Salt plays an important role in our health, both good and bad. Like
everything, it should be consumed in moderation.
Salt is essential to maintaining a healthy body, and sodium—the major
component of salt—contributes to maintaining a balance of bodily fluids and
keeps muscles and nerves operating properly.
Salt vs. Sodium
While the words salt and sodium are often used interchangeably by consumers,
in the medical field they are different.
“Salt is what you find in the shaker on the dinner table. It is made from
sodium chloride – 40% sodium and 60% chloride. Sodium is a mineral that is
essential to optimal health that is found in packaged and prepared foods. It
also occurs naturally in foods such as celery, beets, meats, shellfish, and
milk,” said
Dr. Quinn Pack,
preventive cardiologist at Baystate Health.
How Salt and Sodium Impact Your Health
Too much salt disrupts the natural sodium balance in the body resulting in the
body holding onto water – think your feet being swollen or your rings
difficult to put on your fingers. And the extra water in your blood increases
the pressure exerted by the blood against blood vessel walls, resulting in
high blood pressure.
According to the
US Food and Drug Administration, Americans eat on average about 3,400 mg of sodium per day – or about 150%
of recommended levels. However, the Dietary Guidelines for Americans recommend
adults limit sodium intake to less than 2,300 mg per day – equal to about 1
teaspoon of table salt. For children under age 14, recommended limits are even
lower. And for those with high blood pressure, 1,500 to 2,000 mg per day is
recommended.
Dr. Pack said when he asks patients if they eat a lot of salt, they often tell
him, “Oh, I don’t eat any salt, I never use the salt shaker.”
“This is a really important point. Most of the salt Americans eat comes from
sodium added to prepackaged foods by the manufacturer. Some 80% of the salt we
eat is added at the time of processing. Table salt is only 5-10% of our
intake, another 10% is naturally occurring and all else is added during food
processing,” he said.
Salt and Sodium Impact Blood Pressure
In 1904, French doctors reported that six of their subjects who had high blood
pressure were “salt fiends.” Over 100 years later, research continues to show
a direct relationship between high sodium intake and
high blood pressure. High salt intake puts you at risk for
heart disease
and stroke, the
leading causes of death in the United States.
The good news is that a more recent study supports the American Heart Association’s position on salt and blood
pressure. The authors noted two important facts – 1) consuming excess sodium
beyond recommended levels is associated with high blood pressure and 2)
reducing salt can be as effective as taking blood pressure medication.
The randomized trial compared the effects of high-sodium and low-sodium
diets on blood pressure in adults with normal blood pressure and high blood
pressure. It found that following a low-sodium diet significantly lowered
blood pressure safely and rapidly in 70%-75% of participants in as little as
one week, including people currently taking blood pressure
medications.
“There are some studied populations in the world that do not have high blood
pressure. These include populations where access to salt is very limited, and
the preferred diet is high in fruits and vegetables. But while some salt is
important for your diet, we know that excess salt is required for the
development of high blood pressure. This naturally happens in America and in
Western societies where diets are high in salt, and almost everyone gets high
blood pressure eventually,” said
Dr. Pack.
“Some Americans are more affected by salt than the average person, a condition
known as salt sensitivity. Salt sensitive individuals include older people,
the Black community, and those with
kidney disease or diabetes.
People who are salt sensitive are less efficient in eliminating excess salt
from the body,” Dr. Pack said.
For salt sensitive individuals, eliminating excess salt has a more powerful
effect on blood pressure reductions. Dietary salt reduction helps everyone
with hypertension to lower blood pressure, but those with salt sensitivity
benefit the most.
Foods High in Sodium
The first step in reducing your salt and sodium intake is being able to
recognize high sodium foods. Some will surprise you!
“Canned soup is filled with enough salt to meet 100 percent of your daily
allowance. Deli meats are loaded with salt. When you buy a frozen chicken
breast, for example, most of the time, it was soaked in salt water before
freezing. This makes the chicken breast weigh more and taste better. Because
it retains water, it can also be sold for a higher price. Even frozen
vegetables are sometimes soaked in salt water before freezing,” Dr. Pack
said.
“Condiments are loaded with sodium. I call them the ‘five colors’ of salt –
white for table salt, red for ketchup, yellow for mustard, green for pickles,
and black for soy sauce. If you consider a standard hot dog, there is salt in
the meat, in the bread, and then in the condiments. A single hot dog could get
you 70% of your daily salt intake. The same goes for a burger at your favorite
fast food restaurant. There is salt in the burger, in the bun, in the ketchup,
in the pickles, in the special sauce. It can add up quickly, getting you 50
percent of your daily salt intake in just one sandwich,” he added.
According to the CDC, the following foods contain up to 40% of American sodium
intake:
- bread
- deli meats
- pizza
- chicken dishes
- soup
- packaged cereals
- frozen waffles
- sandwiches and burgers
- cheese
- eggs with added ingredients when you scramble them or make an omelet
- burritos and tacos
- snack foods like pretzels, chips and popcorn
Other high sodium foods include:
- smoked or cured meats
- salted nuts
- canned vegetables which should be rinsed before heating
- salad dressing
- tomato paste
- jarred sauces
- soda
- energy drinks
- hot cocoa
- canned fruits
- stuffing and cranberry sauce
- stews
- spices such as onion and garlic salt and many others
- sauerkraut
Your favorite restaurant, whether ordering fast food or an expensive high-end
meal, may be serving up more than just a delicious, flavor-filled meal.
“When at a fast-food restaurant, you are most likely getting 100% of your
daily sodium, while a fancier restaurant could be as much as 150% and a buffet
a whopping 200% depending on your choices,” Dr. Pack said.
How to Reduce Salt and Sodium Intake
Reducing salt in your diet isn’t easy, but it is achievable with
planning.
“The first two to three weeks of reducing salt in your diet may make your food
taste bland, but if you stick with it, the food will begin to taste better. It
is a natural adaptation of the body with time. When you do this, you can use
half as much salt as the recipe calls for in the kitchen, and you won’t taste
any difference,” Dr. Pack said.
To help you select lower sodium foods, the U.S. Department of Health and Human
Services offers a
Lower Sodium Foods Shopping List
to help guide you when you go to the grocery store.
When shopping be mindful of looking for foods labeled “low sodium” or “no salt
added” and remember to use the Nutrition Facts label to check the amount of
sodium to help you to choose products with 5% Daily Value (DV) or less. A food
item with 20% DV or more of sodium is too high.
Lifestyle Changes for Blood Pressure Management
But using that salt shaker or consuming high-sodium foods are not the
only risk factors for raising your blood pressure. Some risk factors can be
changed simply by leading a healthier lifestyle, while factors that cannot be
changed include age, sex, family history, genetics, race, ethnicity, and
co-existing diseases such as diabetes and kidney disease
A heart healthy lifestyle can help prevent high blood pressure and its
complications. The National Heart, Lung, and Blood Institute and Dr. Pack
recommend:
How to Mitigate Salt Intake
Did you indulge at a family BBQ or an unexpected fast food stop on a road
trip?
“Research suggests that by following a high-potassium diet for a couple of
days after a high-sodium meal you can reduce your blood pressure. Potassium
works the opposite of sodium by helping to relax your blood vessels. Potassium
with plenty of water helps to flush out excess sodium in your body through
your kidneys. Unfortunately, most Americans get twice as much salt as needed
and half as much potassium needed by the body,” said Dr. Pack, noting that
following a DASH (Dietary Approaches to Stop Hypertension” diet can
help.
Research supported by the
National Heart, Lung, and Blood Institute (NHLBI)
showed that blood pressure is reduced with an eating plan that is low in
saturated fat, cholesterol, and total fat and that emphasizes fruits,
vegetables, and fat-free or low-fat milk and milk products. Known as the DASH
eating plan, it also includes whole grain products, fish, poultry, and nuts.
It is reduced in lean red meat, sweets, added sugars, and sugar-containing
beverages compared to the typical American diet. It is rich in potassium,
magnesium, and calcium, as well as protein and fiber.
“The DASH diet—which is low in salt and includes plenty of fresh fruits,
vegetables and other healthy foods—can lead to a 10 to 12 ml reduction in
blood pressure which is equal to a maximum dose of blood pressure medication,”
Dr. Pack said.
Foods that are high in potassium include:
- Bananas
- sweet potatoes
- apricots
- avocados
- beets
- cantaloupe and honeydew melons
- coconut water
- fat-free or low-fat milk
- fat-free and no sugar added yogurt
- grapefruits (for those not on a cholesterol-lowering medication)
- halibut
- leafy greens
- lima beans
- molasses
- mushrooms
- peas
- potatoes
- raisins and dates
- salmon
- spinach
- nuts and seeds
- oranges and 100% orange juice
- prunes and 100% prune juice
- tuna
- tomatoes and 100% tomato juice and tomato sauce
- whole grains
How to Control Blood Pressure
Doctors for years have been stressing the importance of knowing your numbers
for many reasons.
“We refer to high blood pressure as the silent killer. Half of Americans have
high blood pressure but are not aware of it. This is because high blood
pressure rarely causes symptoms until they become serious such as kidney
failure, heart failure, blindness, stroke and heart attack. Regular
appointments with your physician are important when your blood pressure is
checked as part of your physical health,” Dr. Pack said.
“Blood pressure gets worse if ignored and damages arteries resulting in high
blood pressure. The longer you wait to control your high blood pressure, that
harder it is to get it back under control,” he added. “There are plenty
of good medications that exist that are well tolerated. There are more than 80
FDA approved medications. If you work with your doctors, they can handle just
about any situation to get your blood pressure controlled,” he said.
However, many who are successful at leading a healthy lifestyle may still need
one of two medicines, noted Dr Pack. Most people need two medications to
control their blood pressure. This is because each medication only lowers
blood pressure by 10 mm Hg or so, and most people need 20-30 mm Hg systolic of
lowering by the time they get started on medications.
Among the many medications your doctor may prescribe could include ACE
inhibitors, which relax blood vessels and prevent kidney damage; Angiotensin-2
receptor blocks, which also help to relax your blood vessels, calcium channel
blockers, which also help relax your blood vessels, and diuretics which flush
sodium and water out from your body in order to lower your blood
pressure.
Research suggests that owning a
home blood pressure monitor may help some people control high blood pressure.
Along with the American Heart Association and the American College of
Cardiology, Dr. Pack recommends owning a home blood pressure monitor,
especially for patients with high blood pressure. However,
according to the CDC, only about a third of people with high blood pressure check it at home once
a month.
“A home blood pressure monitor can offer you direct insight into your health.
For many people, it provides an incentive to control their salt intake,
especially if they see an increase in blood pressure after a salty meal. For
your doctor, sharing your numbers will help to identify if your medications
are working,” Dr. Pack said.
Even if you don’t have high blood pressure, a home unit can have other
benefits.
“Patients often tell us their blood pressure is high because they are nervous.
We call that white coat hypertension. It may or may not be accurate of your
true blood pressure, so it needs additional investigation. Monitoring it at
home for several days can help us determine if you really do have high blood
pressure and, if needed, set a course of action to help bring it down,” Dr.
Pack said.
To learn more about blood pressure monitors and how to use them, Consumer
Reports has a Blood Pressure Monitor Buying Guide to help you choose.
“Blood pressure is the single most controllable disease in America. When
trying to reduce your salt intake choose fresh or homemade over processed or
prepared foods, follow a healthy lifestyle, and take your medications as
directed by your doctor,” Dr. Pack said.