Making Sense of Sodium Recommendations
We’ve all heard the recommendations to cut back on salt intake because it’s bad for your health, especially for your heart. Eat too much salt and you increase your risk of developing high blood pres-sure, which can trigger a heart attack or stroke. The tricky question that experts wrestle with is how much is too much.
Salt vs. sodium. The real culprit here is sodium, which makes up 40 percent of the weight of table salt (sodium chloride). In the U.S., the average sodium intake is about 3,400 milligrams (mg) a day (about 1½ teaspoons of salt). It helps to know what that means in terms of teaspoons of salt, since that’s what we use in cooking and at the table. Here are approximate salt-to-sodium equivalents:
What the science says on sodium. The 2010 U.S. Dietary Guidelines for Americans recommended that we limit our sodium intake to less than 2,300 mg a day. Both the Dietary Guidelines and the American Heart As-sociation go even further to recommend that everyone over the age of 51, those already diagnosed with high blood pressure, anyone with diabetes or chronic kidney disease and African Americans limit their sodium in-take to 1,500 mg a day, which together makes up the majority of U.S. adults. In 2004, the Institute of Medicine agreed with the 2,300 mg per day limit set by the Dietary Guidelines, but in 2013, came out with a report that said there wasn’t enough evidence to recommend lowering sodium intake to 1,500 mg per day.
Two recent studies on the effects of sodium restriction published in the British Medical Journal (BMJ) and the American Journal of Hypertension came to seemingly opposite conclusions. The first study looked at the effect of a national effort in England to reduce sodium in foods and the effect on blood pressure, stroke and death from heart disease. The researchers found that the reduction in the sodium intake in the country was related to an overall drop in blood pressure. However, the second study combined the results from several studies on sodium restriction and concluded that the link between salt intake and blood pressure has been overestimated.
The Type of Salt Can Make a Difference
Amy Myrdal Miller, MS, RDN, recommends using Diamond Crystal Kosher Salt in cooking to help trim sodium. While ounce-for-ounce the diamond-shaped crystals provide the same amount of sodium as regular table salt, on a measured basis, the larger diamond crystals provide about 60 percent less sodium than regular table salt. And, contrary to what you may have heard, sea salt provides the same amount of sodium as regular table salt. The same goes for a variety of gourmet salts, such as Fleur de Sol and grey salt. Seasoned salt, however, has slightly less per teaspoon because of the added seasonings.
So, should you still cut back on sodium for disease prevention? Feng He, PhD, researcher at Queen Mary University of London and one of the authors of the BMJ study, explains, “In some individuals, blood pressure is less responsive to a change in salt intake, but over the long-term a lower salt intake is still beneficial for blood pressure, particularly to slow the rise in blood pressure that occurs with aging.”
The American Journal of Hypertension analysis of several studies concluded that if sodium goes too high or too low, it could spell trouble. But a lot of foods are saturated with sodium, making it more likely that you’ll go too high.
Where’s the sodium? The lion’s share of sodium in our diets—about 75 per-cent—comes from restaurant and processed foods. According to the U.S Department of Agriculture, 21 percent of our sodium intake comes from burgers and sandwiches; 7 percent from rice, pasta and grain dishes; 6 percent from meat, poultry and seafood dishes; 6 percent from pizza, 5 percent from dairy, 4 percent from soups, and 4 percent from condiments, gravies, spreads and salad dressings. A quick look at restaurant and fast-food menus reveals items that provide anywhere from 4,000 to 8,000 mg per serving. Add the rest of the day’s intake from sodium and you’re in the sodium stratosphere.
Despite experts’ repeated pleas for Americans to cut back on their salt intake, salty foods are eve-rywhere. Enter the Food and Drug Administration, which recently announced that the agency will soon be is-suing voluntary salt reduction guidelines for the food industry. That could trigger a major change in sodium intake, since most of our sodium intake comes from processed foods. While food manufacturers won’t be required to follow the guidelines, chances are if one company does, others will follow suit.
Shaving sodium from your diet. Cutting back on sodium can be tricky. “Few of us realize how much sodium is ‘hidden’ in foods that taste great, but don’t seem salty,” says Amy Myrdal Miller, MS, RDN, Senior Director of Programs and Culinary Nutrition at the Culinary Institute of America in New York. In order to trim sodium, Miller recommends preparing more food at home and when you do, to use cooking techniques that influence our perception of salt in foods. For example, roasting or caramelizing (slowly cooking until food becomes brown and sweet) foods increases the perception of a salty taste. Umami-rich foods—the fifth category of taste in food, besides sweet, sour, salt, and bitter—like tomatoes, onions, and mushrooms also increase your sodium sensory perception.
—Densie Webb PhD, RD
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