It's 8:30 a.m. Monday, and you're rushing to make an appointment. With your stomach grumbling, you toast a whole grain sesame bagel, smear it with low-fat peanut butter, hop in the car, and hit the coffee shop drive-through for an unsweetened skim latte.
Not bad, you think as you idle in the parking lot and quickly eat your meal. A little fiber, a little calcium, and not too much fat. By the time you get back on the road, however, you might have already consumed two-thirds of your recommended sodium limit for the day.
To be fair, salt isn't harmful by nature. The body relies on sodium to help transmit nerve impulses and maintain optimal fluid levels in cells. But the amount of sodium we need is just 180–500 mg per day, according to the Centers for Disease Control and Prevention. The average American consumes at least six times that: 3,000–4,200 mg per day. Many studies have shown a correlation between high sodium intake and hypertension, a leading cause of stroke, cardiovascular disease, and kidney failure. In fact, a June 2018 study published in the International Journal of Epidemiology directly correlates excess sodium intake with increased mortality risk. The American Medical Association estimates that excessive sodium consumption contributes to 150,000 premature deaths every year.
On the other hand, the body seems to respond quickly to sodium reduction. A landmark 2001 study found that volunteers who switched from a standard American diet to a diet low in salt (and high in unprocessed foods) saw significant declines in blood pressure within 30 days. In 2009 a research team led by Francesco Cappuccio at Warwick Medical School in England crunched the numbers on 19 follow-up studies and found that reducing sodium to 2,000 mg a day was associated with a 23 percent decline in stroke incidence and 17 percent fewer cases of heart attack, congestive heart failure, and coronary artery disease. Skeptics point out that sodium doesn't act alone.
Here are 15 things you need to know about sodium to cut down on your risk for high blood pressure health conditions:
A whopping 77 percent of sodium in the American diet comes from packaged foods with the sodium already mixed in.
That's because food labels assume the daily sodium allowance for all Americans is 2,400 mg, a number that is outdated, says Lawrence Appel, M.D., director of the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins University. For children, adults over 51, and people of any age who are African-American or who have hypertension, diabetes, or chronic kidney disease, dietary guidelines issued this year by the USDA advise a daily sodium limit of 1,500 mg (and 2,300 mg for everyone else). In other words, if you're among the 50 percent of Americans who fit these criteria, a salad dressing that contains 260 mg of sodium per serving delivers 17 percent of your daily limit, not 11 percent as stated on the label. Labeling practices soon could change.
Table salt is about 40 percent sodium and 60 percent chloride. Here’s how the dashes and spoonfuls in your recipe shake out in terms of sodium content:
¼ teaspoon salt: 575 mg sodium
½ teaspoon salt: 1,150 mg sodium
¾ teaspoon salt: 1,725 mg sodium
1 teaspoon salt: 2,300 mg sodium
"It's a dose-dependent relationship," Appel says. "Right now our sodium consumption is so high that any reduction brings benefit." Preparing meals at home using fresh, unprocessed ingredients is among the easiest ways to cut back. When you do reach for a packaged food, "aim for less than 200 mg of sodium per serving in any single product, and less than 600 mg per meal," Appel says.
It might sound odd, but think of “diluting” salty foods, says Mary Felando, a registered dietitian at Cedars-Sinai Heart Institute in Los Angeles. For example, try cutting preseasoned rice with plain couscous. "It's similar to how our mothers stretched ground beef by mixing it with other ingredients to make meat loaf," Felando says. "Here you're stretching out the salty stuff so every serving contains a bit less." Most experts agree that with the right know-how and committed involvement from the food industry, we might just shake the sodium problem. "It's absolutely within our power," Cappuccio says
The American Heart Association’s #BreakUpWithSalt initiative has pinpointed “The Salty 6,” or the top six items that crank up Americans’ sodium consumption the most. Examine the labels of these products before you purchase, and seek out alternatives with lower sodium levels when possible:
Breads and rolls - Salt content adds up when you think about a slice of toast at breakfast and two (or three!) pieces of bread for a lunch sandwich or club stack.
Pizza - That processed pepperoni and salty cheese piles on the sodium quickly.
Cold cuts and cured meats - One 2-ounce serving of deli meat can supply more than half your daily sodium.
Sandwiches and burgers - When you combine bread with cold cuts, the sodium sum can inch quite high.
Soup - One cup can have as much as 940 mg sodium!
Burritos and tacos - Hot sauce and other condiments are common salty additions.
Many people believe sea salt is lower in sodium, but that's not true, says registered dietitian Elisabetta Politi, director of Duke University Diet and Fitness Center. Sea salt simply is less dense because its large, lumpy crystals leave more space for air in every spoonful. Ounce for ounce, the two types of salt contain equal amounts of sodium.
These products, which mimic the look and taste of table salt and are typically made from potassium chloride, aren't safe for people who are taking certain medications or who have kidney disease, says Mary Felando, a registered dietitian at Cedars-Sinai Medical Center Heart Institute. Check with your doctor before using one.
Manufacturers began adding iodine to table salt in the 1920s to help control an epidemic of thyroid disease, says Donald Kirby, M.D., director of the Center for Human Nutrition at Cleveland Clinic. The salt in processed foods, however—which accounts for much of the sodium in the American diet—generally is not iodized. So you can reduce your sodium intake dramatically while still using iodized table salt. If you can't have salt at all, consider taking a multivitamin that contains iodine, Dr. Kirby says.
One day is all you’ll need to be convinced. Try this low-sodium meal plan that also happens to be low in calories (since maintaining a healthy weight is also important for overall wellness)—but not low in quality ingredients. Psst... Cookies are included!
Breakfast: Oatmeal with Goat Cheese, Dates, Walnuts, and Honey (318 calories, 83 mg sodium)
Snack: Hot and Chunky Guacamole with 2 cups cucumber slices (89 calories, 69 mg sodium)
Dinner: Garlic Shrimp with Tarragon-Wine Sauce with one glass of red wine (457 calories, 223 mg sodium)
Dessert: 2 Double-Almond Macarons (192 calories, 32 mg sodium)
Total: 1,393 calories, 709 mg sodium
Jessica Goldman, creator of the blog Sodium Girl, manages her lupus symptoms by watching her salt intake—and now shares her tips, tricks, and go-to recipes on her site and in her cookbook, Sodium Girl's Limitless Low-Sodium Cookbook. Rather than focusing on salt, Jessica boosts the flavor in her recipes via the four tips in Nos. 12–15 below.
"I use freshly squeezed lemon and orange juice to add subtle dimension to slow-cooking dishes like roasted chicken and pulled pork, or I splash them on at the last minute to brighten dishes like grilled fish and kale salad," Jessica says.
"It's not just for dessert! The sweetness naturally enhances savory flavors, as in classic dishes like pork chops and baked apples,” Jessica says. “But don't be afraid to experiment. One time I made a blueberry steak sauce that was amazing."
"I've always loved plain extra virgin olive oil, but now that I've discovered versions infused with garlic and other extras, I'm really hooked. These oils take a really simple dish—like chicken and rice—and give it a punch of unexpected flavor," Jessica says.
"The intense flavor of dill, basil, oregano, parsley, and other leafy herbs can wake up almost any dish,” she says. “I throw them in at the end of cooking to ensure their flavors stay bright."