Thursday Thoughts: Sodium

It's Thursday, so you know what that means...

Thursday Thoughts

If you are new to my blog, or haven't been reading on Thursdays, this is a segment where I post my thoughts about various nutrition and health related topics, or maybe even something else if it is really an intriguing topic.  Most of my current views and opinions come from experience working as a dietitian and as college instructor in nutrition courses.  Most of that learning is science based or observational from the clinical setting.  In general, I hate over-generalizations, so for many of the things I post, I expect there is one or two exceptions because broad sweeping generalizations are always bound to miss out on something. 

I am choosing this topic because I know it is getting some press now with a new guideline coming out lowering the daily recommendation from 2300 mg to 1500 mg.  So, here are my thoughts...

1) This 1500 mg recommendation is nothing new.  This is the amount the body needs daily for functions within the body that need sodium.  This has always been the guideline from the American Heart Association, or at least the past few years because this is what I have found in my textbooks and that I use in classes I teach.  This is the RDA value as well.  The higher number, 2300 mg, is used on the food label for the %DV listing, and can also be seen listed in the 2005 Dietary Guidelines for Americans.  I think that some shock among people hearing this guideline, which is not a new number, is due to the fact that is seems like a big jump from the number they were told before, the 2300 mg guideline (sometimes seen as 2400 mg).  When the average intake is more like 3000 mg (3436 mg on the American Heart Association website) a jump to cut back so much seems, well, like a big reduction.  Basically, it seems like asking a lot because it is asking a lot.  It is one thing to say let's go from 3000 to 2300, but another to say let's go from 3000 to 1500 mg.  I think in the eyes of those setting guidelines, the jump was not so much from 3000 to 1500 but more like 2300 to 1500 mg.

2) Do I think a new and lower guideline is going to be beneficial?  My answer is no.  This comes from experience where guidelines have been changed in the past, made more rigid (or an increase in some cases) before the original guideline was ever achieved.  I am a big fan of setting a goal, meeting it, and then reevaluating to set a new goal.  I am not however a fan of setting a new goal before anyone was ever able to have success with a previous goal.  I remember when we would tell our clients to aim for 5 servings of fruits and veggies a day.  Then one day in an RD meeting at work we went over new guidelines coming out saying to aim for 12 servings a day (I think it was 12, at least I know it was over 10).  My first thought was "Boy, this is going to be a huge stretch".  I was still trying to get people from 1-3 servings a day up to five and now I needed to try and get clients/patients to go from 1-3 to 12 a day.  This seemed like a huge lofty goal and I just wasn't comfortable with this.  My issue wasn't with the guideline, as I know more fruits and veggies are beneficial, but my issue was with the huge increase in a goal that would be nice but did not seem realistic without ever having reached the first goal to begin with.  So that is exactly how I felt when I heard about this new guideline released for 1500 mg.  Sure, I think reducing sodium has health benefits and it would be great if everyone could do this, but I am also realistic about what the major of Americans can do, and I do not think a new goal should be set until we can get the majority of Americans down to the previous reduced (from the average intake) guideline of 2300 mg daily.

3) Why are American diets so high in sodium? My though on this is likely the same as yours.  Foods made to last a long time are high in sodium.  Americans consume foods in forms known to last longer.  It is beneficial for busy families and those trying to save money.  Foods in cans and foods in the freezer, plus overly processed, prepackaged, shelf stable foods are higher in sodium because it is a natural preservative.  Like my use of the word natural here (for my thoughts on that one click here.  Not everything that is natural is good for you.  Sodium is a natural preservative, but does that doesn't mean we can eat sodium rich foods liberally.  Salting foods to preserve them has been around for a long time and I imagine was really helpful back when refrigerators and freezers did not exist.  When we cut back on foods that need to be preserved, we can cut back on sodium intake.  Looking for reduced sodium and no added sodium products is a great start to cutting back.  Another thing I have learned is that once you start cooking more at home and using less salt, you really notice it when you eat those prepackaged foods, and it no longer seems appealing.  I tend to not even add salt, even if the recipe calls for it, because I can add so many other things add flavor without the negative effects of sodium adding up in my daily diet.

4) If you are concerned about heart health and the link with sodium, work on not only decreasing sodium in the diet, but also increasing potassium, which is a mineral just like sodium.  Potassium has a protective effect for heart health where as sodium exhibits a negative effect.  Overall, stick with guidelines for both.  You can't eliminate sodium altogether because some is needed in the diet.  Too much potassium could have some negative effects (like in renal failure), but for most people eating a balanced diet rich in fruits and veggies, it is easy to meet the guidelines for potassium without getting too excessive.  The recommendation for potassium is 4700 mg, but since potassium is not required on the food label, it will be hard to tell how much you get on average daily just by using labels.  Some foods containing potassium include bananas (which always are mentioned first, but there are better sources per serving), avocado, tomato, spinach, orange, mango, beans and lentils, along with others.  A nice list can be found here.  As with all things, balance is the way to go.  Cutting back on sodium and getting enough potassium is a a good way to go for heart health.

5) For someone consuming around 3000 mg of sodium a day, a decrease to 1500 mg may seem unrealistic and maybe even a turn off and cause people to question where these guidelines come from and who is "making this stuff up".  Is that really happening, I don't know, but I can see this huge jump as a turn off for someone who is eating a lot more sodium than the old guideline even suggested.  In the meantime, I think if you are consuming over the old recommendation of 2300 mg, still work on cutting back to there before striving for 1500 mg.  At any rate, cutting back from 3000 to 2300 mg is a reduction of about 30% sodium, and I would think that a 30% reduction will still have a benefit even if not down all the way to 1500 mg.  If you are already at 2300 mg, it may not be so far fetched to work on cutting back even more.  To go from 2300 mg to 1500 mg is a decrease of about 35%.  Basically, the goal is to cut back by about 1/3.  When needing to cut back to even 2300 mg and wondering how to do this, think about how many times you eat a day, including snacks.  Imagining splitting the sodium "allowance" up for the day among those.  I used to visually show this to clients with 600 mg x 3 meals, and then 250 mg for 2 snacks.  No, I did not tell all my clients to eat like that but rather used this as a discussion point to show how it can be done, just one example, and show that it is doable.  Guess what?  A "healthy" frozen entree often hovers around 600 mg, so even a prepackaged food can fit into a diet meeting those sodium guidelines.  Many people may not get near 600 mg for breakfast, freeing some of this sodium "allowance" up for later in the day.  The good news is that sodium is on the food label, so you can easily track this.  Everyone will be different and so each person needs to see what they want to aim for for sodium at their own meals and snacks.

Overall it is nice to have the guideline match what other guidelines have always used based on body needs and heart health, but I think this new guideline assumes the American population on average (and as a whole) met the old guideline in the first place.  As far as I can tell, this is not the case.  I think we need to improve the nation's health and nutritional status, but huge cut backs and goals is not the way to achieve this.  We need to focus more on meeting older (and higher in this case) guidelines and looking at why, after how ever many years, we have not met these goals.  The focus should be more on what health professionals can do to help Americans cut back on sodium in their diets because just saying eat less than we said before is likely not going to do the trick.  Words are great, but actions make all the difference in the world.  In my opinion, any reduction, even a small one, over the excess consumed now (for sodium or anything else in excess) is a success and an improvement to health.

QUESTIONS: What are your thoughts on this sodium and the new guidelines?  Any tips for cutting back on sodium?