The Case for Salt Reduction
Expert Answers to Readers’ Questions
What evidence is there that cutting back on salt will make a meaningful difference in public health—and in healthcare spending?
- Nearly one in three Americans has high blood pressure (hypertension), and roughly another third have somewhat elevated blood pressure (pre-hypertension). () Nine out of 10 U.S. men and women will develop hypertension at some point in their lives. () This epidemic places a huge burden on the healthcare system and on our economy, estimated at $73.4 billion in direct and indirect costs for 2009 alone. ()
- Researchers estimate that reducing the average daily sodium intake in the U.S. to 2,300 milligrams (about 1 teaspoon of salt) per day would prevent 11 million cases of hypertension and would save $18 billion in health care costs each year. () Another study estimates that cutting average daily sodium consumption by 1,200 milligrams (about ½ teaspoon of salt) would prevent up to 99,000 heart attacks and 66,000 strokes, and would save up to 92,000 lives a year. () That’s a huge public health payoff—similar to what the U.S. would see if Americans cut their tobacco use in half.
- Beyond hypertension, heart disease, and stroke, lower sodium intake is associated with lower risk of some cancers. (5, )
Does everyone need to cut back on salt? Or are only some people “salt sensitive”?
- The idea that only some people are “salt sensitive” is a myth. Our bodies are exquisitely sensitive to salt, and most adults would benefit from cutting back. People who have high blood pressure or are likely to develop high blood pressure should consume no more than 1,500 milligrams of sodium per day (about 2/3 of a teaspoon of salt). That includes people over age 40, African Americans, people who have somewhat elevated blood pressure (pre-hypertension), and people who have diabetes. When you add it up, according to a recent analysis by the Centers for Disease Control and Prevention, nearly 70 percent of U.S. adults should limit their sodium to 1,500 milligrams a day! ()
- There is no way to screen out who might be exempt from the risks of a high-salt diet. That’s why the most prudent approach to sodium reduction is the public health approach: Let’s lower sodium levels across the food supply—and do so without sacrificing flavor—so we can make it easier for everyone to cut back.
- Ninety percent of adults will develop high blood pressure at some point in their lives, an insidious disease that can start in childhood and progress steadily over time. So it is only prudent to take steps in childhood to prevent this trajectory. In addition, if we become conditioned to prefer high-salt taste early in life, and we are surrounded by a high-sodium food supply, it becomes that much more difficult for us to cut back on sodium later in life.
What is the maximum recommended amount of sodium per day?
- The Dietary Guidelines for Americans 2005 recommends a maximum of 2,300 milligrams of sodium per day (about 1 teaspoon of salt), but also notes that people who have high blood pressure or are who are likely to develop high blood pressure should consume no more than 1,500 milligrams per day. That includes people over age 40, African Americans, people who have somewhat elevated blood pressure (pre-hypertension), and people who have diabetes. Nearly 70 percent of U.S. adults should limit their sodium to 1,500 milligrams a day. ()
- Since the Centers for Disease Control and Prevention estimates that nearly 70 percent of U.S. adults should limit sodium intake to 1,500 milligrams per day, nutrition experts at Harvard School of Public Health, the American Heart Association, and the Center for Science in the Public Interest have called for the U.S. government to lower the upper limit of daily recommended sodium intake from 2,300 milligrams to 1,500 milligrams per day (2/3 teaspoon of salt).
How much sodium does the average American consume each day?
- Current average daily intake of sodium in the U.S. is more than 3,400 milligrams (about 1½ teaspoons of salt). This has been trending upwards since the early 1970s, despite extensive efforts to reduce Americans’ sodium consumption. And many individuals consume much more than 3,400 milligrams of sodium per day, sometimes in just one meal.
Will sodium be banned from foods, just like New York City banned trans fats?
- No one is recommending a ban on using salt or sodium in foods, since such a ban is unrealistic—and unnecessary. The best approach to achieve a big cutback in sodium may be to phase it in over several years, industry-wide, in moderate steps.
- Government regulations can help create a level playing field for sodium in foods, and this level playing field is crucial for achieving sodium-reduction goals: If all companies reduce their sodium levels slowly and simultaneously, our taste buds will not notice the change.
- The sodium reduction challenge is very different from past public health campaigns to stop smoking or eliminate trans fats from the food supply. A certain amount of sodium in our diets is safe, and sodium is critical to both palatability and to a variety of valued food manufacturing, culinary, and preservation techniques. No sodium reduction initiative is going to be successful if it results in foods and flavors that people don’t want to eat.
If we reduce the sodium levels in the U.S. food supply, does that mean we will all have to get used to eating bland food?
- Sodium reduction does not mean that we all will need to eat bland food. Human taste buds aren’t sensitive enough to notice a reduction in salt of about 10 percent—and for many types of foods, up to 25 percent. That means home cooks, professional chefs, and the food industry can easily make “silent”—yet still meaningful—cuts in salt.
- Once we make these silent cuts in sodium, we can replace salt with other delicious seasonings and make additional gradual, steady reductions in sodium over months and years. That way people can slowly (and imperceptibly) become accustomed to lower salt fare without having to settle for bland-tasting food. See The Nutrition Source for that spare the salt.
To lower my sodium, do I have to give up my favorite foods? What about high-salt foods that are part of my family’s food traditions?
- Many traditional cuisines incorporate foods that are high in sodium: soy sauce (China), salted pickles and fish (Japan), salty cheese and olives (Greece, Italy), to name a few. There’s no need to give up these foods or other favorite foods completely. Just consume smaller amounts.
- Traditional Greek salads, for example, use a sprinkling of feta cheese and a few olives to complement fresh lettuce, tomatoes, and cucumbers—vegetables that are naturally low in sodium.
- Low-salt alternatives are available for many traditional high-salt products. Taste-test a few alternatives to find foods that please your palate and let you preserve your traditions.
References
1. Institute of Medicine. . The National Academies Press: Washington, D.C., 2010.
2. Vasan RS, Beiser A, Seshadri S, et al. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. . 2002; 287:1003-10.
3. Palar K, Sturm R. Potential societal savings from reduced sodium consumption in the U.S. adult population. . 2009; 24:49-57.
4. Bibbins-Domingo K, Chertow GM, Coxson PG, et al. Projected effect of dietary salt reductions on future cardiovascular disease. . 2010; 362:590-9.
5. Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. . 2009; 339:b4567.
6. World Cancer Research Fund, American Institute for Cancer Research. . London, 2007.
7. Application of lower sodium intake recommendations to adults—United States, 1999-2006. . 2009; 58:281-3.
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