“Sodium Wars” is a term used to describe the battle between food processors eager to keep profiting from the use of excess salt in their products, vs. regulators and educators trying to either get them to cut it back, or get people to stop eating excessive doses of sodium through these unhealthy products. Like other forms of modern warfare, there is considerable “collateral damage” among innocent bystanders, who may be quite ignorant of the high stakes in the battle.

The American Dietetic Association (newly named Academy of Nutrition and Dietetics) conducted a new survey about opinions of Americans in order to gauge the success of the educational efforts about sodium. Of those surveyed, 59% said that they are “not concerned” about sodium and 70% don’t know what the recommended daily maximum is (2,300 mg for most Americans and 1,500 mg for the higher risk groups –not a small group, 70%). Ouch! Especially, for those that are “not concerned.” The study actually found even more disturbing results as related with those with high blood pressure – only 56% knew what sodium level that they should be targeting. In addition, in another ADA/AND survey, 49% of consumers think they’re already doing all they can to eat a healthy diet.  It appears that the massive advertizing of the food marketers is so far winning out over the poorly funded health education efforts, pronouncements of scientific bodies, and efforts to regulate the food processors.

So maybe we should all pay a bit more attention to this warfare, since we are caught in the crossfire. The Tufts Health & Nutrition Letter October 2011, called it The Sodium Wars. (See, vol.29, Number 8. they are just one of many voices airing the debate about sodium. The American Heart Association (AHA) is standing firm on its advice to slash sodium intake to 1,500 milligrams daily or less. They insist that reducing sodium, even for people with normal blood pressure, can reap enormous long-term benefits.

For many people, cutting sodium intake will decrease blood pressure and that’s without the side effects that come with high blood pressure medication. If you learn that you have high blood pressure, you may want to consider reducing your sodium intake as a first line of action. Secondly, you should be sure that you’re eating lots of potassium-rich fruits and vegetables. Certainly, if you have kidney disease, you’ll not be able to do this without the strict guidance from your doctor and dietitian. But for many people, the resulting lower blood pressure could be a pleasant reward for changing the diet.

Processed foods and restaurant meals are, by far, the leading source of dietary sodium. Because processed foods and restaurants frequently use sodium (It is SO cheap.) instead of herbs and spices, the food processors back groups that argue for not limiting sodium in food. In the debates, they also argue that people like things saltier, ignoring their responsibility at having gotten people used to over consumption of sodium. Let’s not bet our health on the advice of those who are designing foods and menus, with profit margin as a guiding purpose.  Let’s realize that our tastes for too much salt can be changed fairly quickly if we are serious about it. If we want to lower our national risk of heart disease and stoke, resulting from high blood pressure, we will need to become informed about where the sodium is lurking. We may need to learn to prepare foods differently; make some adjustments in our menu planning; and make changes when ordering in restaurants.

In the October 21, 2011, the U.S. Centers for Disease Control and Prevention (CDC) report Morbidity and Mortality Weekly Report says that most of the sodium in the typical American diet is added to commercial foods during processing or during preparation of restaurant foods and does not come from the consumer’s salt shaker. A relatively small percentage (25%) comes from naturally occurring sodium, plus the sodium added at the table or in cooking by the consumer.  Holy Cow! That’s 75% coming from processed food and restaurant meals.

There are eight excellent hints listed on the government’s National Heart Lung and Blood Institute (NHLBI) website. I think that the NHLBI approach is much more valuable than a large campaign that focuses on helping people learn the new goals. While it is true that the average intake of Americans is about 3400mg – that’s about 2000mg/day too much according to the American Heart Association, it seems to me that we should put the main focus on educating the public how to reduce the sodium. I doubt that many people are inclined to count milligrams of sodium each day.

Suggestion – The NHLBI tips could be used as a guide for seven weeks.  Each week take one of the seven ‘tips’ and think about how your meals and menus can be altered to achieve that tip. Taking one tip at a time may protect you from feeling overwhelmed, if you presently rely on a considerable amount of processed foods. Also, it may not be as difficult as reading all seven and realizing that a whole foods diet is what’s going to solve ‘the too much sodium problem.’ I realize that most of NHLBI’s tips are for the foods that you control – through your efforts in purchasing and preparation. Note: When you start controlling the food at home, you will also be impacting the amount of sugar, bad fats, other additives and often calories, as well as excess sodium.

Eating Out

As to eating out, that’s huge! I’ve been a Registered Dietitian for a very long time, and during those years, it has gotten ever more difficult to control sodium when we eat at restaurants. Maybe the first hint should be to go to an older article called Heart Attack Entrees and Side Orders of Stroke by the Center for Science in the Public Interest; you can see that high sodium meals are 3.8 to 4.7 times one entire day’s worth of sodium, if you’re trying to follow the AHA’s recommendations, you may want to skip these and similar items.

The following are hints for reducing the salt load when eating out:

• Be careful with the dressings and sauces. There’s about 1000 mg of sodium in 1 tablespoon of regular soy sauce (575 mg in the low sodium version). Good grief! Ask for the dressing on the side – not mixed into the entire salad; dip the tines of your fork into the dressing, so you get a taste of dressing with each bite. You may be surprised how much dressing is left. Consider scraping off some of the sauce served with the meat. Ask for the secret sauce to be left off your burger, chicken or fish sandwich.
• Cheese is usually contributes much of the sodium. Skip the cheese or only use a tiny amount. Don’t order the items that come smothered in cheese or cheese sauce.
• See if you can find steamed vegetables on the menu – lucky find!
• Limit your breads and pastries.
• Asian, Italian and Mexican restaurants are fairly difficult. Try ordering as plain as possible.
• Talk to your waiter. Try to learn if there are sauces and cheese on the items you are considering. Ask if it can be cooked to order – with less or without.
• Ask for slices of lemon or sprinkle some pepper to flavor food without sodium or bring your own bottle of Mrs. Dash.
• Skip the crusty deep-fried versions of zucchini, chicken and fish and whatever else can be battered and deep-fried.
• Skip or limit the bacon, croutons, bread sticks, and cheesy biscuits.
• If you can find plain grilled fish, chicken or meat and a plain baked potato (use sour cream instead of butter or use butter sparingly), you can be ahead of the game. Try to learn if the baked potato is salt-crusted.
• Skip the mashed potatoes and gravy or have a tiny serving, once in a great while.
• Think ‘portion control’ when the rolls and especially the cheesy biscuits are set on the table.
• Be careful with the salsa and chip scooping. Salsa is low calorie, but the restaurant/jar versions are often loaded with sodium.

We have listed these and other hints on the Dr. Grandma’s website in the past, but it seems that we as a nation need to be reassured that it is a real benefit to cut back on sodium. If we see how recalcitrant the food processors are to reducing sodium, we know that the battle is going to be prolonged. The food processors have a vested interest in using cheap sodium to make processed food tasty at a low price. We do not need to wait; risking our health while this Sodium War drags on.

The crux of the problem is that many people have no idea how much sodium they’re consuming. Maybe instead of focusing on the number of milligrams of sodium, the focus should be on the actual types of foods that will support the consumer’s desire to achieve a lower sodium intake. For example, if the consumer learns that having a small can of Campbell’s tomato soup, is 1200 mgs of sodium, then they may begin to realize that it’s almost impossible to be sodium wise, while including that type of food in their diet frequently. If you’re trying to stick with the AHA’s recommendation of sodium; you could have enough sodium left over for a couple servings of Ritz Crackers (270 mgs) and 30 mgs left for two other meals and a snack for the day. Yes, it is really difficult to eat processed food and restaurant foods while trying to protect your arteries, heart, and brain from heart attack and stroke. Don’t wait for the dust of the Sodium Wars to settle; begin taking steps to protect yourself and your family – begin Shaking the Salt Habit today.