SALT: The Party’s Over

In fact, the best response to “what has salt in it?” would be…almost everything.

Long before people pick up a salt shaker to season their food, they’ve likely taken in significantly more sodium than their bodies need to function well, doctors and dietitians say. In fact, they could get enough of the mineral each day from fresh fruits, vegetables, whole grains and healthy meats—the diet everyone should follow anyway—without ever opening a package of anything. So it’s no surprise that most Americans eat enough sodium to put them at risk for high blood pressure and all the health problems that can come with it, including heart disease, stroke, kidney failure and limb amputations.

“A lot of people overlook salt almost completely,” says Lisa Raum, a registered dietitian with the Richmond-based company R.D. to GO. “They may learn all about fats and carbohydrates, but they don’t realize how abundant salt is in everything. Many will start to worry only if they develop high blood pressure—they don’t think about working in a proactive way to prevent it. The problem is that once you actually have a diagnosis of high blood pressure, you often are at a point where it’s very dangerous and very difficult to fix.”

The assault on salt

Luckily, doctors, dietitians and federal agencies have started to pay more attention to sodium content in recent years. Current dietary guidelines from the United States Department of Agriculture (USDA) set the maximum daily intake at 2,300 milligrams, or approximately one teaspoon of table salt, but new recommendations to be released by the end of the year likely will drop that number to 1,500 milligrams. That’s closer to half a teaspoon a day.

Other prominent groups, including the American Heart Association and the National Academy of Sciences’ Institute of Medicine (IOM), already have adopted the 1,500-milligram standard and urge even greater caution for people at higher risk for elevated blood pressure, including African-Americans and anyone 40 and older. The Food and Drug Administration also has asked food and beverage makers to voluntarily cut the amount of salt in their products, and some have complied. And a growing number of publicized nutrition guides, including some restaurant Web sites, now list sodium along with calories, fat and carbohydrates.

Diabetics looking for low-sugar items, or dieters focused on limiting calories and fat, may pick up meals and snacks that manufacturers have loaded with salt to make them taste better.

Local health experts unanimously applaud the attempted crackdown on sodium. At the same time, they concede that getting Americans down to 1,500 milligrams a day—or, for that matter, 2,300 milligrams—is an extremely tall order. The average person takes in at least 3,400 milligrams of sodium a day, according to the IOM, and some eat much more.

A single restaurant dish or fast-food combination meal alone may pack 3,000-plus milligrams (and that’s before people include high-salt extras such as ketchup and pickles). People eat out more and cook less than past generations, and increased portion sizes have only pushed sodium intake higher. Food manufacturers also add sodium to packaged and canned goods, both as a preservative and flavor enhancer.

Salt is prevalent in so many foods that only about 10 percent of an average person’s intake comes from a salt shaker, says Mary-Blake Summerlin, a registered dietitian with Sentara Norfolk General Hospital and the Sentara Heart Hospital. And because salty foods are an acquired taste, Summerlin says, getting people to cut back can be a battle.

“I tell people, ‘Take it one step at a time,’” she says. “That’s much better than trying to cut salt totally for a week or two and then going right back to the same old habits. Maybe you reduce fast food down to once or twice a week. Or you go from deli meat to a fresh piece of chicken. Look for low salt items—look at labels so you don’t just blindly load up your grocery cart. Look at serving sizes and be realistic: are you really just going to eat seven pretzels? If you’re eating 21 pretzels, then you need to triple the sodium you’re about to take in.”

If people don’t specifically look at sodium content on a label, they’re likely to buy many high-salt products unknowingly, says Dr. Charlie Nelson, a Richmond-based cardiologist with Bon Secours’ Cardiovascular Associates of Virginia. That’s even if they mean well: Diabetics looking for low-sugar items, or dieters focused on limiting calories and fat, may pick up meals and snacks that manufacturers have loaded with salt to make them taste better. To cite just one example, Lean Cuisine’s baked chicken with cornbread stuffing and whipped potatoes meal has only 240 calories—but it packs 650 milligrams of sodium.

“I tell people, ‘Salt is either put into things
to improve flavor or to hide a lack of flavor,’” Nelson says. “You can find items that are low in everything, but you’ve got to put in some effort. You don’t want to be tricked into buying something that, over time, may cause you lots of
health problems.”

Salt’s hidden dangers

While muscles and nerves do need sodium to operate, too much causes the body to retain excess fluids; that’s why your hands and feet often swell after you eat a salty meal or snack. The extra volume then forces the heart to work harder to pump blood throughout the body. Excess salt also thickens blood vessel walls. “It has a direct effect on the vessel’s makeup, which eventually will push blood pressure higher,” says Dr. John Herre, a Norfolk-based cardiologist, medical director of the Sentara Heart Failure Program and a professor of medicine at Eastern Virginia Medical School. “And the consequences of high blood pressure are pretty severe. I see a lot of patients looking at a kidney transplant, for example, and more than half of them have high blood pressure.”

Salt is prevalent in so many foods that only about 10 percent of an average person’s intake comes from a salt shaker, says Mary-Blake Summerlin, a registered dietitian with Sentara.

Research is ongoing as to whether a high-salt diet also can weaken bones, adds Dr. Phillip Snider, a family practice physician with Bon Secours Medical Associates in Virginia Beach. Doctors already know that people who consume too much salt excrete more calcium in their urine, says Snider, who is also a registered dietitian. They also lose more protein, a sign of kidney damage.

Salt reduction is a huge part of managing patients with high blood pressure and congestive heart failure, which occurs when the heart struggles to pump enough blood to the body. With a smart diet, patients can reduce the amounts of medication they need, improve the effectiveness of the drugs they take and keep themselves out of the hospital. For someone with congestive heart failure, a single binge on salty and fatty foods can be dangerous.

“Maybe they’re doing OK and taking all their medications, but then they go to a barbecue and eat too many chips and hot dogs,” Herre says. “A health crisis can happen very quickly—within a couple of days—and if you are hospitalized, your likelihood of dying really is quite high.”

Of course, everyone can benefit from eating less salt, doctors and dietitians say—even people who are young and have perfectly normal blood pressure and hearts. One major bonus is that low-salt foods also tend to be low in other unwanted ingredients, including saturated fats and refined carbohydrates. “If you go low sodium, you automatically go healthy,” Lisa Raum notes. “Everything else falls into place.”

How can I reduce my salt intake?

Dietitians’ advice boils down to a few basic points. First, seek out foods that don’t come in a package, particularly fresh or frozen fruits and vegetables (as long as the frozen packages have no added seasonings). “A good general rule is that the fresher something is, the less sodium comes with it,” Snider says.

Second, read labels carefully, looking beyond the type that say “reduced” or “lowered” sodium. “That just means [they have] less than the original atrocious amount,” Raum says. Truly low-sodium items have less than 140 milligrams per serving. People who pay attention to labels can find significant differences between types of the same foods; certain brands of whole-wheat bread, for example, may have half the sodium of white breads. Before dining out, check a restaurant’s Web site for nutritional breakdowns of menu items.

Third, understand serving sizes and watch portions. Fourth, cook more at home, using seasonings such as salt-free spice blends, pepper, garlic, onions, basil and thyme; try lemon juice or vinegar in place of salty sauces such as teriyaki and soy. Finally, don’t add table salt to anything. If the salt shaker is too tempting, get rid of it altogether.

If all that seems tough, take heart: a person’s
taste buds will almost always acclimate to the changes over time, and the long-term health payoffs may
be huge. “When I get certain meals at a restaurant, I can’t even eat the food because it tastes so salty to me,” Dr. Charlie Nelson says. “Even if you don’t cut all the way back to 1,500 milligrams, you can do something. Aim for 2,000 milligrams. Or at least aim to make some small changes. Everyone can do something to help themselves.”

Written By Alison Johnson