Most Americans are consuming too much sodium, and it's likely harming our health
By Natasha Persaud
Are we addicted to sodium? According to a 2012 report from the Centers of Disease Control and Prevention (CDC), almost all of us—9 in 10 adults in the United States—are getting far more sodium from our diets than is recommended.
In just one day, the average American consumes about 3,300 milligrams (mg) of sodium—nearly 50 percent more than the daily recommended allowance of 2,300 mg and more than twice the 1,500 mg limit for 3 out of 5 of us.
Nora Keenan, Ph.D., an epidemiologist with CDC's division for heart disease and stroke prevention, coauthored an eye-opening 2009 report that found most of us need to cut back on sodium for our health. We talked with her to learn about our sodium problem and how to fix it.
What's causing the sodium overload?
According to the 2012 report by the CDC, Americans consume up to 65 percent of their sodium from processed foods from the grocery store and 25 percent from restaurant meals. The salt shaker on the table isn't the problem.
More than 40% of our daily sodium intake comes from the following 10 types of foods, in descending order:
1. Breads and rolls (partly due to the amount eaten)
2. Cold cuts and cured meats, such as deli or packaged ham or turkey
3. Pizza
4. Poultry
5. Soups
6. Sandwiches such as cheeseburgers
7. Cheese
8. Pasta dishes (excluding macaroni and cheese)
9. Dishes containing meat, such as meat loaf with tomato sauce
10. Savory snacks such as chips, pretzels, and popcorn
You might be surprised to find foods that otherwise seem healthy on the list, such as turkey breast. Some varieties may contain high levels of sodium. Other foods that you eat several times a day, such as bread, add up to a lot of sodium even though each serving may not be high in sodium.
How much more sodium do prepared foods contain?
Sodium is used for flavoring and, in many cases, as a preservative. While one cup of fresh tomatoes provides 16 mg of sodium, one variety of canned tomato sauce may contain as much as 1,400 mg of sodium. Depending on the brand and the type of meal, a single frozen dinner can easily contain 600 to 800 mg of sodium, or half the day's supply.
At the grocery store, you may find extra sodium in: condiments, frozen meals, canned vegetables and beans, smoked meats, pickled and brined foods, tomato sauce, soups and prepared mixes. Cereals, bagels, cheeses, candies and desserts, even drinks can also contain hidden sodium. And many foods that you might consider healthy, such as low-fat items, actually contain extra sodium as a flavor enhancer.
Beyond the grocery store, we also get a lot of our sodium from takeout and restaurant meals. Depending on what is eaten, restaurant meals can contain 1,000 to 2,000 mg of sodium, or even more.
Despite what you might think, only 5 percent of our sodium intake comes from salt we use in cooking and 6 percent from salt we add at the table. We cook with extra salt when we use seasonings such as celery salt, garlic salt and the like. That's why it's important to be aware of everything you're eating.
Do we crave foods with lots of salt?
Yes. We've grown accustomed to consuming a higher level of sodium than we need. A lot of our cravings, including our desire for salt, develop over time. The more high-sodium foods we eat, the more we eventually want.
According to preliminary research in animals, sodium may act as an antidepressant. When we're in a bad mood, we may automatically reach for salty foods. More research needs to be done to confirm these findings.
Why is it dangerous to consume excess sodium?
Over time, it raises your chances of high blood pressure, a serious condition that, when uncontrolled, damages blood vessels throughout the body. High blood pressure can eventually lead to heart disease and stroke, as well as other health problems.
Of course, to lower your risks for high blood pressure, it's not sufficient to focus just on sodium. You also need to be taking other steps, such as
- engaging in at least 30 minutes of moderate physical activity every day,
- losing excess weight,
- quitting smoking
- and minimizing your consumption of alcohol.
Should we all be lowering our sodium intake, or is it more important for some people than others?
Most American adults over age 20 probably need to lower their sodium intake to bring it down to a healthy level of 2,300 mg of sodium a day. What's more, 3 in 5 of us need to lower our sodium intake even further, to 1,500 mg or less a day. This includes anyone over the age of 40, all adults of African-American ancestry, and anyone with high blood pressure.
How can we lower our sodium intake?
The best way to gauge how much sodium you're consuming is to record your intake for a week. Write down what you’re eating for a full seven days because you probably eat differently on the weekend than you do on weekdays. Become familiar with the sodium content of foods you typically eat. If you’re not sure how much sodium foods contain, check out this helpful list giving sodium counts from the USDA.
Pay attention to your body, too. You might suspect high sodium intake if a few hours after you eat, you feel very thirsty and/or you retain water and your ankles swell. However, these signs can also indicate other health problems.
If you have high blood pressure, discuss your eating habits with your doctor to determine whether high sodium foods might be one cause.
So, what should we eat?
In general, we should all be eating more fresh foods. Follow an eating plan, such as DASH (Dietary Approaches to Stop Hypertension), that is rich in fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds and nuts.
Compared to the typical American diet, the DASH plan contains less salt and sodium, and contains fewer sweets, added sugars, sugar-containing beverages, fats and red meats. It's also well-balanced, providing nutrients and fiber that we all need to stay healthy.
The National Heart, Lung and Blood Institute offers a diet based on a daily intake of 2,300 mg of sodium, and it gives additional suggestions for those who need to lower their sodium intake to 1,500 mg or less a day.
Can we use nutrition labels to determine what foods we can and can’t eat?
Yes. Check the nutrition facts for the number of milligrams of sodium contained in one serving of the food. Be aware that a package may contain more than one serving.
The daily value of sodium, which is listed as a percentage on the label, is not as useful as the actual number of milligrams of sodium because it is based on an intake of 2,400 mg of sodium a day, which is higher than most of us need. The nutrition facts label will probably be revised in the future to reflect these new guidelines.
Won't food with less salt taste bland and boring?
That's a matter of perception. Many consumers who see "low sodium" on a food product automatically think it'll taste bland, but, if they took a blind taste test, they might not notice a difference.
Research also suggests that your taste buds will adjust after a few months of consuming less salt, and you’ll enjoy your meals as much as before.
You can also increase the flavor of your dishes you make by using spices and herbs instead of salt.
Should we use salt substitutes (such as light salt, "low sodium" salt or "no sodium" salt)?
Unless your dietitian or doctor recommends it, don’t use them. Sometimes the ratio of sodium to potassium in these products is not beneficial to your health.
What efforts are the government and food industry making to lower sodium consumption in the United States?
The CDC, in collaboration with various government agencies, is working with food manufacturers and chain restaurants to lower sodium levels in foods and improve cardiovascular health for the nation. In addition, CDC will continue working with their public health partners at the national, state, and local levels to support these efforts.
Tips to Reduce Salt and Sodium
Here are some helpful tips from then National Heart, Lung and Blood Institute on lowering your salt intake:
- Buy fresh, plain frozen, or canned "with no salt added" vegetables.
- Use fresh poultry, fish, and lean meat, rather than canned or processed types.
- Use herbs, spices, and salt-free seasoning blends in cooking and at the table.
- Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta and cereal mixes, which usually have added salt.
- Choose "convenience" foods that are lower in sodium. Cut back on frozen dinners, mixed dishes such as pizza, packaged mixes, canned soups or broths, and salad dressings—these often have a lot of sodium. Choose ready-to-eat breakfast cereals that are lower in sodium too.
- Rinse canned foods, such as tuna, to remove some sodium.
- When available, buy low- or reduced-sodium, or no-salt-added versions of foods. Low sodium foods contain 140 mg or less sodium per serving. Reduced sodium foods contain at least 25 percent less sodium than the original product.
- Change gradually. Add a vegetable or fruit serving at lunch and dinner.
- Use only half the butter or margarine you do now.
- If you have trouble digesting dairy products, try lactase enzyme pills or drops—they're available at drugstores and groceries. Or buy lactose-free milk or milk with lactase enzyme added to it.
- Get added nutrients such as the B vitamins by choosing whole grain foods, including whole wheat bread or whole grain cereals.
- Spread out the servings. Have two servings of fruits and/or vegetables at each meal, or add fruits as snacks.
- Treat meat as one part of the meal, instead of the focus. Try casseroles, pasta and stir-fry dishes. Have two or more meatless meals a week.
- Use fruits or low-fat foods as desserts and snacks.
Reproduced from the National Heart, Lung and Blood Institute of the National Institutes of Health.
Tips on Making the Switch to the DASH Eating Plan
Reproduced from the National Heart, Lung and Blood Institute of the National Institutes of Health.
Spice It Up—Without Using Salt
Try these flavoring, spices and herbs:
For Meat, Poultry and Fish
Beef
Bay leaf, marjoram, nutmeg, onion, pepper, sage, thyme
Lamb
Curry powder, garlic, rosemary, mint
Pork
Garlic, onion, sage, pepper, oregano
Veal
Bay leaf, curry powder, ginger, marjoram, oregano
Chicken
Ginger, marjoram, oregano, paprika, poultry seasoning, rosemary, sage, tarragon, thyme
Fish
Curry powder, dill, dry mustard, lemon juice, marjoram, paprika, pepper
For Vegetables
Carrots
Cinnamon, cloves, marjoram, nutmeg, rosemary, sage
Corn
Cumin, curry powder, onion, paprika, parsley
Green beans
Dill, curry powder, lemon juice, marjoram, oregano, tarragon, thyme
Greens
Onion, pepper
Peas
Ginger, marjoram, onion, parsley, sage
Potatoes
Dill, garlic, onion, paprika, parsley, sage
Summer squash
Cloves, curry powder, marjoram, nutmeg, rosemary, sage
Winter squash
Cinnamon, ginger, nutmeg, onion
Tomatoes
Basil, bay leaf, dill, marjoram, onion, oregano, parsley, pepper
Reproduced from the National Heart, Lung and Blood Institute of the National Institutes of Health.
Additional Sources:
CDC. "Vital Signs: Food Categories Contributing the Most to Sodium Consumption — United States, 2007–2008" Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm61e0207a1.htm?s_cid=mm61e0207a1_w Accessed on: February 10, 2012.
FDA. "Code of Federal Regulations Title 21." Available at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=101.61 Accessed on February 15, 2012.
