Shake the Salt Cutting Salt Saves Lives By Katie Clark, M.P.H., R.D., C.D.E. For this chapter program, members are encouraged to bring to the meeting a Nutrition Facts label from a packaged or canned food preferably one that they eat on a regular basis. Such foods may include canned vegetables, soups, frozen entrees, packaged meals, crackers, etc. In the battle to shed pounds, weight-conscious people often overlook the role of sodium in their diet. We focus on avoiding excess calories and high-fat foods that cause weight gain. This leaves consideration for salt on the sidelines, as sodium is often viewed as the lesser of all evils when it comes to weight management. New research is showing us that high-salt diets are more dangerous than most consumers know and that cutting back on salt should become more of a priority for everyone. Sodium? Salt? Sodium is a mineral that is essential to the proper function of the human body. It is most often ingested in the form of sodium chloride, more commonly called salt. Sodium works in tandem with another essential mineral, potassium, to maintain balance at the cellular level, so nutrients and waste can process properly. Sodium is necessary for fluid balance, electrolyte balance, ph balance, the digestive enzymes in our stomachs, the proper functioning of our nerves, and the contraction of our muscles (the heart is our hardestworking muscle). Consumption of sodium/salt requires a balancing act. Too little sodium can have adverse effects on our health, such as spasms, poor heart rhythm, risk of heart attack, and sudden death. What s so bad about salt? It s no surprise that a high-salt diet is linked to high blood pressure and having high blood pressure means big problems for overall health. A report from the Institute of Medicine found that, in 2005, high blood pressure was responsible for one in six deaths in the United States. High blood pressure affects various parts of the body, including: Cardiovascular system hypertension (high blood pressure) increases risk of heart disease, stroke, heart attacks and heart failure Kidneys high blood pressure is a leading cause of 32 TOPS NEWS / AUGUST-SEPTEMBER 2010
chronic kidney disease, a condition that affects one in nine Americans Brain elevated blood pressure contributes to the risk of dementia Bones a high-sodium diet increases urinary calcium loss, which could possibly increase osteoporosis risk What if I don t have high blood pressure? People tend to pay attention to salt intake only when they have hypertension. The reality is, according to the Centers for Disease Control (CDC), almost 90% of middle-aged North American adults will develop high blood pressure during the remainder of their lifetime and nearly one in five people with hypertension do not know they have it. You can have high blood pressure while feeling fine, which is why it is often called a silent killer. The reality is that too many of us are eating too much salt, and it is having too great an impact on the development of disease and early death. Sodium Sleuthing While removing the salt shaker from your table is a noble idea, most people are surprised to learn that added salt makes up only a small percentage of total salt intake. According to the Center for Science in the Public Interest, 75 to 80% of the sodium we consume is in the form of packaged, processed and fast foods. Almost everything we eat, if it s not made from scratch, contains salt. Manufacturers love sodium and for good reason. Salt is an excellent way to preserve food pickling, brining and curing all increase shelf life makes food taste sweeter by blocking the bitterness of other ingredients enhances the flavor of foods and improves the texture of some, as well Salt is everywhere in prepared, packaged and processed foods. Some of the greatest sources of sodium in our foods come from: canned soups frozen dinners tomato and vegetable juices convenience foods like packaged rice mixes and pre-marinated meats cheese deli meat fast foods fried foods sauces and dressings snack foods like nuts, chips, crackers and popcorn Salt Hides in the Grocery Store At the Meat Counter Manufacturers add salt everywhere, including meat products. If you look closely at packaging on chicken, you ll notice that many brands are now adding sodium. This makes the meat taste juicier, but it also increases water weight. This, in turn, increases the price of your purchase, since you buy by the pound. Don t be fooled by meats and chicken labeled natural, as this can include added sodium. Instead, look for no added salt or read the ingredient list and Nutrition Facts label. Raw poultry that is not treated with sodium will have only 50 to 70 mg of sodium per 4-ounce serving, compared to 400 to 500 mg in an enhanced chicken product. Avoid pre-marinated and prepared roasts and meats. These are often made with high-sodium sauces and seasonings. Instead, buy plain, untreated meats and season with lower-sodium options at home. In the Dairy Section Beware of sodium lurking in the dairy section. Cheese is naturally high in salt, but some reduced-fat and low-fat cheeses are even higher in salt than their full-fat counterparts. Cottage cheese can be high in sodium, with up to 800 mg per cup in some brands. Compare different brands and options by reading the ingredient lists and nutrition labels, keeping in mind that organic or made without hormones has nothing to do with potential sodium content. In Fruits and Vegetables Fresh and frozen fruits and vegetables are generally better options than are canned ones. Canned products use salt as a preservation method, and the TOPS NEWS / AUGUST-SEPTEMBER 2010 33
nutrient content of some canned fruits and vegetables is lower than their fresh and frozen counterparts. Rinsing and draining canned beans or vegetables under the faucet before use can reduce sodium by about one-third. In Packaged and Snack Foods (see chart below) Sodium labeling on packages can be confusing. Choose foods that are labeled unsalted or no salt added. If a product says low-sodium, it contains 140 mg or less of sodium per serving. Very lowsodium foods have 35 mg or less, and sodium-free foods must have less than 5 mg per serving to be labeled as such. Be on the lookout for reducedsodium foods. They have at least 25% less sodium than the original version of the same food, but can still be high in sodium. Light in sodium foods have 50% less sodium than their reference values. Participant Activity: Food Label Reading Reading Nutrition Facts labels on the packages of foods you buy is the first step in combating excessive sodium intake. Pay attention to portion size; manufacturers often put two or more servings in one package. Daily sodium intake of 2,300 mg has been the recommended norm for healthy adults. Highrisk populations (those over age 40, all African Americans, and people who already have hypertension) have always been advised to limit sodium intake to 1,500 mg per day. Following continued research, the American Heart Association recently revised their guidelines in this matter, now advising SALT LABEL Unsalted No salt added Sodium-free Sodium Labeling Terminology SODIUM PER SERVING (MG) No additional salt Less than 5 mg sodium per serving that most healthy adults over the age of 20 should also limit sodium intake to no more than 1,500 mg per day. Take a look at this food label. It is from a can of Chicken Corn Chowder. If a high-risk person were to have one can of this soup (two cups), would they be eating more sodium than they should be ingesting in a day? Answer: Yes. One can of this soup (2 cups/2 servings) has 1,780 mg sodium (890 mg x 2 = 1,780). 1,780 mg sodium is more than 100% of the 1,500 mg per day recommended for people at high risk for hypertension. Nutrition Facts Serving Size 1 cup (255g) Servings Per Container about 2 Amount Per Serving Calories 200 Calories from Fat 80 % Daily Value* Total Fat 9g 13% Saturated Fat 2g 10% Trans Fat 0g Polyunsaturated Fat 3.5g Monounsaturated Fat 2g Cholesterol 15mg 5% Sodium 890mg 37% Potassium 480mg 14% Total Carbohydrate 23g 8% Dietary Fiber 2g 8% Sugars 6g Protein 7g Vitamin A 0% Vitamin C 0% Calcium 0% Iron 4% *Percent Daily values are based on a 2,000 calorie diet. This would mean that the person should be eating no other sodium at all during the day a task that is nearly impossible! Now it s your turn Take out the Nutrition Facts label you brought to today s meeting. Determine how much sodium is in one serving of the food. How much sodium is in two servings? If a high-risk person were to have two servings of this food, would they be eating more sodium than they should be ingesting in a day? Very low-sodium Low-sodium Reduced-sodium Light sodium 35 mg sodium or less per serving 140 mg sodium or less per serving 25% less sodium than original food 50% less sodium than original food Slashing Salt: Tips and Tools Salt is an acquired taste. It takes approximately six weeks to train and wean your taste buds off of salt. You could consciously and actively start 34 TOPS NEWS / AUGUST-SEPTEMBER 2010
decreasing your salt intake today. Within a few weeks, if you went back to eating high-salt foods, you would notice that the way you used to eat had become distasteful, since you had become re-sensitized to salt. Cooking and preparing foods at home is the easiest and most effective way to gain control over your salt intake. When you choose what goes in foods, you can limit the amount of salt in those foods. Whole grains, fruits, vegetables, 1% and skim milk, and untreated raw meat and poultry are naturally low in sodium. There are also a number of salt substitutes on the market. Some of these are blends of sodium and potassium chloride. You should avoid these products if you have kidney disease or if you take hypertension medications that increase potassium retention. Those on medications such as ACE inhibitors and potassium-sparing Make your own salt-free seasoning! Mix the following ingredients together in a bag and keep the mixture in a shaker for a quick and tasty, no-salt, seasoning alternative. 1 T. garlic powder 1 T. paprika 1 T. dried thyme 1 T. dried mustard 5 T. onion powder 1/2 t. cracked black pepper 1/2 t. celery seed diuretics should avoid salt substitutes. Instead of purchasing salt substitutes, use lemon juice, hot pepper sauce, and herbs and spices to season your foods with lower-salt options. Participant Activity: Menu Makeovers You can make low-salt substitutions in everyday recipes you use at home. For each of the recipes below, find one high-salt ingredient for which you can recommend an alternative, lower-salt replacement. Southwest Salad 1 can black beans 1 can yellow corn 2 T. chopped cilantro 2 T. chopped red onion 2 large tomatoes 1/4 cup bottled Italian salad dressing Wild Mushroom Risotto 1 small can mushrooms 1 1/2 cups water 2 14.5-oz. cans vegetable broth 2 t. olive oil 2 garlic cloves, minced 2 1/2 cups chopped mushrooms 1/2 t. salt 1/4 t. black pepper 2 1/2 cups uncooked Arborio rice Spicy Asian Stir-Fry 1 8-oz. bag seasoned, prepared, cooked chicken breast strips 1/2 cup stir-fry sauce 1 cup each chopped bell peppers, pea pods, bean sprouts 3 oz. Asian noodles Soy sauce for dipping Deluxe Hamburger Patties 1 lb. extra-lean ground beef 2 T. seasoned salt 2 T. Creole seasoning 4 slices Swiss cheese 1/4 cup barbecue sauce Menu Makeovers Answers: Southwest Salad Use homemade black beans prepared without salt instead of canned. Rinse canned black beans and/or corn under water before adding to salad. Use fresh corn-off-the-cob or frozen corn instead of canned corn. Make own salad dressing of oil/vinegar instead of using bottled. Wild Mushroom Risotto Use dried or fresh mushrooms instead of canned. Use low-sodium broth or make your own lowersodium broth. Use 1/2 broth and 1/2 water to cut sodium in half. Spicy Asian Stir-Fry Use homemade chicken breast strips, as packaged ones are often highly salted. MORE TOPS NEWS / AUGUST-SEPTEMBER 2010 35
Make own stir-fry sauce with low-sodium soy sauce and rice wine vinegar. Use low-sodium soy sauce for dipping, or make own peanut sauce with crushed peanuts. Deluxe Hamburger Patties Use salt-free seasoning mix (such as Mrs. Dash) instead of seasoned salt and Creole seasoning. Use low-sodium cheese. Make your own barbecue sauce using low-sodium soy sauce and ketchup or eliminate barbecue sauce. Salt in Summary Maintaining healthy blood pressure and limiting salt intake are important goals for everyone. Reading food labels, choosing whole foods over processed foods, and preparing meals at home instead of eating in restaurants are the best ways to reduce salt in your diet. Exercising at least 30 minutes per day most days of the week, limiting alcohol, and increasing potassium by eating more fruits and vegetables can further help to lower blood pressure and maintain healthy levels. Together, these steps can make serious progress in the fight against early death caused by high blood pressure. Limiting salt is just one tool you have for preventing and combating high blood pressure. Recent studies show that it is possible to lower blood pressure by following the Dietary Approaches to Stop Hypertension (DASH) eating plan. Chapter Leaders and Designates: to view and share a Quick n Easy chapter program focusing on the DASH eating plan, visit the Leaders Corner of the TOPS website at www.tops.org. Katie Clark is a Registered Dietitian, Certified Diabetes Educator, and Assistant Clinical Professor of Nutrition at the University of California San Francisco Graduate School of Nursing. 36 TOPS NEWS / AUGUST-SEPTEMBER 2010