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Detecting hidden sodium in your diet

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May 4th, 2017
Container of salt.
Container of salt.

Almost all Americans (90%) consume too much dietary sodium, according to the Centers for Disease Control and Prevention (CDC). Far too much, in fact. “The average American eats 20 times more sodium than is recommended,” says Lauri Wright, Ph.D., R.D.N., L.D., assistant professor in public health at the University of South Florida and spokesperson for the Academy of Nutrition and Dietetics.

Sodium is an electrolyte that your body needs to function properly. It contributes to muscle and nerve functioning and helps to control blood pressure and blood volume. Too much dietary sodium, however, increases your risk of high blood pressure. According to the CDC, more than 800,000 people in the U.S. die each year from diseases associated with high blood pressure, including heart disease and stroke.

Aging alone is a major risk for developing high blood pressure. At age 75, about 67% of men are affected and almost 80% of women. Thus, seniors need to be especially vigilant about limiting dietary sodium.

“When sodium is absorbed into your bloodstream through your digestive tract, excess water is also absorbed,” explains Dimitri Cefalu, M.D., medical director at Seabrook, an Erickson Living community in Tinton Falls, N.J. “That excess water increases your blood volume, which is one way your blood pressure can go up. Other factors may also play a role, including how well your kidneys work, because your kidneys control how much sodium stays in your body.”

When you are younger, your body can compensate for excess dietary sodium in part because your kidneys are healthy. “But aging may lead to a decrease in kidney function,” Cefalu adds. “Any chronic condition also puts more stress on your body’s compensatory mechanisms, and some medications affect how your body processes sodium.”

Where it hides

“Despite what many people think, use of the salt shaker is not the main cause of too much sodium,” Wright says. “In fact, about 75% of dietary sodium comes from eating canned, processed, convenience, and restaurant foods.”

The CDC estimates that 44% of sodium in the American diet comes from ten types of foods: breads, cold cuts and cured meats, pizza, fresh and processed poultry, soups, cheese, pasta dishes, sandwiches, mixed-meat dishes such as meatloaf, and salty snacks. Some foods that seem otherwise healthful may also have significant sodium, such as cottage cheese and certain fresh meats such as chicken and turkey, which may have added salt solution to enhance flavor and maintain freshness. “In some instances, a grilled chicken sandwich could contain more sodium than a hamburger,” says Miriam Pappo, M.S., R.D., C.D.N., director of clinical nutrition at Montefiore Medical Center in Bronx, N.Y.  

Stringent guidelines

The American Heart Association (AHA) recommends adults consume no more than 2,300 milligrams (mg) of sodium, which is roughly equivalent to one teaspoon of table salt (table salt is about 44% sodium). For the best health, however, the AHA states most adults should limit themselves to an upper limit of 1,500 mg (a little less than one-half teaspoon table salt). People with severe heart failure, liver cirrhosis, or kidney disease may need to limit sodium even more. 

Take a glance at a few nutrition labels on your favorite foods and you can see how quickly sodium adds up. Do not necessarily rely on the sometimes imprecise language on the front of the product. “Manufacturers can claim ‘low sodium’ if their product has 140 mg or less sodium per serving,” Pappo explains. “A label that reads ‘reduced’ or ‘lower’ sodium, however, means it is at least 25% less than the usual amount in that particular food from that particular brand.” 

Have your calculator ready because a reduced-sodium version of soy sauce, for instance, may still contain a whopping 500–750 mg of sodium per serving. In addition, different brands of the same product can have vastly different amounts of sodium. Two different slices of whole-wheat sandwich bread can be very different thicknesses, thus one may have 150 mg of sodium and the other have 100 mg.

Salt substitutes 

There are many salt substitutes on store shelves. Some contain various nonsalt-based spices, but some may contain salts such as potassium chloride, or mixtures of sodium chloride and other salts. If you have medical conditions—kidney disease in particular—or take certain medications such as diuretics, talk to your doctor about whether certain salt substitutes should be part of your diet. 

Relying on salt substitutes may not be the best way to go in the long term, however. “Your goal should be to reset the salt-craving center of your brain,” Cefalu says. Studies show that sour and pungent seasonings work best to “trick” your brain. “Be creative and season your foods with spices such as lemon, garlic, ginger, vinegar, and pepper instead of salt,” Wright advises.

Making it easier for consumers

Recently, the FDA issued recommendations for changes to nutrition information labels. “Grams of sodium and percent of the daily value (DV) will continue to be provided but in a larger font,” Wright says. “A quick guide for sodium is 5% DV or less is considered low and 20% DV or more is considered high.’’ The new label changes should be phased in by mid-2018.

In addition, last year the FDA released voluntary sodium targets for food manufacturers and restaurants.  Many companies and restaurants are aiming for this standardization, which should make it easier for you to make choices about dietary sodium. 

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