Sodium: How Low Should You Go?

 A look at our complicated relationship with the other white stuff

We all need sodium to survive. It is an essential nutrient that helps control water balance in our bodies and supports healthy muscle and nerve function. It also assists with muscle contraction and regulates our cells’ water levels to prevent dehydration.Too much salt, however, causes fluid retention, which increases blood pressure, putting a strain on our heart and blood vessels.

We get it: This sounds like common-sense stuff and you’ve heard it all before. But before your eyes glaze over, it’s important to note that the discussion around salt has been contradictory and confusing for a very long time.   

So let’s get what you know out of the way: Yes, Americans eat a lot of salt. About 90 percent of us regularly consume amounts considerably higher than the Department of Health and Human Services’ target intake of 2,300 milligrams a day and significantly more than the American Heart Association’s preferred recommendation of 1,500 milligrams. In fact, the average healthy American eats 3,400 milligrams of the white stuff each day. 

As long as people with high blood pressure reduce their sodium intake (recent research shows this is happening), everyone should be happy, right? Wrong. Instead of a consensus among public health experts about the nation’s sodium consumption habits, researchers generally have fallen into two groups: team “if you’re healthy, don’t worry about sodium” versus the “everyone should reduce their salt intake” crew. 

There is solid evidence that people who are sensitive to sodium—meaning they retain sodium more easily, leading to fluid retention and increased blood pressure—should slash their intake in order to ward off serious health complications. That’s those who already have high blood pressure and those at high risk of developing it, which includes people older than age 51, the age when salt sensitivity begins to increase for everybody; those with diabetes or chronic kidney disease; and African Americans, who have the highest rates of high blood pressure in the world.

But that doesn’t mean the healthy half of the population should shake salt with abandon, says Elliott Antman, a cardiologist at Brigham and Women’s Hospital in Boston and past-president of the AHA, who stands firmly entrenched in the less salt for everyone group. Too much sodium negatively affects blood pressure in overweight people—roughly 70 percent of the adult population and one-third of American children. Too much sodium strains the kidneys; over a long period of time, this can lead to high blood pressure. High-sodium diets also have been linked to heart disease, and they may leach calcium from your bones, leading to osteoporosis.

Also, he says, lowering dietary sodium can diminish significantly the rise in blood pressure that tends to happen to all of us as we age. This part is crucial: It is expected that 90 percent of us will develop high blood pressure at some point in our lifetime, he says, even those of us who are currently healthy and in our 30s and 40s.

“Everyone should take steps to limit salt in their diet, for one simple reason: to lower their risk of death,” Antman says.

This concern is, in large part, because Centers for Disease Control and Prevention studies show our salt habit has been getting worse, not better, over the past two decades.

A much-debated 2016 meta-analysis published in The Lancet concluded that adults with normal blood pressure don’t need to lower their salt intake below 2,300 milligrams a day, and, in fact, found that healthy people who consumed less than 3 grams of sodium per day had a 26 percent increased risk for heart disease and stroke.

But the research in that study, which seems to reach similar conclusions as earlier studies from the Institute of Medicine and the New England Journal of Medicine, has been debunked by the CDC, the AHA, the Centers for Science in the Public Interest, the World Health Organization and others for relying on flawed data (most of the small number of participants were from clinical trials of already sick people taking several medications and with a high risk of dying).

If the big guns can’t agree, is it any wonder the average American is twisted in knots trying to figure this stuff out? Samantha Heller, a nutritionist at NYU Langone Medical Center in New York City, isn’t surprised by our confusion. This may make it easier. In spite of the dueling data, there’s no proof that otherwise healthy people with normal blood pressure need to reduce their salt to rock-bottom (read: below 2,300 milligrams a day) levels.

Besides, Hellers says, it’s highly unlikely that adults in this country are getting too little sodium. “Keep in mind that just one teaspoon of table salt has about 2,300 milligrams of sodium,” she says. 

“Most of us probably get that if we eat a piece of cheese, a bowl of cereal or a piece of bread,” says Marisa Moore, an Atlanta-based dietitian. “So I’m not concerned with people not getting enough sodium.”

Why does it seem that salt makes some folks’ blood pressure soar, while others can tolerate loads of it with no negative effect? Right now, there’s no simple way to test for salt sensitivity, which affects an estimated 10 percent of the population. That’s why public health officials try to limit the confusion by recommending that everyone cut back on salt. 

The bigger concern for nutrition experts is the source of our sodium. We get the bulk of it, 77 percent, from packaged foods and restaurant meals. “Sodium is in virtually everything when you consider the American consumer’s demand for processed foods in the interest of convenience,” says Rovenia “Dr. Ro” Brock, a nutritionist and author of Lose Your Final 15. “In addition, manufacturers who wish to sell you processed and overly processed foods add sodium to preserve and extend the shelf life of their products.”

The best bet to lower your sodium intake is to make more meals at home. If this conjures up images of folks hunched over reading labels, trying to calculate milligrams, don’t worry. Much of that heavy lifting can be alleviated with these tips:

Eat more fruits and vegetables. These can be fresh or frozen, Moore says, just don’t buy the ones with sauce. This accomplishes two things. First, we get potassium from fruits and vegetables (think: avocados, bananas, kiwi, potatoes), which helps lower total blood pressure. If you’re getting sodium from other sources, the potassium in those five-to-seven daily servings helps balance it. Second, when 4 o’clock snack time rolls around, reach for baby carrots, grape tomatoes, cherries and the like instead of chips. “Fruits and vegetables can absolutely be a snack,” Moore says. “I want them to be the first option instead of the vending machine.”

Roast vegetables. An underutilized technique when it comes to vegetables, roasting caramelizes them, “which brings a lot of flavor out without having to add a lot of salt,” Moore says.

Use herbs. Look no further than your garden or windowsill for herbs such as parsley, rosemary and thyme to boost flavor in your dishes. But be sure to go with fresh herbs. “People reach for the dusty ones in the cabinet,” Moore says, “and the flavor’s all gone.”

Add citrus. Choose grapefruit, lime or orange to marinate meats and fish. Use them in vinaigrettes and sprinkle that on salads instead of sodium-heavy dressings.

Shake salt. Yes, you read that right. Though many nutritionists advise against lifting your salt shaker, Moore believes you don’t have to avoid it. But follow these rules: Do use sparingly, add it at the end and add it yourself. “I would much rather you have roasted vegetables, a salad or a grain that’s seasoned well so you’ll actually eat healthy foods,” Moore says, “than to avoid those healthy foods because you can’t season them well.”

Do your homework. “Evaluate your own search for information,” Dr. Ro says. “Find an expert or arsenal you can trust to be informed and to share what they know, including guide you to relevant and trustworthy resources.”