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Making Sense of Salt

Friday, July 15, 2016

And the food debates continue…eat eggs, don’t eat eggs, eat eggs…butter out, margarine in, nope wait, olive oil in!  Now add to the list, confusion over salt (sodium).  A recent study published in The Lancet reported that a low salt diet was associated with increased risk for heart disease and death.  Whoa, hold the presses, what?  Haven’t we been told for years that a low salt diet is associated with better health?  It can be frustrating to read headlines that contradict everything we’ve been told for the last decade or more.  To sort out the confusion, several doctors analyzed The Lancet report and then looked at the evidence from several other major respected and well-researched studies.  Their conclusion recently published in the New England Journal of Medicine was that The Lancet study was flawed in a number of ways.  Their suggestion based on an overwhelming amount of evidence – keep holding the salt.  For the majority, lower sodium levels will significantly improve blood pressure and heart health.  Over the last 40 years, the average sodium intake has increased dramatically and most Americans consume way too much.

The average American consumes more than 3,400 milligrams of sodium each day.  The American Heart Association (AHA) recommends people eat no more than 1,500 milligrams per day.  The CDC and the American Diabetes Association suggest consuming less than 2,300 mg sodium per day.  While the numbers vary a bit, everyone agrees that minimally cutting back to 2,300 mg or less will significantly improve blood pressure and heart health for many people. The 2009-2012 National Health and Nutrition Examination Survey looked at almost 15,000 participants.  They found 89% of adults and over 90% of children exceeded the recommended daily allowances for sodium.  Among hypertensive adults (those with high blood pressure), 86% exceeded the 2,300 mg threshold.  Here is what we know.  High sodium intake contributes to high rates of blood pressure, heart attack, and stroke. And while everyone’s individual body chemistry is different, the majority of people will benefit from a low sodium diet, rich in fruits, veggies, whole grains, and lean meats as opposed to a high-sodium processed food diet.  Nearly 400,000 deaths per year are attributed to high blood pressure and decreasing sodium levels could prevent some of these deaths.  

Keeping tabs on your sodium intake is one piece of the prevention puzzle.  But who knows how much salt they eat?  It turns out not too many people.  Most folks underestimate how much they take in, if they can estimate at all.  The AHA surveyed 1,000 adults and found that 33% could not estimate how much sodium they ate; and another 54% thought they were eating less than 2,000 mg sodium a day (but they weren’t!). We estimate poorly because 75% of our sodium comes from processed, prepackaged, and restaurant foods – not from the salt shaker. In addition, not all processed foods are created equal so one slice of frozen cheese pizza can range from 450 mg to 1200mg.  

So where do you start?  The American Heart Association, American Diabetes Association, and the CDC offer the following information and tips:

  • Six popular foods can add high levels of sodium to your diet including:  bread and rolls, cold cuts and cured meats, pizza, poultry (sodium varies depending on preparation methods), canned soups and broths, and sandwiches/burgers from fast food restaurants.  Check labels to find lower sodium varieties.  Many of the large chain restaurants include nutrition facts on their menus or websites.

  • Consider using a sodium tracker, either a paper/pencil type or an app.

  • Buy fresh, frozen (no sauce), or no salt added canned vegetables.

  • Use fresh poultry or pork (with no saline or salt solution added), fish, and lean meat.

  • Read labels and buy low sodium, lower sodium, reduced sodium, or no salt added versions of products.  For example, compare ½ cup serving sizes of three types of Delmonte diced tomatoes:

    • Regular diced tomatoes – 130 mg sodium – 5% of daily allowance

    • Diced tomatoes with basil, garlic, and oregano – 350 mg sodium – 15% of daily  allowance

    • No-salt added diced tomatoes – 15 mg sodium – 1% of daily  allowance

Six popular foods can add high levels of sodium to your diet including:  bread and rolls, cold cuts and cured meats, pizza, poultry (sodium varies depending on preparation methods), canned soups and broths, and sandwiches/burgers from fast food restaurants.  Check labels to find lower sodium varieties.  Many of the large chain restaurants include nutrition facts on their menus or websites.

Consider using a sodium tracker, either a paper/pencil type or an app.

Buy fresh, frozen (no sauce), or no salt added canned vegetables.

Use fresh poultry or pork (with no saline or salt solution added), fish, and lean meat.

Read labels and buy low sodium, lower sodium, reduced sodium, or no salt added versions of products.  For example, compare ½ cup serving sizes of three types of Delmonte diced tomatoes:

Regular diced tomatoes – 130 mg sodium – 5% of daily allowance

Diced tomatoes with basil, garlic, and oregano – 350 mg sodium – 15% of daily  allowance

No-salt added diced tomatoes – 15 mg sodium – 1% of daily  allowance

Limit your use of mixes and “instant” products, including flavored rice and ready-made pasta in a can.

Before heading out to dinner, check to see if the restaurant lists nutrition facts on its website.  

Request that no salt be added to your food.

Beware of hidden sources of sodium such as salad dressings, marinades, spaghetti sauce, taco sauce, teriyaki sauce, salsa, ketchup, and barbeque sauce.

Watch out for pickled foods such as pickles, relish, and sauerkraut.  One pickle wedge can have 500 mg of sodium.  Read the label first and eat these occasionally.

Eat plenty of vegetables and fruits.   They have no added sodium!  

One final note, some people do need a bit more sodium in their diets.  According to the AHA, the 1,500 mg guideline does not apply to people who lose big amounts of sodium in sweat, like competitive athletes, and workers exposed to major heat, such as foundry workers, fire fighters, or outdoor workers in the summer, or to those directed otherwise by their physician.  Talk with your doctor if you have any questions or concerns about your sodium levels.  

For more information on sodium, try these websites:

American Heart Association at http://sodiumbreakup.heart.org/

CDC at https://www.cdc.gov/salt/

American Diabetes Association at http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/food-tips/cutting-back-on-sodium.html

Lorraine Wichtowski is a community health educator at Noyes Health in Dansville.  If you have questions or suggestions for future articles she can be reached at lwichtowski@noyeshealth.org or 585-335-4327.  

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