Rumored to have once been more valuable than gold, we take salt for granted today. It’s used in nearly every food we eat – even in desserts! But in the same way we can overindulge in sweets, alcohol, and fat, we can and do overindulge in salt, often without even knowing it. May is High Blood Pressure Education Month, and one of the key things people with hypertension, or high blood pressure, need to do is watch their salt intake. This means nearly one in three Americans needs to eat less salt! Read below to find out everything you need to know about salt, its effect on health, surprising sources of extra sodium, and how to keep your intake at a healthy and safe level.

What is Salt?

In the most technical sense, salt, or sodium chloride, is a compound composed of 40% sodium and 60% chlorine. The mineral’s cube-shaped crystals add flavor and are also used to preserve, bind, stabilize, and enhance the color of food. Sea salt is produced by evaporating salt water from the ocean or saltwater lakes, and it is usually minimally processed. The taste and color may vary depending on the water source, due to the different trace minerals and elements found in the water. Table salt usually comes from underground salt deposits, often the result of old, evaporated salt water sources. It is highly processed to remove minerals, and has added iodine and anti-clumping agents. While salt is considered to have a low toxicity level, too much of it over a lifetime can definitely have a toxic effect on your health.

Are All Salts Created Equal?

If you look on the supermarket shelves, there are a variety of salts available, like sea salt or kosher salt, black, gray, or Himalayan pink salt, and artisanal flavored salts from truffle to bacon, among countless others. But is one salt better than another, or do all salts work the same? While the different types of salt may impart different textures or tastes depending on their mineral content or flavoring agents, different salts generally have the same basic nutritional value and comparable amounts of sodium by weight.

Do We Need Salt?

The body does need some salt to help maintain the balance of fluids, to aid in muscle contraction, to help conduct nerve impulses, and to perform some metabolic functions. It regulates sodium levels through cues. For example, when you consume too much salt, it responds by making you thirsty, hastening the process of elimination through the kidneys.

Negative Health Effects of Excess Sodium

Too much sodium can lead to an array of serious health issues, beginning with high blood pressure. These conditions include: High Blood Pressure. Sodium influences kidney function and causes the body to store more water; the excess water raises blood pressure and puts strain on the arteries, kidneys, heart, and brain. Blood pressure of 140/90 or higher is considered high for most adults, and blood pressure of 150/90 is considered high in those over 60; pre-hypertension, or the likelihood of developing high blood pressure, is having blood pressure readings between 120/80 and 139/89.

"High blood pressure is the leading risk factor for death in women in the U.S., according to the American Heart Association."

Dementia. Elevated blood pressure can cause a reduction in the amount of blood reaching the brain, causing a condition known as vascular dementia. Because the brain cells do not receive the necessary amount of oxygen and nutrients, the cells do not function as they should. Stroke. High blood pressure can cause arteries leading to the brain to become completely clogged or burst. The part of the brain served by that artery no longer receives oxygen and nutrients, resulting in a stroke, which can lead to disability or death. Heart Attack. Increased blood pressure reduces the amount of blood reaching the heart. Over time, the arteries may become clogged or burst, resulting in a heart attack. Osteoporosis. Studies have shown that sodium chloride causes calcium loss, and eventually weakens bones. Postmenopausal women eating a high-salt diet have been found to lose more bone minerals than same-aged women who consumed less salt. Kidney Disease. Elevated sodium levels reduce the ability of the kidneys to remove water from the body, causing excess fluid and strain on the kidneys. The kidneys then become unable to effectively filter out waste from the body, leading to kidney disease, and eventually, kidney failure. Headaches. Too much s sodium stimulates nerve cells, sending impulses to blood vessels to release serotonin, prostaglandins, and other substances. These chemicals cause vessel constriction and dilation, and together, these activities may trigger headaches. Excess sodium also affects your appearance negatively by causing fluid retention and making you look puffy and bloated, both in the face and body.

How Much Sodium is Too Much?

The Centers for Disease Control (CDC) recommends that most healthy adults consume no more than (and ideally less than) 2,300mg of sodium, equaling to just under one teaspoon of salt, per day. However, for adults 51 years and older, African Americans, and adults with high blood pressure, diabetes, or kidney disease, daily sodium consumption should be no more than 1,500mg, or just under ¾ teaspoon.. This means that about half of all American adults should be limiting their sodium intake to 1,500 mg every day. Unfortunately, only one in ten Americans is meeting daily recommended sodium limits. According to a study by the CDC, less than 10% of Americans met the recommended limit of 2,300 mg/day, and among those for whom the limit was 1,500 mg, results were even worse, with just 5.5% meeting the recommendation. "In fact, the national average was 3,466 mg per day, more than 150% of the highest recommended limit." 8 Major Sodium Offenders So where are we getting all this sodium from? Turns out that up to 75% of our excess daily sodium intake comes from processed and packaged foods. According to author and Pulitzer Prize-winning journalist Michael Moss, the processed food industry purposefully gets us addicted to food, much like smokers addicted to cigarettes, through specific, scientific, taste-enhancing ratios of sugar, fat, and salt. The following foods are major contributors to excess sodium consumption: Poultry. When we think of poultry like chicken and turkey, we think “healthy.” Unfortunately, a lot of the uncooked poultry in grocery stores has been injected with added sodium solutions or marinades, to which we add even more salt when cooking. And the pre-cooked chicken products like chicken nuggets, patties, and wings? Even worse! Just five chicken nuggets can contain nearly 600mg of sodium – more than 25 - 40% of the daily limit! Processed Meats. Cold cuts, sausages, and cured meats like salami, bacon, and pepperoni have high levels of sodium, both for flavor and preservation. One serving of deli turkey meat can contain more than 1,000 mg of sodium, close to half of the daily recommended amount for the healthiest of Americans! Salt by the Numbers (INFOGRAPHIC) Cheese. Salt is a common ingredient used when making cheese. A 100g serving of Roquefort cheese, or about five one-inch cubes, can have up to 75% of the daily limit of sodium, as can Parmesan and overly-orange, processed Cheez Whiz. Cheddar, Swiss, Blue, Feta, and Provolone follow close behind, coming in between 40-65% of the daily recommended limit for the same small serving! Bread. This lunch staple is an unexpected offender, because we don’t think “salty” when we think of bread. However, one slice can have up to 230 mg of sodium, so two slices can add up to 30% of the limit for those watching their salt intake. Sandwiches. With bread and, often, cheese and/or meat inside, this one is a no-brainer. This includes sandwiches by other names, like hamburgers. Depending on the ingredients and condiments, it’s easy to exceed the limits in one meal! Pizza. An obvious offender, the combination of crust, tomato or other sauce, cheese, and processed meat is a salt bomb. One slice can have up to 760 mg of sodium, and who stops at just one slice? Pickled Foods. Adding olives to that pizza will drive sodium content even higher, as pickled foods are typically pickled in salt brine. 100g of olives would add 1,556 mg of sodium, and a dill pickle on the side of your sandwich will cover half the day’s sodium! Soup. Canned food in general, but especially canned soup, is high in sodium. A typical can of chicken noodle soup has more salt than chicken or noodles, with up to 940 mg of sodium. Making your own? Skip the bouillon cubes – a 5g cube can contain a whopping 1,200 mg of sodium!

6 Surprising Sources of Sodium

A lot of sodium comes from some surprising sources, too. Breakfast Cereals. It may seem counter intuitive that a bowl of Cheerios or Rice Krispies would contain sodium, but a serving of each provides over 300 mg of sodium. If your morning starts with Cream of Wheat, the sodium content is 350 mg. Start your day with a bowl of fruit topped with yogurt and you’ll start your day on the right foot. Condiments. The dash of this or that we add to our food is often overlooked as a major source of sodium. However, salad dressings, sauces, dips, hot sauces, and other condiments like ketchup and mustard are heavily concentrated in flavor and sodium. Soy sauce has 1,160 mg per tablespoon, and two tablespoons of Italian dressing has 430 mg. Relish contains 240 mg per tablespoon, but coupled with ketchup (154 mg/tbsp.) and mustard (57 mg/tsp.), on a hotdog (567 mg), it adds up quickly. Desserts. Sure desserts are sweet, but did you know there’s a lot of sodium hiding in your sweets? That morning donut can have up to 300 mg of sodium, and a blueberry muffin isn’t any better with 250 mg. Puddings and pie fillings can run as high as 285 mg per serving, too. Baked goods using baking powder or baking soda also contain sodium (488 mg and 1,259 mg, respectively), and while a cookie might only have 92 mg, it’s easy to eat more than one in a sitting. Sodium Content of Selected Foods Reduced-Sodium Foods. This is a tricky one that hides behind creative wording. By definition, a “reduced-sodium” product is one that contains at least 25% less sodium than the original version, so if the original version is ultra-high in sodium, the “reduced-sodium” version isn’t a big improvement. “Reduced-fat” foods don’t fare much better either, as salt is often added to compensate for the missing fat. In addition, be wary of foods labeled “Heart Smart,” or with the American Heart Association label, as products low in saturated fat and cholesterol can use the logo, regardless of sodium content. Medications. Many powdered, effervescent, or soluble products, used for pain relief, gastrointestinal symptoms, or calcium or zinc supplementation, can be high in sodium! Studies have shown that, taken on a regular basis, these over-the-counter and prescription medications can increase mortality risk by as much as 28%. Look for sodium or “soda” in the ingredients list, and ask a healthcare professional about possible sodium in medications you may be taking. Softened Water. Many areas have “hard water,” or water with large amounts of calcium and magnesium, so use of water softeners to prevent hard water stains and erosion of pots, pans, and appliances is common. However, most water-softening systems use sodium ions to replace the calcium and magnesium ions, and this means sodium added to the water. According to the Mayo Clinic, an 8 oz. glass of softened water generally contains less than 12.5 milligrams of sodium, but that still adds to your daily sodium intake. An alternative option might be to soften only hot water or use a potassium-chloride system instead.

Tips to Reduce Sodium Intake

If sodium is hiding everywhere, how can you reduce your intake? Here are some quick and easy tips: Read Food Labels. Know what’s in your food. Look for the words “salt,” “sodium,” “soda,” and the symbol “Na” on labels. Consider the serving size carefully, and remember the daily recommended limits of 2,300 mg or 1,500 mg, and make your choices accordingly. Avoid Processed and Pre-packaged Foods. These foods have the highest levels of sodium, and are often also high in sugar, fat, and other mysterious chemicals, so eliminating them from your diet as much as you can promotes good health. Opt for health-promoting foods like leafy greens, beans and peas, and tree and vine-based fruits and vegetables, which are naturally low in sodium and rich in potassium. Eat More Fresh or Frozen Fruits & Vegetables. It’s much easier to control salt intake when using fresh and frozen fruits and vegetables. If you must buy canned, choose low or no-salt added versions, and give them a rinse to reduce sodium even further. Choose Unsalted or Low-Sodium Foods. Nuts, seeds, meats, and even potato chips come in low or no-salt versions, so remember to read that label! Use More Spices and Herbs. Salt isn’t the only source of flavor, so experiment with citrus, vinegars, garlic, herbs, and other seasonings. Herbs and spices can promote health and add a punch of flavor to food that salt simply can’t. Taste Food Before Salting. Sometimes, we reach for the salt before even taking a bite. Try your food before you add salt, and you might find that you appreciate the flavors just as they are. Hide the Salt Shaker. Out of sight, out of mind. Adding salt only adds to your sodium intake, so don’t even give yourself the option. As your taste buds adjust, you’ll find the natural flavors of food heightened. Eat Out Less Frequently. It’s hard to control the sodium in food when you’re not involved in its preparation. A single meal out can max out a few days’ worth of sodium if you’re not careful. For example, did you know a single onion blossom appetizer can contain up to 6,360 mg of sodium? Be Prepared. When you do eat out, choose a restaurant where the food is cooked to order. Peruse the menu ahead of time, if possible. Ask questions about how food is prepared and if a low-sodium request can be accommodated. Skip sauce or dressing altogether, or ask for a little bit on the side and use the fork-dip method. Choose grilled, baked, roasted, or steamed options instead saucy, smothered entrees. And have fruit for dessert, in lieu of cheese or baked goods with hidden salt. By middle age, most Americans face a 90% chance of developing high blood pressure, but eating less salt is the first step in defeating this sobering statistic! Also keep in mind that just like getting used to foods that are less sweet, you can get used to foods that are less salty. As with sugar, you can retrain your taste buds by slowly cutting back on sodium.