How salt shakes out in American diets

Sodium is public enemy still, but now it's put in before food is served.

Health & Fitness

April 06, 2003|By Mariko Thompson | Mariko Thompson,New York Times News Service

Long before the carbs vs. protein wars, before good fats squared off against bad fats, salt reigned as public health enemy No. 1.

We were warned to set down the salt shaker, to substitute spices in our home cooking and to go easy on the potato chips. Twenty years later, the public health campaign against sodium is still being waged. But the target has shifted from the obvious sources to the hidden ones.

The average American consumes 4,000 milligrams of sodium per day, far exceeding the maximum of 2,400 milligrams recommended by USDA dietary guidelines and major health organizations such as the American Heart Association. These days, only an estimated 25 percent of daily sodium intake is added at the table. The remainder is unseen, consumed in restaurant and processed foods.

"People juggling career and family will go for the convenience foods," said Bettye Nowlin, a spokeswoman for the American Dietetic Association. "But they need to be aware that sodium is everywhere."

Take a look at the food labels on common grocery items. For example, a half cup of Ragu's Old World Style spaghetti sauce contains 780 milligrams of sodium.

What about restaurants? Accord-ing to the Center for Science in the Public Interest, a Burger King Broiler Chicken Sandwich has 1,110 milligrams of sodium and the garden vegetable soup at Au Bon Pain has 1,240.

The levels recently led the American Public Health Association to call on those industries to cut sodium levels in half over the next decade. People who consume high levels of sodium are more likely to develop hypertension, said Dr. Stephen Havas, the lead author of the new policy and professor of epidemiology and preventive medicine at the University of Maryland.

Determine your risk

An estimated one in four American adults suffers from high blood pressure. Studies have shown about 90 percent of the population is diagnosed with hypertension by the age of 80. People with high blood pressure have an increased risk for heart disease and stroke. High sodium levels also raise the risk of osteoporosis and kidney problems.

While salt plays a role in health conditions, the underlying causes and solutions are multi-faceted, said Sanford Miller, a senior fellow at Virginia Tech's Center for Food and Nutrition Policy. With hypertension, factors such as genetics and regular exercise affect who will develop the disease. People with a family history of hypertension and African-Americans, who as a group are more likely to develop the disease, should be careful about their sodium intake.

In the case of osteoporosis, potassium appears to offset calcium losses from excessive sodium. A recent study at the University of California, San Francisco, found that postmenopausal women with diets high in salt lost higher amounts of bone mineral. Eating potassium-rich foods such as bananas, tomatoes and orange juice helped stem the calcium loss.

Still, Havas predicts gradual sodium reduction across the board would save 150,000 lives a year. Mandatory food labels allow consumers to gauge their daily sodium content.

Restaurant roulette

But with no labels to peruse, eating at restaurants can pose greater challenges. There's no way to know whether the garden vegetable soup contains more sodium than the beef barley soup. The best thing a consumer can do is ask, said John Dunlap, president of the California Restaurant Association.

"Most restaurants will alter food preparation methods when requested," he said. "Salt is in many respects a core seasoning. There are a lot of terrific flavors that emerge with little or no salt. I think consumers need to be educated and shouldn't be afraid to ask questions."

At a minimum, the human body requires only 500 milligrams of sodium, about a quarter teaspoon of salt. Healthy people excrete extra sodium. But outside of the groups that are considered at risk, most people won't know if their bodies are sodium sensitive until it's too late, Miller said.

When ordering from a menu, descriptions provide clues. Pickled and smoked items, as well as foods prepared with soy sauce and broth, are likely high in sodium. Choose dishes where the meat has been broiled, baked or grilled. Avoid sauces and salad dressings or order them on the side.

"The taste for salt is learned -- and we can unlearn it," Nowlin said. "It's like going from whole milk to nonfat milk. After a period of time, it tastes just as good."

Ways to reduce sodium

* Choose fresh, frozen or canned food without added salts.

* Select unsalted nuts or seeds, dried beans, peas and lentils.

* Limit salty snacks like chips and pretzels.

* Avoid adding salt to homemade dishes.

* Select unsalted, fat-free broths, bouillons or soups.

* Select fat-free or low-fat milk, low-sodium and low-fat cheeses, and low-fat yogurt.

* When dining out, ask for your dish to be prepared with little or no salt.

* Use spices and herbs to enhance food.

Source: American Heart Association

Looking for sodium on labels

To keep your diet within the recommended maximum of 2,400 milligrams of sodium per day (a little more than 1 teaspoon), the American Dietetic Association suggests reading labels. Processed foods may be labeled in different ways under guidelines set by the Food and Drug Administration. Here's what those labels mean:

Sodium-free: less than 5 milligrams per serving

Very low sodium: 35 milligrams or less per serving

Low sodium: 140 milligrams or less per serving

Reduced sodium: usual sodium level is reduced by 25 percent

Unsalted, no salt added or without added salt: made without added salt but still containing the sodium that occurs naturally in the food

Sodium samples

Here's a sampling of sodium levels in foods:

Weight Watchers Smart Ones Fire-Grilled Chicken and Vegetables entree: 780 milligrams

McDonald's hamburger: 590 milligrams

Cheerios: 210 milligrams per 1 cup

Coca-Cola Classic (12-ounce can): 20 milligrams

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