By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Salt is often viewed as taboo in the medical world, especially among cardiologists. But even though it’s a four-letter word, salt is not as inherently bad as you may think. In fact, table salt actually contains 40% of a mineral that your body needs to function correctly: sodium. You read me right – you need some sodium for blood pressure and blood volume control, not to mention electrolyte balance and muscle, nerve, and cell function.
The real problem with sodium is that most Americans consume WAY too much of it… and an excess of high sodium foods can bring about serious consequences.
For one, the kidneys have a hard time filtering the extra sodium. As it accumulates in the bloodstream, the body retains water to dilute it. This leads to increased blood volume, which means more work for the heart and greater pressure on blood vessels. Over time, this can cause high blood pressure and even a heart attack or stroke. And that’s not all. Research shows that high sodium levels can also result in kidney stones, bone loss and osteoporosis, and even stomach cancer.
So generally, people definitely need to cut back on sodium intake…however, limiting it too much or cutting it out completely is also a bad idea.
Ironically, a 2011 study published in the prestigious JAMA showed that too-low sodium levels were associated with higher cardiovascular disease mortality.
Low sodium has also been found to increase renin activity (which negatively impacts blood pressure), insulin resistance, and cholesterol and triglyceride levels. And through this meta-analysis of 25 clinical trials researchers concluded that, “both low sodium intakes and high sodium intakes are associated with increased mortality…”
Obviously, conscious moderation, not total avoidance, is key. Here’s my advice on how to find the “sweet spot” when it comes to sodium…
Reduce Your Intake of Foods High in Sodium
While everyone’s sodium requirements vary, my general recommendation is to limit your intake of salt to 2–3 grams per day. Some people can go up to 3.5 grams and be okay, but no one should be going above that. This equates to roughly ½ teaspoon to just shy of ¾ teaspoon per day. (To put this in perspective, the average adult takes in roughly 2 teaspoons a day—more than twice the recommended amount!)
To stay in this 2–3 gram range, the first thing you want to do is cut out foods high in sodium. Sounds easy, but it’s not.
Most people don’t realize that the majority of their sodium doesn’t come from the salt shaker; it comes from hidden salt in processed and canned foods.
Various forms of sodium are added to virtually all processed and packaged foods to preserve the products and extend shelf life. Some of the most common include monosodium glutamate (MSG), sodium nitrite, sodium bicarbonate, and sodium benzoate.
The list of foods that include these sodium additives is extremely long…but here are some of the top foods high in sodium:
- Soy sauce, Worcestershire sauce, ketchup, and other condiments
- Salad dressings and marinades
- Canned soups and vegetables
- Canned and jarred tomato/spaghetti sauce
- Jarred spices and seasoning packets
- Packaged cookies, cereals, and other snacks such as crackers, pretzels, and chips
- Frozen dinners
- Dill pickles and other pickled foods
- Hot dogs, bacon, sausage, and other processed meats
- Deli meats and cheeses
- Salted nuts
Now, I know that it’s close to impossible to eliminate all foods high in sodium from your diet. So the next best thing is to read labels carefully. Many of the canned items, especially tomatoes and sauces, are available in low- or no added-salt options.
In addition, you many not realize it, but eating out can also spike your sodium intake. Probably the worst offenders are fast food and fast-casual restaurants because they don’t prepare from scratch; they simply heat up mass produced food and assemble it. The average fast food single-patty hamburger contains just shy of 400 mg of sodium. And a flame-broiled chicken sandwich can contain upwards of 1,400 mg. Certain ethnic restaurants like Italian, Chinese, Thai, and Japanese are also notorious for serving foods high in sodium because they use lots of sauces, stocks, and soups.
Reserve restaurant dining for special occasions. And when you do eat out, ask lots of questions about the preparation of the food. Skip the sauces, marinades, and dressings, and ask if the chef can accommodate requests for less salt. When all else fails, opt for simply grilled or baked dishes with a side salad topped with olive oil and balsamic vinegar.
Increase Your Intake of Low Sodium Foods
As you’d probably guess, some of the best low sodium foods are natural and unprocessed (or at the very least, less processed). Fresh and frozen fruits and vegetables are your best bets, as are fish, chicken and beef; dry beans, peas, and lentils; eggs; unsalted nuts and seeds; and milk and yogurt.
Look for breads, cheeses, condiments, and seasonings that are labeled “low” or “reduced” sodium.
Make up for the reduced salt in your diet by cooking with fresh herbs and spices. Lemon, lime, basil, hot peppers, ginger, garlic, turmeric, oregano, rosemary, chives, parsley, cilantro, and onion are great sources of flavor, and many of them contain compounds that reduce blood pressure.
Finally, when you do use salt, consider Himalayan or sea salts, which contain trace minerals and don’t have the added anti-caking agents that go into standard processed table salt. Both salts contain various trace minerals and other elements that are found in the human body, including sodium chloride, calcium, magnesium, and potassium. They’re less refined, so you get less sodium than with regular table salt. Potassium is especially important because, whereas sodium increases water retention and and blood pressure, potassium keeps blood vessels relaxed and reduces blood pressure.
I just love fresh ground salt crystals over fresh steamed broccoli, asparagus, Brussels sprouts or green beans drizzled with extra virgin olive oil! Organic meat and poultry too. Yes, salt makes food taste better (which is why it’s in so many prepared foods). But if you’re using it moderately to eat a healthier diet made up of fresh, whole foods that are close to their natural sources, you’re on a good track. Salt can definitely threaten cardiovascular health when you’re loading your body with processed junk; but it can also be relatively healthy when used to enhance health-supporting food.
By following the steps above, your sodium levels should dramatically go down—and good health (heart and otherwise) will gain a stronghold.
- He FJ and MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens. 2009 Jun;23(6):363-84.
- Stolartz-Skrzypek K, et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA. 2011;305(17):1777-85.
- Alderman MH and Cohen HW. Dietary sodium intake and cardiovascular mortality: controversy resolved? Am J Hypertens. 2012;25(7):727-34.
- Graudal N, et al. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis. Am J Hypertens. 2014 Sep;27(9):1129-37.
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