The Salt Controversy Should You Put That Shaker Away?

The Salt Controversy Should You Put That Shaker Away?

By Cynthia Herrick , MD

Salt (also known as sodium) is everywhere! Not limited to the salt shaker, it is already present or, more often, added into many food products we buy or prepare. So if salt is everywhere, why the concerns about salt? Let’s review what is known about salt and its effects on your health.

Why worry about salt?

Many people think salt is essential to the flavor of food. We crave salty foods because they taste good. Unfortunately, many studies have shown that salt can have toxic effects on the body when taken in levels that are higher than recommended. The biggest impact: salt raises blood pressure. While you may not feel bad when your blood pressure is elevated, high blood pressure increases your risk for heart attacks, strokes and kidney problems over time. This is because it makes the arteries (blood vessels) thick, hard and prone to damage, so the heart must work harder. While there are many medicines for high blood pressure, reducing salt in the diet, in addition to weight loss and reduced alcohol intake, is a side-effect-free way to lower blood pressure. Moreover, blood pressure is typically treated when it is above 140/90 (often even lower for people with additional problems, like diabetes), but there can be increased health risks even when blood pressure is in the “pre-hypertensive” range (120-139/80-89), which is another good reason to watch salt intake.

What are sources of salt in my diet?

We get most of the salt in our diet not from adding it at the dinner table, but from foods that already contain it. Salt is added to foods both as a preservative and because it improves the flavor. Processed foods such as soups, canned goods, preserved meats (lunch meats, sausage, hot dogs, some poultry) and prepared mixes are the biggest sources of sodium in the diet. Additionally, snack foods can be very high in salt chips, olives, even sauces such as soy that are added to foods. However, breads and grains, cheese and beans also contain more sodium than anticipated. Finally, foods purchased in restaurants, and particularly fast food establishments, are also very high in sodium. For example, a Big Mac at McDonald’s has 1000 milligrams (mg) of sodium, and even a six-inch turkey breast sub on wheat from Subway contains 810 mg of sodium.

So how much salt is okay?

It is impossible to completely eliminate salt from your diet, nor would that be necessary! The American Heart Association (AHA) now recommends no more than 1500 mg of sodium per day for everyone. The U.S. Department of Agriculture (USDA) dietary guidelines recommend no more than 1500 mg of sodium per day for people at “higher risk” (defined as African Americans, adults>51, or people with high blood pressure, diabetes, kidney or heart problems), with no more than 2300 mg of sodium per day for everyone else. Most of us take in double this amount (3000-4000 mg in most estimates) in our typical daily diet. To put this into further perspective: one teaspoon of table salt or sea salt = 2300 mg of sodium chloride. The good news: within a few weeks on a low-salt diet, people begin to prefer the taste of lower-salt foods. The bad news: given the high quantity of sodium in everyday foods, it may not be easy to keep within the guidelines of safe salt intake.

How can I cut the salt in my diet?

Some simple rules:

  • Eat at home when you can
  • Throw away the salt shaker
  • Don’t add salt before tasting

When you cook your own meals, you have much greater control over what goes into your food. Surprisingly, some single restaurant dishes contain more than the recommended daily amount of sodium. To support healthier choices, the AHA now certifies that foods in grocery stores meet nutrition standards with a “heart-healthy check mark.” Right now, this means certified main dish/meal products contain 600 mg or less sodium per serving, most other foods (meats, fish, bread, grains and dairy) contain 480 mg or less sodium per serving, and nuts contain 140 mg or less sodium per serving. These requirements will be even lower beginning in 2014. Some canned products are available in a “no added salt” version, and sodium can also be limited by rinsing canned vegetables and beans prior to eating. Further, the salt content of any packaged food is available as “sodium” in “mg per serving” on the food label. Look for this information on any packaged food item.

Recognizing that eating at home isn’t always realistic, there are ways to eat healthy at restaurants, too. For example, try to avoid foods that are fried, pickled, smoked, in broth, or in soy, cocktail or teriyaki sauce. You can also ask that foods be prepared without salt or MSG (monosodium glutamate is another common seasoning that is very high in sodium), and ask for salad dressing “on the side.” Many restaurants and fast-food chains now provide nutrition information on their menus, websites or by request. If this information is available, you can look specifically for the sodium content in a particular dish. The AHA is also beginning to work with restaurants to certify meals.

On restaurant menus, a “heart-healthy check mark” means that the whole meal contains 900 mg or less sodium. Foods with the check mark in grocery stores and restaurants must also meet other criteria for fat, cholesterol and other ingredients. The AHA maintains a list of certified foods in the Getting Healthy: Nutrition Center section of its website ( HEARTORG/). As always, when interpreting food labels and restaurant nutrition facts, it is important to stick to the recommended serving size because the amount of sodium is linked to that serving size.

Finally, the DASH (Dietary Approaches to Stop Hypertension) diet is commonly recommended for lowering blood pressure. This eating plan is low in fats that are not healthy, sodium and cholesterol and high in fiber. It recommends limiting red meats, sugar sweetened beverages and sweets, and maximizing whole grains, fish, poultry, nuts, fruits and vegetables. More information on the diet can be downloaded from the National Heart, Lung, and Blood Institute:

How do I season food without salt? Food just does not taste the same without salt!

There are many salt-free seasoning combinations on the market, but even simple spices can be used to add delicious flavor to foods. Examples include rosemary, sage or thyme for meats, lemon juice for fish and vegetables, and cinnamon for fruit. The AHA has a comprehensive list of seasoning alternatives and low-salt recipes available at its website (above) under Conditions: High Blood Pressure: Prevention and Treatment: Reducing salt. Seasoning alternative recommendations are also available from the National Kidney Foundation at

The bottom line:Use the tips above to aim for 1500 mg of sodium in your diet per day in order to lower your risk for high blood pressure, heart attacks, strokes and kidney problems. And explore the world of alternative seasonings and flavors as you take this step to better health!

Dr. Gillian Boyd-Woschinko is an Endocrinology Fellow at The Mount Sinai Hospital in New York, NY. She attended medical school at Jefferson Medical College and trained in internal medicine at New York Hospital-Weill Cornell in New York, NY. She is board certified in internal medicine. She spoke at the 2012 Endocrine Society national conference in Houston, TX on using mobile health in diabetes management and is currently conducting research on the use of smart phone applications for improving diabetic outcomes.