As I have noted previously, the sodium we eat, mainly in the form of salt (sodium chloride), is a major cause of high blood pressure (hypertension)—a serious threat to health, usually accounting for premature death from cardiovascular disease. Salt, which is the main source of sodium, contains about 40% of this element. Hypertension affects almost 75 million American adults, rising to a lifetime probability for individuals with advancing age to as high as 90%. Although blood pressure can be controlled with medication, as many as 50% of individuals still remain above desirable levels despite such treatment. Even in those whose blood pressure is controlled with medication, their risk of developing heart disease and stroke remains higher than for those who have a normal blood pressure level naturally.
With this background, the need for prevention and control of blood pressure is an urgent priority in this—and most other—nations. Although major lifestyle factors (avoiding obesity, regular exercise, moderation of alcohol intake, and diet rich in fruits, vegetables and low fat dairy products) are important in reducing this risk, all the major health organizations have recognized sodium as the preeminent culprit and have recommended that each individual should control the amount of sodium he/she consumes, limiting it no more than 2,300 milligrams daily, and for high risk groups such as those with hypertension, diabetes, or chronic kidney disease, no more that 1,500 mg/day. Unfortunately, the current per capita sodium consumption of American adults is about 3,800 mg/day (not including what is added from the salt shaker). No more than 1% of the population consumes as little as 1,500 mg/day. Although the media have expressed recent doubts about possible risks of consuming too little sodium, these doubts have been debunked by careful analysis.§
According to one estimate, at least 150,000 premature deaths per year could be prevented in the U.S. alone if the sodium content of packaged and restaurant foods were reduced by 50%. This is especially meaningful since approximately 33% of calories are obtained from food purchased from restaurants and other sources outside of the home, constituting major and hidden sources of sodium. Overall, approximately 80% of the sodium consumed by Americans has been added by food manufacturers and restaurants. Are these latter companies doing anything to reduce this risk? The answer at present is very little, for one large survey# disclosed only minimal and inconsistent changes in the sodium content of their products—already far too high—between the years 2005 and 2011. To their credit, however, several major companies§ have issued statements committing to lowering sodium levels in some products over the next several years. Especially noteworthy is that Walmart, the nation’s largest supermarket chain, has called on its suppliers to lower sodium levels in their products by 25% by the year 2015. Nevertheless, even if these efforts are implemented, they would not nearly address the necessary reduction in sodium content. Thus short of a major public health initiative involving the government, we are unlikely to see sufficient voluntary changes in our food supply within the next several years.
So, given insufficient outside support, what can the individual do about this health danger? Urging the food industry voluntarily to label all ingredients contained in processed and restaurant foods would be a step in the right direction, but most are unlikely to do so unless they are forced. A public initiative directed at governmental leaders might also bring about some desired results in this direction. But, at present, limiting sodium intake is a matter of personal choice, and I can help by offering some information about the contents of various processed and restaurant foods, as of the year 2011:
SUMMARY OF SODIUM LEVELS PER 100 GM (ABOUT 3 OZ) IN MULTIPLE FOOD SUBCATEGORIES, IN DESCENDING ORDER.
PROCESSED FOODS (per 100 gm) SODIUM
Bacon (smoked) 1,803
Salad Dressing, Caesar 1,079
Barbecue Sauce, Original and honey 989
Hot Dogs 927
Turkey Breast, sliced, Deli 878
Macaroni and Cheese 831
Pork Sausage 822
Cheese, Cheddar, sliced 645
Salsa, medium 611
Pizza, Pepperoni 560
Potato Chips and Crisps 547
Pizza, Cheese 521
Bread, White 500
Bread, Whole Wheat 493
Sauce, Spaghetti, tomato, marinara 407
Soup, Tomato 286
Tuna Fish, white, albacore, canned in water 261
Soup, Vegetable 243
Pork, Fresh or Frozen 186
Tomatoes, Canned, Diced 174
Chicken, Fresh or Frozen 77
Sausage Biscuits, breakfast 895
Chicken strips or tenders 736
Cheeseburgers, all sizes 568
Pizza, cheese, hand-tossed style 541
Grilled chicken sandwiches 525
French fries, medium 503
Hamburgers, all sizes 428
This is obviously only a partial list of various foods. Moreover, adding any additional salt with the shaker amplifies the problem—so don’t do it!
So at this time, all I can do is to wish each and every one of you good luck in your food choices. Also remember to have your blood pressure checked at regular intervals, at least yearly, inasmuch as high blood pressure usually develops in the absence of warning symptoms or signs that might alert you to possible impending disaster!
§ Nutrition Action Healthletter, July/August 2013.
# Jacobson M.F. and McCarter R. Changes in sodium levels in processed and restaurant foods, 2005 to 2011. JAMA Internal Medicine. 173;20134:1285-91.
§ Campbell’s Soup, ConAgra Foods, Domino’s Pizza, General Mills, Hormel Foods Corp., McDonald’s, Smithfield Hams, Sodexo, Inc., Subway, and Walmart.