Salt Under Coming Under Sharper Public Health Focus
More than half of Americans have either high blood pressure or pre-hypertension, says cardiologist Clyde Yancy, president of the American Heart Association and medical director at the Baylor Heart and Vascular Institute in Dallas.
“That puts a lot of us in the bucket of people who need to be on a lower sodium diet. Sodium contributes to most people’s high blood pressure, and for some it may be the primary driver.”
Cutting back on sodium could save thousands of people from early deaths caused by heart attacks and strokes each year, and it could save billions of dollars in health care costs, he says.
Others second that. “Salt is the single most harmful element in our food supply, silently killing about 100,000 people each year,” says Michael Jacobson, executive director of the Washington, D.C.-based Center for Science in the Public Interest. “That’s like a crowded jetliner crashing every single day. But the food industry has fended off government action for more than three decades.”
Now salt has our attention.
But reducing it in the American diet is easier said than done. “We have, in essence, ignored the advice because we are driven by convenience, and sodium makes a fast-food lifestyle very easy,” Yancy says. “To change, we would need to live and eat differently.”
Very differently.
Americans now consume an average of about 3,400 milligrams of sodium a day, or about 1½ teaspoons, government data show. Men consume more than women.
But most adults — including those with high blood pressure, African Americans, the middle-aged and the elderly — should consume no more than 1,500 milligrams a day, according to the dietary guidelines from the U.S. Department of Agriculture. Others should consume less than 2,300 milligrams, or less than a teaspoon, the guidelines say.
And yet it’s virtually impossible to limit yourself to such amounts if you often eat processed foods, prepared foods or restaurant fare, including fast food. Most Americans’ sodium intake comes from those sources, not the salt shaker on the table.
Some restaurant entrees have 2,000 milligrams or more in one dish. Fast-food burgers can have more than 1,000 milligrams. Many soups are chock-full of sodium. So are many spaghetti sauces, broths, lunch meats, salad dressings, cheeses, crackers and frozen foods.
Can’t see it, can’t taste it
Salt serves many functions in products. Besides adding to a food’s taste, it is a preservative.
“You can’t see it,” Yancy says. “You can’t even taste it because you are so accustomed to it. If you want the freedom to make healthy choices, you are limited by today’s foods. That’s a problem.”
To change that, food companies and restaurants will have to come up with new ways to formulate products and recipes to help consumers gradually lower their salt levels, which would wean them off the taste.
That’s a huge challenge, but nutritionists and public health specialists say it can be done and will be worth it. “There is no health benefit to a high-sodium diet, and there is considerable risk,” says Linda Van Horn, a professor of preventive medicine at Northwestern University Feinberg School of Medicine.
Even those whose blood pressure is in the normal range should watch their intake, Yancy says. “Here’s a wake-up call: Every American who is age 50 or older has a 90% chance of developing hypertension. That increases the risk of heart disease and stroke. This is a preventable process, and it’s preventable with sodium reduction, weight control and physical activity.”
Why it can be harmful
There are several theories for why sodium increases blood pressure, Yancy says, “but the most obvious one is that it makes us retain fluids, and that retention elevates blood pressure,” which injures blood vessels and leads to heart disease and stroke. “It’s a connect-the-dots phenomenon.”
Some people, especially some African Americans, are more salt-sensitive than others, Yancy says.
“When they are exposed to sodium, they retain more fluid, and because of the way their kidneys handle sodium, they may have a greater proportional rise in blood pressure,” he says.
The cost of this damage? An analysis by the Rand Corp. found that if the average sodium intake of Americans was reduced to 2,300 milligrams a day, it might decrease the cases of high blood pressure by 11 million, improve quality of life for millions of people and save about $18 billion in annual health care costs.
The estimated value of improved quality of life and living healthier longer: $32 billion a year. Greater reductions in sodium consumption in the population would save more lives and money, says Roland Sturm, a senior economist with Rand.
Yancy says the country doesn’t just need health care reform, “we need health reform. If we don’t adjust the demand part of the equation, no system will work. Remarkably, people might be overall healthier by simply reducing sodium.”
But Yancy says people need to keep in mind that sodium is just one of the factors that increase the risk of heart disease and stroke. Others include obesity, consuming too much sugar and too few fruits and vegetables, lack of physical activity and smoking.
