By Dayle Hayes, MS, RD 2014-10-28 11:13:28
Sodium: What’s the Story? Sodium guidelines, controversies and smart solutions that you should know. Until fairly recently, the major source of sodium in human diets was salt, known chemically as sodium chloride and abbreviated as NaCl. For thousands of years, salt has played a truly pivotal role in human history, affecting everything from trade routes to religion, to the extent that entire books have been written about its enduring importance. Before we get into the role of salt in your diet—and in the school meals that you serve to students—let’s take a brief, fun detour, with the following short list of salt-based trivia. It may whet your appetite for reading more about its extraordinary history. • Salt often was used as money. In fact, the Latin word salarium, money given to Roman soldiers for buying salt, became today’s salary. Over the centuries, humans have searched for, traded with, fought over, coveted and frequently hoarded salt. • Since ancient times, salt has been linked to health and well-being. Salus was a Roman goddess of health and prosperity; salud is the Spanish word for health. Salad comes from the Italian salata, a dish of raw vegetables with a brined dressing. • Many common idioms and proverbs refer to salt’s uses through the ages, such as Back to the salt mines (going to work in uncomfortable situations), Worth one’s salt (use of salt as money) and Salt of the earth (biblical worthy person from Matthew 5:13). • The Bible makes several references to salt, including the Old Testament story of Lot’s wife being turned into a pillar of the substance. Covenants in both the Old and New Testaments were sealed with salt, which is said to be the origin of the word salvation. That was then. This is now, and recently, the worldwide focus on salt and sodium has been much more negative. Public and private U.S. and international agencies like the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the American Heart Association (AHA) have created multimedia campaigns, promoted strategies and developed specific guidelines all aimed at encouraging people to improve their health by reducing overall sodium intake. But how much is too much? How much is appropriate? And are these numbers the same for all age groups? Men and women? People from different ethnic backgrounds? It’s not surprising that such debates have started to arise. Let’s dig deeper into these issues by exploring four questions: • What are the current guidelines for sodium intake? • What controversies exist around sodium guidelines? • What can individuals do to reduce their sodium intake? • Are salt substitutes safe to use? What Are the Current Guidelines for Sodium Intake? With so many respectable organizations touting the sodium-is-bad-foryou messages, you may not realize that sodium is an essential nutrient. You cannot live without some sodium in your diet, because it helps with many functions of both your nerves and muscles. Sodium also helps to maintain the proper balance of fluids in your body. While sodium is essential, the fact is that most of us consume far more sodium than we need for good health. Too much sodium can increase your risk of high blood pressure, also known as hypertension. When blood pressure stays high for extended periods, you are more likely to have a heart attack or stroke, especially when you have other risk factors like smoking, excess weight or inactivity. Consuming too much sodium also may have harmful effects on your kidneys and bones and increase your risk for stomach cancer. While there is plenty of proof for the harmful effects of too much sodium in adults, there is only moderate evidence for a similar relationship between sodium and hypertension in children and teens. But because an individual’s preference for salty foods seems to be shaped by early exposure, experts suggest that there are many good reasons to limit sodium intake in the early years of childhood. Current CDC guidelines recommend that the general American population should consume no more than 2,300 milligrams of sodium per day. At-risk populations, including African-Americans and those with high blood pressure, diabetes or chronic kidney disease, should consume no more than 1,500 milligrams of sodium per day. The AHA goes further, recommending no more than 1,500 milligrams for all Americans. How do these numbers compare with what we actually consume? According to National Health and Nutrition Examination Survey’s What We Eat in America, for 2007-08, the average sodium intake for Americans was an estimated 3,400 milligrams per day. It’s important to realize that these guidelines are for sodium, rather than salt. Table salt (2,300 milligrams of sodium per teaspoon) is only one of many sodium sources in American diets today—and, in fact, it’s not where we get the majority of our sodium. Even if we are overly liberal with the salt shaker when cooking or at the table, the vast majority of the sodium we consumed comes from processed, prepared and restaurant foods, as these types of foods typically contain sodium for two purposes: taste and preservation. In fact, more than 40% of our sodium intake comes from just 10 food categories: breads and rolls; cold cuts and cured meats (bacon, packaged ham, etc.); pizza; fresh and processed poultry; soups; sandwiches; cheese; prepared pasta dishes; meat-mixed dishes (such as meatloaf with tomato sauce); and salty snacks (such as chips, pretzels and popcorn). What Controversies Exist Around Current Sodium Guidelines? While the debate about appropriate sodium levels has been raging among nutrition experts for decades, it really heated up in 2013 when the Institute of Medicine (IOM), at the request of the CDC, published an assessment of the evidence. The conclusions in IOM’s report rocked the health, nutrition and food communities, because they disagreed with current recommendations from both the CDC and AHA. Specifically, IOM noted, “The evidence on direct health outcomes does not support recommendations to lower sodium intake within [groups at increased risk for heart disease] to or even below 1,500 mg per day.” This was a stunning finding, because IOM reports are well regarded and used to develop a variety of U.S. government positions, recommendations and requirements, including the Dietary Guidelines for Americans, and the federal nutrition standards set for reimbursable school meals. While the 2013 IOM report did not challenge the 2,300 milligrams per day guideline, a presentation in May at the World Congress of Cardiology 2014 Scientific Sessions added still more fuel to the fiery debate. In an analysis of data collected from the Prospective Urban Rural Epidemiology (PURE) study, a Canadian researcher suggested that individuals who consumed between 3,000 and 6,000 milligrams of sodium per day had the lowest risk of death. Many questions have been raised about both the PURE study and the IOM report, so there has not been any major shift in official sodium guidance—so far. However, the Dietary Guidelines Committee is currently meeting to discuss the 2015 Dietary Guidelines for Americans, so we may be hearing more about optimal sodium levels in the future. What Can Individuals Do to Reduce Their Sodium Intake? While we wait for a resolution in the great sodium debate, it is probably smart for most of us to begin taking a few reasonable steps toward consuming less sodium. This is especially important advice for anyone with high blood pressure. Hundreds, if not thousands, of publications (brochures, flyers, newsletters and tip sheets) have been produced on the topic of cutting back on sodium. (One excellent resource available from MyPlate can be found at http://tinyurl.com/sodiumtips.) The advice for lower-sodium, heart-smart eating boils down to four basic strategies: 1. Reduce sodium intake gradually, rather than trying to do so all at once. Most of us are accustomed to salty flavors in our food and it’s not uncommon to reject meals with less sodium. Gradual reductions are much less likely to be noticed than dramatic changes in taste. 2. Read Nutrition Facts labels for the sodium content of all packaged foods and restaurant recipes. Food manufacturers are working hard to gradually reduce the total sodium content in their products. Some brands may have half as much sodium as an identical product from another manufacturer. Be cautious about relying on the labeling of lower-sodium products; too many consumers tend to think that a “low-sodium” designation means “low-flavor.” Similarly, some reduced-fat items wind up featuring higher sodium levels to compensate for taste. 3. Cook from scratch with more herbs, spices and natural flavorings. The best way to bypass the sodium in prepared, processed and restaurant meals is to cook for yourself at home. A recent AHA study showed that adults who learned to cook with herbs and spices consumed 966 milligrams less sodium per day than adults who had not learned to do so. Garlic, onions, lemon and lime are great sodium-free flavorings. 4. Follow the DASH (Dietary Approaches to Stop Hypertension) Plan. DASH is a well-researched eating plan based on fruits, vegetables and reduced-fat dairy foods that consistently has been shown to lower blood pressure and improve cardiac risk factors without medication. Complete details of the eating plan are available in a free online booklet called Your Guide to Lowering Your Blood Pressure With DASH. Visit http://tinyurl.com/bloodpressureguide to download this booklet. Are Salt Substitutes Safe to Use? Many commercial salt substitutes contain potassium chloride and can be safely used by most healthy individuals as a salt replacement. While there are no known side effects in healthy people or children and teens who consume extra potassium in this form, doing so could be harmful to people with certain medical conditions. People with diabetes, kidney disease and heart disease, as well as those taking diuretic medications, should check with a doctor before using salt substitutes. The best substitutes for salt are herbs, spices, garlic, onions, lemon and limes. Commercial blends of these items are considered completely safe to use in cooking and at the table. No Definitive Answers An August 2014 issue of the New England Journal of Medicine added more data to the sodium wars with the publication of three major studies from around the globe. One, for example, contended that eating too little sodium might prove a risk for heart disease. While no clear consensus emerged, one of the papers did provide additional support for DASH by suggesting that increasing potassium was at least as important as decreasing sodium. For now, what’s the best advice when it comes to sodium, salt and health? While working to reduce your own sodium intake, simply “stay tuned.” Pay attention as the issue continues to be hotly debated in both medical and public health circles—and be prepared for sodium to be a major focus of the 2015 Dietary Guidelines when they are released. Dayle Hayes is a nutrition consultant and speaker based in Billings, Mont. She also maintains the School Meals That Rock Facebook page (www.facebook.com/SchoolMealsThatRock). You can reach her at EatWellatSchool@gmail.com. Sodium Compounds Found in Food A review of a product’s ingredients list may lead to raised eyebrows. Disodium phosphate? Monosodium glutamate? What role do such sodium compounds play in the foods you eat every day? Most of these have important functions, typically to prevent the growth of microbes and to extend shelf life. Let’s take a look at some of the most prevalent forms: • Salt (sodium chloride): Used in cooking, canning and preserving, and at the table • Monosodium glutamate (MSG): Used in restaurant cooking and in many packaged, canned and frozen foods as an umami seasoning • Baking soda (sodium bicarbonate): Used to leaven quick breads and cakes • Baking powder ( sodium bicarbonate plus additives): Used to leaven quick breads, biscuits and cakes • Disodium phosphate: Used as a texturizer and preservative in some quick-cooking cereals and processed cheeses • Sodium alginate: Used as an emulsifier in flavored milks and ice creams to make a smooth mixture • Sodium benzoate: Used as a preservative in many condiments, such as relishes, sauces and salad dressings • Sodium hydroxide: Used in food processing to soften and loosen the skins of ripe olives and certain fruits and vegetables • Sodium nitrate: Used as a preservative in cured meats and sausages • Sodium propionate: Used in pasteurized cheeses and in some breads and cakes to inhibit the growth of molds • Sodium sulfite: Used to bleach certain fruits that are then artificially colored and as a preservative in some dried fruits, such as prunes, and wine Sea Salt or Kosher Salt? Is sea salt or kosher salt better for you than regular table salt? The sodium content of all three salts is the same by weight. While they are processed differently, leading to variations in appearance, there is no variation in how they affect your health. Sea salt tends to have more minerals and other nutrients, adding colors and flavors that are popular with chefs and foodies. Some kosher salt has larger grains, like many sea salts. By volume, larger grains salts will add less sodium to a recipe than regular table salt. While a teaspoon of table salt has about 2,300 milligrams of sodium, a teaspoon of sea and kosher varieties can have significantly less sodium because fewer grains fit into the spoon. [Editors’ Note: To learn more about salt varieties, see “Solving the Salt Puzzle,” NewsBites, August 2014.]
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