Clearing Up the Confusion About Salt

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If you’re confused about salt, I’m not surprised. There’s been a steady back-and-forth on claims that reducing dietary sodium (which represents 40 percent of the salt molecule) is crucial to our well-being, countered by claims that following this advice can sometimes be a health hazard.

While some studies have concluded that only people with hypertension on high-salt diets need to reduce salt intake, the overwhelming strength of scientific findings bolsters advice from major health organizations that most Americans should cut back on sodium for the sake of their health. Excess sodium is responsible for most cases of hypertension in Western societies, and hypertension is a leading risk factor for heart attacks, strokes and kidney failure.

Because salt added to our foods by processors and restaurants, not that from our saltshakers, is the main source of sodium in our diets, protecting the health of the most vulnerable requires a society-wide reduction in sodium.

The recommended daily intake for healthy American adults — 2,300 milligrams of sodium a day, or the amount in about 1⅛ teaspoons of salt — will be reflected in the new nutrition facts label, scheduled to take effect, depending on the size of the companies, beginning in mid-2018 until January 2021. Currently, the average American consumes more than 3,400 milligrams a day, an amount often found in a single restaurant meal. A lunch of soup and a sandwich can easily add up to a day’s worth of sodium.

However, an expert team reported last year in The New England Journal of Medicine that an average reduction of just 400 milligrams of sodium a day could save 28,000 lives and $7 billion in health care costs a year.

Seventy-five countries, including the United States, have adopted or advocated salt-lowering goals, and wherever this is happening, rates of hypertension and deaths from cardiovascular disease are declining.

To be sure, sodium is an essential nutrient, as is chloride that makes up the rest of the salt molecule. We evolved from ocean-dwellers, and human tissues still swim in a salty sea.

Our kidneys are fine-tuned machines for keeping blood levels of sodium within a physiologically healthy range; when there’s too much sodium on board, the kidneys dump it into urine for excretion, and when more is needed, they reabsorb it from urine and pump it back into the blood.

Unfortunately, faced with a chronic excess of sodium to deal with, the kidneys can get worn out; sodium levels in the blood then rise along with water needed to dilute it, resulting in increased pressure on blood vessels and excess fluid surrounding body tissues (read, swelling).

So why, you may wonder, is there any controversy? Shabby science, resulting in claims that is it unsafe to reduce sodium intake below 1,500 milligrams a day, is one reason, according to Bonnie Liebman, director of nutrition at the Center for Science in the Public Interest, a health advocacy organization in Washington, D.C.

“Very few people consume so little sodium, and most of those who do are sick to begin with, so they eat less and consume less sodium,” she explained. “It’s a phony issue.”

But when a study is published that runs counter to prevailing beliefs, it tends to get undue media coverage. “The media like ‘man bites dog’ stories, and studies with surprising results make headlines,” Ms. Liebman said.

Also feeding the debate is resistance from the food and restaurant industries, which fear that consumers will reject a change in recipes. However, two developments indicate no negative effect on sales or consumer choice when salt is reduced.

In 2015 New York City pioneered a requirement that chain restaurants place a high-salt warning — a saltshaker icon — next to menu items that contain 2,300 milligrams or more of sodium in a serving. Even some fast-food salads can exceed that amount. The ruling recently withstood a court challenge by the National Restaurant Association.

Six years earlier, the city created a National Salt Reduction Initiative, which now has more than 500 partners, including some food companies and restaurant chains, that seeks to lower sodium levels for restaurant-prepared and processed foods.

A nationwide sample of 172,042 households revealed that between 2000 and 2014 the amount of sodium from packaged foods and drinks purchased declined by 396 milligrams a day on average per person, although most households still exceeded recommended amounts.

Hats off to a companies like General Mills, which lowered sodium in 10 categories of foods and snacks by 18 percent to 35 percent by the end of 2015. Kudos as well to companies like Pepperidge Farm, Sara Lee and Oroweat, which market whole grain breads with no more than 140 milligrams of sodium in each slice, and thus qualify for a low-sodium claim on the label. Years earlier, General Mills test-marketed reduced-sodium Wheaties, a company staple, and it fizzled. The company later simply lowered the sodium content of this top-selling cereal without ballyhooing the change, and sales stayed the same.

“Consumers are sometimes wary of low-sodium products, thinking they will lack flavor,” Ms. Liebman observed. But when sodium is reduced gradually and without fanfare, they hardly notice it.

That, in fact, is the key to cutting back on salt generally: do it a little at a time to give taste buds a chance to adjust. While I still like some salt, highly salted foods I once enjoyed, like corned beef, cured olives and smoked fish, are now unpleasantly salty to me.

A culinary trick worth trying is to prepare foods without adding salt, then sprinkle some on at serving time. You’ll get a bigger bang for that salt buck while consuming less sodium. Some producers of chips rely on this tactic — consumers taste only the salt on the surface, which to my taste is more than enough on chips labeled “low sodium.”

Likewise, when buying canned or packaged soups, select ones labeled low-sodium and, if desired, add some salt at the table. Better yet, enhance the flavors of low-sodium soups with herbs, peppers, garlic and other salt-free seasonings. Also helpful, for reasons beyond sodium reduction, is to eat more fruits and fresh vegetables. They are naturally low in sodium and many are high in potassium, which helps to lower blood pressure.

Often, most of the salt in a restaurant dish comes from the sauce or dressing; ask for it served on the side and use only a small amount on the food. For dishes cooked to order, ask for them prepared without salt; you can always add some at the table, if desired.