Monday, July 8, 2019

It’s Time to Reduce and Substitute the Salt in Our Diets


By Nishant Jalandhara, MD
Clinical Nephrologist, Fort Worth
2019 Graduate, Texas Medical Association Leadership College 

Americans love salt. The average American is estimated to consume 10.4 and 7.3 grams of salt per day, respectively. The U.S. Department of Agriculture and U.S. Department of Health and Human Services both recommend people consume less. Too much salt threatens our health. The ideal target is 5.8 grams of salt per day (2.3 grams of sodium). Adults over age 40, African-Americans, and people with hypertension should consume no more than 3.7 grams of salt per day. (One gram of sodium is equivalent to 2.5 grams of salt, or sodium chloride.) 

We do need some salt in our diets, however. It is estimated that we need about 500 milligrams of sodium daily for our body’s vital functions. But too much sodium in the diet can lead to high blood pressure and stroke, as the DASH diet and INTERSALT studies have shown. 

Salt, also known as sodium chloride, is about 40% sodium and 60% chloride. It is found in many different food items, and is used as a binder and stabilizer. Salt has endured as an important part of our culture. Many different salt variants serve different needs, including as a way to preserve foods to prolong their shelf life. 

There are various types of salt used in our foods:

 Table 1: Common Types of Salt in Foods

  • Table salt: The most common salt. Extracted from mines. Heavily processed. Kosher salt: Kosher salt dissolves fast, and its flavor disperses quickly. Same sodium content as table salt.
  • Fleur de sel: Origin in France, melts in mouth, leaving salty aftertaste. Same sodium content.
  • Sea salt: Produced by evaporating ocean or sea water. Has other minerals in it in minute quantities, like zinc, potassium, and iron.
  • Himalayan pink salt: Harvested from mines in the Himalayas. Considered the purest form of salt in the world.
  • Garlic, onion, and celery salt: These are salts with garlic, onion, or celery.


Salt consumption is a cultural thing, where consumption is driven by taste and our appetite for processed food. Most salt we consume today comes as a preservative in foods that we buy. Table salt and salt added while cooking contributes to about 10% of salt consumption. (Figure below) 


Table 2: Top 10 food items with highest salt consumption, according to the Centers for Disease Control and Prevention (CDC)

  1. Bread and rolls (80-230 mg)
  2. Cold cuts/cured meats (1 bacon 194mg/ 1 beef jerky 443 mg)
  3. Pizza: 1 slice (500-700)
  4. Fresh and processed poultry (300-700 mg)
  5. Soups (300-500 mg)
  6. Sandwiches like cheeseburgers (700-1700 mg)
  7. Cheese, one ounce slice (330-440 mg)
  8. Pasta dishes like spaghetti with meat sauce (400 mg)
  9. Meat dishes like meatloaf with tomato sauce (600-1100 mg)
  10. Snacks like chips, pretzels, etc. (140 mg)


Salt History: How Did We Get Here?
Salt has long been part of the human diet, becoming commonplace about 5,000 years ago. Ancient Chinese texts described more than 40 types of salt about 4,700 years ago. People began using salt as a food preservative long ago, which helped humans migrate longer distances. (Bacteria cannot thrive in the presence of a high amount of salt.) 

Decades ago, a study indicated some people were healthier due to less salt in diets. The 1975 study examined South America’s Yanomami tribe and its “salt-free culture.” The tribe survived on traditional hunting, and gathering of fruits and berries from forests. They were not farmers. On an average, each person in the tribe consumed one-tenth of a typical packet of salt (the packets commonly found in American restaurants). The tribesmen’s average systolic blood pressure reading – the first of the two common pressure readings – was less than 110 mm Hg across all age groups. (The American Heart Association defines a systolic pressure below 120 as normal blood pressure.) Bottom line: they consumed less salt, and their blood pressure was in a healthy low range. 

High blood pressure is linked to greater risk of heart attack, stroke, and other chronic health problems.

Recommendations
If reducing salt intake helped the Yanomami tribe and also is recommended by physicians and groups like the American Heart Association, it is a healthy goal, right? 

The list of all the salt-laden foods we showed above leaves us with limited options to reduce salt in our diet, but this is what I recommend: 
  • Limit processed foods high in sodium.
  • Purchase healthy options and talk with your grocer or favorite restaurant about stocking lower sodium food choices. E.g. - deli meat, low-sodium bread, and soup. 
  • Avoid frozen meals, as they are high in sodium.
  • Read labels. Foods considered low in sodium have less than 5% (125mg) of the daily value of sodium.
  • Eat a diet rich in fresh fruits and vegetables, and frozen fruits and vegetables without sauce.
  • When eating out, request lower sodium options.
  • Use sodium-free salts (which contain potassium chloride): AlsoSalt, Morton Salt Substitute, NoSalt, Nu-Salt
  • Instead of salt, use herb and spice blends: Chef Paul’s Magic Salt-Free Seasoning, Mrs. Dash
Too much salt is the enemy. To ensure a healthier lifestyle, try to follow these suggestions to limit how much salt you consume.

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