Nutritionists recommend sodium management for better health

Friday, February 8, 2008 | 2:00 p.m. CST; updated 4:39 p.m. CDT, Saturday, July 19, 2008

A few years ago, restaurant chefs became fascinated with exotic varieties of sea salt, putting the mineral’s “good” side in the spotlight as they sprinkled dishes with flecks of fleur de sel, smoked sea salt and French gray and pink Hawaiian varieties.

Although professional chefs agree that salt is an essential seasoning, other people are raising questions about its health aspects — more precisely, too much sodium.

To cut down on the amount of sodium in your diet:

Eat out less often. Choose restaurants where food is cooked to order, and ask questions about or make requests for food preparation. Ask for proteins grilled without marinades or added salt; oil and vinegar on the side in place of prepared salad dressings; skip the soy or dipping sauce that arrives with sushi. Take advantage of the nutrition information on the Web sites of fast-food and chain restaurants. Read labels carefully, particularly on frozen dinners, pizza and packaged rice and pasta mixes. Add more foods containing potassium to daily eating. Potassium-rich foods also help to blunt the effects of salt on blood pressure, nutritionist Sue Gebo said. Good sources of potassium are dried fruits; strawberries, bananas, cantaloupe and oranges; beets, greens and tomatoes; dried beans; turkey, fish and beef. In the meat department, read labels to determine if fresh meat or poultry has been marinated, injected with a salty solution or salted. Look for canned vegetables packed without salt, or rinse and drain canned vegetables and beans to reduce sodium content before cooking. Or switch to fresh or frozen (without added sauce) vegetables. Limit salty snacks such as potato and tortilla chips and pretzels. Check not only the sodium content on the nutrition label but also the serving size. To reduce the taste for salt, gradually cut back on salt used in cooking or at the table. Experiment with herbs and spices for seasoning. Make homemade soups, using from-scratch broth or canned or packaged low-sodium varieties. Cut back on foods that require larger amounts of salt in processing: cured foods such as deli meats, bacon and hot dogs, pickles and condiments such as soy sauce and Worcestershire sauce. Sources: Sue Gebo, R.D.; Linda Drake, M.S.; American Heart Association.

In November, acting on a request by the consumer watchdog group the Center for Science in the Public Interest, the Food and Drug Administration staged a public debate to determine if new regulations and guidelines on the use of salt, particularly in processed foods, are needed. The center went as far as asking the FDA to reconsider salt’s status as “generally recognized as safe.”

The government has recommendations. “The Dietary Guidelines for Americans,” published jointly by the departments of Agriculture and Health and Human Services, suggests an upper limit of 2,300 milligrams of sodium a day, the amount in a teaspoon of salt. The Institute of Medicine, part of the National Academy of Sciences, goes even further, suggesting 1,500 milligrams as adequate.

The problem is that Americans consume nearly twice the guideline for sodium. “Most of us get 4,000 milligrams or more a day in the American diet, so it doesn’t hurt anyone to cut back,” said Linda Drake, a nutritionist at the University of Connecticut and program director of the Expanded Food and Nutrition Education Program.

Processed foods account for 75 percent to 80 percent of the daily sodium intake. “Americans don’t consume large amounts of salt because they request it but often do so unknowingly because manufacturers and restaurants put it in food,” said Stephen Havas, vice president for science, quality and public health for the American Medical Association.

Only 5 percent to 10 percent of daily sodium consumption comes from the “discretionary” use of salt, either sprinkled on food at the table or during “from-scratch” cooking, said Sue Gebo, a registered dietitian in West Hartford, Conn., and a spokeswoman for the American Heart Association. Sodium naturally occurring in fresh foods accounts for another 10 percent.

How can someone cut back on sodium, even when relying more on prepared and convenience foods and restaurant meals? Some sodium is necessary in the diet. Sodium in conjunction with potassium enhances nerve-impulse transmission; both are involved in the balance of fluids in the body. But there is room for the “less is more” philosophy.

A bit of palate retraining is a first step. “The preference for salt isn’t fixed; we aren’t born with it,” Gebo said. The taste for salt “is a fixable thing, not something we’re stuck with.”

Tasting also can help with salt management. “Taste your food first; some people salt before tasting,” Drake said. “If you cook without salt and sprinkle salt on your food when eating, it’s probably better than salting during cooking.”

Fresh foods tend to be low in sodium, while fruits and vegetables are low in sodium and high in potassium, which helps to balance sodium in the body. A shift away from packaged, processed and prepared foods to more fresh foods and dishes prepared from scratch can lower sodium intake.

On one level, managing the amount of sodium from processed foods is easy — if one commits to becoming a label reader. “If you’re buying (a product) off the shelf, at least you can read the label and see how much sodium you are getting,” Drake said.

Sometimes, those values can be surprising. One cup of Progresso vegetable beef soup has 880 milligrams of sodium, 43 percent of the daily allowance. But don’t think that Muir Glen Garden Vegetable soup is a better choice, just because it is organic; it contains 990 milligrams. “If you have two cups of (canned) soup, that’s pretty much it for the day,” Drake said.

Foods such as soy sauce and deli meats are large sources of sodium because salt is an essential ingredient in their processing. Sodium occurs naturally in dairy products, while calcium in milk and other dairy products has a beneficial effect on blood pressure. Some cheeses are saltier than others: Swiss cheese tends to be lower in salt than other varieties; extra sharp cheddar has more sodium than regular cheddar.

While certain foods seem shockingly high in sodium — one tablespoon of Tamari soy sauce has 960 milligrams — Drake suggested looking at the big picture. It’s not the occasional indulgence in a high-salt food that matters but the day-to-day consumption. If Tuesday’s meals score high on the sodium meter, cut back on Wednesday. Over the course of the week, aim for an average of 2,400 milligrams, Drake said.

Managing sodium in the diet is only one piece of the diet puzzle, Gebo said. “Although sodium is important, it shouldn’t be the only piece to look at. If people are resistant to focusing on sodium, it’s more important to focus on activity, limited alcohol, not smoking and maintaining good weight.”

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