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The Honolulu Advertiser
Posted on: Friday, May 30, 2003

Caught in the salt trap

• Uncover the hidden salt in your diet

By Marian Uhlman
Knight Ridder News Service

The American Heart Association recommends adults should consume no more than 2,400 milligrams of sodium, or about one teaspoon of salt each day.

Richard Ambo • The Honolulu Advertiser

It's hard to believe salt once was a rare commodity — the subject of conflicts, exploration and exploitation.

Today, you can barely avoid the stuff.

It's in almost everything you eat, often, in much higher quantities than you might think.

Grab a half-pound cheeseburger at a fast-food restaurant and you'll ingest about 1,100 milligrams of sodium in salt — almost half the government's recommended maximum of 2,400 milligrams a day. Tack on a medium order of french fries, and, in a few gulps, you have close to 1,400 milligrams altogether.

How about a six-inch tuna hoagie? One can contain more than half the daily sodium allowance. A large taco? It can have more than 1,200, according to government data.

Even foods that don't taste particularly salty slip sodium into your diet: A tablespoon of ketchup, about 190 milligrams.

A slice of whole-wheat bread, about 150. A doughnut, about 200.

It all adds up.

Salt is sodium chloride, and by eating salted food, the average American adult consumes about 4,000 milligrams of sodium a day — nearly 70 percent more than the daily maximum the government recommends. Up to 75 percent of the daily sodium intake in the United States comes from salt in processed food.

Many public-health officials say the amount of hidden sodium in food makes it hard, if not impossible, to reduce your consumption. So they want to get the restaurant and food industries on board to lower the sodium content in their offerings.

The American Public Health Association last fall set a goal for industry to reduce the sodium content of processed foods by 50 percent over the next decade. The resolution also was endorsed by the National High Blood Pressure Education Program coordinating committee.

The association says extra sodium in the diet isn't good for the nation's health. It's linked to high blood pressure and contributes to stroke and heart disease. The sodium in salt elevates blood pressure by increasing fluid retention in the body, which puts added pressure on vessel walls.

More than 50 million American adults — one in four — have high blood pressure, according to the National Heart, Lung and Blood Institute.

Taking measures to lower the population's blood pressure, even a little bit, could have a profound effect on the nation's overall health, according to the public-health body.

Stephen Havas, lead author of the public-health policy statement, said about 150,000 lives a year could be saved if industry met the 50 percent reduction target.

"Calling for a 50 percent reduction is a big change, and represents a public-health approach to the problem of excess sodium consumption," said Havas, a professor of epidemiology and preventive medicine at the University of Maryland School of Medicine. In the past, "the major focus was on consumers, who generally had little information on how much sodium they were receiving, particularly in restaurants."

Robert H. Eckel, a spokesman for the American Heart Association, said the research now is "good enough" for a public-health campaign to lower salt content in food. "It is a step in the right direction," said Eckel, the heart association's chairman of the nutrition, physical activity and metabolism council.

Eckel said some people could handle more salt in their diets than others without health troubles. But, he said, enough people are "salt sensitive" to make sodium reduction a goal for the entire population. Salt sensitivity is a measure of how blood pressure responds to a decrease in salt intake.

Eva Obarzanek, a research nutritionist at the National Heart, Lung and Blood Institute, said the policy made sense, even for people with normal blood pressure.

"Because blood pressure rises with age, by keeping salt intake low, the expectation is that you will prevent the rise of blood pressure with age," she said.

Salt reduction is not the only way to help prevent or reduce high blood pressure. Other measures include maintaining a healthy weight, being physically active, limiting alcohol consumption, quitting smoking, and eating a diet that emphasizes fruits, vegetables, and low-fat dairy foods, and that is low in saturated fat, total fat and cholesterol.

The American Public Health Association says it has not yet gotten much reaction from the food industry.

Gene Grabowski, a spokesman for the Grocery Manufacturers of America, said, "The industry has provided low-salt and no-salt alternatives for several years.

"The industry provides variety, and taste is still the No. 1 reason why people purchase food," he said.

On its Web site, the American Iron and Steel Institute says canned foods today "generally deliver" about 40 percent less sodium than the same products did a few years ago.

There's little doubt people love a salty flavor.

Salt also "strengthens the perception of flavors of other compounds in food," said Lynn Riddell, a Drexel University assistant professor of nutrition.

But people can adapt to the taste of less salt in food over several months. "If you stick at it," Riddell said, " ... you can start to appreciate the natural taste" of food more.

The quest for salt has dominated history. As Mark Kurlansky wrote in his 2002 best seller "Salt," the compound "became one of the first international commodities of trade; its production was one of the first industries and, inevitably, the first state monopoly."

People need some sodium to stay healthy. But how much?

The national Food and Nutrition Board estimates that 500 milligrams of sodium is the minimum most healthy adults should consume per day. People need sodium to help regulate the body's water balance, keep muscles functioning and conduct nerve impulses.

In Britain, a public-health movement to reduce salt in the overall population's diet has been around since the mid-1990s. And it's making inroads, said Graham MacGregor, a cardiovascular medicine professor at St. George's Hospital Medical School in London.

He said one of the nation's large supermarket chains two years ago agreed to cut the salt in its store-brand processed foods and achieved a 12 percent reduction across its product line. The chain plans to cut salt by another 10 percent before the end of 2004. Sales have not dipped, said MacGregor, who has helped lead the movement.

The strategy isn't aimed at taking all the salt out, he said, but rather to "make small reductions which cannot be detected by consumers." The process then is repeated every few years until there is a 50 percent reduction without anyone noticing, he said.

Other supermarkets are adopting the strategy, too, he said.

• • •

Uncover the hidden salt in your diet

The American Heart Association recommends adults should consume no more than 2,400 milligrams of sodium, or about one teaspoon of salt each day.

How to reduce sodium in your diet

  • Choose foods without added salt.
  • Select unsalted, low-fat and low-sodium products.
  • Avoid adding salt and canned vegetables to homemade recipes.
  • When dining out, ask that food be prepared without salt.
  • Use spices and herbs instead of table salt.

Some sodium compounds to avoid

  • Salt: Used in recipes and at the table
  • Monosodium glutamate (MSG): A seasoning used in restaurants and found in many packaged, canned and frozen foods
  • Baking soda (sodium bicarbonate): Used in recipes and as an alkalizer for indigestion
  • Baking powder: Used in recipes

Source: American Heart Association

Blood pressure concerns

Blood pressure levels in adults
Category Systolic Diastolic
Optimal 120 80
Normal 130 85
Prehypertension 120-139 80-89
Hypertension 139 and above 89 and above

Preventing high blood pressure

  • Eat a healthy diet.
  • Reduce salt and sodium in your diet.
  • Maintain a healthy weight.
  • Exercise.
  • Limit alcohol to one drink a day for women, two drinks a day for men.
  • Quit smoking.

Source: National Institutes of Health

Correction: Hypertension is defined as consistently exhibiting blood pressure of 139 and above systolic over 89 and above diastolic; the condition called prehypertension (formerly known as high-normal or borderline) is defined as consistently having blood pressure in the range of 120 to 139 systolic over 80 to 89 diastolic.