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. Indeed, 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 that was 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.
Still, knowing that excessive sodium is harmful doesn't mean it's easy to avoid. Even if you closely review the Nutrition Facts panels on commercially made foods—the source of 77 percent of sodium in the American diet—the percentages you see might not apply to you. That's because food labels assume the daily sodium allowance for all Americans is 2,400 mg, a number that is outdated, says Lawrence Appel, M.D., director of the Welch Center for Prevention, Epidemiology, and Clinical Research at the Johns Hopkins University.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.
Unless your doctor has given you a strict sodium limit, simply eating less—even a small amount less—can help your health.
"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 can also help to dilute 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. Says Cappuccio, "It's absolutely within our power."
For Jessica Goldman, cutting down on salt was a matter of life or death.
In 2004, the San Francisco native was diagnosed with systemic lupus erythematosus, an autoimmune disorder that had attacked her kidneys and rendered them incapable of processing high levels of sodium. After spending nearly a year on dialysis anticipating a kidney transplant, Jessica began to experiment with low-sodium cooking. Her health miraculously improved—and her meals got a lot more exciting.
"A lot of people pitied me and said, 'Your diet must be so bland without salt,' " Jessica says. "In all honesty, it was way better! I was improving my cooking skills and becoming a more adventurous eater." So Jessica, now 28, started a blog called Sodium Girl (sodiumgirl.wordpress.com), where today she shares her recipes and low-salt savvy with a devoted and hungry following. With a Sodium Girl cookbook due out next year, Jessica offers a peek at her go-to ingredients.
Citrus juice: "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."
Fruit: "It's not just for dessert! The sweetness naturally enhances savory flavors, as in classic dishes like pork chops and baked apples. But don't be afraid to experiment. One time I made a blueberry steak sauce that was amazing."
Infused oils: "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 are a great way to take a really simple dish—like chicken and rice—and give it a punch of unexpected flavor."
Fresh herbs: "The intense flavor of dill, basil, oregano, parsley, and other leafy herbs can wake up almost any dish. I throw them in at the end of cooking to ensure their flavors stay bright."
For a basic kitchen staple, salt creates a lot of uncertainty. Read on as top nutrition experts answer the most common questions.
Is sea salt better for me than table salt? 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.
I've heard that certain types of salt contain important minerals. Should I be using those instead of the regular stuff? Although some gourmet specialty salts (as well as sea salt) do contain essential minerals, such as magnesium, most of us have no trouble getting these micronutrients through a normal healthy diet, Politi says. Unless you prefer the taste, skip the pricey pink Himalayan salt and stick to classic crystals.
Are commercial salt substitutes safe? It depends on your health situation. 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.
Doesn't my body need the iodine in salt? 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 suggests.
Take heart: It’s easy to go overboard. Not only is sodium found in your kitchen salt shaker—in the form of sodium chloride—it’s abundant in commercially made foods such as canned soups, frozen dinners, and, yes, bagels.
To complicate matters, sodium isn’t always listed as “salt” on food packages. In forms such as sodium phosphate and disodium inosinate, it acts as a preservative, flavor booster, stabilizer, binding agent, and texture enhancer in sweet stuff from cookies to raisin bread. Given our increasing reliance on grab-and- go foods, it’s no wonder Americans are eating 55 percent more sodium than we were in the 1970s. Yet in the decades since, leading health organizations have consistently revised recommended limits downward, exhorting us to eat less. Every year, it seems the gap between goal and reality gets a little wider. And our health may depend on bridging it.