Salt─ More Harmful Than You Thought

• Based on mounting evidence that thousands of lives could be saved each year by cutting sodium consumption across the population, the American Heart Association has issued a statement recommending 1500 mg a day as the upward limit for healthy sodium intake. This is much lower than the earlier WHO recommendation of salt intake of <5 g or 2000 mg sodium (90 mmol/day).¹

• Population studies have shown that high salt intake is associated with increased risk of hypertension (high blood pressure) and stroke and heart attacks.

• Most of the world’s population consumes 2300- 4600 mg of sodium (100-200 mmol or 1-2 teaspoon of salt).

• Our bodies need a small amount of sodium to function smoothly (180 to 500mg daily), however the average American consumes a whopping 3500 mg a day─ the amount in about 1.5 teaspoons of salt.² The Indian diet contains 3-4 times this amount in their diet and is often added during cooking unlike the western countries.

• A regulatory intervention designed to achieve a reduction in salt intake of 3 g per day would save 194,000 to 392,000 quality-adjusted life-years and $10 billion to $24 billion in health care costs annually in the US.^{2, 3}

• In 2005, the National Academy of Sciences established adequate intakes of sodium:1500 mg/d for 9-50 year olds, 1300 mg/day for those  for 51-70 years, and 1200 mg/day for those aged 71 and over. The tolerable upper limit of intake was set 2300 mg/day for all ages.⁴

• In the US 77% of sodium comes from processed foods 12% occurs naturally in foods, 6% added at the  dinner table and 5% added during cooking. In India 90% of the salt is added during cooking especially in hot spicy curries. Many restaurant meals, especially fast food meals contain 2300-4600 mg sodium.

• High intake of sodium (particularly from soy sauce which contains 1840-2520 mg per two tablespoon) is responsible for very high rates of blood pressure and stroke in Japan, China and other Asian countries except India.

• Given the fact that 90% of Americans will develop hypertension at some point in their lives, experts urge all individuals (not just those who currently have elevated blood pressure) to strive for the new goal.

• Two of the key metrics for ideal cardiovascular health are a BP of <120/80 mm Hg and sodium consumption of <1500 mg/d.

• Major sources of sodium in UK and perhaps US include table salt (23%), processed meat (18%), bread and bakery products (13%), and dairy products (12%). In addition, 37% of sodium purchased was accounted for by five food categories: bacon, bread, milk, cheese, and sauces.⁵                          

Strategies for Reducing Salt Intake 

• Avoid prepared high sodium foods: Salty snacks such as chips and pretzels; canned soups and sauces;  cured meats such as bacon and ham;  foods packed in salt water such as pickles, olives, and canned tuna;  frozen pizzas and dinners; fast food.

• Select unsalted nuts or seeds, dried beans, peas and lentils. Eat a diet rich in fruits, vegetables and whole-grain, high-fiber foods. Select unsalted, fat-free broths, bouillons or soups. Select fat-free (skim) or low-fat milk; low-sodium, low-fat cheeses; and low-fat yogurt. Learn to use spices and herbs to enhance the taste of your food.

•  Use fresh foods whenever possible. Good choices include: Fresh, frozen, or canned vegetables without added salt; Fresh meats, fish, and poultry rather than cooked or prepared items; Herbs and spices as seasoning instead of salt. Avoid adding salt and canned vegetables to homemade dishes.

• Learn to read food labels.  Look at the “Nutrition Facts” panel on the label of packaged foods. This will tell you how much sodium is in the food. Be aware that the milligrams (mg) listed is per serving. It is not for the whole package.  If you eat more or less than what they consider one serving, you’ll have to do the math to figure out how much sodium you are getting.  The percent of daily value (% DV) is based on 2400 mg a day, not the recommended 1500 mg. That means the sodium in a serving is a higher percent of your daily limit than what is listed on the label. 

• Choose carefully in restaurants. Restaurant food is high in sodium. Some ways to eat out and still keep your sodium level under control include: Having your meal prepared without added salt;- Asking that sauces, gravies, and salad dressings be served on the side;  Selecting fresh vegetables, fruits, and salads and plain meats or fish from the menu.⁶

Sources

1. WHO. Prevention of cardiovacular disease. World Health Organization, Genewa Switzerland2007.

2. Appel LJ, Frohlich ED, Hall JE, et al. The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation. Mar 15 2011;123(10):1138-1143.

3. Bibbins-Domingo K, Chertow GM, Coxson PG, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. Feb 18 2010;362(7):590-599.

4. Havas S, Dickinson BD, Wilson M. The urgent need to reduce sodium consumption. Jama. Sep 26 2007;298(12):1439-1441.

5. Ni Mhurchu C, Capelin C, Dunford EK, Webster JL, Neal BC, Jebb SA. Sodium content of processed foods in the United Kingdom: analysis of 44,000 foods purchased by 21,000 households. Am J Clin Nutr. Mar 2011;93(3):594-600.

6. www.cardiosmart.org. Accessed July 28, 2011, 2011.