The Assault on Salt How you can win the war on sodium from added salt.


Its been a tough year for salt. Most recently, the Dietary Guidelines Advisory Committee (DGAC)-whose recommendations will form the basis of the 2010 federal Dietary Guidelines for Americans to be released late this year-called for slashing the recommended maximum daily sodium intake from 2,300 to 1,500 milligrams (mg).That lower figure for dietary sodium- which mostly comes from salt- was already the recommendation for about 70% of American adults, including those with hypertension, all African- Americans and everyone over age 40. But changing the recommendation for all Americans could increase pressure on food processors to ratchet back on salt content. If the percentages on Nutrition Facts labels (currently based on 2,400 mg) are also changed to reflect a 1,500 mg standard, the 480 mg in a serving of tomato soup would jump from 20% of your daily allotment to 32%.The DGAC recommendation came on the heels of a call from the prestigious Institute of Medicine to crack down on added salt in foods. Arguing that past public-education campaigns have failed, the institute asked the US Food and Drug Administration (FDA) to regulate the amount of salt added to foods and gradually roll back that limit as the industry and consumer taste buds adjust.Then the Interstroke study, which compared 3,000 stroke victims to the same number of controls from 22 countries, fingered hypertension as the strongest predictor of stroke. Publishing their findings in The Lancet, Martin J. ODonnell, MB, PhD, of McMaster University and colleagues said that sodium reduction was key to preventing strokes. Although most people have firmed up in their head the importance of salt reduction, ODonnell commented, the real target population are those who consume excess salt. (For more on stroke prevention, see our August Special Supplement.)

7 Surprising Sodium Sources
Salad Dressing-Make your own to avoid the 300-600 mg per serving. Rice Mixes-Nearly 1,000 mg (as much as a Big Mac) per serving of rice pilafs and other seasoned mixes. Soup-Seek low-sodium varieties to skip the 900 mg in a serving of vegetable soup. Diet Ice Teas-80 mg of sodium per serving-and a bottle contains two servings. Flour Tortillas-360 mg in a single 8-inch tortilla; pick corn tortillas instead. Breakfast Cereal-Check the label to shun high-sodium varieties like raisin bran (350 mg per cup). Granola bars-They sound so healthy, but each little bar has 65-80 mg of sodium.

Not surprising, the industrys Salt Institute responded sharply to this assault.President Lori Roman said, It is reckless for the government to risk the health of Americans by relying on substandard levels of evidence and refusing to consider new evidence. The institute said not a single modern society consumes such a low level of salt as the DGAC recommendation, and cited research showing that low-salt diets actually increase cardiovascular mortality. At least some of those studies, however, adjusted for blood pressure-the chief link between sodium and heart disease- and excluded participants with existing heart problems.In recommending the 1,500-milligram standard, the DGAC built on evidence compiled for the 2005 Dietary Guidelines, which included more than 50 clinical trials. An updated evidence review added 12 primary studies and one meta-analysis. The committees report concluded that of nine new randomized trials, each reported the effects of sodium reduction on blood pressure. In total, a significant reduction in either systolic or diastolic blood pressure occurred in all but one of these studies, and significant reductions in both systolic and diastolic blood pressure in five studies.Wheres It Coming From?
But some scientists do share the Salt Institutes skepticism about the lower, 1,500-milligram guideline- for a different reason. No one made it down to only the 2005 recommended max of 2,300 mg of sodium, commented Keith Ayoob, EdD, RD, of Albert Einstein College of Medicine. If people have trouble reaching that mark, then 1,500 mg will be even tougher.ODonnell of the Interstroke study echoed that concern, noting that the higher 2005 guideline proved elusive for many people.Indeed, a new Centers for Disease Control (CDC) survey found just 1 in 10 Americans meet their current applicable standard. Of those who should be aiming for 1,500 mg, only 1 in 18 manages to do it. Sodium has become so pervasive in our food supply that its difficult for the vast majority of Americans to stay within recommended limits, said the CDCs Janelle Peralez Gunn.The problem is not primarily that were too liberal with the salt shaker at the stovetop or dining table. The CDC estimated that 77% of dietary sodium comes from processed foods and restaurant items. Americans average 3,466 mg of sodium a day-the equivalent of the amount in one and a half teaspoons of salt. The survey identified five categories of foods-including some surprises-that contribute the most sodium to our diets:1. Grain mixtures, frozen meals and soups (530 mg/day)-Arent grains supposed to be healthy? Not when theyre in the form of pizza, burritos, tacos, egg rolls, prepackaged pasta dishes and frozen dinners.2. Ham, bacon, sausages and lunch meats (423 mg/day)-Processed meats are increasingly being implicated in cardiovascular disease; their high sodium content is a key reason.3. Breads (354 mg/day)-Americans love bread, and all those sandwiches add up. Two slices of Wonder bread, for example, contain 300 mg of sodium.4. Meat, poultry and fish mixtures (286 mg/day)-Its not the meat; its what we put on or in the meat. The DGAC also warned, A major new concern is the excessive sodium addedto products such as poultry, pork and fish through injections or marination.5. Cakes, cookies and crackers (229 mg/day)-Crackers are no surprise, but cakes and cookies contain salt as well as sugar. Three Oreo cookies, for instance, have 160 mg of sodium-more than 10% of the new guideline. And who can eat just three?The DGAC report also spotlighted a strong connection between calories and sodium: The more calories you consume overall, the more sodium youll get because of the omnipresence of added salt. Although certain items such as fast food (see box) contain truly eyepopping amounts of sodium, the DGAC concluded, The problem of excess sodium reflects frequent consumption of foods that are only moderately high in sodium. In short, it all adds up.Can It Be Done?
Is the new 1,500-mg target even possible? The DGAC report describes an analysis of three eating scenarios: a typical diet thats high in sodium, a scenario in which nutrient-dense foods are mostly prepared without added salt, and a low-sodium regimen. In the latter, foods inherently high in sodium or with added salt are replaced with lower sodium foods; for example, substituting fresh meats, not those augmented with sodium solutions, for processed meats and using the lowest sodium value currently available on the market for both white breads and quick breads. The second scenario achieved sodium levels about 40% lower than the US average, while the low-sodium plan did indeed lower intake to roughly the new 1,500-mg goal.Miriam E. Nelson, PhD, director of Tufts John Hancock Research Center on Physical Activity, Nutrition and Obesity Prevention and author of The Strong Womens Guide to Total Health (see an excerpt in the May Healthletter), served on the DGAC. She points to the sodium-reducing success of the DASH (Dietary Approaches to Stop Hypertension) eating plan, endorsed by the National Heart, Lung and Blood Institute. The DASH plan focuses on eating whole foods, with very few processed foods.

5 Fast Tracks to Salt Overload
Fast-food meals arent known for their healthfulness, but when it comes to sodium in particular the wrong choices can make your intake sky-high. Fast-food menus have plenty of items that contain more than the new recommendation of 1,500 mg for an entire day, and some that threaten the previous 2,300 mg maximum. But the most sodium-filled choices arent always obvious-the wrong breakfast order, surprisingly, can contain a whole days worth of sodium. Here are the worst sodium offenders at the top quickservice restaurants (excluding Starbucks, which doesnt post sodium numbers), along with some less-salty suggestions:1. McDonalds-The Big Breakfast with Hotcakes and Large Size Biscuit blows away the better-known Big Mac on the sodium scale, with a whopping 2,260 mg. At 1,040 mg, the Big Mac is also a lower-sodium choice than the Angus Bacon & Cheese, McDonalds saltiest sandwich at 2,070 mg of sodium. The better bet, though, is a plain Hamburger, with 520 mg of sodium; its also lower in calories and saturated fat.2. Subway-Despite Jared, the sandwichchainsslimmed-down spokesman, not everything at Subway is health food. Among regular menu items, youll find the most sodium in the Footlong Black Forest Ham sub (2,400 mg). Opt for the 6-inch Veggie Delite instead and you can cut the sodium to 410 mg.3. Burger King-No, the most sodiumladen choice here isnt the famous Whopper (1,020 mg). Youll actually get more sodium in the American Original Chicken Sandwich (1,830 mg) or the breakfast Biscuits and Sausage & Gravy Platter (2,350). And the Sodium King is the unheralded Country Pork Sandwich, with an astonishing 3,310 mg. Try the four-piece Chicken Tenders (310 mg) instead.4. Wendys-Who would have suspected the Hot & Spicy Boneless Wings, topping the menu at 2,490 mg of sodium? Order a plain Hamburger and youll go home with 480 mg instead.5. Taco Bell-Here the bell tolls for the burritos, all high in sodium-especially the 2,180-milligram Chicken Grilled Stuffed Burrito. Compare to the Fresco Crunchy Taco, at 350 mg of sodium and a fraction of the calories and saturated fat.

For years, many of us in the nutrition community have been advocating a diet rich in whole foods, especially vegetables, fruits, whole grains, low-fat and fat-free dairy foods, legumes, nuts and seeds, and small amounts of animal proteins, Nelson says. This is a pattern of eating that maximizes the good ingredients in food (vitamins, minerals, phytochemicals, healthy proteins, the right oils, and fiber) and minimizes the negative ones-including salt-while at the same time naturally keeping calories at a modest level.Many people are surprised by the amount of food allowed in the DASH plan, she adds. By eating lots of fruits and vegetables (4-5 servings of each on a 2,000-calorie daily diet) and healthy grains (7-8 servings), you simply dont have room on your plate for as much salty, processed food.Also key, Nelson says, is changing the way you eat. In recent years, Americans are eating more often on the run, away from home or in front of the TV. Unfortunately, when wedine in restaurants or fast-food places, we not only eat more because of large portions, but what we eat also tends to be less healthy than what we serve at home. A 2005 survey, she adds, found that womens top three most popular foods ordered in restaurants or for take-out were French fries, hamburgers and pizza-all loaded with salt.Reducing your sodium intake isnt easy, but the smart choices youll make will also improve the overall quality of your diet. You can win the war on salt-and your taste buds dont have to be a casualty.TO LEARN MORE: DGAC report www.cnpp.usda. gov/DGAs2010-DGACReport.htm.The Lancet, July 10, 2010; abstract at S0140-6736(10)60834-3.USDA Nutrition Evidence cfm?cat=3142.Sodium Intake Among Adults cdc. gov/mmwr/preview/mmwrhtml/mm5924a4.htm?s_ cid=mm5924a4_w.Your Guide to Lowering Your Blood Pressure with DASH public/heart/hbp/dash/new_dash.pdf.


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