Yes, it’s true that salt (sodium chloride) is a vital mineral for human life (muscles, including the heart muscle and nerves need sodium to function – all kinds of things would go wrong in a body without sodium). But please don’t suffer too much anxiety about this happening. For one thing, your body has protective mechanisms to keep its sodium in balance. But we SHOULD have more than a bit of concern about the flipside of the issue – too much sodium in our diets.

Unfortunately, the western diet provides between 10 and 12 grams of sodium a day (10,000 to 12,000 milligrams). Most healthy adults need just a couple hundred milligrams of sodium per day to sustain life. Health professional, including me, are trying to help the public reduce their intake and keep it under 2 grams per day. The picture helps visualize this discrepancy – although the 5-6 teaspoons American’s take in on average is seldom seen as salt crystals.  This amount of salt is dissolved in gravies, meat rubs, even soft milkshakes and other drinks (to keep your thirst up). We do see a few crystals on fries, popcorn, pretzels, and when we shake it on.

I think that most of us can't imagine using 5 or 6 teaspoons of salt in a day; but many are - they just don't see it. Just in case you're curious, I used a level  standard measuring teaspoon to fill each teaspoon for the illustration - nothing tricky.

One-teaspoon of table salt, sodium chloride is 6,200 mg; of which 2,300 milligrams is sodium. Many health organizations are trying to guide people to keep their sodium intake between 1,500 to 2,300 milligrams per day (1 teaspoon of salt maximum). That’s not as easy as it may sound, because only 11 percent of sodium in the national diet comes from saltshakers: nearly 80 percent is added to foods before purchase.  What does that say to us?

• Maybe we should consider buying foods that do not have salt added.
• Maybe we should consider buying more fresh foods and preparing them ourselves – keeping control of the added salt ourselves.
• Maybe we should consider eating fewer restaurant meals (so frequently loaded with fat, and salt – and too many calories).
• Do we really believe that we will suffer any ill effects if we cut back in our salt consumption?
• Do we want to risk delaying the benefits of cutting back on salt while the ‘salt war’ arguments go on?
• Will eating more fruits and vegetables and less salt, losing some weight and being more physically active be bad for the general public?
• Can moderation help?
• Is it possible that some of the arguments in the ‘salt wars’ come from individuals or groups with vested interests in maintaining an unnaturally high salt content in the diet?

Some believe that we should not legislate salt reduction, based on what happened when we had a ‘war on fat.’ If you’re not old enough to remember the ‘war on fat,’ the outcome was that everything except fat was considered almost a freebee.  People began eating unlimited calories as long as they were carbohydrates or protein. Not surprisingly, they gained weight, increasing the obesity numbers and the number of diabetics all because they were eating more calories. Have we learned anything about moderation? Just as the public learned that we need some fat, especially good fat; we learned that many of the people that cut back drastically on fat, lost the satiation fat provides (fat helps us feel satiated – full); which drove the increase in calories. People weren’t feeling full so they kept eating, as long as it was carbohydrates or protein.

It helped everyone remember that calories do count. Then there was the backlash of the Atkins concept, ‘protein and fat are your friends.’  Well, the bottom line is that I wish that we’d recognize that we do not have to go over the edge.  We can have a moderate approach.  Cutting back on sodium moderately will not kill you.  Missing out on junk foods, processed foods, and restaurant foods will not mean the end of life. Research says, on average, it will definitely mean a longer, healthier life.

While some of the researchers battle back and forth, we don’t need to wait to eat a little less sodium. Let them get their decimal points straightened out.  Let us get our teaspoons down from six to closer to one. My guess is that they will learn that the Mediterranean-style diet of fruits, vegetables, whole grains, nuts and beans, some fish and not very much meat will work just nicely. O.K., I’m not going very far out on a limb to predict this. See Appel’s July 2009 paper. When you’re eating this way, you are naturally controlling much of your intake of salt.

A Substantial Body of Evidence

A public health researcher, Lawrence J. Appel M.D. of Johns Hopkins University, says, if we live long enough, we Americans are “almost guaranteed to get hypertension. But that is not true across the world”. He continues; “we should be aware of the link between high blood pressure and poor health.” He makes a point to say that the environments we live in have a lot to do with it, and that the high levels of sodium in processed foods and restaurant food are, “unnecessarily high.”

Advice: Appel gives us some great advice in his July 2009 position paper that even if we don’t have hypertension, we can delay hypertension – even prevent it -- by decreasing our salt intake. We can best do this by increasing our potassium intake (fruits and vegetables), losing excess weight, drinking alcohol only moderately (those that drink), and eating a healthy diet.

In summary: Consume a diet rich in fruits and vegetables (8–10 servings ⁄ day). Cut way back on diary products that are high in saturated fat and cholesterol. Switch to low-fat dairy products (be careful with these, no more than 2–3 servings ⁄ day).

Appel documents the fact that elevated blood pressure is extraordinarily common. About 32% of adult Americans have hypertension (high blood pressure), and roughly another third have pre-hypertension. Hypertension increases the risk for cardiovascular disease and kidney failure. His report shows that some weight loss can reduce blood pressure even without attaining a desired weight.

Dietary factors have a prominent and likely predominant role in explaining the rising blood pressure statistics. One of the most important features of the high blood pressure epidemic is the age-related rise in blood pressure. Appel makes a point that if we reduce dietary sodium, it can prevent hypertension with or without simultaneous weight loss. In addition, reducing the sodium intake blunts age-related rise in systolic blood pressure. This sounds worth the effort to me; it’s motivating to both lose weight and reduce sodium – even if we don’t have high blood pressure yet.

To reduce sodium intake, consumers should choose foods low in sodium and limit the amount of added salt. However; to do this, because more than 75% to 80% of sodium comes from processed foods, any effective strategy to reduce sodium intake must either involve the cooperation of food manufacturers and restaurants, or we must take matters into our own hands.  Food providers should progressively reduce the sodium added to foods by at least 50% over the next 10 years, as recommended by the American Medical Association. The report seems to accept the idea that we have to ask the food processors and restaurants to reduce sodium; but I would suggest that we should start without them. Slow down on the processed foods and restaurant meals, and do it now.  Do not wait 10 years to see if food providers will measure up to their social responsibilities. They will only do so if the majority of us “just say No”.

The preferred strategy for reducing sodium is to increase potassium intake through the consumption of potassium-rich foods rather than pills.

A study reported in The New England Journal of Medicine, found that a modest sodium reduction could have huge health benefit. “This study represents the evidence that a reduction of salt intake not only lowers blood pressure but also prevents cardiovascular events. The case for population-wide salt reduction is now compelling,”

In another study, Feng and MacGregor have shown that decreasing salt intake can cut the risk of stroke and coronary heart disease. (Journal of Human Hypertension).  Also increased salt intakes have been linked to kidney  and stomach damage (both reported in the Journal of Hypertension.) Too much salt in the diet reduces bone density, which impacts those with the risk of osteoporosis (Reports in the American Journal of Clinical Nutrition). One of the newer findings is that salt may be contributing to artery hardening. A small study was reported in the American Journal of Clinical Nutrition that measured the pulse wave velocity (PWV) which measures the stiffness of the arteries, it was observed that increased sodium intake caused an increase in the PWV and blood pressure. Oh my goodness, is this a wake up call?

The American Heart Association’s publication Hypertension, reported on a large double-blind trial of modest salt reduction in a free-living population; they found that reducing salt intake from 9.7 to 6.5 grams per day reduced the average blood pressure from 146/91 to 141/88 mmHg within six weeks. That’s pretty fast; plus no side effects from meds.

If you carefully add a little salt to low sodium foods to make an acceptable taste, it will probably be less than what the food processors are used to adding. Although it is just based on measurements taken by one individual, Dr. Grandpa, who weighs himself daily, has shown me graphs made by his iPOD ap, “Weightbot” that it takes his body about two days to recover from a single meal at most restaurants. He uses a good balance scale and weighs every morning before eating. The extra weight from salty restaurant food is largely based on the body holding onto extra water because of the extra salt. Moreover, this one individual goes to great pains in a restaurant to find any vegetables and fiber-rich foods on the menu and avoid salty, fatty meats. Despite this, the effect in the next few days is easily measured using a good but simple bathroom scale once a day.

It seems that our western diet, including fast foods and restaurant meals is giving us more than convenience; it’s giving us too much salt (also calories, fat, and sugar – and not enough fiber, fruits, vegetables, whole grains and nutrients; but that’s for another day). There is a substantial body of evidence that supports the importance of reducing our intake of salt. Just being careful with the saltshaker will not significantly reduce salt in our diet, if we are eating lots of fast foods and restaurant meals. The result of sticking with the high sodium intake carries with it huge costs to health and well-being. My advice is to begin making changes now – don’t wait for the government to legislate it. Remember, the food processors and restaurant owners will keep adding excess salt unless enough of us just say NO.

Wheat Berries and Roasted Cauliflower

There are a couple of salt-saving tricks in this recipe. One is the use of the limejuice and the other is the spices in the wheat berry mixture; herbs and spices often decrease the need for too much salt.

Ingredients:

3 cups of cooked Wheat berries

If you don’t have cooked wheat berries in your refrigerator or freezer, boil 1½

cups of wheat berries in 4 cups water, for about 1¼ hour.

Approximately 6 cups cauliflower florets, about 1½ inches in diameter

¼ cup extra-virgin olive oil

2 tablespoons lime juice

Ground pepper, to taste

1 teaspoon curry powder

¼ teaspoon salt

½ teaspoon chili powder

1 cup chopped onion

1 cup chopped green pepper

1 cup sliced mushrooms

1 tablespoon extra virgin olive oil

2 teaspoons minced garlic

¼ cup Parmesan cheese

Directions:

Preheat the oven to 450 degrees F.

Mix the limejuice and ¼ cup oil in a large bowl. Add the cauliflower florets and toss. Spread the cauliflower on a rimmed baking sheet. Sprinkle with pepper. Place in the oven and bake for 45 minutes, until browned. Stir every 15 minutes.

Sauté onions, green pepper, mushrooms, curry powder, salt and chili powder with a tablespoon of extra virgin olive oil, until onions are clear and mushrooms have shrunk by half, add the minced garlic during the last couple of minutes. Add 3 cups of hot cooked wheat berries to the large skillet and mix.

Spread the wheat berries mixture on an ovenproof platter or a 9” X 13” baking dish.

Arrange the roasted cauliflower over the wheat berry mixture. Sprinkle with Parmesan cheese. Return to the oven for about 2 minutes. Serve.