Table the Salt
Chefs love it; doctors don’t. How, and why, to cut back on salt.
Real Simple
March 2006

By Sally Solo

Every few years, certain foods take a pounding from the medical establishment. Most recently, it was carbs, and before that fat. But the assault on salt has been ongoing -- and it has always had detractors, and rightly so. Still, if you're healthy, do you really have to worry about how much salt you consume? The short answer is yes. Too much salt can be bad for the heart and other internal organs. Even if your blood pressure is normal now, "over time excess sodium consumption causes blood pressure to rise in most people," says Stephen Havas, M.D., vice president for science, quality, and public health for the American Medical Association. Sodium is a major cause of hypertension, which the overwhelming majority of the U.S. population develops.

Unfortunately for those trying to cut back, salt is everywhere. It occurs naturally in meat, milk, and eggs. Most people add more as they cook, and many add still more at the table. But by far the biggest sources of sodium -- at least three-quarters of the total consumed in this country -- are processed foods at the supermarket and meals from restaurants. And it's those sources that explain why Americans now take in an average of 4,000 milligrams of sodium a day -- about 75 percent more than the government-recommended upper limit of 2,300 milligrams.

To follow a truly low-salt eating plan, you could move to the Brazilian Amazon and live with the Yanomami Indians, who consume just 20 mililgrams of sodium a day. Or you can cut back to a reasonable amount by becoming more salt savvy. Here' how:

Salt and your blood pressure

Blood pressure is a measure of how hard the heart works when it pumps blood around the body (systolic pressure) and when it's at rest (diastolic pressure). Blood pressure tends to rise with age, and eating a salty diet makes matters worse. Too much sodium causes extra fluid to accumulate in cells, which increases blood volume and blood pressure, putting stress on the heart.

Normal blood pressure is considered to be less than 120/80 mmHG (millimeters of mercury). High blood pressure, or hypertension, is at or above 140/90, and everything in between is called prehypertension, bordering on high. The higher the numbers, the higher the risk of cardiovascular disease, stroke, and kidney failure. An estimated 65 million American adults have high blood pressure, up about 30 percent from the early 1990s -- partly because of the aging of the population and the rise in obesity, and partly, experts believe, because of the prevalence of salt in our diets. But because high blood pressure generally doesn't cause pain or manifest itself through specific symptoms, the American Heart Association estimates that one-third of Americans with hypertension don't know they have it.

Along with sodium, the other contributors to high blood pressure that you can control are obesity, alcohol consumption, and lack of exercise. Risk factors that can't be controlled are race (high blood pressure is more prevalent among African-Americans), age (it's estimated that almost 80 percent of Americans 75 and older are hypertensive), and family history. For Americans in the higher-risk groups and for people who already have hypertension, the 2005 U.S. dietary guidelines recommend a sodium limit of 1,500 milligrams a day.

So is eating a potato chip a risky behavior? Not exactly. But eating potato chips and other salty foods every day is. "Once you get used to a diet that's unhealthy, you tend to continue to eat a diet that's unhealthy," Havas says. Over time, "if you can limit your salt intake to the recommended limit, you will lower your risk of developing high blood pressure or perhaps delay it," says Lawrence Appel, M.D., a professor at the Johns Hopkins Bloomberg School of Public Health and chairman of the committee that wrote the latest U.S. dietary guidelines for sodium and potassium consumption.

The American Public Health Association, a Washington, D.C.-based nonprofit organization of researchers and health-service providers, estimates that if the amount of salt in processed and restaurant food were halved, there would be a 20 percent drop in cardiovascular disease and 150,000 fewer deaths per year. So far, the government hasn't taken any steps to encourage manufacturers or restaurants to lower the amount of sodium they add to food.

Why you're hooked

If you like ketchup with your French fries, dip with your chips, or frozen dinners that cook up in 10 minutes, you know salt is a flavor that's difficult to give up. People eat salty foods because they like salty foods -- but they also like salty foods because they eat them, explains Gary Beauchamp, Ph.D., director of the Monell Chemical Senses Center, a Philadelphia-based institute that researches taste and smell. "If you put people on a lower-sodium diet, after three months the level they like is lower," he says. "Their tongues aren't less sensitive, but their preference has changed."

Meanwhile, no one has invented a good salt substitute. "There is no aspartame for salt," says Beauchamp, referring to the omnipresent sugar substitute, because researchers are still trying to figure out how the salty taste works. There seems to be a much more selective mechanism for transmitting saltiness than there is for sweetness, so it's harder to fool the tongue with an impostor. Many salt substitutes available today are a mixture of sodium chloride and potassium chloride. They are, to put it mildly, imperfect. "Potassium chloride is salty, but it's also bitter," Beauchamp says. Nor does it have the capacity to bring out flavor in food, salt's other strength.

How to cut down

Once you understand how ubiquitous salt is in your diet, it's not that hard to begin cutting back. For starters, become an informed label reader. That doesn't mean choosing only foods labeled "low sodium," which are defined as having 140 milligrams or less per serving for most foods -- that would be too restrictive. But using more of these products is a good step. The key is to train yourself to seek out the sodium line, about halfway down the nutrition-facts box, and to know what's excessive. If a single-serving meal has 1,000 milligrams of sodium (almost half your daily allotment), look for another product. According to data from the U.S. Department of Agriculture, the sodium in a 4-ounce serving of frozen cheese pizza, for example, can vary, depending on brand, from 450 milligrams to 1,200 milligrams. A cup of tomato juice may have 340 milligrams of sodium -- or 1,040.

While you're checking the label, look down one line from sodium to see if potassium is listed. The government recommends that healthy people consume 4,700 milligrams a day because, they guidelines say, "a diet rich in potassium blunts the effects of salt on blood pressure." Potassium helps the kidneys excrete sodium and is abundant in many fruits and vegetables.

Finally, the most important step in lowering your salt intake is to limit your amount of processed foods. "If you go to a supermarket and buy foods on the outside aisles" -- where fresh fruits and vegetables and dairy products are usually found -- "you'll have a diet much lower in sodium and everything else you're trying to avoid," says Marion Nestle, Ph.D., a professor of nutrition, food studies, and public health at New York University. Adding salt to those fresh foods during cooking (and to cooked foods at the table) is rarely the cause of runaway salt consumption. Make your own soups and stews, stir up a salad dressing with oil and vinegar (store-bought brands are usually salty), and try using herbs and homemade marinades instead of jarred sauces. If you do need to use canned beans, say, that have been packed in salt, rinse them off first with water. After you've spent a few months whittling away at your salt intake, that everything bagel and General Tso's chicken will probably seem too salty. Then you'll know that you've really kicked the habit.

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