Diabetes Self-Management Blog

Hopefully you all had an enjoyable and relaxing Thanksgiving holiday. And hopefully you didn’t overindulge too much, but if you did, you’re getting back on track. If you ate a “traditional” Thanksgiving meal (plus leftovers), which usually includes turkey, gravy, stuffing, and the rest of the fixings, chances are you got more than your fair share of sodium.

OK, you may argue, but it’s one day out of the year! Well, not really. What many people don’t realize is that sodium stealthily hides itself in so many of the foods we eat every day, and not just in the usual suspects, like canned foods. Sodium is everywhere!

Why care about sodium?
Sodium is a mineral that we all need to help regulate fluid volume and blood pressure. Our muscles and nerves depend on sodium, too, to function properly. But as with everything in life, some is good, but too much can be harmful. Too much sodium in the diet can cause the body to hang on to fluid.

This can be a serious problem for people with high blood pressure, congestive heart failure, or kidney disease. People with diabetes are more likely to have these conditions than people without diabetes. Also, some people are “salt sensitive,” meaning that when they consume a high amount of sodium, their blood pressure increases in response to the sodium. You can’t tell if someone is salt sensitive just by looking at them.

How much sodium do we need? And what’s too much sodium?
The latest edition of the Dietary Guidelines for Americans was released in 2010. The recommendation is to limit daily sodium intake to no more than 2300 milligrams (mg). However, if you are age 51 or older, are African-American, or have diabetes, hypertension (high blood pressure), or kidney disease (a little more than half of the US population, by the way), you should aim for just 1500 mg per day.

In case you’re wondering, the average daily sodium intake is about 3300 mg, but many people take in close to twice that amount. Obviously, most of us are probably taking in way more sodium than we need.

Where is the sodium coming from? You might be surprised.
When you think of the word “sodium,” you probably think of “salt.” They’re not quite the same thing, though. Table salt is 40% sodium and 60% chloride. A teaspoon of salt contains about 2300 mg of sodium, so there’s your daily intake right there. Sea salt, by the way, which is made by evaporating seawater, really isn’t lower in sodium than table salt, although some people claim that they use less of it. It’s still a source of sodium, though.

Most of our sodium intake doesn’t come from the saltshaker, however. Instead, the majority of our sodium comes from foods we buy in the grocery store. Recently, the Centers for Disease Control (CDC) looked at data from the National Health and Nutrition Examination Survey (NHANES) on 7,227 Americans ages two and up.

The CDC team found that more than 75% of the sodium that we consume is added to the foods that we buy or to foods that we purchase in restaurants. Only about 5% of our sodium intake is added by us during cooking or with the saltshaker. Food manufacturers and restaurant owners love sodium because it helps to preserve food and, of course, adds flavor. To be fair, though, food companies are making an effort to cut back on the amount that they use.

Here are the top 10 “heavy hitter” foods that are laden with sodium, based on the CDC’s research:

• Bread and rolls: They contribute 7.4% of the sodium in our diets. Some breads contribute more than 200 mg per slice. Read the label for sodium and don’t assume that “healthy” breads are low in sodium.

• Cold cuts and cured meats: This isn’t so surprising, but deli meats like turkey, ham, bologna, bacon, and hot dogs contribute 5.1% of our sodium intake. Look for lower sodium versions.

• Pizza: Contributing 4.9%, pizza’s ingredients — cheese, sauce, the crust and meat toppings — are not exactly low in sodium. Making your own is the best bet.

• Fresh and processed poultry: 4.5%, thanks to chicken nuggets, fried chicken, and chicken plumped up with salt solution.

• Soups: 4.3%. Making your own is easy.

• Sandwiches and burgers: Big Macs, chicken sandwiches, and the like contribute 4%.

• Cheese: 3.8%. Use it sparingly!

• Pasta mixed dishes: Frozen pasta entrees and restaurant pasta meals contribute 3.3%.

• Meat mixed dishes: Meatloaf, chicken pot pie, and so on — 3.2%

• Salty snacks: Chips, pretzels, tortilla chips, crackers — 3.1%

Making our own food with fresh ingredients (and not a lot of salt) is the best way to slash sodium. But the reality is that we all use at least some convenience foods. Compare food labels between brands and whenever possible, choose the no-salt-added, low-sodium, or reduced-sodium versions. Cook with herbs, pepper, and other spices. And taste your food before you salt it. You really can retrain your taste buds to prefer less salt!

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Comments
  1. I have to admit I’ve been overdoing the sodium since Thanksgiving. We had stuffing and creamed corn with our turkey, both of which had lots of sodium. The next day I fixed pork and sauerkraut. I’ve been eating the leftovers ever since, and my ankles just won’t go down. Just one more dinner and one more breakfast and they’ll be gone. Then I’ll be back to limiting my sodium to 1500-1800 mgs a day, by not adding salt to what I cook as well as avoiding most processed foods or using low-sodium versions.
    I don’t anticipate any trouble getting back to lower sodium, but it can be hard at first. I found that going cold turkey was best for me - eat lots of fresh foods and unsalted frozen vegetables, use a good herb mixture in place of all added salt in cooking. Unsalted butter combined with oil makes a better spread in small quantities. In the space of a week or so your taste buds will be retrained, and if you eat out you will be astounded how salty everything is!

    Posted by Deb |
  2. Heart patients and diabetics may be harmed by cutting sodium below 3000 mg/day, according to recent research.

    Reference: http://www.acsh.org/factsfears/newsID.3922/news_detail.asp/

    -Steve

    Posted by Steve Parker, M.D. |
  3. Thank you Dr. Parker for some other data and research.

    Here we go again:

    butter’s bad - use margerine.

    Margerine’s trans fat can kill one - use butter.

    Oh well, obviously a balance is required and where to draw the line gets confusing.

    We need to stop relying on statistics mining and cross corelate against actual science and testing against the affected body parts to see if the statistical mining is helpful on a premature basis or just sends us relentessly scurring from one end of the ball park to the other end.

    Posted by jim snell |
  4. Great article ! One thigh I think ought to be said though. As you say, many cannot or will not cook with fresh veggies, fruit or use unprocessed meats. In my opinion processed meats contributed a lot of salt to my old way of eating along with salt in prepared fruits and yes, even prepared fruits.
    We cook from scratch, no processed foods so we completely control our salt intake. We eve n use unprocessed mined sea salts which are supposed to be better for you than processed salts.
    If, and not very often we use prepared veggies but always rinse them to remove the salts used in preparation.
    We do can some veggies but use minimum salt and we then know how much they contain.
    Salt is an addiction to most people and when you cut back or even quit salts it will take a while to get used to the taste,but, once you do, eating out will usually mean too much salt for your taste.

    Posted by Dan |
  5. Jim: If we did that pharmaceutical sales would tank. Take for example cholesterol lowering medicines. It is true that there is a correlation between high cholesterol and cardiovascular disease, but there is no evidence that lowering cholesterol medically does anything at all to treat cardiovascular disease. Still, Lipitor is the most prescribed drug on the planet.

    Posted by Joe |
  6. Another reason that salt is so common in processed foods is that many of them contain significant amounts of relatively flavorless extenders and binders -most often starches or water- to bulk up the foods’ weight and volume. The extra salt prevents the additives from making the food too bland to be palatable.

    Posted by Joe |
  7. Thanks for the comments, everyone.

    Dan — that’s correct — when you start using less salt and eating less sodium in your diet, you eventually do adapt to the lower sodium intake and foods with even a little bit of salt on them can taste way too salty!

    Steve — thanks for pointing out this study. The study you mention was a little flawed in that the subjects all had normal blood pressure, they were all white, and were younger and fairly slim (not exactly a high risk population). Also, urinary sodium was measured only once, and that was at the start of the study. The study authors also concluded that people with high blood pressure would still benefit from a lower-sodium diet.

    Posted by acampbell |
  8. Interesting. My mother on dialysis (at the time 88 years old) and myself (63 at that time) cut our salt back to 1800 and walked around dizzy and almost falling over for two days. I had to up our salt intake to 2400. Still, that was an improvement and seemed to help her tremendously. (I did notice a favorite dish at Applebee’s had 3,900 all by itself. Thus, even a smaller cut-back seemed to help) Maybe it was “addiction reaction.” We could, as a nation, be addicted to the salt. On the other hand, maybe we shouldn’t rush to go so very low.

    Posted by sue |
  9. Thanks for the warning!

    If you have to eat salty dishes one way to combat is to have a potassium salt shaker nearby and learn to sprinkle on some to compensated for the sodium.

    And don’t forge to drink some water to dilute your salty dishes and help to eliminate the salt.

    Posted by Bimbam |
  10. We ate lunch out today, I ordered a cup of tomato gorgonzola soup with half sandwich. I could not believe how salty the soup tasted to me, I have been cooking with no salt at home and my taste buds must have been retrained!!
    We like to eat out as a once in a while treat but it seems that the only safe order is salad with mostly greens and the dressing on the side!

    Posted by amyjacque |
  11. When we try to lower our sodium intake we may unknowingly subjct ourselves to an opposite danger—a sodium deficiency. This can be fatal; the chemicals in one’s body have to be at a certain level. Ten years ago my sodium level fell so low that I lost consciousness and was hospitalized for a month, taking 2 sodium pills a day to normalize my sodium level.

    Posted by Ruth Migdal |

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