Lower-Salt Diet Would Have Major Impact

If all Americans cut their salt intake by less than half a teaspoon a day, we could save up to $24 billion in health costs every year.

Researchers from Johns Hopkins University built a computer model to test the idea. Experts recommend less than 5.8 g of salt per day. Women eat about 7.3 g per day, and men 10.4 g. Most salt in the diet comes from processed foods, such as lunchmeat, canned food and sauces.

The study was published January 20 in the New England Journal of Medicine.

What Is the Doctor's Reaction?

A group of epidemiologists has shared their calculations about the large health benefit we could gain on a national scale if adults 35 years and older are willing to eat a less salty diet. The calculations come from the predictable relationships between salt and blood pressure, and between blood pressure and heart or stroke events.

Most Americans eat a total of about two teaspoons of salt in a day: Men take in 10.4 grams (g) of salt, and women consume 7.3 g.

If we reduced our average salt intake by 3g per day (this would translate to 1,200 milligrams of sodium per day), how much would this help the collective health of Americans? The study's calculations are startling. During the first decade after the change, a computer simulation predicts 54,000 to 99,000 fewer heart attacks per year, 32,000 to 66,000 fewer strokes per year, and 44,000 to 92,000 fewer deaths per year from any cause. Roughly 1 in 4 people who need medicine to treat high blood pressure would be able to go off the medicine.

It is not news to say that a low-salt diet can result in better health—we have known this. A randomized study published three years ago demonstrated that if you have pre-hypertension (mildly elevated blood pressure, but not enough to need treatment), reducing salt intake to about three-fourths of what you had been eating could lower your risk for heart and stroke events by 25%. “Events” include heart attacks, strokes, a need for an angioplasty procedure or bypass surgery, strokes and premature death.

What is interesting from this new report? The clear implication that the American diet is costing us, both in health quality and health dollars.

Based on this national computer simulation, reduction in dietary salt of 3g per day would give us as large a benefit as we would get from having all of our overweight population lose 5% of body weight, or from cutting tobacco use in half, or from adding cholesterol medicines to treat everyone who has any risk for heart disease (and who is currently not being treated). Lowering salt intake also would give us as much benefit as we would get by giving medicines to treat everyone who has high blood pressure.

What Changes Can I Make Now?

This new wisdom on salt and health would have the average American cut his or her salt intake by a third or more. About 80% of the salt we eat comes from processed foods. Cutting down your salt really means cutting down your sodium. In addition to table salt, sodium is found in seasoned salt (garlic, onion and celery salts), soy sauce and monosodium glutamate. You may think of bread or bakery products as bland or sweet, rather than salty. However, sodium is found in baking powder and baking soda, so most breads and baked products (breads that have risen and baked goods with a cake-like texture) are higher-salt foods.

Here are tips for reducing salt in your diet.

• The most effective way to lower your salt is to cook your own food, starting with basic ingredients. Find new ways to flavor your food. Try out other spices, cinnamon, or herbs. Try them in very small amounts, or in foods you might not have considered, such as salad dressings. Use natural acids for flavor, such as lemon juice, lime juice, vinegars, tomatoes and yogurt.



• Reduce your “portion size” for condiments. You don’t have to abandon barbeque sauce, ketchup, teriyaki sauce or soy sauce, if these are tastes that you love, but these are among the most high-salt sauces you can find. You probably will enjoy your food just as much if you squirt or dip into half your usual amount.



• Buy fresh or frozen vegetables, or canned vegetables with no salt added.



• Use fresh poultry, fish, and lean meat. Avoid salted canned tuna or processed meats, such as ham.



• Keep herbs, spices, and salt-free seasoning blends in your kitchen and at your table.



• Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes.



• Cut back on frozen dinners, packaged mixes, canned soups or broths, salad dressings, and foods packed in “brine” (pickles, sauerkraut).



• Rinse canned foods, such as tuna, to remove some sodium.



• When available, buy low-sodium, reduced-sodium, or no-salt-added versions of foods.



• Choose breakfast cereals that are lower in sodium.



• Snack on fruits and vegetables, instead of chips.



• A few salt-free salt substitutes exist, including Spike and Mrs. Dash. Salt substitutes marketed as "lite salt” replace about half the sodium chloride found in regular salt with potassium chloride. Lite salt still adds a substantial amount of salt into your diet. Plus, it can’t be used in cooking, because potassium chloride that is heated to high temperatures develops a bitter taste.

What Can I Expect Looking to the Future?

The U.S. Food and Drug Administration categorizes salt as a food additive that is “generally regarded as safe.” With this designation, it does not regulate the concentration of salt that can be allowed in processed food products. Should this change, and should the U.S. government begin to regulate salt as a public health imperative? Is this even feasible? Maybe.

Several countries—Japan, the United Kingdom, Finland and Portugal—have imposed salt-related regulations that limit the salt content in processed foods. In some cases, they limit salt content in restaurants. In the United Kingdom, government efforts to lower population salt intake have resulted in a 10% reduction in dietary salt intake over the first 4 years of the program. Snack-food sales have been essentially unchanged, but the salt content of available snack foods is lower.

Imagine if salt in the diet was reduced gradually from now until 2019. Let's say we only get a third of the way towards our goal—we reduce salt intake by an average of 1 g per day. Just this modest success would save us somewhere between $19 billion and $32 billion in health care costs over the course of the next 10 years. If we were truly able to reach the more challenging goal (3 g less salt per day on average), we could save between $57 billion and $97 billion in health care dollars.

Of all the habits we could shake, it will pay off for us—as a nation—to become "salt shakers."