When a recent study showed that people who said they ate little salt were more likely to die from cardiovascular disease than those who didn’t restrict sodium, many of us got confused.
Are we now free to gobble pretzels to our hearts’ content? Or do we remain dedicated sodium watchers, rinsing every last trace of salt from our canned kidney beans?
Hillel Cohen, DrPH, a researcher at the Albert Einstein College of Medicine in New York, fired the latest salvo in the great sodium debate. His study found that people who reported eating limited salt were actually 37 percent more likely to die of cardiovascular causes, such as stroke and heart disease, than people who ate larger amounts of salt. Cohen is an associate professor of epidemiology and population health.
But the medical establishment has revered the low-sodium diet for so long that it’s hard to get doctors to question it, he says. Cohen doesn’t bother to follow the conventional wisdom himself. “I actually don’t pay attention to sodium.”
He says his study, which was published in the March American Journal of Medicine, doesn’t mean that everyone should abandon the low-sodium diet right away. He does say, though, that researchers need to ask if the current recommendations are truly useful for everyone -- and whether a low-sodium diet might even have negative effects on health.
Cohen says he’d much rather see people try to stay healthy by focusing on calorie intake and exercise to control obesity, as well as smoking cessation -- not low-sodium diets.
Not so fast, says Jeffrey Cutler, MD, a scientific advisor at the National Heart, Lung, and Blood Institute who has studied high blood pressure.
“There’s an immense body of evidence that links salt to high blood pressure,” Cutler says. High blood pressure is a known risk factor for cardiovascular disease. What’s more, people who eat a salt-laden diet don’t just have high blood pressure to worry about. They may also be courting osteoporosis, kidney stones, and -- as seen in some Asian countries -- even stomach cancer, he says.
So for now, hold off on the pretzels. “When you look at all the evidence, the balance is still for the low-sodium diet,” Cutler says.
Rosemary Yurczyk, MS, RD, CDE, agrees that limiting sodium is the prudent choice for the general population. “The whole idea is moderation,” she says. Yurczyk is a dietitian and diabetes educator at the University of California Davis Medical Center in Sacramento.
Government guidelines recommend that people consume less than 2,300 milligrams of sodium per day -- about one teaspoon of salt. If you eat three meals a day, you’ll want to stay within 800 milligrams of sodium per meal, Yurczyk says -- and that means no nacho chips on the side.
Nutrition labels can help you to judge whether you’re looking at a low-sodium food. According to Yurczyk, here’s the breakdown:
Low-sodium food: less than 140 milligrams per serving Moderate-sodium food: less than 400 milligrams per serving High-sodium food: more than 400 milligrams per serving
For example, seedless raisins, at 16 milligrams of sodium per cup, are low-sodium. A piece of angel food cake, at 210 milligrams, is moderate.
Now what about the biggies?
Most of your salt intake doesn’t come from liberal sprinkling at the dinner table, Yurczyk says. The bulk is hidden in many of the foods that we buy at the grocery store.
Most people know that chips, pretzels, crackers, and salted nuts and popcorn are loaded with sodium. But they may be surprised to learn how much sodium lurks in canned soups, processed cheeses, hot dogs, bacon, lunch meat, frozen meals, sauce and gravy mixes, stuffing, soy sauce, bouillon cubes, and other processed foods.
The U.S. Department of Agriculture lists typical sodium content for thousands of foods -- and some of these numbers may shock you:
Dehydrated onion soup mix (1 packet): 3,132 milligrams
Seasoned bread crumbs (1 cup): 2,111 milligrams
Spaghetti sauce (1 cup): 1,203 milligrams
Canned chicken noodle soup (1 cup): 1,106 milligrams
Frozen turkey and gravy (5 ounces): 787 milligrams
Canned cream-style corn (1 cup): 730 milligrams
Teriyaki sauce (1 tablespoon): 690 milligrams
Vegetable juice cocktail (1 cup): 653 milligrams
Beef or pork salami (2 slices): 604 milligrams
Canned jalapeno peppers (1/4 cup, solids and liquids): 434 milligrams
For many Americans, eating too many of these foods can easily push them over the daily recommendation -- all in just one sitting.
Keep an Eye on Labels
Looking at labels can help you find the sodium in your grocery items. But realize that the sodium listing is for just one serving size, not the whole container, Yurczyk cautions. “If you eat two servings, you’ll have to double the amount of sodium.”
Labels can guide you in making better choices within food categories, too, such as breads and pastries. For instance, a croissant contains 424 milligrams of salt, compared with only 148 milligrams for one slice of whole-wheat bread.
Restaurant dining poses another hazard. If you frequent fast-food restaurants -- where sodium abounds in sauces, fries, lunch meats, and even salad dressings -- ask for a nutrition fact sheet, Yurczyk suggests.
That way, you’ll get the skinny on how much sodium is really in that biscuit with egg and sausage: 1,141 milligrams. Or that 6-inch submarine sandwich with cold cuts: 1,651 milligrams. “It’s a bit scary how much sodium is in fast-food meals,” she says.
Other types of restaurants aren’t likely to have nutrition fact sheets. But Yurczyk says that you can still make sodium-sensible choices.
What gets the thumbs down from Yurczyk? “Soup -- in restaurants, it’s not likely to be low-sodium; appetizers with cheese and proscuitto and processed meats; a casserole with cheese and sausage.”
And the thumbs up? “If you order fish, steamed vegetables, and a salad on the side, it’s not going to be a high-sodium meal.”Other tips for staying within the 2,300 milligram-limit per day:
Take the salt shaker off the table. Don’t add salt to dishes as you’re cooking. Instead, try herbs and sodium-free spices. Use fresh or frozen foods instead of canned foods. If you buy canned products, look for low-sodium or unsalted ones. When you eat out, ask that your meal be prepared without sodium sources, such as salt, soy sauce, and monosodium glutamate. Keep a daily record of how much sodium you eat and drink.
And last, when you shake the sodium habit, don’t start complaining too early that your unsalted oatmeal tastes like glue, Yurczyk says. “Salt is an acquired taste. It takes three weeks to get over it and then you get used to the natural taste of food.”
By Katherine Kam, reviewed by Louise Chang, MD
SOURCES: Hillel Cohen, DrPH, associate professor of epidemiology and population health, Albert Einstein College of Medicine. Jeffrey Cutler, MD, scientific advisor to the director of the division of epidemiology and clinical applications, National Heart, Lung and Blood Institute. Rosemary Yurczyk, MS, RD, CDE, University of California Davis Medical Center. USDA National Nutrient Database for Standard Reference, release 18. Cohen, H., American Journal of Medicine, March 2006; vol 119(3): pp 275.e7-275.e14.