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HEART Insight:
doi: 10.1097/01.HEARTI.0000319865.64331.6b
Features: Nutrition Know-Hows

Shaking Salt From Your Diet

MacReady, Norra

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Putting Away The Shaker Is Just A Start

For years, health experts have been telling us to lower the salt in our diets. You may think the advice doesn't apply to you, because you don't have high blood pressure. Or that all you need to do to eat less salt is to put away the saltshaker. Well, read on ‘cause you're in for a surprise’.

Salt contains sodium, and high sodium intake causes the body to retain water, which puts an extra burden on the heart and blood vessels that increases your risk of developing high blood pressure — a major risk factor for heart disease and stroke. “Excess salt intake can raise blood pressure,” although the physiological mechanisms for this relationship still aren't clear, says Ronald Krauss, M.D., director of Atherosclerosis Research, Oakland Research Institute in CA.

“In general, as your salt intake increases, so does your blood pressure,” says Lawrence Appel, M.D., M.P.H., Professor of Medicine, Johns Hopkins University in Baltimore, MD. He calls hypertension a “massive, ubiquitous problem,” and estimates that 90 percent of Americans will develop it within their lifetimes.

The average American eats 2,900 milligrams (mg) to 4,300 mg of sodium a day — significantly more than American Heart Association (AHA) recommendations of less than 2,300 mg per day for most people, but less than 1,500 mg per day if you're black, middle-aged or older, or already have high blood pressure.

But not everyone has high blood pressure, so why does the AHA want all of us to control the amount of salt we eat?

Even if your blood pressure is normal — less than 120/80 mmHg (millimeters of mercury) for an adult — since nine out of 10 Americans will develop high blood pressure in their lifetimes, anything that delays its onset is beneficial, notes Appel. “It is good for even healthy people with normal blood pressure to lower their salt intake,” he adds.

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Believe it or not, most of the sodium you eat does not come out of the saltshaker. It's already in your food! “Most salt is hidden. Ninety percent comes from processed foods,” Appel explains. “For example, one-third of the salt in our diet comes from baked goods, and most people aren't aware of that.” He recommends reading labels carefully and choosing items that provide less than 200 mg of sodium per serving. “Anything with more than 400 mg per serving is a red flag.” Canned and powdered soups are notoriously high in salt, but many low-sodium versions are available, with no real sacrifice in flavor, he adds.

Limiting salt intake isn't the only thing you should do to lower your risk of high blood pressure, says Krauss. It's also important to keep your weight within a healthy range, and to eat lots of fresh fruit, vegetables and fat-free and low-fat dairy products because they're good sources of potassium, which helps keep blood pressure levels normal. As an added bonus, these foods are naturally low in sodium so if you fill up on them you'll have less room in your tummy for the salty stuff.

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Figure. The average ...
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A low-salt diet needn't be bland or boring [see the recipes in this issue on pages 30–38]. Nutritionist Susan Bowerman, M.S., R.D., assistant director of the Center for Human Nutrition at the University of California-Los Angeles, offers these tips:

▪ Experiment with herbs, spices, lemon, wine, fruit juice and other zesty flavorings. For example, broccoli pairs well with onions or garlic, while most herbs have too strong a flavor and might compete with it. But before you stock your spice rack, check that a flavoring or spice blend is not high in sodium.

▪ For recipes and tips on combinations of spices and flavorings you probably haven't thought of, visit McCormick (, Spice Islands ( and other Web sites of companies that sell these products.

▪ Read labels. The sodium content lists all sources of the stuff in a food, such as preservatives. Plus, you might find sodium where you least expect it — for instance, powdered hot cocoa mix. And keep in mind that even “low-salt” versions of your favorite foods may still take a big bite out of your salt budget.

▪ Unless you're on an extremely salt-restricted diet, if you remove as many processed and prepackaged foods from your diet as possible, you will cut your overall sodium intake enough that you can add a little salt to your food while cooking without exceeding the AHA's recommended limits.

▪ Frozen fruits and vegetables are convenient to have on hand, and contain very little added sodium, as long as they are plain and not in a sauce.

▪ When eating out, you can avoid unwanted sodium by ordering grilled chicken or fish, steamed vegetables and salads — just steer clear of dressings, gravies and sauces, which tend to be loaded with salt.

Follow these simple suggestions, and you could be salting your life with a few more healthy years.

© 2008 American Heart Association, Inc.