Remember Sodium? We're Still Getting Too Much - And the Risks, Besides Heart Attack And Stroke, Include Osteoporosis And Kidney Trouble
New York Times Syndicate

By Mariko Thompson

Wednesday, March 12, 2003

Long before the carbs vs. protein wars, before good fats squared off against bad fats, salt reigned as public health enemy No. 1.

We were warned to set down the salt shaker, to substitute herbs and spices in our home cooking and to go easy on the pretzels and potato chips. Twenty years later, the public health campaign against sodium is still being waged. But the target has shifted from the obvious sources to the hidden ones.

The average American consumes 4,000 milligrams of sodium per day, far exceeding the maximum of 2,400 milligrams recommended by USDA dietary guidelines and major health organizations such as the American Heart Association. These days, only an estimated 25 percent of daily sodium intake is added at the table. The remainder is unseen, consumed in restaurant and processed foods.

``People juggling career and family will go for the convenience foods,'' said Bettye Nowlin, a Calabasas-based spokeswoman for the American Dietetic Association. ``But they need to be aware that sodium is everywhere.''

Take a look at the food labels on common grocery items. A half cup of Ragu's Old World Style spaghetti sauce contains 780 milligrams of sodium. A Weight Watchers Smart Ones frozen entree may be low in fat and calories, but it's not so light in sodium. The fire-grilled chicken and vegetables entree packs in 780 milligrams of sodium.

While labels on processed foods provide a tool for consumers, what about restaurants? According to the Center for Science in the Public Interest's ``Restaurant Confidential,'' a Burger King Broiler Chicken Sandwich has 1,110 milligrams of sodium, the garden vegetable soup at Au Bon Pain has 1,240 milligrams, and a bean burrito at Taco Bell has 1,080 milligrams.

The whopping levels in some grocery and restaurant items recently led the American Public Health Association to call on those industries to cut sodium levels in half over the next decade. People who consume high levels of sodium are more likely to develop hypertension, said Dr. Stephen Havas, the lead author of the new policy and professor of epidemiology and preventive medicine at the University of Maryland.


An estimated one in four American adults suffers from high blood pressure. Studies have shown about 90 percent of the population is diagnosed with hypertension by the age of 80. People with high blood pressure have an increased risk for heart disease and stroke. High sodium levels also raise the risk of osteoporosis and kidney problems.

While salt plays a role in certain health conditions, the underlying causes and solutions are multifaceted, said Sanford Miller, a senior fellow at Virginia Tech's Center for Food and Nutrition Policy. With hypertension, factors such as genetics and regular exercise impact who will develop the disease. People with a family history of hypertension and African-Americans, who as a group are more likely to develop the disease, should be careful about their sodium intake.

In the case of osteoporosis, potassium appears to offset calcium losses from excessive sodium. A recent study at the University of California, San Francisco, found that postmenopausal women with diets high in salt lost higher amounts of bone mineral. Eating potassium-rich foods such as bananas, tomatoes and orange juice helped stem the calcium loss.

Still, Havas predicts gradual sodium reduction across the board would save 150,000 lives a year.

``Hypertension is preventable,'' he said. ``This is a largely preventable condition. It does not have to happen.''

Robert Earl, a registered dietitian and the senior director for nutrition policy at the National Food Processors Association, said consumers who buy processed foods have the tools and the choices to reduce sodium in their diets without new industrywide measures.

In addition to improving taste, salt historically has been used as a preservative. In the last 50 years, overall sodium levels in processed foods have been reduced through better technology and the introduction of other preservatives, Earl said.

Over the last 20 years, food manufacturers have developed reduced- and low-sodium versions of many of their products, including chicken broth and snack foods. Mandatory food labels allow consumers to gauge their daily sodium content.

``There have been enormous strides in reducing the amount of sodium in the last few decades,'' Earl said. ``Consumers have the tools to make clear dietary choices. Not everyone has the same need for restriction. You have different age, level of activity and other variables.''


With no labels to peruse, eating at restaurants can pose greater challenges. There's no way to know whether the garden vegetable soup contains more sodium than the beef barley soup. The best thing a consumer can do is ask, said John Dunlap, president and CEO of the California Restaurant Association.

``Our members recognize the importance of providing healthful menu options in order to accommodate a wide range of dietary needs, including low sodium,'' Dunlap said. ``Most restaurants will alter food preparation methods when requested.''

The more informed people are about cooking and food, the better their choices will be, he said. A salad loaded with bacon, cheese and salad dressing is a nutritional time bomb next to a dish of pasta, grilled chicken and steamed vegetables.

``Salt is in many respects a core seasoning,'' Dunlap said. ``It depends on the cuisine. There are a lot of terrific flavors that emerge with little or no salt. I think consumers need to be educated and should not be afraid to ask questions.''

At a minimum, the human body requires only 500 milligrams of sodium, about a quarter teaspoon of salt. Healthy people excrete extra sodium. But outside of the groups that are considered at risk, most people won't know if their bodies are sodium sensitive until it's too late, Miller said.

``Even back (in the '80s) it was pretty clear not everyone was susceptible,'' Miller said. ``What we realize now is that there are fewer people than we thought in that group. The problem is you don't know if you are. The prudent thing to do is assume everyone is. I'm not saying you have to cut out all sodium. That's not possible and it causes difficulties in its own right.''


The ADA's Nowlin suggests buying products with less than 20 percent of the daily recommended sodium intake per serving. A product that contains less than 5 percent of the daily value per serving is considered low sodium, she said. Consumers also should consider portion size. One serving of soup may contain 480 milligrams of sodium or 20 percent of the daily value. But if you eat the whole can - as many do - you'll need to double the amount.

When reviewing a list of ingredients for sodium, look for the symbol ``Na'' as well as soda (as in sodium bicarbonate). Even everyday medications such as antacids and headache remedies contain sodium and must be labeled if the amount is more than 5 milligrams per dose, according to the American Heart Association.

Carol Koprowski, assistant professor of preventive medicine at USC, warns against using salt substitutes such as potassium chloride. In place of salt, use lemon juice, balsamic vinegar, fresh herbs and garlic as seasonings.

``I don't recommend salt substitutes,'' she said. ``They can have adverse health consequences. If a person has any kidney impairment, they might not be able to get rid of the extra potassium.''

When ordering from a menu, descriptions can provide clues. Pickled and smoked items, as well as foods prepared with soy sauce and broth, are likely to be high in sodium. Choose dishes where the meat has been broiled, baked or grilled. Avoid sauces and salad dressings or order them on the side.

``It's like a bank account - you've got 2,400 milligrams to work with for the day,'' Nowlin said. ``Eating habits learned early in life are habits for a lifetime. The taste for salt is learned - and we can unlearn it. It's like going from whole milk to nonfat milk. After a period of time, it tastes just as good.''