Shaving salt, saving lives

A high sodium diet contributes to high blood pressure (hypertension), a major cause of heart attacks and stroke. Conversely, reducing sodium (a component of salt) can lower blood pressure, and this can save tens of thousands of lives a year, according to a recent study published in the New England Journal of Medicine, led by researchers of the University of California in San Francisco. And these figures are probably an underestimate.

“The health benefits to the population would be on par with cutting the number of smokers and the number of people exposed to secondhand smoke by half,” says researcher Kirsten Bibbins-Domingo. Experts now predict that sodium reduction is poised as the next major health movement.

Another recent research published in the British Medical Journal showed that a decrease in intake of five grams of salt a day a little less than a teaspoon was associated with a 23-percent lower rate of strokes and as much as 17-percent lower risk of cardiovascular disease. In an accompanying editorial in the same issue of the journal, Lawrence J. Appel, MD, MPH, of Johns Hopkins Medical Institutions, commented that the importance of the association between excess salt intake and raised blood pressure leading, in turn, to strokes and coronary heart disease “cannot be overstated.”

Yet, the typical salt intake in the American diet is estimated to be about 10 grams daily. The US Department of Agriculture recommends limiting salt intake to only 5.8 grams per day, while the World Health Organization calls for no more than five grams daily. But when it comes to salt intake, the Filipino diet is even worse. “Most Filipinos love to use dipping sauces or sawsawan with their meals. Commonly used are salty seasonings like patis, toyo, bagoong, which comprise 40- percent sodium. Filipinos take seven to 15 grams of salt every day, which is equivalent to 2,800 mg-6000 mg of sodium,” according to the Nutritionist-Dietitians Association of the Philippines (NDAP).

The US Center for Disease Control (CDC) declared last year that adults should restrict their intake to no more than 1,500 milligrams a day. Those singled out include everyone over 40 and people who already have hypertension. To stay within a 1,500-milligram sodium limit, you must eat whole fresh foods and cook from scratch nearly all the time you can eat out (or bring home takeout food) but only on occasion. That’s a tall order even for the most motivated and health-conscious person.

But here’s what you should know to help ease that transition to a lower-sodium lifestyle.

What’s the difference between salt and sodium?

Sodium is a component of table salt (sodium chloride). One teaspoon of salt, which is 40 percent sodium and 60 percent chloride, has 2,300 milligrams of sodium, the upper recommended limit. If you are restricting sodium to 1,500 milligrams a day, that’s only two-thirds of a teaspoon of salt. Besides salt, sodium is also a major component of other common food ingredients and additives, such as MSG (monosodium glutamate), baking soda (sodium bicarbonate), disodium phosphate, sodium benzoate, sodium propionate, sodium sulfite, and sodium nitrite/nitrate. Many of these are used as preservatives.

Can I just hide my salt shaker?

That won’t help much. About three-quarters of the sodium we consume comes from processed and restaurant foods, not the salt shaker. Salting food at the table and in cooking accounts only for about 10 percent of our sodium intake. Another 10 percent comes naturally from food. Canned foods, frozen meals, smoked and cured meats, prepared mixes, sauces, bouillion cubes, vegetable juice, and pickled foods tend to be particularly high in sodium. But even cottage cheese has more sodium than you may think about 400 milligrams per half cup. Nearly all processed foods from bread and cheese to ketchup and candy contain added sodium. Even foods that don’t taste particularly salty can be high in sodium (see table on Page E-1).

How salty is restaurant food?

It varies. But as recently reported by the Center for Science in the Public Interest, a meal at a chain restaurant can easily have more than a day’s worth of sodium for people limiting sodium intake to 1,500 milligrams and sometimes three to five days’ worth high enough to bring on heart failure on susceptible people. Don’t assume that high-end restaurants are better many serve overly salted foods. Ethnic cuisines also tend to be highly salted.

Why do processed foods contain so much salt?

Traditionally, salt has been used to preserve food. Today, though, manufacturers use salt to improve food qualities and enhance flavor. Salt can make foods taste sweeter by blocking the bitterness of certain ingredients. But if you check the sodium content of similar products, you will see a large range, which indicates that it’s possible to reduce sodium without adversely affecting quality and taste. Many food companies have started lowering the sodium content of their foods due to increasing pressure. These include Campbell, Unilever, ConAgra and others.

Won’t cutting down on salt make my food unappetizing?

You won’t miss the salt for long. Though humans have an innate liking for salt, preferences are largely learned and can be unlearned. It takes several weeks for your taste buds to adapt to a lower sodium level, but what once tasted just right will eventually taste too salty, and you will begin to notice flavors that were previously masked by the salt. According to a recent survey, three out of four people on sodium-restricted diets say they do not miss the salt.

How do I know how much sodium a food has?

Check the nutrition facts panel. It lists the amount of sodium in milligrams per serving. It also gives the “percent Daily Value” how much sodium a serving of the food contributes to the total daily limit. But because the Daily Value is set at 2,400 milligrams (not 1,500 milligrams), this percentage will be an underestimate for most people.

What else can I look for on food labels?

Look for foods labeled “unsalted” or “no salt added.” “Low-sodium” foods contain 140 milligrams or less of sodium per serving; “very low-sodium” foods have 35 milligrams or less; “sodium-free” foods, less than 5 milligrams. “Reduced-sodium” foods have at least 25 percent less sodium than the original, but they may still be high in sodium. Reduced- sodium soy sauce, for instance, can still have close to 700 milligrams per tablespoon if the original has 900 milligrams.

How else can I bring out flavor in food, if not with salt?

Swap the salt shaker for the pepper mill or herb/spice blends that contain no sodium. Make your own blends using various combinations of garlic powder, dried parsley, rosemary, tarragon, thyme, celery seed, dill, cumin, and curry powder, for example. A mix of cinnamon, ground cloves, ginger, allspice and/or anise seed is good on poultry and vegetables. Or simply add lemon juice or flavored vinegar. Fresh herbs are also wonderful.

Are salt substitutes a good idea?

Yes, but not for everyone. Talk to your doctor before using one. Most (such as Morton Salt Substitute, No salt, and Nu-salt) consist of potassium chloride, which taste somewhat like table salt, though more bitter. “Lite” or “low sodium” salts are blends of sodium and potassium chloride. Though many people could benefit from the extra potassium, you should not use salt substitutes if you have kidney disease or certain other conditions, or if you take hypertension medications that increase potassium retention, notably ACE inhibitors and potassium-sparing diuretics. If your doctor says it’s okay for you to use them, note that the lite and low-sodium products contain some sodium, so you must still use them sparingly.

Do medications contain sodium?

Many do, including antacids, laxatives, and cough medicines usually in small amounts. But some, like effervescent antacids/analgesics, have a lot. A dose (two tablets) of Alka-Seltzer, for instance, has more than 1,100 milligrams of sodium, from sodium bicarbonate.

A salt assault

A number of health groups have now been pressuring the food industry to take more action and in January this year, New York City launched the National Salt Reduction Initiative. Supported by more than 40 city, state, and national health organizations, the program aims to encourage food manufacturers and national chain restaurants to gradually reduce the sodium in their products by 25 percent, on average, over the next five years.

Doing so could save tens of thousands of lives and billions of dollars in health-care costs annually.

To learn more: BMJ, online before print; abstract at www.bmj.com/cgi/content/abstract/339/nov24_1/b4567 and Sodium Tipsheet: 10 Tips to Cut Back www.mypyramid.gov/downloads/TenTips/SodiumTipsheet.pdf.