sodium levels are low, or the mineral is in short supply, the kidneys and sweat glands retain water, preventing sodium from leaving the body in the urine. When sodium levels are high, the kidneys excrete the excess sodium by making more urine. Drinking plenty of water actually helps the kidneys to flush excess sodium out.

However, if your kidneys cannot eliminate enough sodium, the sodium starts to accumulate in the blood. Because sodium attracts and holds water, your blood volume increases. Increased blood volume makes your heart work harder to move more blood through your blood vessels, which increases pressure in your arteries. Diseases such as congestive heart failure, cirrhosis, and chronic kidney disease can reduce your kidneys’ ability to keep sodium levels balanced.

Some people are more sensitive to the effects of sodium than others. Individuals most likely to see a rise in blood pressure with increased sodium intake include those who are obese, elderly, female, African American, or have type 2 diabetes. If you are sodium sensitive, you retain sodium more easily, leading to fluid retention and increased blood pressure. If chronic, such a sensitivity can lead to heart disease, stroke, kidney disease, and congestive heart failure.

Sodium is acquired through the diet, mainly in the form of salt (sodium chloride, NaCl). Unfortunately, most of us get too much. Since the 1970’s, there has been a 55% increase in the average sodium intake! U.S. guidelines call for less than 2,300 milligrams (mg.) of sodium per day — about 1 teaspoon of table salt. Approximately half of Americans should drop to 1,500 mg. a day for health reasons. However, greater than 85% of Americans are consuming over 2300 mg. of sodium each day, according to the 2010 Dietary Guidelines for Americans (DGA) (11). Surprisingly, most of our salt intake is hidden in the foods we buy at the grocery store.

Many people think that the main source of salt in their diet is what they add to food when they are cooking or at the table while eating. In reality, more than 75% of the sodium in the average American’s diet is added to food during processing. Another 12% is already naturally in the food. For example, 1 cup of low-fat milk contains 110 mg. of sodium. About 6% of sodium in the diet is added as salt during cooking and another 5% from salting food while eating (Diet.com).

Many Americans have acquired a taste for a high salt diet. One way to cut back on sodium is to avoid table salt. However, most sodium in the diet comes from packaged, processed, and restaurant foods. Eating these foods less often can reduce your intake of sodium and can help lower your blood pressure or prevent high blood pressure from developing in the first place.

 

Salt Facts:

• More than 90% of sodium occurs as salt (sodium chloride, NaCl).
• Sodium chloride, or table salt, is approximately 40% sodium.
• More than 75% of salt intake is derived from processed foods, just under 15% from natural sources, about 10% is added during cooking or when eating, and 1% comes from tap water.
• Cereal products including breakfast cereals, bread, cakes, and biscuits provide about a third of the salt in our diet.
• Meat and meat products provide just over a quarter of the salt in our diet.
• In addition to sodium chloride, there is a wide variety of other forms of sodium in our diet, many of which are used as additives in food processing, usually to add flavor, texture, or as a preservative. For example, monosodium  glutamate is commonly used as a flavor enhancer.
• Sodium and chloride levels are comparatively low in all foods which have not been processed. Since most foods in their natural state contain sodium, you need to be aware of both natural and added sodium content when you  choose foods to lower your sodium intake. But most sodium in our diet is added to food while it is being commercially processed or prepared at home.
• A diet high in sodium contributes to the development of high blood pressure (hypertension) and subsequent cardiovascular disease, thus increasing the risk of blood vessel stiffening (atherosclerosis), heart attack, heart failure, or stroke. Damage to the heart, aorta, and kidneys can occur, even in the absence of high blood pressure.
• A diet high in sodium contributes to the bone-thinning disease, “osteoporosis.” The more salt you ingest, the more calcium is flushed out in the urine. If your diet is deficient in calcium, the calcium can be leached out of your bones. However, reducing salt intake causes a positive calcium balance, thus enabling calcium to remain in the bones (16).
• The words “hypersalinity,” “salad,” “salami,” “salary,” “salina,” “saline,” “salsa,” “sauce,” and “sausage” were all derived from the word “salt.”

 

Sodium and health:

In some people, sodium increases blood pressure because it holds excess fluid in the body, placing an added burden on the heart. If your blood pressure is 120/80 Hg or above, your doctor may recommend a low-salt diet or advise you to avoid salt altogether.

Too high a concentration of sodium in the blood causes a condition called “hypernatremia.” Excess sodium in the diet almost never causes hypernatremia. Causes of this condition would include excessive water loss from severe diarrhea, restricted water intake, untreated diabetes which contributes to water loss, kidney disease, and hormonal imbalances. Symptoms of dehydration include extreme thirst, dark urine, sunken eyes, fatigue, irregular heart beat, muscle twitching, seizures, and coma.

Hypernatremia and hyponatremia are at the extreme ends of sodium imbalance.

Research shows that high dietary intake of salt and other sodium-containing products can definitely contribute to the development of high blood pressure (hypertension) as one ages. Chronic hypertension often does not exhibit serious complications until the second half of an individual’s lifetime. Over time, hypertension silently damages the heart, blood vessels, and kidneys, increasing the risk of a heart attack, stroke, and permanent kidney damage.

A low sodium diet is often recommended for those trying to prevent or reduce the risk of high blood pressure, such as diabetics or individuals with heart or kidney disease. Low sodium diets tend to have fewer processed foods and more fruits, vegetables, whole grains, legumes including unsalted beans, nuts and seeds, fish and other lean sources of protein, and nonfat or low-fat dairy foods, which offer numerous health benefits. Such diets can significantly lower blood pressure in 30-60% of people with high blood pressure and a quarter to half of people with normal blood pressure.

 

Medications may influence sodium levels in the body:

Certain drugs cause large amounts of sodium to be removed from the body by the kidneys and excreted through the urine. Diuretics (‘‘water pills’’) are among the best known of these drugs. Other types of drugs that may cause low sodium levels, especially in ill individuals, include non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil, Motrin, and Aleve, opiates such as codeine and morphine, selective serotonin-reuptake inhibitors (SSRIs) such as Prozac or Paxil, and tricyclic antidepressants such as Elavil and Tofranil.

 

What are the current recommendations of the American Heart Association (AHA) and 2010 Dietary Guidelines for Americans (DGA), released January 31, 2011, regarding sodium intake? (1, 2, 8, 9, 10, 11, 13, 25, 26):

The United States Department of Agriculture (U.S.D.A.) and the Department of Health and Human Services recommend that sodium intake be less than 2,300 milligrams (about 1 teaspoon) per day for healthy individuals, and less than 1,500 milligrams a day for anyone:

• Age 51 or older, since this group has a very high percentage of hypertension and pre-hypertension
• With high blood pressure, diabetes, or chronic kidney disease
• At high risk for these diseases
• All African Americans, since they tend to have a greater sensitivity to dietary sodium

The recommendations include all sources of sodium, i.e., salt naturally found in food, added during processing, preparation, and before eating.

The AHA states that the current DGA limit of 2300 mg. of sodium per day is too high for most Americans. According to the AHA, more than 68% of the American population fit the categories requiring less than 1500 mg. per day. Nearly 34% of American adults have hypertension (high blood pressure) and 36% have pre-hypertension (blood pressure levels above normal). Therefore, the AHA recommends that the daily intake for all Americans should be limited to 1500 mg. or less, in order to reduce the risk of hypertension and subsequent cardiovascular disease which kills more Americans than any other condition.

Two of the dietary factors that are most linked to high blood pressure are excessive sodium intake and insufficient potassium intake. Consequently, some of the key recommendations of the AHA and DGA are to limit sodium and increase consumption of a more heart-healthy, nutrient-rich diet of fruits and vegetables, dried beans, nuts and seeds, low-fat or non-fat milk and yogurt, unrefined whole grains, fish, and healthy fats.

Keep in mind that the recommended sodium intakes are upper limits. Less is usually best, especially if you are sensitive to the effects of sodium and trying to control your blood pressure. If you are not sure how much sodium your diet should include, talk to your doctor.

 

Why is sodium added to food?

Salt (sodium chloride) serves a number of purposes. This white crystal has been used as a preservative for meats and vegetables and flavoring agent for centuries. It helps prevent spoiling by inhibiting the growth of bacteria, yeast, and mold. Salt also enhances flavor in food. For example, it accentuates sweetness in cakes and cookies and helps disguise metallic or chemical aftertastes in products such as soft drinks. Additionally, salt is used as a color developer, binder, texturizer, and fermentation control agent, e.g., in bread baking. For these reasons, salt is added to foods such as ham, sausage, bacon and other meat products, smoked fish and meats, canned vegetables, butter, margarine and spreads, cheese, bread, sauces, condiments, pasta sauces, soups, savory snack foods, salad dressings, and breakfast cereals. Salt also reduces the perception of dryness in foods such as crackers and pretzels (21). However, many food and nutrition experts agree that processed foods need not contain the high levels of salt they currently do.

 

Primary dietary sources of sodium (10,11): According to Xavier Pi-Sunyer, MD, MPH, a member of the 2010 and 2005 Dietary Guidelines Advisory Committee (DGAC), Professor of Medicine at Columbia University College of Physicians and Surgeons, and Chief of the Division of Endocrinology, Diabetes, and Nutrition at St. Lukes-Roosevelt Hospital Center in New York City, Americans today consume an average of  3,400 mg of sodium a day — much more than recommended (11). The most common dietary sources of sodium include:

• Processed, packaged, and prepared foods: The vast majority of sodium in the typical American diet, approximately 75%, comes from processed foods that are sold packaged or prepared at supermarkets and other stores (16, 21). These foods are typically high in salt, which is a combination of sodium and chloride, and in additives that contain sodium. Processed foods include baked goods, bread, prepared meals, “TV” dinners, meat and egg dishes, pizza, bacon, cold cuts, cheese, soups, and fast foods (Additional food items listed below).

• Natural sources: Some foods naturally contain sodium. These include all vegetables and dairy products such as milk, meat, and shellfish. While they do not have an abundance of sodium, eating these foods does add to your overall sodium intake. For example, 1 cup (237 milliliters) of low-fat milk has about 107 mg of sodium.

• In the kitchen and at the table: Most of the sodium that Americans consume doesn’t really come from salt added during cooking or at the table. However, many recipes call for salt, and some people salt their food at the table. Condiments may also contain sodium.

 

Sodium content in some unprocessed foods (16):

Fresh foods higher in sodium:

Milk, 120 mg. per cup

Scallops, 260 mg. per 3 oz.

Fresh meats: about 30-70 mg. per 3 oz. (Chicken, beef, fish, lamb, pork)

Fresh vegetables: about 30-50 mg. per 1/2 cup (Celery, Chinese cabbage, sweet potatoes)

Fresh vegetables: about 10-20 mg. per 1/2 cup (Broccoli, brussels sprouts, carrots, corn, green beans, legumes, potatoes, salad greens)

Grains: (cooked without salt), about 0-10 mg. per 1/2 cup (Barley, oatmeal, pasta, rice)

 

The top 10 individual food sources of sodium in the American diet according to the National Health and Nutrition Examination Surveys which evaluated the combination of each item’s sodium content and frequency of consumption (5, 18):

1. Meat pizza
2. White bread
3. Processed cheese
4. Hot dogs
5. Spaghetti with sauce
6. Ham
7. Catsup
8. Cooked rice
9. White rolls
10. Flour tortillas

 

Sodium content in some common seasonings, sauces, salad dressings, and processed foods (8, 16):

• Salts, 1 tsp: 2,000-2,300 mg (Table salt, sea salt, seasoned salt, onion salt, garlic salt): Herb seasoning blends may contain different sodium concentrations, so read labels.

• Baking powder, 1 tsp: 339 mg.

• Chili powder, 1 tsp: 26 mg.

• Garlic salt, 1 tsp: 2,050 mg.

• Onion salt, 1 tsp: 1620 mg.

• Horseradish, 1 tbsp: 165 mg.

• Meat tenderizer, 1 tsp: 1680 mg.

• Mustard, prepared Dijon, 1 tsp: 126 mg.

• Green olives, 4: 323 mg.

• Dill pickle, large: 1731 mg

• Chili sauce, 1 tbsp: 227 mg.

• Ketchup, 1 tbsp: 168 mg.

• Soy sauce, 1 teaspoon: 304 mg. (1 tbsp: 1029 mg.)

• Tabasco, 1 tsp: 66 mg.

• Worcestershire, 1 tbsp: 147 mg.

• French dressing, 1 tbsp: 214

• Mayonnaise, 1 tbsp: 78 mg.

• Thousand Island, 1 tbsp: 109 mg.

• Canned chicken noodle soup, 1 cup: 850-1,100 mg

• Canned pasta, about 800-1,000 per serving (Beefaroni, macaroni and cheese, ravioli)

• Canned vegetables, about 200-450 mg. per 1/2 cup (Carrots, corn, green beans, legumes, peas, potatoes)

• Ham, 3 ounces: 1,000 mg

• Foods prepared in brine, about 300-800 mg. per serving (2 fillets anchovies, 1 dill pickle, 5 olives, 1/2 cup sauerkraut)

• Sauerkraut, 1/2 cup: 780 mg

• Processed cheeses, about 550 mg. per 1 1/2 oz. (American, Cheddar, Swiss)

• Instant puddings, about 420 mg. per 1/2 cup (All flavors)

• Pretzels, 1 ounce: 500 mg

• Potato chips, 1 ounce: 165-185 mg

• Deli turkey breast, 1 ounce: 335 mg

• Hot dogs, about 500-700 mg. per 2 oz. (Hot dogs, smoked sausages)

• Smoked and cured meats, about 700-2,000 mg. per 2 oz. (Canned ham products, corned or chipped beef, ham, lunchmeats)

• Fast foods and TV dinners, about 700-1,500 mg. per serving [Breakfast biscuit (cheese, egg, and ham), cheeseburger, 10 spicy chicken wings, frozen TV dinners, 2 slices pizza, taco, vegetarian soy burger on bun]

• Dry soup mixes (prepared), about 1,000-2,000 mg. per 1 cup (Bouillon cube or canned, noodle soups, onion soup, ramen)

• Cereals, dry ready-to-eat, about 180-260 mg. per 1 oz. (Cheerios, cornflakes, corn bran, Cocoa Puffs, Total, others)

 

“Hidden” sources of sodium in the diet: Although most sodium in food comes from salt, other sources of sodium include preservatives and flavor enhancers added during processing. Sodium content is required to be listed on food labels of processed foods.

• Natural foods: Most foods such as vegetables, meat, shellfish, and dairy products including milk, contain low amounts of sodium in their natural state. Some natural foods such as cheeses, seafood, olives, and legumes may have a higher-than-expected sodium content.

• Drinking water derived from a home water softening system: However, softened water which has passed through a reverse-osmosis filtration system generally has negligible sodium levels.

• Processed foods such as canned, frozen and prepared foods: Approximately 75-77% of sodium in the American diet comes from prepared or processed foods and cold cuts like bread, bagels, crackers, cheese, cold cuts, bacon, hotdogs, pasta, pizza, potato chips, pretzels, tomato sauce, soups, condiments, canned foods, prepared mixes, “fast foods,” ready-to-eat meals and prepared frozen foods. When buying prepared and prepackaged foods, read the labels. Many different sodium compounds are added to foods. These are listed on food labels. Watch for the words “soda” and “sodium” and the symbol “Na” on labels; these words show that sodium compounds are present. The American Heart Association (AHA) is working with federal agencies to determine how to reduce the amount of sodium in the food supply and is also encouraging food manufacturers and restaurants to reduce sodium in foods by 50% over a 10-year period.

• Additives and Condiments: Capers, ketchup, mustard, relish, dips, salad dressings, barbecue and other sauces, seasoning mixtures and packets, soy sauce (Choose low-sodium soy sauce when available).

• Baked goods prepared from mixes or sold commercially: White bread, rolls, flour tortillas

• Flavored soda beverages: Cherry soda, Coca Cola, Pepsi, Ginger Ale, Seven-Up, Mountain Dew, Root Beer, etc., contain sodium benzoate as a preservative. Avoid mixing soda containing sodium benzoate with juices or juice drinks containing ascorbic acid (vitamin C), since the combination can cause benzoate to chemically change to benzene, and increase the risk of cancer or leukemia.

• Table salt (sodium chloride): Used in cooking, seasoning at the table, canning and preserving.

• Salted butter, dips, spreads

• Frozen dinners

• Ready-to-eat cereal

• Vegetable juices: Choose low-sodium varieties when available

• Canned vegetables and legumes: Choose sodium-free varieties when available. Dry beans are virtually sodium-free.

• Cured meats

• Packaged deli meats

• Commercially-prepared soups

• Marinades and flavorings

• Restaurant meals, including baked goods, casseroles, dressings, entrees, marinades, sauces, soups: Fish, steamed vegetables, and salad with olive oil and vinegar or dressing on the side tend to be lower-sodium choices at a restaurant. Request that salt be omitted from whatever you do order, though. Low-sodium dessert options include fruit, ice cream, sherbet, or angel food cake.

• Salted nuts: Choose plain, unsalted nuts

• Seasoning  and spice mixtures and packets

• Snack foods: Cheese puffs, flavored popcorn, potato chips, pretzels, tortilla chips, etc.

• Some over-the-counter drugs: Some over-the-counter medications contain high levels of sodium. Carefully read the label before buying an over-the-counter drug. Look at the ingredients list and warning statements to see if sodium is mentioned. A statement of sodium content must appear on labels of antacids containing 5 mg. or more per dosage unit (table- or teaspoon). Some companies produce low-sodium, over-the-counter products. If in doubt, ask a healthcare professional.

• Some prescription medications: Some headache or heartburn medicines contain sodium carbonate or bicarbonate. Read the ingredient list and warning statement to be sure. Consumers can’t tell by looking at a bottle whether a prescription drug contains sodium. If you have high blood pressure, ask your physician or pharmacist about the sodium content of prescription medications. Regardless, never stop taking your prescribed medication without first checking with your doctor.

• Baking soda (sodium bicarbonate): Sometimes used to leaven breads and cakes; sometimes added to vegetables in cooking; used as alkalizer for indigestion. (1 teaspoon of baking soda = 1,000 mg. sodium)

• Baking powder: Used to leaven quick breads and cakes.

• Disodium phosphate: An emulsifier to prevent oil from separating from the the rest of the mixture, leavening and texture-modifying agent used to change the appearance or feel of food and increase the shelf life of food. Found in some quick-cooking cereals and processed cheeses.

• Monosodium glutamate (MSG): Flavor enhancer

• Na: Chemical abbreviation for sodium

• NaCl : Chemical abbreviation for sodium chloride (table salt)

• Sodium alginate: A flavorless gum used to increase viscosity, produce a gel-like consistency, and as an emulsifier. Used in many chocolate milks and ice creams to make a smooth mixture.

• Sodium ascorbate: Vitamin C

• Sodium benzoate: A preservative in many condiments such as relishes, sauces and salad dressings, as well as in numerous soda beverages.

• Sodium bicarbonate (baking soda): Leavening agent (See “Baking soda” above)

• Sodium caseinate

• Sodium chloride: Table salt

• Sodium citrate: Acidity controller

• Sodium hydroxide: Used in food processing to soften and loosen skins of ripe olives and certain fruits and vegetables.

• Sodium nitrate or nitrite: Meat-curing agent in bacon, ham, salami, sausages, etc.

• Sodium propionate: Mold inhibitor used in pasteurized cheese, some breads, and cakes.

• Sodium saccharin

• Sodium stearoyl lactate (SSL): A dough conditioner, emulsifier, foaming agent, stabilizer, shelf-life enhancer, fat and sugar replacer (due to it’s mildly sweet taste). SSL is often used in baked goods, bread, salad dressings, sour cream, cheese products, crackers, cookies, and puddings.

• Sodium sulfite: Used to bleach certain fruits such as maraschino cherries and glazed or crystallized fruits that are to be artificially colored; also used as a preservative in some dried fruits such as apricots, prunes, etc..

• Soy sauce

• Trisodium phosphate

 

Salt vs. Sodium Equivalents: Sodium chloride, or table salt, is approximately 40% sodium. Note how much sodium is in salt so you can better control your intake:

1/4 teaspoon salt = 600 mg sodium

1/2 teaspoon salt = 1,200 mg sodium

3/4 teaspoon salt = 1,800 mg sodium

1 teaspoon salt = 2,300 mg sodium

 

Food labels defining sodium concentration ( 10, 18, 19):

• “Sodium-free” or “salt-free”: Less than 5 mg. of sodium per serving

• “Very low sodium”: 35 mg. or less of sodium per serving

• “Low sodium”: 140 mg. or less of sodium per serving

• “Low-sodium meal”: 140 mg. or less of sodium per 3 1/2 oz. (100 g.) serving

• “Reduced or less sodium”: At least 25% less sodium than the regular version

• “Lite sodium”: 50% less sodium than the regular version

• “Unsalted,” “no salt added,” and “without added salt”: No salt added to the product during processing. Note that the “unsalted” product still contains whatever sodium is a natural part of the food.

 

Determine your approximate daily salt intake: When reading a nutrition label while shopping for groceries, the term you should look for is not “salt,” but “sodium.” Keep a daily tally of the foods you eat and drink, as well as the number of servings. Then calculate how much sodium is in each. The average American takes in 3,400 milligrams of sodium each day, well above the limits recommended for good health.

 

Some tips to reduce your sodium intake (17):

• Choose foods as close to the way they grow in nature as possible, i.e., fresh, unprocessed, and minimally prepared: About 75% of our sodium intake comes from hidden sources in the American diet, including packaged, processed, prepared, and restaurant foods (27). Processing often leads to a loss of nutrients and other benefits of whole or semi-intact foods. Processed, cured meats typically have much more sodium than fresh meats. Canned vegetables and beans usually contain more sodium than fresh vegetables and dried beans. Therefore, choose fresh or unprocessed foods as often as possible, so you can reduce your sodium intake, increase your nutrient intake, and promote good health.
• Canned, boxed, frozen, and prepared foods can be high in sodium: Check the label for sodium amounts and choose foods that have less than 300 milligrams per serving. But pay attention to serving sizes, as they are often unrealistically small. Look for no more than one milligram of sodium per one calorie of food. Be aware that some foods that are high in sodium do not list “salt” in the ingredients. That’s because there are other forms of sodium used in food processing, and these all contribute to the total amount of sodium listed in the Nutrition Facts. Examples of these ingredients include monosodium glutamate, sodium citrate, sodium bicarbonate, and sodium alginate.
• Drain and rinse canned foods, like beans and fish, to reduce the amount of sodium per serving.
• Eat more fresh fruits and vegetables: These are naturally low in sodium, and many are excellent sources of potassium. Our bodies need more potassium than sodium, but most Americans’ diets provide just the opposite, which can contribute to high blood pressure. Fill at least half of your plate with fruits and vegetables. If you think you won’t like lower sodium foods, try biting into a crunchy apple or pear, juicy orange, or sweet strawberry!
• Always read the Nutrition Facts label to see how much sodium is in packaged foods: Salt lurks where you least expect it! Reading labels helps you to find hidden sources of sodium. Note the serving size, and be aware that some products, e.g., seasonings, may use grams instead of milligrams to describe the sodium content to make it seem lower than it really is. Check the ingredients for sources of sodium, and choose foods labeled “low sodium” or “no salt added.”
• Buy plain, unsalted, frozen vegetables, instead of canned ones, when fresh vegetables are not available: Frozen vegetables are convenient, often as nutritious as fresh vegetables, and generally more nutritious and much lower in sodium than canned versions.
• Avoid adding salt to your food: Hide the salt shaker in the cabinet. Make it available “upon request only” or when you have guests.
• Always “wait and taste” before you do salt: When preparing food, add salt late in the cooking process. Foods release their flavors (and salt, in the case of salted ingredients) during the cooking process. Cooks tend to over-salt if “tasting” is undertaken too early.
• Buy unsalted or low-sodium versions of foods: Convenience foods like broth, canned beans, nuts, tomatoes, and other vegetables often come in low-sodium or salt-free versions. Avoid high-salt canned soups; choose heart-healthy, low-salt soups instead.
• Use healthy fats and oils, like extra virgin olive oil, canola oil, natural almond or peanut butter, roasted nuts and seeds by themselves or ground up with spices, avocados, as well as red wine vinegar or balsamic vinegar, in place of commercially-produced salad dressings, to enhance the flavor of your food: These all contribute their own flavors and can make up for any flavor loss from using less salt. Commercially-prepared salad dressings usually contain high sodium levels per serving. Unfortunately, the big low-fat and no-fat product push in the 1990’s wasn’t rooted in sound science. Many well-meaning product developers cut both good and bad fats out of formulations, and in order to maintain consumer acceptance of their products, they were forced to increase levels of sugar and sodium. Skip most fat-free salad dressings and other similar products.
• Prepare foods with fresh or dried herbs and sodium-free spices such as basil, bay leaves, chili peppers, chili powder, cinnamon, cumin, curry, dill, garlic, ginger, mint, oregano, black pepper, rosemary, thyme, lemon or other citrus juice, vinegar, or wine: Mediterranean, Indian, Thai, and North African cuisine often use a variety of healthful herbs, nuts, roots, and spices, to create wonderful flavors with very little or no salt.
• Reduce your portion size of foods you suspect of being salty or unhealthy: Sometimes the “richer” a meal seems, the more calories and sodium it has. Share a meal when dining out, or order from the children’s menu for smaller portions. You’ll trim your salt intake, as well as your waist.
• Don’t rely on your taste buds: Just because a food doesn’t taste salty, doesn’t mean it is low in sodium per serving. Just because a food tastes salty, doesn’t mean it contains a lot of sodium. For example, some types of chips that taste salty have less salt than a slice of bread that has the salt baked in. Read the label and note the serving size.
• Say no to the salt shaker: When dining out, ask that your food be made without salt. Avoid adding salt when you get your dish.
• Reduce your intake of cheeses, especially processed types.
• Reduce your intake of cold cuts, cured meats, and other processed, high-sodium foods such as bacon, deli meats, pepperoni, sausage, soy sauce, hot dogs, olives, and pickled foods.
• Increase your intake of potassium: Potassium can help lower blood pressure, so add more fruits and vegetables, low-fat dairy, and unsalted beans to your diet.
• Eat everything in moderation. The new guidelines don’t require you to give up your favorite foods. Everyone needs some sodium to maintain fluid balance and transmit nerve impulses in the body. However, watch your portion sizes and focus more on eating a variety of nutritious foods.
• Look for processed foods that say ‘‘no salt added.’’
• Limit or eliminate salty snacks such as chips, crackers, pretzels, and flavored or seasoned nuts.
• Use condiments in moderation: Certain condiments, such as soy sauce, ketchup, and BBQ sauces are very high in sodium. Pickles, capers, cured meats, grated aged cheeses, mustard, catsup, soy sauce, hot sauce, smoked fish, and other condiments and specialty foods all bring added satisfaction to the table. There is no need to give up condiments, which in many cases represent culinary traditions that are centuries old. In some cases, reduced sodium versions of these are now available;
• Switch ingrediants: Use plain non-fat or low-fat Greek yogurt in place of commercially-prepared sour cream or mayonnaise. Try making your own mayonnaise by whipping together cooked eggs, lemon juice, a little dry mustard, or garlic, for extra flavor. Salsa is another condiment that can be made easily without salt, from garden fresh ingredients, and can be made ahead.
• “Fresh” and “natural” meats and poultry may be injected with salt solutions as part of their processing, and manufacturers are not required to list the sodium content on the label. The best way to find out whether your favorite brand has been treated with a salt solution is to ask the grocer or butcher, or to call the toll-free consumer hotline on the product’s label.
• Note that some foods that are high in sodium may not taste especially salty, such as breakfast cereals, baked goods like muffins, energy drinks, sodas, and sports drinks.Baked goods are often remarkably high in sodium – baking soda is a salt!
• Use soy sauce sparingly: one teaspoon contains about 0.36gof sodium (equivalent to 0.9g salt). Reduced sodium soy sauces are available in many markets.
• Switch sides: Certain condiments, such as soy sauce, ketchup, and BBQ sauces are very high in sodium. Try making your own mayo for a picnic potato salad. It is quite easy and quick if you do it while the eggs are cooking. Add a little dry mustard or garlic for extra zip! Salsa is another condiment that can be made easily from garden fresh ingredients and can be made ahead.
• Buy fresh or frozen vegetables, or those canned without salt
• When making soup, dilute reduced sodium chicken broth with water or wine instead of using it full strength, and add vegetables and herbs for extra flavor.
• Choose nutritious, high fiber breakfast cereals that are low in sodium or have no salt.
• Shop the perimeter of the supermarket: Fresh foods like fruits, vegetables, fish, lean meats, and dairy are naturally lower in sodium. A diet that focuses on these foods has been clinically proven to lower high blood pressure more than just sodium restriction alone (25).
• Since sodium levels vary widely for the same or similar grocery items, compare brands of processed food, including breads, cured meats, cheeses, snack foods, and other foods, choosing those with the lowest levels of sodium that still taste good: There is much variation from brand to brand. Some food manufacturers have already reduced sodium levels in their products, and others never added as much sodium in the first place.
• Substitute whole grains for bread: Bread is one of the largest contributors of sodium to our diets, because we eat so much of it. Even whole grain bread, while a healthier choice than white, can contain considerable sodium. While some sodium in bread is for taste, much of it is used to help the bread-making process and preserve the final results. You can avoid extra salt when you prepare whole grains by themselves with water or low-sodium chicken or vegetable broth. Enjoy a Mediterranean-inspired whole grain salad with chopped vegetables, nuts, legumes, herbs and spices, a small amount of cheese, and extra virgin olive oil, vinegar, or citrus (e.g.,lemon) juice. Many of the same flavors you love in a sandwich can therefore be offered in a delicious new form with much less sodium. For any meal, cook steel cut oats, farro, quinoa, wheatberries, or other intact whole grains with fresh or dried fruit, and skip the toast and the extra sodium.
• Salt is an acquired taste: Your family can learn to enjoy foods with less salt. One key to success: Make the changes gradually and consistently over a period of time, rather than trying to cut back by a large amount all at once (unless of course you find that an immediate 25 percent reduction in sodium doesn’t undermine your enjoyment of a particular food). Try this trick: Combine a reduced sodium version of a favorite product (e.g., vegetable soup) with a regular version in proportions that gradually favor the reduced sodium version. As time goes on, you won’t miss the salt.
• Parents should set a good example and provide fresh or frozen fruits and vegetables, raisins, plain nuts and seeds, low-fat dairy products like kefir and yogurt, and other heart-healthy, nutritious, low sodium foods and snacks to their children, rather than less nutritious, salty, snack foods.
• If you cannot eliminate salt from a recipe, gradually reduce it in your favorite recipes: For many foods and preparations, the average person cannot detect moderate to substantial differences in sodium levels, including reductions of up to as much as 25 percent.
• Avoid “double salting” your foods when cooking, and look for ways to pair salted flavors with unsalted or under-salted foods, especially fresh produce: If you are adding a little cheese to your salad, you don’t need much or any salt in your dressing. If you are adding a ham bone to a soup pot, lighten up on the sodium for the rest of the soup. In a sandwich, try adding sliced cucumber instead of pickles. A pot of brown rice or whole grain pasta doesn’t need to be salted if you are serving it with other adequately seasoned items or sauces. A seasoned crust or condiment may reduce the need for salting the rest of a dish.
• Use simple cooking techniques which enable you to avoid or reduce the use of salt, like broiling, poaching, roasting, searing, sauteing, steaming: Searing and sautéing foods in a pan builds flavor. Roasting brings out the natural sweetness of many vegetables and the savoriness of fish and chicken. Steaming and microwaving tend to dilute flavors; perk up steamed dishes with a finishing drizzle of flavorful oil and some citrus juice or lemon.
• Save your “sodium budget” to enhance the flavors of produce, whole grains, nuts and legumes, and other healthy ingredients versus “overspending” it on salty snacks, heavily processed food, high-sodium fast foods, and other foods that we should be consuming in smaller amounts.
• Buy organic produce when it is season: Shop for raw ingredients with maximum natural flavor, thereby avoiding the need to add as much (if any) sodium. Seek produce from farmers’ markets and your local supermarket when it is season and grown locally.
• Be careful with salt substitutes: Many are made with potassium instead of sodium and can aggravate kidney problems. If you are taking a potassium sparing diuretic, an excess of potassium can build and harm the heart. Stick to tried and true, salt-free flavoring blends.
• Know which ingredients and individual foods are high in sodium, and eat them sparingly: Salt is ubiquitous in the American diet, but the “top 10 list of popular food sources of sodium in the U.S. diet” is a good place to focus. Choose carefully when buying foods in these categories or eat less of these items: pizza, white bread and rolls, processed cheese, deli meats, bacon, hot dogs, sausage, spaghetti with sauce, ketchup, cooked pasta or rice, flour tortillas, wraps, and snack foods (4, 17).

 

When dining out:

• Check restaurant websites for a nutrition fact sheet or sodium information, before you head out, or ask for this information at the restaurant, to help you make the best possible low-sodium choices: Sodium levels can vary widely from one dish to another and from one restaurant to another. Some chain restaurant and fast-food meals may contain 5,000–6,000 milligrams of sodium per serving and sandwiches and fast-food entrées about 2,000–2,500 milligrams of sodium per serving—as much as or more than a day’s recommended sodium intake!

• Select a restaurant where food is made to order, and keep your order simple.

• After reading the menu, speak with your server to learn how food is prepared and what unsalted or low-salt options are offered. Request that no salt or sodium-containing seasonings be added to your food.

• Add a dash of low-sodium seasoning you brought from home.

• Save high-salt foods for very limited special occasions.

•Choose simple foods with little or no butter (often salted or seasoned butter is offered), cheese, or sauce. Broiled, poached, or roast chicken, lean meats, and fish, fresh or steamed vegetables, a  plain baked potato, salads (ask for oil and vinegar at the table, instead of dressing), fresh fruit for dessert, etc., are good choices.

• Avoid using the salt shaker.

• Request that fish, poultry, and vegetable entrees be prepared with herbs and lemon or lime juice, instead of salt and seasoned butter.

• Ask that your food be prepared with a minimum of sauce or salad dressing, rather than the regular amount. Otherwise, ask that they not be added to your food, but rather be “on the side,” so that you can control the amount used.

• If your meal must be prepared with sauce or toppings, or you have little control over the meal preparation, simply scrape any  sauce to the side of the plate, and enjoy the vegetables, lettuce, and tomatoes. Skip the cheese and go easy on condiments.

• Eat a heart-healthy, high-potassium, low-sodium diet during the rest of the day.

 

Both foodservice and food manufacturing—together with consumers and home cooks—need to be part of the solution to the sodium reduction challenge. As more consumers demand low-sodium, heart-healthy, meal alternatives, chain restaurants and other foodservice providers will be obligated to reduce sodium use in their products. Bon Appetit!

 

References:

1. American Heart Association. “USDA Sodium Advice Gets thumbs down from AHA.” 02/01/11. (Source: www.theheart.org/article/1179345.do)
2. American Heart Association. 7272 Greenville Avenue, Dallas, TX 75231. Telephone: (800) 242-8721. (Source: <http://www.americanheart.org > and www.heart.org)
3. American Heart Association. American Heart Association Low-Salt Cookbook: A Complete Guide to Reducing Sodium and Fat in Your Diet. 3rd ed. New York: Clarkson Potter Pubs., 2006.
4. “BBC Health: Salt Facts.” BBC-Health: Salt. (Source: www.bbc.co.uk/health/treatments/healthy_living/…/healthy_salt.shtml)
5. Cotton, P.A., A.F. Subar, J.E. Friday, A. Cook. “Dietary Sources of Nutrients Among U.S. Adults, 1994 to 1996.” Journal of the American Dietetic Association. Volume 104. 2004. pp. 921-930.
6. “Dietary Guidelines for Americans 2005.” January 12, 2005. (Source: http://www.healthierus.gov/dietaryguidelines>)
7. Gargulinski, Ryn. “Hidden Sources of Sodium.” 06/24/11. (Source: http://www.livestrong.com/article/478163-hidden-sources-of-sodium/#ixzz1aow6ir3N)
8. Health and Healing the Natural Way: Eating for Good Health. Reader’s Digest. The Reader’s Digest Association, Inc. Carroll & Brown Limited, London. New York. 1995, pp. 56, 126, 131, 133.
9. “Sodium: Are you getting too much?” Mayo Clinic Staff. MayoClinic.com. 05/24/06. (Source: http://www.mayoclinic.com/health/sodium/NU00284>)
10. “Sodium: How to tame your salt habit now.” Mayo Clinic Staff. MayoClinic.com. 08/02/11. (Source:  http://www.mayoclinic.com/health/sodium/NU00284>)
11. Institute of Medicine. Strategies to Reduce Sodium Intake. 04/20/10.
12. Kim, Janet. “2010 Dietary Guidelines From USDA and HHS. Medscape Public Health. Medscape interview with Xavier Pi-Sunyer, MD, MPH, about his work with DGAC and the latest edition of the DGA. Dr. Pi-Sunyer is a nationally recognized expert on obesity, type 2 diabetes, carbohydrate and lipid metabolism, and general medicine, member of the 2010 and 2005 DGAC, Professor of Medicine at Columbia University College of Physicians and Surgeons, and Chief of the Division of Endocrinology, Diabetes, and Nutrition at St. Luke’s-Roosevelt Hospital Center in New York, NY. 02/14/11.
13. Kurlansky, M. Salt: A World History. Walker and Company. New York. 2002.
14. Levinson, Jessica.”2010 Dietary Guidelines and Sodium.” Sweet Spot Blog. 03/ 23/11. (Source: blog.sweetsurprise.com/2011/03/23/2010-dietary-guidelines-sodium/)
15. Grocery Manufacturers Association. Sodium and salt: a guide for consumers, policymakers, and the media. Washington, D.C., 2008.
16. Sizer, Frances Sienkiewicz and Eleanor Noss Whitney. Nutrition Concepts and Controversies. Thomson Wadsworth. United States. 2008. p. 289.
17. “Tasting Success With Cutting Salt: Twenty-Five Science-Based Strategies & Culinary Insights.” The Nutrition Source: Salt Reduction Strategies. Department of Nutrition, Harvard School of Public Health and The Culinary Institute of America. 10/14/11.
18. “Lower Salt and Sodium: A Key to Good Health.” The Nutrition Source. Harvard School of Public Health. The President and Fellows of Harvard College. 2011.
19. “Two Kinds of Salt-Obvious and Hidden.” The New American Heart Association Cookbook: 25th Anniversary Edition. The American Heart Association. Times Books, Randon House. 1998. p. 631-632.
20. “Your Guide to Lowering Your Blood Pressure With DASH: What is the DASH Eating Plan?” U.S. Department of Health and Human Services. National Institutes of Health National Heart, Lung, and Blood Institute.NIH Publication No. 06-4082. Originally Printed 1998. Revised April 2006. (Source: www.nhlbi.nih.gov/health/public/heart/hbp/dash/introduction.html)
21. Zelman, Kathleen. “Salt Shockers Slideshow: High-Sodium Surprises.” WebMD, LLC. October 15, 2011. Reviewed by Kathleen M. Zelman, MPH, RD, LD on 06/20/11. (Source: www.webmd.com/diet/ss/slideshow-salt-shockers)
22. Zeratsky, Katherine. “Why do processed foods contain so much sodium?” Mayo Clinic Nutrition and Healthy Eating. February 26, 2011. Updated 08/20/11. (Source: “Low-sodium diet: Why is processed food so salty?” MayoClinic.com and www.mayoclinic.com/health/food-and-nutrition/AN00350)
23. “Sodium in Foods.” (Source: www.alsosalt.com/sodium.html)
24. Sodium-Diet.com
25. www.dashdiet.com
26. www.diet.com/g/sodium
27. www.mayoclinic.com