For dinner tonight, you’ve planned what you think is a nice, healthful meal for your family: seasoned grilled salmon, asparagus tossed with feta cheese, and prepackaged long-grain wild rice.
The salmon is loaded with omega-3 fatty acids and vitamin D. The greens are chock-full of nutrients like vitamins A and K and folate. The rice has iron and vitamin B.
But there is also something lurking there you hadn’t banked on, thanks mainly to the seasoning, cheese and rice: nearly 1,600 milligrams of sodium, or almost 70 percent of the maximum daily allowance.
Sodium, it turns out, is hidden almost everywhere, and most Americans are getting far too much of it, raising their risk of high blood pressure, stroke and heart disease. Although salt is not the sole culprit, one in three Americans has high blood pressure and the number of deaths from hypertension rose by 48 percent from 1996 to 2006, according to the American Heart Association.
A January study in the Journal of Medicine found that if the general U.S. population cut its daily sodium intake by about 3 grams, or half a teaspoon, it could save 44,000 to 92,000 lives a year and cut annual health care costs by $10 billion to $24 billion.
The mineral is found in virtually every food product at the grocery store, including breakfast cereal, canned vegetables, cheese, luncheon meat, juice, milk, cookies, chips, soups and salsa, making it very hard to cut back.
This week, the Arizona Department of Health Services is announcing an initiative to educate residents about how much sodium they are consuming and encourage them to eat less. The campaign ties in to a national movement being driven by New York City to encourage food manufacturers and restaurants to cut the sodium in their products by 25 percent over the next five years.
So far, 17 national health organizations and 26 cities, states and counties have signed on, including Arizona.
But cutting sodium in the American diet is a tough task.
For one thing, saltiness is an addictive pleasure. Bland foods taste better with it, and we’re accustomed to the flavor. People also crave salt because, in moderation, it is an essential nutrient.
But keeping sodium consumption in check is difficult, even for people who strive to eat healthful foods. Only about 20 percent of the average person’s daily intake comes from the salt shaker. The other 80 percent is found in ubiquitous processed and packaged food that is part of our always-on-the-go world.
“If a consumer really, really pays attention, they can definitely reduce sodium,” said Will Humble, interim director of the state health department. “But it’s a problem because there are so many high-sodium products in the stores, and it’s not always obvious where it’s hiding.”
Attack on your heart
Many consumers are avid label readers.
At the grocery store, they scan products for caloric and fat content. Some check the carbohydrate and sugar counts, even the protein.
But few people check the sodium number, public-health experts say. And at restaurants, people are even less likely to be informed because the nutritional information often isn’t available on the menu.
Sodium is a component of common table salt, or sodium chloride, which has many uses, including as a preservative and flavor enhancer. Salt is essential to the human body because it helps ensure normal function of cells and organs, including the nerves, muscles, brain and heart, said Dr. Farouk Mookadam, a Mayo Clinic cardiologist.
But excessive amounts can cause health problems. If sodium can’t be excreted out of the body by the kidneys, water retention and bloating can follow.
That can mean big problems down the road, especially for people whose bodies and blood pressure respond aggressively to fluctuations in salt intake, Mookadam said.
It works like this: When your body retains fluids, it can force your heart to work harder to move blood through your arteries. The more forcefully blood is pumped, the more your arteries must stretch to accommodate the blood flow. Over time, high blood pressure can stretch the tissue of the artery walls as well as damage the heart. That can lead to stroke, aneurysms, kidney damage and heart attacks.
The U.S. Food and Drug and Administration recommends that the average adult consume no more than 2,300 milligrams of sodium daily. That’s roughly equivalent to a teaspoon of table salt.
The guidelines are more stringent – 1,500 milligrams or less – for the many Americans who already have high blood pressure and other risk factors.
The American Heart Association estimates that as many as 74.5 million Americans age 20 and older, or about one in three adults, have high blood pressure. Many don’t know it.
Those recommendations pose a diet challenge when individual food servings can easily make up a large share of the daily allowance. One serving of canned soup or packaged rice can contain about 900 mg of sodium. Two frozen waffles can top 400 mg.
The New England Journal of Medicine study found that the average U.S. male consumes about 4,160 milligrams of sodium a day, nearly twice the recommended maximum. That equates to more than 13 cups of salt a year.
Women tend to eat less salt, probably because they consumer smaller portions, but still take in too much sodium – about 2,920 milligrams a day, or about 9.7 cups a year.
“The majority of Americans who continue to eat (excessive) salt per day will develop high blood pressure in their 50s, 60s and 70s,” Mookadam said. He called it an “epidemic.”
Educating the public
Last month, the New York City health department launched the National Salt Reduction Initiative, vowing to take the lead in trying to persuade food companies and restaurants to voluntarily cut the amounts of sodium in their products. The goal is to reduce sodium consumption by 20 percent over the next five years.
The program is modeled after a similar effort in Britain, where daily sodium intake was reduced by about 9 percent from 2001 to 2008.
Arizona has joined the initiative, pledging to support New York City’s effort. Other participants include California, Maine, Maryland, Michigan, Chicago and Seattle.
Arizona also plans to launch its own initiative on Tuesday: a multipronged program that will offer a Web site and e-mail campaign aimed at reducing consumers’ sodium intake. There will be nutritional tips, low-sodium recipes and a tutorial to help consumers better understand food labels, including how to pay attention to serving size.
Arizonans also can sign a pledge to reduce salt intake. The Web page containing the link to the salt reduction program is www.eatwellbewell.org.
Appealing to restaurants
It’s not clear yet whether the national and state initiatives will get much buy-in from food manufacturers and restaurants, though officials say they are hopeful that they would respond to any push for change that the public demands.
“What you really need is a consumer-led revolution,” Humble said. “But it’s not going to happen until we can ingrain the importance of looking at the sodium line (on the label) into the Arizona psyche.”
Restaurant chain Subway already has been working with New York on the National Salt Reduction Initiative. Many of the chain’s choices, such as the 6-inch turkey sandwich, already meet the initiative’s guidelines. Others, such as the 6-inch spicy Italian sandwich, with 1,800-plus milligrams of sodium, do not.
The company has “reduced sodium in some products and is currently working to do more,” spokesman Kevin Kane said.
ConAgra Foods, which makes brands such as Orville Redenbacher’s popcorn and Chef Boyardee pasta, announced in October 2009 that it had already started lowering sodium content and that it planned to cut an additional 20 percent by 2015.
Beyond that, the initiative has met with skepticism.
The president and chief executive officer of the Snack Food Association, Jim McCarthy, said it’s unlikely his members are willing to make further adjustments to their products. Snack foods, he says, contain no more sodium than other food items, such as soups, breads and cheeses.
“Most of our companies already offer low-sodium or salt-free products,” said McCarthy, whose organization represents national brands such as Frito-Lay and regional companies such as the Phoenix-based maker of Poore Brothers chips. “Consumers already have that choice. . . . We follow the tastes and interests of the general population.”