IN THIS ISSUE

From the Winter 2005 Issue

Daily Living

How Eating Less Sodium Can Help Your Cardiovascular Health

People often crave salt—and think that food just doesn't taste right if it's not salty. The trouble is, many have become used to the taste of salt.

If you remember back to high-school chemistry, salt—or sodium chloride (NaCl)—is made up of two elements, sodium (Na) and chloride (Cl). Sodium is the issue here.

People need to know about the sodium content in foods and drinks, so they can make choices that reduce their sodium intake. That's especially true for people with cardiovascular (heart and blood vessel) problems.

How Much Sodium Should You Eat?

Sodium is a mineral that is important to your body. It helps regulate fluid flow into and out of cells. And muscles couldn't contract without sodium.

But as essential as sodium is, we need very little. Eating less sodium is not harmful. In fact, it's recommended for most adults.

A recent report1 says that the median salt intake for American men is 7800 to 11,800 milligrams a day. And for women it's 5800 to 7800 milligrams a day.

Yet the US Department of Health and Human Services recommends that healthy adults eat less than 2300 milligrams (2.3 grams) of sodium a day. This amount of sodium is equal to about 1 teaspoon of salt. And it's much less than many people currently eat.

How Sodium Affects Your Health

The American Heart Association (AHA) notes that for many people sodium increases the risk of:

• High blood pressure
• Heart and vascular problems
• Stroke
• Kidney disease

As a result doctors often ask people with cardiovascular problems—especially heart failure—to eat less sodium by following one of these diets:

• 2000 milligrams a day, known as a 2-gram sodium (Na) diet
• 1000 milligrams a day, known as a 1-gram sodium (Na) diet

That's because sodium intake especially affects people with heart failure. As an indirect effect of heart failure, the kidneys are less able to rid the body of sodium and water. Higher sodium levels help hold or retain fluid in body tissues. This fluid retention can lead to shortness of breath and swelling of tissues, especially in the legs and feet.

If your doctor has prescribed a diet for you, check with your dietitian or doctor before you make changes to that diet.

Medications May Contain Sodium

If you're on a restricted-sodium diet, look at your medications, too. That's especially true for antacids, laxatives, or sleeping aids. Some companies now make low-sodium over-the-counter products. Ask your pharmacist or doctor if you have questions about sodium content.

Re-Think Your Choices at the Grocery Store

Always look at the Nutrition Facts label on foods you buy. (Take along a magnifying glass if that helps.) If you want to keep track of how much sodium you eat, remember that the guideline is less than 2300 milligrams of sodium per day for healthy adults—and lower if your doctor recommends it.

Similar foods can vary widely in sodium content. A look at labels on different brands of spaghetti sauce, for instance, shows sodium ranging from 20 to 800 milligrams per serving.

Low-sodium foods are often identified as such on the front of the package.

Even if foods are "unsalted," small amounts of sodium are often a natural part of the food itself, so always read the Nutrition Facts label.

In addition to "sodium" on the Nutrition Facts label, you may see other ingredients that contain sodium. Some of those ingredients are:

• Na (the chemical name for sodium)
• Baking soda, or sodium bicarbonate
• Baking powder (it contains baking soda)
• Monosodium glutamate (MSG), a flavor enhancer
• Sodium bicarbonate, which leavens baked goods
• Sodium saccharin, an artificial sweetener
• Sodium nitrate, which cures food
• Sodium benzoate, a preservative

Processing Adds Sodium to Foods

To make convenience foods "ready to eat," factories add sodium during the processing, since sodium preserves the food and adds flavor. In general, the more processed the food, the more sodium it probably has. For example, instant bouillon has much more sodium than soup broth you make from scratch.

Avoid these processed high-sodium foods:

• Frozen prepared meals and TV dinners
• Canned foods, such as soup or bouillon and canned vegetables
• Cured meats (ham, bacon, salami)
• Many sauces and gravies
• Foods with flavor enhancers, such as MSG (monosodium glutamate)
• Meat tenderizers, and steak, barbecue, soy, or teriyaki sauces
• Pickles and sauerkraut

Preparing Meals With Less Sodium

With little effort, you can lower the amount of sodium in your favorite recipes.

Use fresh or frozen vegetables instead of canned vegetables. Rinsing doesn't remove enough of the sodium from canned vegetables. Whenever available, choose no-sodium or low-sodium ingredients. For instance, you may be able to find no-sodium or low-sodium brands of canned soups, crackers, pasta, sauces, chips, and other foods.

Try these flavorings instead of salt:

• Lemon juice or balsamic vinegar on vegetables
• Garlic or onion powder (instead of garlic or onion salt)
• Pepper or chili powder
• Herbs like basil, marjoram, curry, pepper, thyme, and bay leaf
• An herb mixture like Mrs. Dash®

You can also make your own herb mixture (see box at right). Or, if you consider buying other spice or herb mixes, check the Nutrition Facts label.

New habits at snack time will help lower your sodium. Instead of salted nuts or chips, try snacking on fresh fruits and vegetables. You can also make your own low-sodium snacks, such as trail mix with unsalted nuts and dried fruits.

Tips for Avoiding Sodium at Restaurants

Because so many Americans are used to highly salted foods, restaurants cater to those tastes. Believe it or not, the "heart healthy" label on menus doesn't always mean low in sodium.

Consider these options when eating out:

• Use oil and vinegar as a salad dressing
• Order other dressings, sauces, and gravies on the side, so you can add very small amounts
• Skip the salted crackers, breadsticks, or croutons
• Choose steamed vegetables
• Ask about low-sodium entrees
• Choose items that can be made without salt—such as grilled meat, fish, or poultry
• Avoid meats, poultry, or fish marinated in sauces that are often high in sodium

Special Tips for Ethnic Eateries

Asian—ask to have your food prepared without MSG, soy sauce, and salt.
Italian—avoid parmesan cheese, cured meats, olives, or pine nuts.
Mexican—choose low-salt menu items and ask the server not to bring chips and salsa.

Beware of Fast Food

If you think the fat and cholesterol content in fast foods is shocking, take a look at the sodium content.

A Burger King Whopper with cheese and a medium (salted) serving of fries have 2090 milligrams of sodium, which gives you nearly a whole day's sodium in just one meal. Adding bacon to the burger and having a medium diet Coke makes it about 2400 milligrams—and puts you over the day's limit.2

You can go online to check out nutrition information for many chain restaurants, or ask before you order to see if there's a better choice. Instead of the high-sodium options, choose these:

• The smallest hamburger (with no cheese, pickles, and sauces)
• A salad (with no dressing)

You Can Enjoy Eating Less Sodium

Your food may not taste the same when you first start to reduce sodium in your foods, but your taste buds will adjust. Try taking a step-by-step approach.

For snacks, eat fruits or vegetables twice a week, then build up to almost daily. Give yourself several months, during which you use less and less sodium in your homemade meals. And don't settle for bland—try different herbs and spices to flavor your meals.

Reminders to Help You Eat Less Sodium:

• Put your salt shaker away so you won't add salt—including kosher and sea salt—to foods.
• Check the sodium content of fruit and vegetable juices.
• Look at serving size. Will you really eat only half the can of soup or the entire can?
• Don't add salt to boiling water when cooking pasta, vegetables, or other foods.
• Generally salt can be completely cut from any recipe (except one containing yeast).
• Use a product called "salt substitute" only if your doctor says it's okay.

Our taste for salt is something we've learned, and we can unlearn it too. Soon you won't even want to go back to high-sodium foods because they will taste too salty. And you'll be helping your heart in the process.

1. The National Academies. Report sets dietary intake levels for water, salt and potassium to maintain health and reduce chronic disease risk [press release]. February 11, 2004. Available at:
http://www8.nationalacademies.org/onpinews/newsitem.aspx?recordID=10925. Accessed September 12, 2006.
2. Available at: http://www.bk.com/Food/Nutrition/downloads.aspx. Accessed September 12, 2006.

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