Yes, you’ve heard of low sodium diets. Unfortunately, most of us don’t understand them well, and there are a number of misconceptions about the topic. I know this from experience.
I fought my nephrologists like a Tasmanian devil when they literally screamed “salt is poison for you!” Well, as I was in the hospital with kidney failure at the time, I eventually gave up and listened. I had acietes and edema because my kidneys could not process fluids and salt exacerbated the problem. The more stressed my kidneys were, the further I fell into complete renal failure. Stage 4. I was 49.
As a retired Chef with a solid background in diet and nutrition I, myself, had called ‘low sodium’ diets bunk for years. I learned that the facts had not been on my side. I’d related these diets to fads and even pointed out that sodium is an essential mineral to ‘prove’ my argument. How little sympathy I had for ill people back then, despite organ failure running in my family! I was satisfied knowing that ‘salt is necessary for life’ without bothering to learn that the average American eats around ten times more than what’s essential.
That’s how my perspective about sodium evolved into what it is today.
Why a low sodium diet?
Most people go on truly low sodium diets for health reasons. The most common introduction to a low sodium diet is a doctor telling you that you must do so for your health or maybe to save your life. This is when you get serious about reducing your salt intake.
People with congestive heart failure and other heart problems, kidney disease, liver disease, Ménière’s Disease, extremely high blood pressure, ascites, edema and a number of other serious conditions are advised to seriously restrict their sodium intake.
Groups of people, including those over 40, diabetics, African-Americans and those with milder hypertension or pre-hypertension may be advised to restrict sodium. This falls into the elective category. People toy with ‘low sodium’ foods in an effort to reduce water weight, banish edema, or to slightly lower their blood pressure but taking minor measures shouldn’t be confused with addressing serious health concerns.
Restricting sodium is hard:
Salt is habituating to such an extent that it could be called addictive.
Taste buds ‘withdraw’. The process takes between 2 and 3 weeks, and there isn’t a quick, easy fix. Once someone’s palate has adapted, they won’t miss the added salt as much anymore. Unfortunately, going cold turkey on the salt is necessary to reach a comfortable state.
What is the difference between salt and sodium?
Sodium is a mineral. Table salt is a compound of 40 percent sodium and 60 percent chloride. In diet, the words are often used interchangeably because it is the sodium component of salt that is a health concern.
Sea salt isn’t any better for your health:
Sea salt is not better for health than regular salt, nor is Kosher. Sea salt can taste better but all sodium is the same as far as health concerns go.
What about sodium deficiency?
Sodium deficiency is called hyponatremia. This condition is a problem with the fluid balance in the body, which has a variety of causes. It is almost never related to a low sodium diet, although there is a lot of misinformation about this online.
Sodium occurs naturally in virtually every food we eat. Celery is a good example. Like many vegetables, it’s pretty salty all by itself. The produce, meats and grains that you eat contain plenty of sodium to sustain a human without adding any extra salt.
Your palate probably hasn’t gotten that memo. We’re so accustomed to added salt in the foods we eat that we can’t taste the minimal amount of sodium that’s already there, which is more than sufficient for good health.
Why is there so much debate about low-sodium diets?
Low-sodium diets have been faddish for a very long time, which made the concept seem frivolous to many of us. When you need to go on a low sodium diet to save your life it’s a serious matter. We’d all rather just enjoy our salted foods than embark on the journey. “Debunking” low sodium diets is an accepted trend which isn’t based on the facts as they apply to people with serious, sodium-related health concerns.
I find this trend marginalizing. I feel that articles that state ‘yes, it’s okay and necessary to eat added salt’ should be inclusive of people that cannot. In the kidney ward I met many patients, some on the edge of death, who were convinced that a low sodium diet was nonsense. I was one of them for a while. Their caretakers had a terrible time restricting their salt intake. They felt like they were asking ill smokers to quit smoking in the face of ‘evidence’ that smoking was good for them. Very ill people can be masters of denial, and organ failure can lead to an extremely hazy mental state.
Perfectly healthy people can process quite a bit of sodium, which does not mean that it is good for them. “The best advice for almost everyone is to cut back,” says Lawrence Appel, M.D., spokesman for the American Heart Association and professor of medicine at Johns Hopkins.
It isn’t yet clear whether restricting sodiu to prevent becoming ill is effective, although it seems to prevent the onset of hypertension. In my own case, the cause of my organ failure was hereditary and reducing salt earlier may have helped. Yes, hindsight.
Incidentally, I have hypotension, which is extremely low blood pressure, and I still had to minimize my salt intake. Doing so had no effect on my blood pressure, which eventually rose to normal. I’m also underweight. Many people mistakenly believe that high blood pressure and excess weight are the only valid reasons to restrict salt and that the reverse must be true, i.e., people with hypotension should increase their salt intake.
How much sodium do people need? How much salt is in a low sodium diet?
Many health professionals believe that the FDA’s recommended intake of sodium is too high, at 2300 mg, recently reduced from 2400 mg. Despite the word ‘intake’, this number is considered to be the upper limit, not the amount necessary for life.
Meanwhile, Americans consume an average of 3400 mg daily or more.
The World Health Organization suggests a maximum intake of 2000 mg.
The minimum amount of sodium people need ranges from 115–500mg daily, which a healthy diet with no added salt whatsoever provides amply. The range factors in an individual’s size, level of athletic activity and the ambient temperature in which he or she lives.
Note that this range is not very wide. From personal experience I can say with confidence that, in the real world in which we eat, consuming only 115mg of sodium is virtually impossible unless the person is being fed entirely via I.V.
A standard lower sodium diet is 1200 to 1500mg daily, which is suitable for people who are fending off health concerns, if not for the seriously ill. If these numbers sound fractional, believe me, they represent a very large difference in both flavor and health.
People with more drastic health issues may want to cut their sodium intake even more, to 1000mgs or so, which is perfectly safe.
After 4 months in the hospital without a clear diagnosis, I was fortunate enough to recover at home without ever undergoing dialysis.
Restricting salt and the two diuretics I’m prescribed and take daily are all I have to thank for this. It was a year later, when I was finally diagnosed, that a supplement targeted at the disease itself was prescribed. Yes, supplement. That’s another story. Suffice it to say that my rare condition involves an inability to process an essential mineral. Which it is not salt.
I know that I will always be at some risk of relapsing into the illness that took my Mother, Aunt, and Grandmother so I still keep a careful eye on my sodium intake. I’m looking and feeling pretty healthy these days and I intend to keep it that way as long as possible.
Part 2: A Chef’s Guide to a Palatable Menu Without the Salt:
Let’s say that you want to limit your consumption to 1000mg of sodium a day. The FDA’s daily value is close to 3 times that. It’s okay to be a little imprecise, because the produce, meats, dairy and grains you eat daily contain around 200-500 mg of sodium by themselves, a number which is dependent on their growing conditions, among other things, making the charts somewhat inaccurate.
An easy way to calculate this in your head is to divide the DVI’s on the labels by 3 and then add them up to find out how much of a food will fit into your diet. Pay attention to the listed serving sizes as well!
For example, a famous brand 8.72 ounce can of prepared beef and vegetable soup that I looked at recently contains 690mg of sodium per serving and ‘about 2 servings’.The entire can contains 1380mg! If you want to limit yourself to 1000mgs daily, or even 1500mgs, eating a bowl of that soup is a real diet-buster.
Can’t an app simplify this?
In short, not really. For example, a fresh corn tortilla has “0% sodium” but a soft corn tortilla made for shelf life contains quite a bit of salt. Broccoli grown in salty soil will have more sodium than broccoli that was not. All of the accurate data available is from prepared foods, and that information is listed on the packages. A calculator can be helpful, however.
Tip: Shellfish is naturally very high in sodium, due to the salt in the sea. If you’re planning on going to a clambake, shrimp boil or having oysters and mussels for dinner it’s worth researching the amounts beforehand. The same is true of seaweed.
Cooking for family:
A few couples embark on low sodium diets together but for the majority of families (this applies to your friends, as well) imposing a 24/7 low sodium diet is virtually impossible. And with all of the salty snacks at work and school, home cooked meals will continue to taste bland to them long after you become accustomed to the flavors.
If everyone concerned is healthy, the best strategy can be to go ahead and put a salt shaker on the table. It’s counter-intuitive, as Chefs hate having their food salted at the table and low sodium advice almost always starts with “throw that salt shaker away!” But it does allow the unwilling to adjust their food to taste, while you adjust your tastes to the unsalted meals.
If you need to help someone else adopt a low sodium diet, the same principles apply. If you must use some salt keep it hidden in the kitchen. It’s much nicer to go low sodium yourself…at least that way you can know for sure that what you’re feeding other people is edible.
Almost any food that comes in a box, bottle, can, out of the freezer case, off a shelf or from the bakery is likely to be high in salt, even if the front of the package says otherwise. Read those labels, remember them, and go for fresh foods as much as possible.
There are products out there that can claim 0 percent sodium, which is possible when the amount is to low to qualify for FDA measurement. Count them as you do your fresh foods.
Making life palatable:
Salads can be a good friend here, as you can add a lot of flavorful veggies, fruits, and nuts and make (or buy) a salt-free vinaigrette to dress it. Yes, you are stuck with vinaigrettes. as creamy dressings are inherently salty.
For some reason, cooked food tends to taste a little worse without added salt than raw food. In other words, a spinach salad with no salt and nice add-ons tastes a lot better than unsalted cooked spinach.
Some of the worst foods for ‘salt withdrawal’ are mashed potatoes, pasta, rice dishes, cooked beans, and meat dishes. That doesn’t mean that you need to go vegan, but life will taste better if you use one of the seasoning ideas listed below.
Spicy foods: If you like spicy, you’re in real luck, because almost nothing covers up the absence of added salt as well as ‘spicy’, whether the heat comes from hot chilis or wasabi. Making your own, salt-free hot sauce is easy and unsalted raw salsas, green and red, really spruce up a meal. Most prepared hot sauces are fairly low in salt.
Sweets: You can make any dessert without salt (except salted caramel and its ilk) and no one will notice if the flavor is good. Just don’t add the salt called for in the recipe.
If you’re a fan of sweet/savory flavor profiles, utilize favorites like pork with berry compotes, fish with mango salsa, and zest up a salad with extra fruit and a sweet and sour dressing. Unlike regular potatoes, sweet potatoes taste fine unsalted.
Acidic foods like vinegar and splashes of citrus juice are very useful in salt-free cooking. Apple cider vinegar, lemon and lime juice, and balsamic make tasty and versatile additions to many dishes.
Sauces: Caramelized onion never needs added salt, and balsamic reductions are always nice. Homemade mayo is good unsalted.
Sauces that don’t work well until your tastes adjust include homemade marinara, gravies, cheese sauces, creamy salad dressings,and most barbecue sauces. If you read the label on ‘lower sodium soy sauce’ you’ll see that it is very salty, as is most prepared horseradish and mustard. Commercial ketchup is always high in sodium.
Chopped onion is your friend: So is chopped parsley, cilantro, bell pepper and tomato. They are really useful as a simple seasoning for foods that are difficult without salt, like mashed potatoes and rice.
Sour cream: Did you know that sour cream is really easy to make? No salt needed! Buy some heavy cream and add a little lime juice or vinegar to it and let it sit for at least half an hour. You can also substitute plain yogurt. Store-bought sour cream is unnecessarily processed and can be high in sodium, which is used as a preservative.
Dry spice blends: By working with the flavors you like the most you can easily make a spice blend such as a dry rub, BBQ powder, or creole seasoning.
The disadvantage to blends is that while they can be good on some dishes, spice blends are not particularly versatile, and the texture can be unpleasant when used as a toping. Some people like Mrs. Dash.
Cheeses: You’re going to have to abandon many types of cheese for a while. A few brands of baby Swiss are very low sodium, and mascapone has none, making it a tasty substitute for cream cheese, among other things. Fresh mozzarella is usually low in salt but check the label. If it’s brined, leave it alone.
You can’t ask a kitchen to remove the salt from dishes that were prepared for service with salt. Most meat and poultry dishes are seasoned in advance, as are sauces and more or less everything else. Fish is usually not salted in advance. Salad may not be your favorite but it’s a safe bet if the dressing is on the side, and you may find other menu items that are mostly raw. Some chain restaurants are now required to list sodium levels on their menus.
How to win the war:
Get through the initial few weeks! Give yourself the best start possible by eating as little added salt as possible.
Allow yourself time to adjust to the taste of unsalted food. Depending on your health situation, you may be able to bend the rules a little one day.
As for me, I recovered from kidney failure after about a year without dialysis. I’m very fortunate but I will always have to be careful. I do believe that my low sodium diet contributed to the healing process.
I still eat a low sodium diet, and when I eat a salted chip or cracker, it tastes too salty to me. I admit to flexing a little and occasionally eating good cheese or store-bought mayo but it isn’t very often, because I no longer crave salt like I once did. To tell the truth, I wouldn’t want to go back to eating excessive salt under any circumstances.
I eat out occasionally but I stick to small portions of foods, usually appetizers that I know from experience have less added salt. I know that I’ll be eating very low sodium foods the rest of the day, so I can ‘allow’ 500mgs at lunch. I could never have gotten here if I hadn’t spent so much time restricting myself and paying attention to those numbers.
My partner has unwittingly adapted and doesn’t add salt at the table anymore, and his blood pressure surprised everyone when it went down to normal without any medications. A while ago I took the salt bowl off of the table when I was cleaning and forgot to put it back. I don’t think he’s noticed yet.