Why You Should Care About Sodium Levels in Your Food

August 29, 2016 6:00 AM

Amid new proposed federal guidelines to cut sodium levels in commercial foods, a U-M cardiologist explains why the salt shake-up has merit.

It often seems as if the dangers of excessive salt take a backseat to campaigns advocating that consumers cut back on fat and sugar.

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In terms of visibility, “I do feel like it’s probably third,” says Scott Hummel, M.D., M.S., a cardiologist at the University of Michigan Health System.

But it shouldn’t be, he says.

A salt-heavy diet can lead to a host of health problems, including high blood pressure. That, Hummel says, can eventually trigger heart attack, kidney problems and stroke.

What might be less obvious is that much of the concern can’t be blamed solely on folks who reach for the salt shaker with gusto: About 75 percent of total sodium intake, according to the Food and Drug Administration, comes from processed and restaurant foods.

Nor might people know the worst offenders — some of which aren’t considered inherently salty.

“I tell my patients anything that comes in a can or a box is automatically suspect,” says Hummel, noting that canned vegetables, soups and sauces as well as frozen TV dinners and pizzas pack a major sodium punch.

Guilty, too, are most commercially prepared breads, meats and cheeses that contain copious levels of salt as a cheap flavor source.

That, then, could make the layers of your lunchtime sandwich seem a little less appetizing.

“If you’re having a good-sized ham-and-cheese sandwich, bam — that’s 1,200 milligrams of sodium,” Hummel says.

Such quantity is magnified when applied to the federal government guidelines for sodium consumption: no more than 2,300 milligrams daily. (The average person in the United States gets about 3,400 milligrams of sodium per day — about 1 1/2 teaspoons total and nearly 50 percent more than the suggested amount.)

The sandwich analogy is even more stark if recommendations from the American Heart Association are applied instead. Those, which Hummel says have been viewed by some as “extremely controversial,” advise no more than 1,500 milligrams of sodium in a 24-hour span.

"We’re eating a lot more salt than we’re evolved to handle."
Scott Hummel, M.D., M.S.

A push for restraint — and a pushback

Although it isn’t uncommon to find lower-sodium versions of various foods at the grocery store, more options could follow.

Seeking to bolster the existing movement, the FDA in June released voluntary sodium reduction goals for commercially processed, packaged and prepared foods.

It didn’t, however, lay out a specific amount that should be cut or any methods to do so.

Hummel, who also directs the heart failure program at the Veterans Affairs Ann Arbor Healthcare System, nonetheless praised the effort.

“I think there’s at least circumstantial evidence that it (the FDA guidelines) would save lives” by helping contribute to lower blood pressure, he says. “I feel like it’s a huge step forward — an admission by our regulators that this is an important issue we should focus on as a country — even though it’s voluntary, even though it’s vague.”

Adds Hummel: “Where it leads is going to be complicated and political.”

He pointed to a New York City rule enacted in December 2015 that required chain restaurants with at least 15 locations to put a symbol on menus next to any item that contains the daily sodium limit of 2,300 milligrams or greater. The National Restaurant Association, citing an unfair burden for its members, sued the New York City Board of Health shortly after.

But a government initiative in the United Kingdom, a two-pronged approach of public-service advertising and cooperation with food manufacturers to cut sodium, helped reduce salt intake by 10 percent. Over the next several years, deaths from strokes and heart attacks in the U.K. fell significantly.

In an editorial published in August, the director of the Centers for Disease Control and Prevention voiced support for the FDA measure and noted that cutting daily sodium consumption by even 20 percent — about 400 milligrams — could spare 32,000 heart attacks and 20,000 strokes each year.

To be fair, Hummel notes: “You need a certain amount of salt to retain fluid, to keep your blood pressure up and circulating to your kidneys … to maintain your normal physical state.”  

Still, he says, “We’re eating a lot more salt than we’re evolved to handle.”

To help people better learn where the sodium in their food is coming from, the CDC released a list of the top contenders. (Article continues below the graphic.)

Positive choices

Hummel advises his patients seeking to cut back on salt to do so gradually. A tapered withdrawal is more likely to maintain long-term success (and help the palate adjust over time.

“To change habits that have built up over years or decades, you have to meet people where they are,” says Hummel, noting that a retiree who meets with friends each morning at McDonald’s might stick to enjoying only a coffee — and ordering a breakfast sandwich just once or twice a week.

Simple preventive steps also can be taken when shopping.

Compare sodium content between like items and choose the lighter one, Hummel says. Cook with fresh vegetables or, if that isn’t possible, thoroughly wash the contents of canned goods to remove excess salt.

Go easy on sauces and dressings; make your own for a healthier option. Consider spices such as basil, curry and turmeric or add lemon juice as alternative means of flavor.

When going out to eat, look for items that you know already are low in sodium. Ask for your dish to be prepared without added salt.

“Keep really good track of what you’re eating and add it (salt content) all up,” Hummel says, noting that folks struggling to adapt or those in poorer health should consult a dietitian.

The ultimate goal for patients and for the FDA’s recent guidance: making less-salty fare the standard default.

“Having a lower content to start with is going to be a good baseline for people with higher risk,” Hummel says. “This might allow patients to eat more of the foods they like without going over their daily amount.”