Salt is everywhere: dumped into cans of soup, packed into hotdogs, and swimming in salad dressing and salsa. Exactly how bad for you are all those tiny crystals? That question's surprisingly controversial. In May, several researchers reignited a debate by suggesting that cutting salt intake doesn't benefit heart health, contrary to conventional wisdom. In their Journal of the American Medical Association study of 3,681 people without heart problems, those who had the most salt in their diets actually had the lowest risk of dying from heart disease.
But that conclusion runs against the long-standing consensus among experts—and against the latest evidence. If Americans made small daily reductions in salt intake, say the authors of a new analysis that appeared Thursday in the British Medical Journal, the country could have up to 120,000 fewer cases of heart disease, 66,000 fewer strokes, and 99,000 fewer heart attacks annually. (Though essential in small amounts, sodium increases blood volume, making the heart work harder and increasing pressure in the arteries.)
The federal government's Dietary Guidelines for Americans, updated in January, recommend people limit sodium intake to 2,300 milligrams a day, or 1,500 milligrams if they are older than 50, African-American, or have hypertension, diabetes, or chronic kidney disease. Here are some suggestions for cutting back on salt, provided by the National Heart, Lung, and Blood Institute and Stephen Havas, vice president for science, quality, and public health at the American Medical Association.
1. Cook from scratch so you know exactly what's in your food. You might be surprised at the sodium content included in your favorite prepackaged meals: The non-profit Center for Science in the Public Interest analyzed a range of processed foods and found, for example, that ready-made roasted carved turkey containing up to an astonishing 5,410 milligrams of sodium per serving. Half of a ready-made pepperoni pizza might contain as much as 1,350 milligrams.
2. When you do opt for packaged foods, choose products that are sodium free or low in sodium. A typical cup of miso soup, for instance, contains 700 to 900 milligrams of sodium, so look for canned soups with "low sodium" or "reduced sodium" on the label. If you can't find many of these products, Havas advises asking your local grocery store to start stocking them. Even bread and cereal may surprise you: The CSPI found whole-wheat bread contains anywhere from 150 to 190 milligrams of sodium per slice, depending on the brand. White bread had 115 to 230 milligrams per slice.
3. Make smart swaps. You don't necessarily have to sacrifice taste. A McDonald's Egg McMuffin, for example, packs 820 milligrams of sodium; a wiser choice is two scrambled eggs, which have just 180 milligrams. Canned tuna typically contains 300 milligrams of sodium per 3-ounce serving, which doesn't include mayonnaise. Substitute fresh grilled tuna steak and you'll only be getting 40 milligrams of sodium. And be wary of salad dressing: Some brands jam more than 700 milligrams into each 1.5-ounce serving. Stick with your own oil and vinegar instead.
4. At restaurants, ask your server which foods are prepared without added salt—and order those items. "The more restaurants hear this, the more they're going to change the way they're cooking," Havas says. Fresh steamed veggies and roasted entrees are often the smartest choices.
5. In the kitchen and at the dinner table, substitute spices, herbs, and salt-free blends for salt.
6. Avoid instant foods such as pasta, rice, and cereals, which usually contain salt. Spaghetti sauce, according to the CSPI, contains 270 to 770 milligrams of sodium per serving, depending on the brand.
7. Rinse canned foods to wash off some of the salt.
8. Check labels for sodium in all its forms. Table salt is mainly sodium chloride, but canned or packaged foods can contain other forms of sodium.
9. Eat lots of fruits and vegetables. Fresh produce has "essentially no sodium," Havas says. If you're cooking veggies, don't add salt, and carefully read the labels on frozen vegetables to make sure it hasn't been added already.