Hidden Salt More Dangerous than the Saltshaker
It's well known that major health
organizations recommend cutting back on salt because of its link to hypertension (high blood pressure), which in turn is a
major risk for cardiovascular disease and stroke. In fact, the American Medical Association testified before the FDA last
year urging that Americans reduce salt consumption by half over the next decade. Stephen Havas, MD, vice president for science,
quality and public health at the AMA, said that 150,000 lives would be saved each year if Americans followed that advice.
Is this an over-reaction? Or a long overdue truth? The answer lies somewhere in between, according to Daily Health
News contributing medical editor Andrew L. Rubman, ND. While there are plenty of health benefits in the dietary recommendation
to ingest less salt, the reality is that our salt intake has little to do with what comes out of the salt shaker. As much
as three-quarters of the salt in the average American's diet is from foods that are packaged, processed or ordered at
a restaurant or fast food outlet. Yet advice gets over-simplified so that it seems unhealthy to sprinkle salt on your fresh
tomatoes or broiled chicken -- and really, that just won't make much of a difference, says Dr. Rubman. Further, salt in
the diet is important to our health, he points out, noting that it is "right near the top of the list of elements required
for human survival."
HOW MUCH IS TOO MUCH?
According to the American Heart Association,
the average healthy adult should eat less than 2,300 milligrams of sodium a day. Some people -- including African Americans,
people with a family history of high blood pressure and older adults -- may benefit from a diet that doesn't exceed 1,500
milligrams/day. But the American Dietetic Association says the average American adult actually consumes 4,000 to 6,000 milligrams
of sodium a day.
An important thing to know, says Dr. Rubman, is that technically there are many compounds called salts,
and thus the term total salt content may mean many things. Also, when it comes to what we use on our food, a distinction should
be made between sodium and salt, which often gets lost in salt-reduction recommendations. The two terms are not interchangeable
-- what's in the saltshaker is actually a mixture of sodium and chloride. Sometimes, says Dr. Rubman, it is the chloride,
rather than the sodium, that causes problems in people with high blood pressure.
Another expert, Mark Houston, MD,
author of What Your Doctor May Not Tell You About Hypertension and director of the Hypertension Institute of Nashville, told me that generally speaking, "the actual physiological
need for sodium chloride (salt) is only 500 to 1,000 mg per day. The relationship to potassium, calcium and magnesium intake
is important in the effects of sodium chloride on the cardiovascular system." Many factors, however, influence how much
salt an individual will require, including level of physical activity, climate and your unique biochemical makeup, and some
people may require more salt than that.
RESEARCH FOUNDATIONS FOR THE RECOMMENDATION
All that
notwithstanding, there is evidence showing that cutting back on sodium can help reduce blood pressure. A 2007 British
Medical Journal study assessing trials including prehypertension patients found that those who participated in a lifestyle
modification program that included a 25% to 35% reduction in sodium lowered their risk of cardiovascular problems by 25%.
Also, other research shows better blood pressure control can be achieved by using the “DASH” (Dietary Approaches
to Stop Hypertension) strategy, which emphasizes a whole-diet approach. The DASH diet is rich in vegetables, fat-free or low-fat
dairy, nuts, seeds and legumes, poultry, lean meats and fish, fruit and grains. It can bring significant drops in blood pressure
in conjunction with low sodium consumption.
SENSITIVE TYPES
Even so, reducing sodium levels
doesn't always make a difference. Only about one-third of those with hypertension are "salt-sensitive," meaning
their blood pressure will react to salt. Dr. Rubman points out that how sensitive you are to sodium depends on a number of
factors. For instance, the elderly and the obese are more vulnerable, as are African Americans.
All in all, says Dr.
Rubman, excess salt consumption can make about one-third of the population vulnerable to hypertension... though he acknowledges
it can be difficult to ascertain whether that describes you or not. If you've observed a relationship between your salt
consumption and your blood pressure, and therefore have reason to believe you are salt sensitive... and also if you have renal
disease, heart disease and hypertension for example, your health will likely benefit if you eat less salt -- ask your physician.
For the rest of us who choose a healthy diet, it's just not much of an issue, says Dr. Rubman. (For more on salt sensitivity,
see Daily Health News, July 25, 2006.)
WHAT TO DO?
If you believe -- or your doctor has told you -- that cutting back on salt would
benefit your health, it's important to focus your attention on the measures that will make a real difference. Here's
how:
- Eat whole foods, emphasizing fresh vegetables, lean protein and whole grains. This is a way to avoid the
sodium used to enhance flavor in packaged foods.
- Read labels carefully. Seemingly healthy foods are often
loaded with sodium. Also serving sizes may be unrealistically small, so look at sodium content in relation to serving size.
For example, a four-inch oat bran bagel has 451 mg of sodium... one ounce of salted, hard pretzels 486 mg... a single slice
of luncheon meat contains about 350 mg... one cup of Cheerios has 200 mg. When you are evaluating intake from these sources,
be clear about what you will actually eat -- not just what you should eat.
- Be aware of other ingredients
that contain sodium -- including baking soda, baking powder, disodium phosphate or other compounds with "sodium"
(or the symbol Na) in the name on the label.
- Don't buy or eat snacks or packaged foods that list a high
sodium content. Limit canned soups and vegetables, which usually contain excess salt to enhance flavor and improve shelf life.
- Avoid or limit fast food.
Following a diet that emphasizes whole foods over prepared and
packaged ones is healthier in every way. Unless your doctor has told you or you otherwise have reason to believe you are "salt
sensitive," you can freely enjoy a sprinkling of salt on your fresh food whenever you like.
Source(s):
Andrew L. Rubman, ND, director, Southbury Clinic for Traditional Medicines, Southbury,
Connecticut.
Mark Houston, MD, author of What Your Doctor May Not Tell You About Hypertension (Warner), an associate clinical professor of medicine at Vanderbilt University School of Medicine and the director of the
Hypertension Institute of Nashville. Dr. Houston is also a consulting reviewer for over 20 major US medical journals and has
published over 150 articles and scientific abstracts in peer reviewed medical journals.
