More Than a Pinch of Salt

Americans' diets contain unhealthy levels of sodium, and much of it comes from restaurant foods.

By Dr. Sanjay Gupta

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One in three Americans will develop high blood pressure, a major risk factor for heart attack and stroke. For many of them, a high-sodium diet is to blame. According to the Food and Drug Administration, a staggering 90 percent of the country consumes too much sodium, most of it from processed and restaurant foods.

“There’s a lot of sodium in restaurant foods because salt or seasonings that contain sodium enhance the taste of food,” said Lauren Cohen, a registered dietician and nutritionist in Englewood, N.J.

The Dietary Guidelines for Americans recommend no more than 2,300 milligrams of sodium per day — the equivalent of a teaspoon of salt — and that number drops to 1,500 milligrams for at-risk people who are 51 and older, African-American, or have hypertension, diabetes, or kidney disease. The reality, however, is that Americans consume more than 3,400 milligrams of sodium daily.

The overconsumption of sodium is a major health concern. Researchers at the Harvard School of Public Health estimate that 1 out of every 10 deaths in the U.S. is linked to eating too much salt. According to a study from the University of California San Francisco, Harvard Medical School, and Simon Fraser University, reducing sodium consumption over 10 years could save as many as half a million lives.

“Our food supply is loaded with excess salt, and it’s killing people,” said Stephen Havas, MD, a preventive medicine specialist at Northwestern University and co-author of a recent study on sodium in fast food meals. According to the Pew Research Center, 8 out of 10 Americans eat at a fast food restaurant at least once a week, with 50 million people served daily.

The Northwestern study tracked sodium content in seven menu items at popular chains such as Burger King, KFC, and McDonald’s over several years. Many of those restaurants, along with food manufacturers such as Campbell’s and General Mills, have made voluntary commitments to reduce sodium in meals. But researchers found that sodium levels increased an average of 2.6 percent.

“It would be great if restaurants lowered the amount of sodium they add to their menu selections,” said Cohen. “But they’re in the business of serving delicious foods, not managing our health.”

Chains like McDonald’s offer a nutritional analysis of menu items on their websites, as well as tips for reducing sodium intake (“Order sandwiches without cheese” and “Ask for French fries without added salt,” for instance). But “there aren’t many menu descriptions that use words to clue you in to how much salt a food item contains,” said Cohen.

Here are a few examples of sodium content in common menu items: A ham and cheese sandwich at Panera Bread contains nearly 1,900 milligrams of sodium; a chicken burrito at Chipotle Mexican Grill has more than 2,000 milligrams; and a serving of lasagna at Olive Garden has 2,800 milligrams.

It’s important to understand how we consume sodium and the effect it has on our bodies. Most people think sodium and salt are the same thing, but they’re not. Table salt or sea salt is 40 percent sodium combined with chloride. A common misperception is that most of the sodium we eat comes out of a shaker, but salt added at the table or while cooking accounts for less than 10 percent of sodium intake.

Sodium is found naturally in most foods, particularly cheese, seafood and certain legumes. According to the U.S. Centers for Disease Control and Prevention, breads and cereals are the source of one third of daily sodium consumption. Sodium is also found in seasonings, preservatives, and even medications.

The body needs a certain, albeit small, amount of sodium to maintain overall fluid balance, and help muscles and nerves function properly. The kidneys control how much sodium the body needs to retain or excrete. When there’s too much sodium, water retention increases blood volume. The result is “high blood pressure makes the heart work harder and [that] can lead to heart disease, stroke, heart failure, and kidney disease,” said Subhashini Ayloo, MD, a bariatric surgeon at University of Illinois Hospital.

So how do you monitor your sodium intake, especially when eating out? Cohen recommends sticking to simply prepared items, typically dishes that are grilled or broiled, and salads — but remember that condiments and salad dressing can be high in sodium. The American Heart Association also suggests passing on “value-size” meals because “super-sizing” a food item inevitably increases the amount of sodium, along with fat and calories.

You can always “take control of what’s in your food by cooking more at home,” as Dr. Ayloo points out. When preparing meals, here are some tips to keep sodium levels low:

• Use low-salt or salt-free seasonings, or flavor with herbs and spices. “You can also add fresh lemon juice instead of salt to fish and vegetables,” said Ayloo.
• Instead of canned, packaged, or processed foods, opt for fresh ingredients. “Even canned foods we might think are healthy, such as canned vegetables, have salt added as a preservative and a taste enhancer,” said Cohen.
• Read nutritional information and look for foods that are “low sodium” (containing 140 milligrams of sodium or less per serving) or “reduced sodium” (containing at least 25 percent less sodium than the regular product). “No Salt Added” or “Unsalted” means salt wasn’t added during processing, but the product may not be sodium-free.
• Rinse canned vegetables with water to get rid of excess salt.
• Don’t add salt to the water when boiling pasta or other grains.
• You can lower your blood pressure by eating foods rich in potassium such as bananas, beans, spinach, potatoes, and yogurt. “Potassium can help blunt the effects of sodium on blood pressure,” said Ayloo.

“It is our responsibility to take care of ourselves,” said Cohen. “We can do our part to lower sodium intake by ordering the simple, healthy options and by preparing things without salt at home.”