SALT

EXAMPLES OF GRAPHICS TO SHOW FOOD VALUES
Scales are:
0-10+ grams for Saturated Fat, Sugar, Fiber, Protein
0-1,000+ mg for Calories, Sodium, Calcium, Potassium, Phosphorus

Permanent URL: salt.globe1234.com

A. Overview
B. Know where to look
C. Health organizations' advice
D. Results of high sodium diet: broken bones, stroke, kidney failure, weakness
E. How much sodium is OK?
F. Institutions
G. Published Diets

A. Overview - Salt leads to broken bones, strokes, and kidney failure, besides raising blood pressure. Studies are in section D. Ordinary meals can vary from 400 mg sodium per day to over 4,000, depending on the exact foods eaten. Section B tells you where to find low sodium choices among the 43,000 items in an average supermarket. Reading thousands of labels is too arduous, and you can ask manufacturers to adopt graphic labels like these:

GROCERIES

SANDWICHES

Section B tells you exactly where to look for low-sodium foods. Here are examples of how your meals could work out (click for a more detailed example). 

LOW  HIGH  (Milligrams of sodium)
395     4,345   TOTAL 
  75          75    Egg or egg white
  35          35    Milk, 2 ounces for cereal
    0                  Oatmeal or shredded wheat
              290    Grape Nuts
  50        920    Vegetable soup
  45        340    Cottage cheese
    0        440    Bread, two slices
    0          95    Butter
  10        350    Cheese, one slice
110     1,400    Turkey, two servings (sandwich & dinner)
  60          60    Vegetables, 3 servings
  10          10    Fruits, 2 servings
    0        290    Buttered popcorn
    0          40    Water, one liter

B. Know where to look. Look for the foods below. All these are far better than the FDA goals.

1. Bread with 0 sodium per slice is nationally available at Publix, Sprouts, Trader Joe's, Whole Foods, and many independent stores (from "Ezekiel/Food for Life Low Sodium"). Trader Joe's also sells its own brand. More 0-sodium bread is available from "Vermont Sodium-Free," and some loaves from Manna Organics have 3-13 mg per slice. Corn tortillas usually have 10 mg each. Other breads, bagels, muffins, and wheat tortillas are high in sodium, 150-300 mg. For your own baking, there are low sodium baking powders.
2. Oatmeal, shredded wheat, Wheatena, Cream of Wheat (1 or 10 minute, not 2.5), Cream of Rice, puffed wheat, puffed rice, and some specialized cereals have no or low sodium. 
3. Soups with no salt or "no salt added" can be found at Whole Foods or online, from Health Valley and others. Zero sodium bouillon is widely available from Herb Ox (Hormel) and Wyler's (Heinz).
4. Peanut butter, butter and popcorn are sold without salt in most stores.
5. Unprocessed vegetables, nuts and fruit are naturally low in sodium, 0-80 mg, but processors add a lot, and artichokes, chard and turnips are high (detailed list).
6. Unprocessed meat, fish, fowl are low in sodium: 50-75 mg per serving. Other processed meats are much higher. Stores may inject brine even in raw meat, so check the label. For example different versions of Boar's Head Turkey range from 55 mg to 700 mg sodium per 2 ounces.
7. Canned beans with "no salt added" can be found at Whole Foods or online, from Eden and others, 35-65 mg. Tofu and tempeh have 0-10 mg. Dried beans with low salt are in most stores.
8. Most Swiss cheese is low: 10-75 mg per ounce, (Boar's Head "no salt added" has 10 mg.) Check the label. Other cheeses are high.
9. Cottage cheese is available with "no salt added" (20-75 mg per half cup) from a few chains: Friendship (East coast), Giant/Martins (MD, NJ, NY, OH, PA, VA, WV), Giant Eagle (MD, OH, PA, WV), Hood/Crowley/Axelrod (New England, NY), Lucerne, (West, mid-Atlantic, TX), Shopright (CT, NJ, NY), Stop+Shop (CT, MA, NJ, NY, RI), Western (ON). Other cottage cheeses have 300-540 mg. USDA says cottage cheese exists with 15 mg per half cup (112g), and the lowest I have found is 20 mg (18 per 100g) from Western in Ontario.
10. Yogurt varies from 45-190 mg per serving. Check the label. Usually the lowest are Fage, Oikos, Yoplait Greek, Dannon nonfat and Stonyfield nonfat.
11. Sodium+Calcium+Protein in Milk alternatives, per 8 ounces (240 ml):
    5 mg       40 mg     12 g      EdenSoy unsweetened
    5              300           4         Hemp Dream 
    5                40           1         Rice Dream-Horchata-cinnamon
    20            300           4         Oat Dream
    30              40           9         WestSoy unsweetened (made from soy, even their almond flavor)
    30-35      350            4         Kidz Dream (soy)
    70           300            7         Silk unsweetened (soy)
    80           300            5         Flax milk from GoodKarma
    85           100            0         Cashew milk from SO Delicious
    95           100            5         Almond+Plus unsweetened from SO Delicious
    90/110    300            1         Almond milk from PC and Earth's Own (both Canadian)
    105         276            8         Cow's milk (USDA)
    110         300            2         Quinoa milk
    Most other alternatives have more sodium, like Ensure (280), protein shakes (150-300), soy milk (100-220), almond milk (150-190)
12. Eggs and alternatives (made from egg whites) have 70-100 mg.
13. Flavor without sodium comes from onions, lemon juice, vinegars, wine, powdered mustard, ground pepper, other spices, and some commercial sauces or here. The only pepper sauces without salt are from Alberto's, Island Treasure, and Trader Joe's.
14. Packaged foods: hundreds with no salt and low salt are at  HealthyHeartMarket  and  LowSaltFoods. Their founders both had congestive heart failure, took seriously their need to reduce salt, and found foods to eat.
15. RECIPES: Add the sodium in your ingredients. There are low sodium baking powders. Each quarter teaspoon of salt in a recipe has 600 mg of sodium. If your pinch of salt has about 50 individual grains, it has 1 mg of sodium. If your pinch is a sixteenth of a teaspoon, it has 150 mg and 8,000 grains. Use small pinches or none.
16. OTHER NUTRIENTS - The Institute of Medicine has detailed nutrient recommendations for men and women at different ages, which we have organized by age group in the "RDA" tab of our menu spreadsheet. Food labels showing "% DV" are based on older FDA daily values for adults, so they are only an approximate guide to the latest research. (There are also FDA values for infants, pregnant and lactating women. The various diet standards are color-coded and compared in the RDA tab of our spreadsheet. Another spreadsheet shows FDA goals for sodium in specific foods, designed to help people reach lower daily totals.) Potassium is important (beans, fruits, squashes, tomatoes), since most multivitamin/mineral pills have only 2% of your daily need, a banana has 10%, and most published diets are short of potassium. The detailed example in section A has good levels of calories, sodium, potassium, calcium and iron. The example also has far more beta-carotene than you need, which is not harmful, though Vitamin A itself would be. Your body converts what it needs to vitamin A and discards the rest. "Beta-carotene is not toxic even at high levels of intake."
    
17. The sample diet in section A is at a free site, MyFitnessPal, which lets you look up most foods, including brand names. Try multiple wordings, like "no salt added." They do not have a compare  button, but if you log in you can add any number of foods to a meal (free login, supported by ads). Then it will compare their nutrients, like the sample diet. You can copy that list to your own account by logging in, going back to that page, clicking "Quick tools - Copy to today" and changing the diet as you wish. Remember the date of your list, and you can go back to the list and add to it. "Diary settings" lets you choose any 5 nutrients which are then displayed on your pages. Some nutrients are shown as % of FDA daily values: calcium 1,000 mg, iron 18 mg, vitamin A 5,000 IU, and vitamin C 60 mg. 
18. Iodine: the sample diet includes Nori seaweed for iodine, though dairy products have some iodine too. When you stop adding table salt, you need to be sure you get enough iodine.
19. Water from a water softener averaged 278 mg/liter in an area where city water had 110 mg/liter. Nationally sodium in city water varies 5-195 mg/liter, with an average of 43, and bottled or distilled spring water is 0-15 mg/liter, but check the website given on label. Bottled mineral water is much higher in sodium. 
20. STORE LABELS - Besides a "Nutrition Facts" label, low salt foods in stores may have the following labels:

• "Very low sodium" means less than 35 mg sodium per serving.

• "No salt added" means the processor did not add any; the result is usually under 50 mg.
• "Low sodium" means less than 130 mg.
• "Reduced sodium" is useless. It means 25% less than regular versions and can still be hundreds of milligrams.
• I recommended (you can too) that the 2015 Dietary Guidelines Committee establish an optional graphic for use on labels to show sodium content, just as appliance labels show energy use.

Each of the Following Has 7 Grams of Protein
Scales are:
0-10+ grams for Saturated Fat, Sugar, Fiber, Protein
0-1,000+ mg for Calories, Sodium, Calcium, Potassium, Phosphorus

21.  RESTAURANTS - When you go to restaurant chains, take this bar graph of outstanding food at each chain. Ask for their list of salt content, or look first at New York's list of many national chains, which you can sort to find low sodium. You can also check the chains' websites as I did. 

• The bar graph shows an entree at each chain with the lowest sodium, saturated fat and sugar per gram of protein. These are usually eggs or grilled chicken. The restaurants have other foods with low sodium, fat and sugar, but without much protein and other useful nutrients. The lowest are at PF Chang's, Bob Evans, Long John Silver, and Denny's.
• Restaurant oatmeal has low sodium (5-45) at Bob Evans, IHOP, Jamba Juice and Chik-Fil-A, but is cooked with 100-470 mg per serving at other chains. Shredded wheat is reliably low in salt at restaurants.

• Restaurant smoothies have low sodium (10-50) at Denny's, Jamba Juice and McDonald's, but not elsewhere. Read the nutrition chart when ordering: "Classic Strawberry Surfrider" at Jamba Juice has 10 mg in a medium smoothie, but the "Make it Light" and "Wild" versions have 125-160.

• Golden Corral - wide range of fruits, vegetables, and pasta with 0 sodium, many more from 5-50. Eggs 60-70 mg each, BBQ pork and turkey at 100-130 per 3 ounces. You'll need to print our sorted list and take it with you, to avoid all the other high sodium choices. They do not list oatmeal or smoothies.
• Denny's (or xls) - Corn, red onion, tomato, lettuce, fruit have 0-7 mg sodium. Grits+margarine 15. Broccoli or spinach 20-22. Smoothies 30-45. Avocado, steamed zucchini, grilled onions, mushrooms, pico de gallo 40-67. Yogurt 100. 1 egg or egg white 118. Garden salad 150. Oatmeal 220. Chicken strips+buffalo sauce 3,450.

• McDonald's - apple slices 0, side salad 10, smoothies 40-50, yogurt 40-70, sundaes 85-170, oatmeal 115, apple pie 170, four McNuggets 360, hamburger 480, Egg McMuffin 740, Big Mac 970, 1/4 pounder+bacon+cheese 1,440. The salad is without dressing, since even their simplest vinegar dressing, Newman's balsamic vinegar, has 420 mg sodium. Newman's company should be ashamed.
• Panera - fruit cup 15, smoothies 75-105, classic cafe salad 140, oatmeal 160, turkey+avocado+BLT+sourdough 980 (lowest full sandwich), bacon+turkey on XL tomato basil 2,990.
• Starbucks - fruit blend 0, greek yogurt+honey 75, greek yogurt+berries 115, choc meringue cookie 115, oatmeal 125 (they wrote to me that the zero shown in their flyer, Nutritionix, and New York's Menustat is an error), smoothies 120-160 (which is shown on their flyer; they show 0 on website, Nutritionix, and Menustat; they wrote to me insisting on 0, though the milk in their recipe would always contribute substantial sodium, so it might be wise to mistrust their other numbers too), large Frappuccino java chip 340, cheese+fruit box 470, protein egg+cheese box 470, turkey+swiss sandwich 1,140.

• Subway - Veggie Delite Salad 80, roast chicken salad 280, Veggie Delite 6" sandwich 280, roast chicken 6" sandwich 610 (lowest sandwiches)

• Suggestions for other foods from New York and LowSaltFoods, but see note 22 below. 
• Non-chain restaurants need other approaches.

22.  REFERENCES include:

• Menustat, New York, compares restaurant chains easily; sort and download. See a graph of outstanding food at each chain. Check with restaurant website if you eat there often. For example New York shows 4 mg sodium in grilled chicken salad from Bojangles, whose website says it has 530mg. They show 0 sodium in Starbucks oatmeal and smoothies, both of which are 125 or more. And you must read carefully; New York shows low sodium in PF Chang's Steamed Gluten-Free Buddha Feast; the company website does show 50 mg in the gluten-free, but 300 in the regular, and 3,440 stir fried.
• MegaHeart, compare non-branded foods easily.
• USDA, look up or sort foods by sodium or other nutrients, or download the database; few brand names. There is extra detail on amino acids and sugars at EatThisMuch.
• MyFitnessPal, look up branded and non-branded foods; add up a day's eating. Many items were entered by the public, often with missing data, so double-check with food labels or USDA where possible.
• HealthyHeartMarket, find low salt brands
• LowSaltFoods find low salt brands
• Globe1234 list of foods with good Fiber, Protein, Calcium, Potassium, compared to their Saturated Fat, Calories, Sugar, and Sodium
• Nutritionix look up branded and non-branded foods. They have some (all?) of the same mistakes as Menustat above: Starbucks oatmeal+smoothies, Bojangles grilled chicken salad, all listed with far less sodium than they have.

C. Health organizations' advice is to control salt in the diet to avoid high blood pressure. The advice usually omits crucial information:

1. Is salt OK for the large numbers of people whose blood pressure is low or is controlled by medicine? No, it leaches calcium from the body, causing broken bones and other harm; see D below.
2. Where can we buy low salt foods? See B above.
3. Do people eating varied healthy diets need to add up all their salt from dozens of labels to watch their total consumption? Yes, start with your most common 5-10 foods, writing sodium from the labels; easiest if you use MyFitnessPal which will let you see and resolve any potassium or calcium shortfall at the same time.
4. How many sandwiches, cups of soup, entrees, etc. can I have per day and keep salt under control? Plenty of "no salt added" versions; see B above.
5. What is the minimum salt needed? 180-500 mg per day; see E below
6. What is a dangerous level of salt? 1,200-2,300 mg per day; see E below.

Below is an attempt to bring some answers together.


D. Results of high sodium diet: broken bones, stroke, kidney failure, weakness.

1. NIH says "Sodium, often from salt, causes the kidneys to excrete more calcium into the urine. High concentrations of calcium in the urine combine with oxalate and phosphorus to form stones. Reducing sodium intake is preferred to reducing calcium intake."
2. An Australian study found that you excrete calcium, and your hip bones lose strength, and break more easily unless your intake of sodium is less than twice as much as the calcium you eat. So if you eat 1,000 mg calcium, you have to stay under 2,000 mg sodium. If you eat only 500 mg calcium, you have to eat less than 1,000 mg sodium to avoid hip fractures.
3. A European study found people's bones lost 12 mg calcium per day eating a diet of 4,400 mg sodium and 1,300 mg calcium. If they kept the same calcium but cut down to 1,600 mg sodium, their bones gained 90 mg calcium per day. A steady loss of 12 mg per day would deplete 3% of their skeleton in a decade, and most of the loss is at the hips, which are then more likely to break. When the same people had a more typical low calcium diet (520 mg), their bones lost 71 or 115 mg calcium per day, depending which sodium level they ate, which would deplete 18% or 29% of the skeleton in a decade. So you need both high calcium and low sodium to avoid bone loss and bone breakage. All the effort you put into eating high calcium foods is wasted if you eat high sodium foods too. None of the volunteers had high blood pressure; all were under 140/90, and their average blood pressure was 115/72.
4. Nutrition labels do not show milligrams of calcium. they show percent of 1,000 mg, so 25% means 250 mg, etc.
5. NIH says "Too much sodium in the diet may lead to:
       *   High blood pressure in some people
       *   A serious build-up of fluid in people with congestive heart failure, cirrhosis, or kidney disease"
6. US Dietary Guidelines 2010 say "association between sodium intake and blood pressure was continuous and without a threshold... blood pressure was... lowered even further when sodium was targeted to the level of 1,200 mg per day" (p.23, which is 4th page of pdf).
7. Mayo Clinic says high blood pressure in turn causes dialysis, blindness, bone loss, dementia, strokes, heart failure, etc.
8. Nutritionist Jane Brody says, "Too much salt can impair athletic performance because it draws water out of your muscle cells. For optimum muscle function during vigorous exercise, the cells should be filled with water." Otherwise "your muscles can’t contract normally and you can feel weak and tired."
9. A summary by WHO and British researchers found: 

• "In adults a reduction in sodium intake significantly reduced resting systolic blood pressure by 3.39 mm Hg (95% confidence interval 2.46 to 4.31) and resting diastolic blood pressure by 1.54 mm Hg (0.98 to 2.11). 
• When sodium intake was <2 g/day versus ≥ 2 g/day [below and above 2,000mg/day], systolic blood pressure was reduced by 3.47 mm Hg (0.76 to 6.18) and diastolic blood pressure by 1.81 mm Hg (0.54 to 3.08).
• Decreased sodium intake had no significant adverse effect on blood lipids, catecholamine levels, or renal function in adults (P>0.05). 
• There were insufficient randomised controlled trials to assess the effects of reduced sodium intake on mortality and morbidity. 
• The associations in cohort studies between sodium intake and all cause mortality, incident fatal and non-fatal cardiovascular disease, and coronary heart disease were non-significant (P>0.05). 
• Increased sodium intake was associated with an increased risk of stroke (risk ratio 1.24, 95% confidence interval 1.08 to 1.43), stroke mortality (1.63, 1.27 to 2.10), and coronary heart disease mortality (1.32, 1.13 to 1.53)." 
• There are minority views that the lack of effect on all cause mortality is important.

E. How much sodium is OK?

1. NIH says "Healthy adults should limit sodium intake to 2,300 mg per day. Adults with high blood pressure should have no more than 1,500 mg per day. Those with congestive heart failure, liver cirrhosis, and kidney disease may need much lower amounts."
2. CDC says, "People who should limit their sodium to 1,500 mg a day are:
   • People who are 51 years or older
   • African Americans
   • People with high blood pressure
   • People with diabetes
   • People with chronic kidney disease"
3. American Heart Association says, "Under conditions of maximal adaptation and without sweating, the minimum amount of sodium required to replace losses is estimated to be no more than 180 mg per day." (p.4)
4. WHO says, "Although the minimum intake level necessary for proper bodily function is not well defined, it is estimated to be as little as 200–500 mg/day" (p.5)
5. Harvard Health Letter says, "Paleolithic diet delivered... well under 700 mg of sodium... The average American consumes... between 2,500 and 7,500 mg of sodium, much of it hidden in processed or prepared foods. That's far more than the scant 200 mg a day the body needs."
6. USDA says "average intake of sodium for all Americans ages 2 years and older is approximately 3,400 mg per day."
7. A CDC study says 99% of people aged 20 or older eat over 1,500 mg sodium per day and 89% eat over 2,300. The study also says 99% of people eat less than the daily requirement of 4,700 mg of potassium.
8. The USDA and Health+Human Services in 2016, under heavy pressure from food companies for higher limits, recommend staying under 2,300 mg per day.
9. Morton says there are 10,000,000 grains of salt in a pound, which means 55 grains of salt per milligram of sodium.
10. CDC converts the measurements in different studies as follows:

• Sodium chloride, commonly known as salt, consists of 40 percent sodium and 60 percent chloride. 
• One level teaspoon of salt contains approximately 2,300 mg of sodium.
• To convert mg of sodium to mg of salt, multiply the mg of sodium by 2.5.
• To convert mmol of sodium to mg of sodium, multiply mmol of sodium by 23.
• To convert mmol of sodium to mg of sodium chloride, multiply mmol of sodium by 58.5.

F. Institutions:

1. Even nursing homes, hospitals and assisted living usually serve too much salt.
2. If they say they never cook with salt, do they use high-salt ingredients?
3. Ask if they if they use zero-sodium bouillon (commercially available from Wyler, Herb-Ox), or high-sodium chicken stock as a base for soup?
4. Ask if they use no-salt bread, butter, cheese, peanut butter, cottage cheese?
5. When you are looking for a nursing home, salt could be one of your criteria. 
6. Find what brands of ingredients they use for soups, breads, cheeses, etc. (often institutional brands with poor labeling, but it is worth looking on their websites).
7. Look up salt content of these brands, and add up a day's diet.
8. If nevertheless you use a nursing home or hospital that provides salty food, take your own low salt food, and avoid their soups and sauces. 
9. When enough patients do this, they will start cooking without salty ingredients.

G. Published Diets:

Most published diets have too much sodium, too little potassium, calcium and iron, according to Diet guidelines. The 4 sample menus below all have enough of the nutrients shown.
 
DAILY MENUS   CALORIES   SODIUM   POTASSIUM   CALCIUM   IRON
Globe1234                1,500            420                 5,300            1,000         18 
Raw                           2,440            846               11,401            1,660         24 
"What I Eat"              3,104         1,404                 6,050            1,070         22
NIH Low Salt #6        1,935         1,472                 4,710            1,214

A list of 40 other sample menus and US dietary standards shows how the recommended diets fall short of the standards, which makes it hard for people to follow the standards. A spreadsheet version of the list also shows how many calories we need, according to our age and height. 

Aside from one NIH diet, #6 listed above, all other diets from NIH, USDA, and the National Institute on Aging fail the standards, with excess sodium or shortfalls in other nutrients. US News and World Report lists 32 other diets, showing some of the same nutrients above; none of those diets has appropriate sodium (below 1,500) and potassium (above 4,700).  

There is a software website, EatThisMuch, (or another version Swole.me)which will generate diets with your choice of calories, sodium, protein, fiber, carbohydrate, fat, cholesterol. It is very helpful and creative, though even that site usually does not give enough calcium, potassium or other micronutrients.

Gerber offers a menu planner for children up to 4 years old. Sometimes a screen asks whether you are a health care professional (undefined); "no" takes you away from the planner, "yes" lets you continue. Click "Generate" for a week of menus, with a mix of Gerber products and unbranded foods. Then click in the "Nutrition Details" box (upper right) to see daily totals of sodium and other nutrients. Finally click  the column heading for each Day to see nutrients of each food. For example they averaged 1,000 mg/day sodium for a 4-year-old, but suggested one day withe 1,500 mg. Clicking on that day showed they included 724 mg from a sloppy Joe sandwich, 241 from a waffle and 164 from a tablespoon of Ranch dressing, so it wouldn't be hard to cut back.