Has Salt Gotten A Bad Shake?

I’m pretty healthy. Do I really have to worry about how much salt I eat?

Here’s the dilemma: While many people are anti-salt because studies have linked it to elevated blood pressure—and thus to heart attacks and strokes—the salt industry vigorously contests this connection. And with some reason.

First, while reducing salt intake does make a blood pressure difference for some people, for many others it doesn’t.

Second, there’s a dearth of evidence that high salt intake directly increases cardiovascular risk. “Only a single study has found an association in the general population between low-sodium diets and reduced incidence of stroke or heart attack, and that was in a Japanese population where ‘low salt’ individuals consumed more than the US average,” claims Richard L. Hanneman, president of the Salt Institute in Alexandria, VA, an association of salt producers. He calls the current dietary advice “one size fits all” thinking.

Third, even hold-the-salt advocates acknowledge that salt seems to be a hypertension trigger only for a core group—not the entire population.

So who is most likely to benefit from a low-salt diet?

In terms of hypertension, the answer is people who are salt-sensitive, meaning their bodies react to salt by shooting their blood pressure through the roof. Likely candidates for this group include African Americans, the elderly and anyone with a close relative who already has hypertension. Overall, an estimated 26 percent of Americans with normal blood pressure and 58 percent with hypertension are salt-sensitive, according to Myron Weinberger, MD, director of the Hypertension Research Center at the Indiana University School of Medicine in Indianapolis. Those people should absolutely keep their salt intake to no more than 2,400mg a day, Weinberger says.

But if my blood pressure’s fine, can I stop worrying about salt?

No, because high blood pressure isn’t the only concern. Salt-loaded diets are also linked to fractureprone bones and stomach cancer. The bone connection is pretty straightforward: Excess salt ups the amount of calcium washed out in urine. The cancer connection is more indirect—put simply, diets high in dried, smoked, salted or pickled foods seem to contribute to stomach cancer in assorted ways, including by damaging cells lining the stomach. (Happily, diets high in fresh fruits and vegetables may protect against stomach cancer.) So even if your blood pressure’s fine, overdoing salt is not.

Can a low-sodium diet benefit vegetarians?

Possibly, especially if you eat a lot of processed and convenience foods and have a family history of high blood pressure. But in general, vegetarians are much less likely to have high blood pressure than meat eaters are, partly because they don’t eat fat-laden meats, which contributes to high blood pressure, and often limit dairy products—which can thicken your blood and force your heart and blood vessels to work harder—and because plant foods are naturally low in sodium.

So how much salt is too much? And how much salt should I aim to take in daily?

Almost all of us eat far more salt than we need (also called sodium; more on that in a bit). While your body can’t live without sodium—it takes about 500mg daily for your nerves and muscles to work and for your fluids to stay in balance—most of us eat at least 10 times that, or 5,000mg daily. That’s way too much to be healthy, according to the American Dietetic Association.

As for how much you should consume, it depends on who you ask, and on your race, age and health.

¦ Race: No more than 1,500mg (about 2/3 teaspoon) for African Americans or middle-aged and older adults, state the 2005 Dietary Guidelines for Americans.

¦ Age: Up to 2,300mg for young adults, add the Guidelines.

¦ Health: Just 1,500mg for healthy adults, says the Institute of Medicine of the National Academies.

¦ In general: Fewer than 2,400mg (about 1 teaspoon), according to the National Institutes of Health.

Overall, it seems that somewhere between half a teaspoon and one teaspoon a day is a sane range.

Can I take in too little sodium?

Since we can get by with as little as 500mg sodium daily, you’d be hard-pressed to underdo. But it is possible to lose the sodium that’s already in us. Prolonged heavy sweating, drinking much too much water—which sometimes happens to marathon runners—and chronic diarrhea can all cause internal sodium levels to drop. The result can be dizziness, confusion, muscle cramps, and, in extreme cases, seizures, coma, even death.

Why is sodium/salt added to so many foods? And what’s the difference between the two?

Well, people love the taste of it for one thing. It also keeps food from spoiling, improves the texture of processed foods and helps control fermentation in bread and cheese.

We tend to use “sodium” and “salt” interchangeably, but they’re not the same. Sodium is actually a component of salt, which is made of roughly 40 percent sodium and 60 percent chloride. (Salt’s chemical name is sodium chloride.)

Sodium is found not only in your salt shaker but in foods that have been pumped up with salt or one of its many cousins, such as monosodium glutamate (MSG), the flavor enhancer often used in Chinese food. Some medications, such as antacids, are chock-full of sodium too—two Alka Seltzers have 1,064mg. That’s why sodium, not salt, is listed on nutrition labels.

What do all the different sodium labels on food packages mean?

Here’s how the US Food and Drug Administration defines those sodium claims:

¦ Sodium-Free Less than 5mg sodium per serving.

¦ Very Low Sodium 35mg sodium or less per serving.

¦ Low Sodium 140mg sodium or less per serving.

¦ Reduced Sodium 25% less sodium than original item.

¦ Light in Sodium 50% less sodium than original item.

What’s the difference between the types of salt?

Regardless of name, they all contain sodium. Iodized salt is simply plain table salt fortified with the mineral iodine, which is added to prevent a thyroid disease called goiter that’s caused by iodine deficiency. Coarse-grained kosher salt adds crunch and a clean taste to food, while unrefined sea salt contains trace minerals and imparts a mineral-y taste that many people love. Seasoned salts are flavored with herbs and contain less sodium than the same amount of iodized salt.

How can I prepare delicious meals with less salt?

Bake with sodium-free baking powder. Drain and rinse canned vegetables and beans before using them (salt is used in the canning process). Spice up recipes with more herbs, and switch to salt substitutes for table seasoning. The American Dietetic Association recommends filling your pantry with the following:

Allspice
Use in: stew, tomatoes, gravy

Basil
Use in: salads, soups, sauces

Cayenne pepper
Use in: soups, casseroles, cheese sauces, egg dishes

Cinnamon
Use in: breads, squash

Cumin
Use in: chili, stews, beans

Curry
Use in: tomatoes, sauces, rice

Dill
Use in: veggies, potatoes, pasta

Lemon or lime juice
Use in: salads, veggies, sauces

Rosemary
Use in: stuffing, potatoes, peas

Sesame
Use in: breads, salads, veggies

Vinegar
Use in: tomato sauces, salads, marinades, veggies