Each week, MyHealthNewsDaily asks the experts to answer questions about your health. This week, we asked nutrition experts: Why is too much salt bad for you? Their answers have been edited and condensed for space.
Dr. Zachary Bloomgarden, professor at the Mount Sinai School of Medicine in New York City:
The simple answer is that salt is associated with higher blood pressure. About 50 to 70 million people in the U.S. have hypertension, and all of them would benefit from a low-salt diet.
Studies of the DASH diet (Dietary Approaches to Stop Hypertension) show just how much of a difference salt intake can make. It’s a very healthy, low-sodium diet, which has a lot of vegetables and not a lot of salt. The DASH diet can drop high blood pressure significantly.
The problem is that salt is very tasty, just like sugar. The combination of salt, sugar and fat is unbelievably tasty. All mammals have the desire to eat these bad foods.
The amount of salt that is available today, just like the amount of sugar that is available today, is far beyond what we were meant to have in our diets.
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Rachel Johnson, professor of nutrition at the University of Vermont in Burlington:
Excess sodium increases blood pressure because it holds excess fluid in the body, and that creates an added burden on the heart. Too much sodium will increase your risk of stroke, heart failure, osteoporosis, stomach cancer and kidney disease. And, 1 in 3 Americans will develop high blood pressure in their lifetime.
Limiting your sodium is tough because about 75 percent of sodium in Americans’ diets comes from processed or prepared foods, not salt that we add at the table. If you’re a savvy nutrition label reader, it can be shocking.
Even foods such as breads and cereals can have high amounts of salt. We call it a silent killer because a lot of people don’t realize they have high blood pressure.
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Marisa Moore, registered dietician and spokesperson for the Academy of Nutrition and Dietetics:
The average American eats about 3,400 milligrams sodium a day, but the recommended amount for a healthy person is 2,300 milligrams a day. For people with high blood pressure or diabetes, African Americans, and anyone who is age 51 or older, the daily recommendation is 1,500 milligrams of sodium.
So, most people are consuming double what they need in terms of salt.
For most people, a high sodium diet can lead to retaining fluid. And for some sensitive people, retaining fluid can lead to higher blood pressure, which puts someone at higher risk of stroke, heart disease and kidney disease. Whenever you have a high blood pressure, it causes your heart to have to work a lot harder and it can cause damage to blood vessels and the heart muscle itself.
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Stephanie Dunbar, registered dietician, director of Nutrition and Medical Affairs at the American Diabetes Association
Excess salt is has been linked to hypertension, and of course hypertension is a risk for heart disease. Some populations of people are very sodium sensitive, meaning when they eat sodium they retain fluid and their blood pressure rises.
There’s some research that shows if everybody reduced sodium in their diet, the rates of heart disease in the United States would go way down.
With our current food production it’s very difficult to cut out sodium. A slice of bread can have 250 milligrams of sodium alone. Unless you get back to a diet where you’re really cooking from scratch, and not using processed foods or canned foods, it’s really hard to reach that recommendation.
Salt has been used for hundreds of years as a preservative, and some food makers use it as a flavoring because it’s cheaper. It’s more expensive to use other herbs and spices to make food taste good better than to add salt.
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Mary Ellen DiPaola, outpatient dietitian at the University of California San Francisco Medical Center
Sodium chloride, which we acquire from table salt as well as from salted food products, is required for metabolic functions in the body and helps regulate fluid volume. The issue with sodium is similar to sugar: The average American consumes well above the recommended amount.
If we are consuming fresh, whole and natural foods, sodium intake can be reduced quite easily. Avoiding added salt, soy sauce or other salty condiments will also help reduce total sodium intake. Look for products less than 140 milligrams per serving, which is considered to be low in sodium.
Requesting less sodium added to foods in restaurants is another means to reduce total daily sodium. More importantly, consider cooking at home with fresh foods and low sodium recipes.
And why should you lower sodium intake? Sodium in excess can increase blood pressure in those who have hypertension (high blood pressure), it can make the body retain fluids which may cause swelling in susceptible individuals, and salty foods tend to also be high in total fat and calories – leading to excess total calorie intake, overweight and obesity.
A long term problem related to hypertension is kidney disease, a chronic illness which can lead to kidney failure.
If you’re like me, you try your best to eat a healthy, whole foods-based diet, which includes whole-grain bread (because avocado toast is life), frozen meals here and there (some of them are organic!), and sushi Fridays (salmon rolls, FTW).
But even though I’m packing in all the good stuff into my diet—like fruits and veggies and lean proteins—I’m probably eating way too much salt. Most people are. Ninety percent of Americans eat more sodium than they should, per the American Heart Association (AHA). The recommended intake is 1,500 mg per day, but most people are consuming more than double that amount.
After a salty binge, you might feel—and look—like you went overboard on the stuff. Here’s what’s happening and how to fix it.
- What are the signs you’ve eaten way too much salt?
- What are some hints that your diet regularly features too much sodium?
- What can you do if you’ve eaten too much salt?
- What are some smart ways to cut back on salt?
- 7 Ways to Reduce Your Salt Intake and Lower Your Blood Pressure
- Americans Are Still Eating Too Much Sodium
- Want to Cut Sodium? Look at Food Labels
- Try These 7 Tricks to Reduce Salt Intake Every Day
- What to Do After Eating Too Much Salt
- Drink a Ton of Water
- Hop on the Treadmill
- Eat a Banana
- Talk to Your Doctor
- Is Salt Bad for You?
- Keep the Sodium Out (Before It Gets In)
- Flush the Sodium Out (Once It’s Already In)
- What Do the Results Mean?
- Salt and athletes: Shake it or leave it?
What are the signs you’ve eaten way too much salt?
One of sodium’s important roles in the body is to help balance fluids—but consume too much and you set yourself up for water retention. You know that “why-are-my-pants-suddenly-tighter?” feeling.
1,500 mg: The daily amount of sodium the American Heart Association recommends.
“One of the biggest short-term consequences of eating a lot of sodium is bloating and puffiness,” says Amy Gorin, RDN, owner of Amy Gorin Nutrition in the New York City area. She points out that your weight may even jump up a few pounds the night after a sushi meal spent dunking your rolls in (super-salty) soy sauce.
What are some hints that your diet regularly features too much sodium?
It’s all about the longer-term consequences here. “Excess sodium intake can put you at risk for a plethora of health problems,” says Gorin. Frequent headaches or kidney stones are just a few examples. Over time, though, high blood pressure can be the most pronounced symptom—and it’s one that you should pay attention to, even if you consider yourself healthy. “High blood pressure is the leading cause of death for women in the United States,” warns Gorin.
Speaking of salty…watch Chrissy Teigen taste-test some wild potato chip flavors:
What can you do if you’ve eaten too much salt?
To bring your bod back in balance, hydrate with water. And eat foods that are good sources of potassium, a strategy that will help in the long-run when it comes to maintaining healthy blood pressure levels, says the Centers for Disease Control and Prevention (CDC). Potassium acts as an opposing force to sodium, and lowers your blood pressure.
That doesn’t mean plying yourself with bananas or watermelon—though both offer stellar sources of the mineral—but simply planning to eat more produce (of whatever variety you’re feeling that day). And commit to cooking your next meal at home. As Gorin points out, just 11 percent of the sodium you eat in the day comes from the salt shaker. Now’s the time to make that healthy recipe you’ve been wanting to try from your fave IG-er.
What are some smart ways to cut back on salt?
The good news here is that you’re not going to have to stress about counting every milligram of sodium—or eat bland food. The truth is that sodium is something that your body needs for proper muscle and nerve function and it’s also a seasoning that boosts the flavor of foods. (It’s what makes those Brussels sprouts to-die-for, after all.)
But it’s not the only way to make meals tasty. When cooking, Gorin recommends turning to other high-flavor seasonings, like garlic and onion powder, and bringing the heat with cayenne pepper and red pepper flakes if you like things spicy. Lemon juice and vinegars will add brightness to foods without salt.
When you’re at a restaurant, you’re probably going to have a meal higher in salt—even if you order well. “If you order the fish and fresh veggies at a restaurant, you can bet the chef is adding more salt than you’d add if you were cooking at home,” Gorin says. When you’re out, she recommends asking that the chef go light on the added salt and ask for sauces on the side, which you can then use to taste.
Finally, eat fresh food when you can. The CDC points out that more than 40 percent of the sodium consumed each day comes from 10 types of food, including breads, pizza, soups, bagged snacks (like pretzels or crackers), and cheese. (Heck, a single sandwich can easily exceed 1,500 mg of sodium, they point out.) Many of these foods are of the ultra-processed variety that nutrition experts advise limiting anyway.
Convenience foods are also awesome when you come home from work and want to practically gnaw your arm off. But even organic frozen meals can pack in more than 700 mg of sodium. She advises looking for the low-sodium varieties, which are just as tasty and satisfying.
And no matter what foods you buy, read the labels to understand how much you’re getting, says Gorin. Your heart (and jeans) will thank you tomorrow.
Jessica Migala Jessica Migala is a health writer specializing in general wellness, fitness, nutrition, and skincare, with work published in Women’s Health, Glamour, Health, Men’s Health, and more.
Salt, also known as sodium chloride, is about 40% sodium and 60% chloride. It flavors food and is used as a binder and stabilizer. It is also a food preservative, as bacteria can’t thrive in the presence of a high amount of salt. The human body requires a small amount of sodium to conduct nerve impulses, contract and relax muscles, and maintain the proper balance of water and minerals. It is estimated that we need about 500 mg of sodium daily for these vital functions. But too much sodium in the diet can lead to high blood pressure, heart disease, and stroke. It can also cause calcium losses, some of which may be pulled from bone. Most Americans consume at least 1.5 teaspoons of salt per day, or about 3400 mg of sodium, which contains far more than our bodies need.
The U.S. Dietary Reference Intakes state that there is not enough evidence to establish a Recommended Dietary Allowance or a toxic level for sodium (aside from chronic disease risk). Because of this, a Tolerable Upper intake Level (UL) has not been established; a UL is the maximum daily intake unlikely to cause harmful effects on health.
Guidelines for Adequate Intakes (AI) of sodium were established based on the lowest levels of sodium intake used in randomized controlled trials that did not show a deficiency but that also allowed for an adequate intake of nutritious foods naturally containing sodium. For men and women 14 years of age and older and pregnant women, the AI is 1,500 milligrams a day.
A Chronic Disease Risk Reduction (CDRR) Intake has also been established, based on the evidence of benefit of a reduced sodium intake on the risk of cardiovascular disease and high blood pressure. Reducing sodium intakes below the CDRR is expected to lower the risk of chronic disease in the general healthy population. The CDRR lists 2,300 milligrams a day as the maximum amount to consume for chronic disease reduction for men and women 14 years of age and older and pregnant women. Most people in the U.S. consume more sodium than the AI or CDRR guidelines.
Sodium and Health
In most people, the kidneys have trouble keeping up with excess sodium in the blood. As sodium accumulates, the body holds onto water to dilute the sodium. This increases both the amount of fluid surrounding cells and the volume of blood in the bloodstream. Increased blood volume means more work for the heart and more pressure on blood vessels. Over time, the extra work and pressure can stiffen blood vessels, leading to high blood pressure, heart attack, and stroke. It can also lead to heart failure. There is some evidence that too much salt can damage the heart, aorta, and kidneys without increasing blood pressure, and that it may be bad for bones, too. Learn more about the health risks and disease related to salt and sodium:
After conducting a review on sodium research, the Institute of Medicine concluded that reducing sodium intake lowers blood pressure, but evidence of a decreased risk of cardiovascular diseases (CVD) is inconclusive. It is clear, however, that high blood pressure is a leading cause of CVD. It accounts for two-thirds of all strokes and half of heart disease. In China, high blood pressure is the leading cause of preventable death, responsible for more than one million deaths a year.
There may be a genetic component to salt intake, as people respond differently to lower sodium intakes. Those who are “salt-sensitive” experience the greatest blood pressure reductions after following a reduced sodium diet. Those who are “salt-resistant” do not experience these changes even with significant increases in sodium intake. Studies have found that women more than men, people older than 50 years, African-Americans, and those with a higher starting blood pressure respond the greatest to reduced sodium intake. However, there is not enough evidence to make strong conclusions about specific groups who may be salt-resistant; the overall evidence supports a benefit of limiting sodium intake for everyone, even though the optimal target amount is not clear.
Observational and clinical research has found that higher sodium intakes are associated with cardiovascular diseases and related deaths. The following are key studies:
- Intersalt: Researchers measured the amount of sodium excreted over a 24-hour period (a good stand-in for salt intake) among more than 10,000 adults from 32 countries. The average was nearly 4,000 mg of sodium a day. Yet the range was huge, from 200 mg a day among the Yanomamo people of Brazil to 10,300 mg in northern Japan. Populations with higher salt consumption had higher average blood pressures and greater increases of blood pressures with age. Four groups of people—the four countries with salt intakes less than 1,300 mg per day—had low average blood pressures and little or no upward trend of blood pressure with age.
- The authors conducted a re-review and update on the Intersalt data. They found: 1) a stronger association than their prior study with higher sodium intakes and higher blood pressure, and 2) a stronger association with higher sodium intakes and higher blood pressure in middle age participants as compared with younger adults.
- TOHP: The two Trials of Hypertension Prevention (TOHP) were conducted from 1987-1995. They tested the impact of lifestyle changes on blood pressure, such as weight loss, stress management, nutritional supplements, and consuming less sodium. In each of the studies, small decreases in blood pressure were seen with sodium reduction over 18-36 months. Years after the trials had ended, the researchers surveyed the participants and found that:
- After an average of 10-15 years, the TOHP participants in the sodium-reduction groups were 25% less likely to have had a heart attack or stroke, to have needed a procedure to open or bypass a cholesterol-clogged coronary artery, or to have died of cardiovascular disease.
- The higher the ratio of potassium to sodium in a participant’s diet, the lower the chances were of developing cardiovascular trouble. This suggests that a strategy that includes both increasing potassium and lowering sodium may be the most effective way to fight high blood pressure.
- TOHP Follow-up Study: A continuation of the two previous TOHP trials in 2000 that looked specifically at CVD or deaths from CVD. When participants with sodium intakes less than 2,300 mg daily were compared with those who had intakes of 3,600-4,800 mg, there was a 32% lower risk of developing CVD. There was also a continuing decrease in CVD-related events (stroke, heart attack) with decreasing sodium intakes as low as 1,500 mg daily.
- DASH: The Dietary Approaches to Stop Hypertension (DASH) trials, begun in 1994, were major advances in blood pressure research, demonstrating the links between diet and blood pressure.
- In the first study, 459 participants were randomly assigned to either 1) a standard American diet high in red meat and sugars, and low in fiber, 2) a similar diet that was richer in fruits and vegetables, or 3) the “DASH diet,” which emphasized fruits, vegetables and low-fat dairy foods, and limited red meat, saturated fats, and sweets. After eight weeks, the fruits and vegetables diet and DASH diet reduced systolic (the top number of a blood pressure reading) and diastolic (the bottom number of a blood pressure reading) blood pressure, with the DASH diet producing a stronger effect.
- The second study found that lowering sodium in either the DASH or standard American diet had an even stronger impact on reducing blood pressure. The DASH study contributed much of the scientific basis for the Dietary Guidelines for Americans 2010, which recommends reducing daily sodium to less than a teaspoon.
- A meta-analysis of clinical trials found that a moderate sodium reduction to about 4,000 mg a day for at least one month caused significant reductions in blood pressure in individuals with both normal and high blood pressure. Further analysis showed that blood pressure was reduced in both men and women and white and black races, suggesting a benefit for the total population.
Chronic kidney disease
Chronic kidney disease (CKD) shares risk factors with cardiovascular disease, with high blood pressure being a major risk factor for both. Salt sensitivity is reported to be more prevalent in patients with CKD due to a reduced ability to excrete sodium, which may lead to increased blood pressure.
Although there is evidence that links high sodium intake with high blood pressure, there is not adequate evidence that a low sodium restriction protects against or causes better outcomes of CKD than a moderate sodium restriction. One systematic review of patients diagnosed with CKD found that high sodium intakes of greater than 4,600 mg a day were associated with progression of CKD, but low sodium intakes less than 2,300 mg a day had no significant effect when compared with moderate sodium intakes of 2,300-4,600 mg a day.
Guidelines generally advise a moderate rather than low sodium restriction to prevent the development and progression of CKD. A daily sodium intake of less than 4,000 mg is recommended for overall management of CKD, and less than 3,000 mg daily for CKD with symptoms of fluid retention or proteinuria, a condition in which excess protein is excreted in the urine.
The amount of calcium that your body loses via urination increases with the amount of salt you eat. If calcium is in short supply in the blood, it can leach out of bones. So a diet high in sodium could have an additional unwanted effect—the bone-thinning disease known as osteoporosis. A study in post-menopausal women showed that the loss of hip bone density over two years was related to the 24-hour urinary sodium excretion at the start of the study, and that the connection with bone loss was as strong as that for calcium intake. Other studies have shown that reducing salt intake causes a positive calcium balance, suggesting that reducing salt intake could slow the loss of calcium from bone that occurs with aging.
Research shows that a higher intake of salt, sodium, or salty foods is linked to an increase in stomach cancer. The World Cancer Research Fund and American Institute for Cancer Research concluded that salt, as well as salted and salty foods, are a “probable cause of stomach cancer.”
Sodium isn’t generally a nutrient that you need to look for; it finds you. Almost any unprocessed food like fruits, vegetables, whole grains, nuts, meats, and dairy foods is low in sodium. Most of the salt in our diets comes from commercially prepared foods, not from salt added to cooking at home or even from salt added at the table before eating.
According to The Centers for Disease Control and Prevention, the top 10 sources of sodium in our diets include: breads/rolls; pizza; sandwiches; cold cuts/cured meats; soups; burritos, tacos; savory snacks (chips, popcorn, pretzels, crackers); chicken; cheese; eggs, omelets.
Are “natural” salts healthier than table salt?
Salt is harvested from salt mines or by evaporating ocean water. All types of salt are made of sodium chloride, and the nutrient content varies minimally. Although less processed salts contain small amounts of minerals, the amount is not enough to offer substantial nutritional benefit. Different salts are chosen mainly for flavor.
The most widely used, table salt, is extracted from underground salt deposits. It is heavily processed to remove impurities, which may also remove trace minerals. It is then ground very fine. Iodine, a trace mineral, was added to salt in 1924 to prevent goiter and hypothyroidism, medical conditions caused by iodine deficiency. Table salt also often contains an anticaking agent such as calcium silicate to prevent clumps from forming.
Kosher salt is a coarsely grained salt named for its use in traditional Kosher food preparation. Kosher salt does not typically contain iodine but may have an anti-caking agent.
Sea salt is produced by evaporating ocean or sea water. It is also composed mostly of sodium chloride, but sometimes contains small amounts of minerals like potassium, zinc, and iron depending on where it was harvested. Because it is not highly refined and ground like table salt, it may appear coarser and darker with an uneven color, indicating the remaining impurities and nutrients. Unfortunately, some of these impurities can contain metals found in the ocean, like lead. The coarseness and granule size will vary by brand.
Himalayan pink salt is harvested from mines in Pakistan. Its pink hue comes from small amounts of iron oxide. Similar to sea salt, it is less processed and refined and therefore the crystals appear larger and contain small amounts of minerals including iron, calcium, potassium, and magnesium.
Larger, coarser salt granules do not dissolve as easily or evenly in cooking, but offer a burst of flavor. They are best used sprinkled onto meats and vegetables before cooking or immediately after. They should not be used in baking recipes. Keep in mind that measurements of different salts are not always interchangeable in recipes. Generally, sea salt and table salt can be interchanged if the granule size is similar. However, table salt tends to have more concentrated, saltier flavor than kosher salt, so the substitution is one teaspoon of table salt for about 1.5 to 2 teaspoons of kosher salt depending on the brand.
Signs of Deficiency and Toxicity
A deficiency of sodium in the U.S. is rare because it is so commonly added to a wide variety of foods and occurs naturally in some foods. Hyponatremia is the term used to describe abnormally low amounts of sodium in the blood. This occurs mainly in older adults, particularly those living in long-term care facilities or hospitals who take medications or have health conditions that deplete the body of sodium, leading to hyponatremia. Excess vomiting, diarrhea, and sweating can also cause hyponatremia if salt is lost in these fluids that are expelled from the body. Sometimes too much fluid abnormally collecting in the body can lead to hyponatremia, which might stem from diseases such as heart failure or liver cirrhosis. In rare cases, simply drinking too much fluid can lead to hyponatremia if the kidneys can’t excrete the excess water. Symptoms of hyponatremia can include: nausea, vomiting, headaches, altered mental state/confusion, lethargy, seizures, coma.
Too much sodium in the blood is called hypernatremia. This acute condition can happen in older adults who are mentally and physically impaired who do not eat or drink enough, or who are sick with a high fever, vomiting, or infection that causes severe dehydration. Excessive sweating or diuretic medications that deplete the body of water are other causes. When sodium accumulates in the blood, water is transferred out of cells and into the blood to dilute it. This fluid shift and a build-up of fluid in the brain can cause seizures, coma, or even death. Extra fluid collecting in the lungs can cause difficulty breathing. Other symptoms of hypernatremia can include: nausea, vomiting, weakness, loss of appetite, intense thirst, confusion, kidney damage.
The interplay of sodium and potassium
Sodium and potassium are closely interconnected but have opposite effects in the body. Both are essential nutrients that play key roles in maintaining physiological balance, and both have been linked to the risk of chronic diseases, especially cardiovascular disease. High salt intake increases blood pressure, which can lead to heart disease, while high potassium intake can help relax blood vessels and excrete sodium while decreasing blood pressure. Our bodies need far more potassium than sodium each day, but the typical U.S. diet is just the opposite: Americans average about 3,300 milligrams of sodium per day, about 75% of which comes from processed foods, while only getting about 2,900 milligrams of potassium each day.
A study in the Archives of Internal Medicine found that:
- People who ate high-sodium, low-potassium diets had a higher risk of dying from a heart attack or any cause. In this study, people with the highest sodium intakes had a 20% higher risk of death from any cause than people with the lowest sodium intakes. People with the highest potassium intakes had a 20% lower risk of dying than people with the lowest intakes. But what may be even more important for health is the relationship of sodium to potassium in the diet. People with the highest ratio of sodium to potassium in their diets had double the risk of dying of a heart attack than people with the lowest ratio, and they had a 50% higher risk of death from any cause.
- People can make a key dietary change to help lower their risk: Eat more fresh vegetables and fruits, which are naturally high in potassium and low in sodium, but eat less bread, cheese, processed meat, and other processed foods that are high in sodium and low in potassium.
- Take Action: How to Reduce Your Sodium Intake
- Public Health Concerns: Salt and Sodium
- Dietary Reference Intakes for Sodium and Potassium. Washington (DC): National Academies Press (US); 2019 Mar.
- Stallings VA, Harrison M, Oria M. Committee to Review the Dietary Reference Intakes for Sodium and Potassium; Food and Nutrition Board; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine.
- He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. Journal of human hypertension. 2009 Jun;23(6):363.
- He J, Gu D, Chen J, Wu X, Kelly TN, Huang JF, Chen JC, Chen CS, Bazzano LA, Reynolds K, Whelton PK. Premature deaths attributable to blood pressure in China: a prospective cohort study. The Lancet. 2009 Nov 21;374(9703):1765-72.
- Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013 Apr 4;346:f1326.
- He FJ, Li J, MacGregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013 Apr 4;346:f1325.
- Intersalt Cooperation Research Group. Intersalt Cooperation Research Group Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24-hour urinary sodium and potassium. BMJ. 1988;297:319-28.
- Elliott P, Stamler J, Nichols R, Dyer AR, Stamler R, Kesteloot H, Marmot M. Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. BMJ. 1996 May 18;312(7041):1249-53.
- Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK, Appel LJ, Whelton PK. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ. 2007 Apr 26;334(7599):885.
- Cook NR, Obarzanek E, Cutler JA, Buring JE, Rexrode KM, Kumanyika SK, Appel LJ, Whelton PK. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Archives of internal medicine. 2009 Jan 12;169(1):32-40.
- Cook NR, Appel LJ, Whelton PK. Lower levels of sodium intake and reduced cardiovascular risk. Circulation. 2014 Mar 4;129(9):981-9. *Disclosures: Dr. Appel is an investigator on a grant from the McCormick Foundation.
- Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH. A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine. 1997 Apr 17;336(16):1117-24.
- Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England Journal of Medicine. 2001 Jan 4;344(1):3-10.
- Smyth A, O’donnell MJ, Yusuf S, Clase CM, Teo KK, Canavan M, Reddan DN, Mann JF. Sodium intake and renal outcomes: a systematic review. American journal of hypertension. 2014 Oct 1;27(10):1277-84.
- Kalantar-Zadeh K, Fouque D. Nutritional management of chronic kidney disease. New England Journal of Medicine. 2017 Nov 2;377(18):1765-76.
- Devine A, Criddle RA, Dick IM, Kerr DA, Prince RL. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. The American journal of clinical nutrition. 1995 Oct 1;62(4):740-5.
- World Cancer Research Fund, American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. London; 2007.
- Centers for Disease Control and Prevention. Sodium and Food Sources. https://www.cdc.gov/salt/food.htm Accessed 3/18/2019
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- Dietary Guidelines for Americans Scientific Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. 2010.
- Yang Q, Liu T, Kuklina EV, Flanders WD, Hong Y, Gillespie C, Chang MH, Gwinn M, Dowling N, Khoury MJ, Hu FB. Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey. Archives of internal medicine. 2011 Jul 11;171(13):1183-91.
The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.
7 Ways to Reduce Your Salt Intake and Lower Your Blood Pressure
We live in a society that measures and medicates. All the tools and technology and medicines deployed to maintain heart health are a help — yet heart disease remains the No. 1 killer in America. And high blood pressure, or hypertension, is a major contributor. Even so, heart disease is largely preventable, and much of that prevention lies in small steps that can make a big difference; diet is foremost among them. To lower your blood pressure, you need to reduce salt intake.
In ancient times, salt was so valuable that people used it for currency. It was used sparingly to season and preserve food. Today, we have an embarrassment of riches, and modern humans consume more salt than is good for them. But the biggest contributor to our sodium consumption is not the salt shaker: Approximately 75 percent of the sodium we eat comes from sodium added to processed and restaurant foods.
Americans Are Still Eating Too Much Sodium
Despite public health efforts over the past several decades to encourage people in the United States to consume less sodium, adults still take in an average of 3,400 milligrams (mg) per day — well above the current federal guideline of 2,300 mg or less daily. (The American Heart Association’s recommended cap is 1,500 mg, which is much less than 1 teaspoon — or 6 g — a day.) Evidence has shown that reducing sodium intake reduces blood pressure, as well as the risk of cardiovascular disease and stroke.
Many high blood pressure medications act as diuretics, which stimulate the kidneys to remove sodium and water from the body, thereby relaxing blood vessel walls and lowering blood pressure. But before choosing to take a medicine that will get rid of the salt in your diet for you, there is another option: What about cutting down on the salt yourself? If you think about it, you can monitor your salt intake and reduce it without swallowing one pill. Medication may be necessary if you can’t control spiking and consistently high blood pressure. But if you initiate your own regimen, you may be able to lower your blood pressure on your own.
Monitoring salt intake begins with avoiding packaged and processed foods, such as smoked, salted, and canned meat, fish, and poultry; ham, bacon, hot dogs, and lunch meats; hard and processed cheeses; regular peanut butter (buy unsalted instead); canned soups and broths; crackers, chips, and pretzels; breads and rolls; pizza and mixed pasta dishes, such as lasagna; and more. You can find a complete list here.
Want to Cut Sodium? Look at Food Labels
To stay under 2,300 mg or less a day, you must read food labels regularly. Look for the “no salt added ” labels (meaning no salt is added during processing, but the product is not necessarily salt- or sodium-free). Foods labeled “sodium-free” have less than 5 mg per serving; “very low sodium” foods contain less than 35 mg per serving; “low-sodium” foods have less than 140 mg per serving. Other terms you might see include “light sodium” or “lightly salted” (meaning at least 50 percent less sodium than in the regular product), and “reduced sodium” (meaning at least 25 percent less sodium than in the regular product — but probably too much for your diet!).
Sodium, despite its hazards, is nevertheless an essential nutrient needed in fairly small amounts, unless you lose a lot through sweating. Sodium helps maintain a balance of body fluids and keeps muscles and nerves working well. A mineral, sodium is one of the chemical elements found in salt. Though used interchangeably, the words “salt” and ”sodium” have different meanings: Salt, or sodium chloride, is a crystalline compound used to flavor and preserve food.
The relationship between sodium and high blood pressure is fairly straightforward. Sodium attracts water, and the higher the sodium intake, the greater the amount of water in the bloodstream — which can increase blood volume and blood pressure. High blood pressure, or hypertension, is a condition in which blood pressure stays elevated over time. That makes the heart work harder, and the higher force of blood flow can damage arteries and other organs, including the eyes, brain, and kidneys.
Sodium and potassium also affect each other along with your blood pressure: Potassium can help lower blood pressure by acting as a counterbalance to the harmful effects of sodium in your diet. To up your intake, eat foods rich in potassium, such as bananas, juices (such as carrot, orange, pomegranate), yogurt, potatoes, sweet potatoes, spinach, tomatoes, and white beans.
Try These 7 Tricks to Reduce Salt Intake Every Day
Since blood pressure rises with age, monitoring your sodium intake increases in importance with every birthday. It’s the “ounce of prevention” that can result in the proverbial “pound of cure.” So here are some tips to help you maintain that sodium-free diet:
- Read the Nutrition Facts label.
- Prepare your own meals (and limit the salt in recipes and “instant” products).
- Buy fresh meats, fruits, and vegetables.
- Rinse canned foods containing sodium (such as beans, tuna, and vegetables).
- Add spices to your food. Instead of salt, try coriander, black pepper, nutmeg, parsley, cumin, cilantro, ginger, rosemary, marjoram, thyme, tarragon, garlic or onion powder, bay leaf, oregano, dry mustard, or dill.
- Reduce portion size; less food means less sodium.
And when you’re eating in, try this recipe for a heart-healthy meal.
VEGGIE BAKE WITH OLIVE OIL AND GARLIC
- 3 tbsp olive oil, divided
- 3 cups, chopped, of any vegetables in your fridge
- 1 tsp minced fresh garlic
- 1 can (14 ounces) low-sodium chopped tomatoes, drained
- 1 can (14 ounces) chickpeas, drained and rinsed
- Salt-free seasonings, such as coriander, cayenne, parsley, or tarragon
- 2 zucchini, sliced into thin sheets
Preheat oven to 350 degrees Fahrenheit.
Place 2 tbsp olive oil in a large skillet over medium heat, then and add the chopped veggies and garlic. Sauté for about 5 minutes. Add the tomatoes and chickpeas, stirring to combine. Add your choice of salt-free seasonings to taste. Remove from heat. Spread the remaining tbsp of olive oil on the bottom of an 8-inch square baking dish. Cover with a layer of zucchini. Spread the sautéed mixture evenly across the zucchini base. Add a layer of zucchini on top. Sprinkle with oil. Bake for 30 minutes.
Yield: 6 servings
The Remedy Chicks
High blood pressure can start developing in childhood, and becoming conditioned to high-salt tastes early in life can make it more difficult to cut back later. Childhood is an important time to focus on preventing the development of high blood pressure, but cutting back on salt and sodium can have a significant impact for people of all ages.
Cut back on prepared foods
About 70% of the sodium Americans eat comes from processed, prepared foods such as crackers, cheese, and canned foods, and restaurant meals.
Even processed foods that don’t taste “salty”—like breakfast cereal—can have surprisingly high sodium levels. Additionally, foods consumed numerous times a day, such as bread, can add up to higher sodium intake even though an individual serving is not high in sodium.
According to the Centers for Disease Control and Prevention, top sources of sodium in the American diet include breads and rolls, cold cuts and cured meats, pizza, fresh and processed chicken, soups, sandwiches, cheese, egg dishes, and packaged savory snacks. Prepared sauces, salad dressings, and gravies also tend to be high in sodium.
Choosing foods with lower sodium doesn’t mean losing flavor. Human taste buds aren’t sensitive enough to notice a minor reduction in salt of about 30%, and for many types of foods, salt reductions of up to 30% won’t taste noticeably different. This means that home cooks, professional chefs, and the food industry can make significant sodium reductions with minimal impact on flavor.
Eat smaller portions of salty foods
There’s no need to completely eliminate favorite high-sodium foods or traditional cultural cuisines such as soy sauce (China), salted pickles and fish (Japan), or salty cheese and olives (Greece, Italy). Instead, it’s best to enjoy such foods in smaller amounts.
Discover reduced or no-sodium alternatives
Salt substitutes, including herbs and spices, and citrus like lemon can provide more flavor with less sodium. For example, citrus and sodium activate the same taste sensors so that less sodium can be used when they are combined. Explore your supermarket for low-sodium versions of traditional high-salt products, or experiment with new alternatives.
The Food and Drug Administration requires a “low-sodium” labeled food to contain less than 140 mg per serving. However, in foods where salt is a key component, such as soy sauce or cold cuts, the best a manufacturer can do is reduce the amount. In this case, the label can say “less sodium” or “lower sodium” although it may still be a high-sodium food. For example, one tablespoon of “less-sodium” soy sauce contains about 550 mg, as compared with 1,000 mg in the regular version. One serving of “lower-sodium” deli turkey breast contains about 380 mg—not much different from 450 mg in regular deli-sliced turkey.
Sodium-free substitutes contain 100% potassium chloride, while “lite” salts replace up to half of the table salt with potassium chloride. Potassium chloride (also called potassium salt) tastes much like sodium chloride, but it has a bitter aftertaste when heated so it is not recommended for cooking. However, check with your doctor before trying a potassium salt, because extra potassium can be dangerous for people who have trouble eliminating excess amounts or who are taking medications that can increase potassium levels in the bloodstream. This includes people with diabetes or kidney disease, those who have had a blocked urinary flow, or those taking a potassium-sparing diuretic, an ACE inhibitor, or an angiotensin-receptor blocker.
Cook your own meals
Instead of eating processed foods and restaurant meals, focus on cooking with fresh ingredients. Cooking with fresh unprocessed ingredients allows you to control the amount of salt (if any) you decide to add to your meals.
To get started, explore our recipes, including these tasty, low-sodium options:
Cardamom Roasted Cauliflower
Roasting cauliflower and other vegetables create a sweet, caramelized flavor. This recipe uses a variety of spices and fresh lemon juice to create intense, craveable flavors.Get the recipe
Citrus Salad with Ginger Lime Dressing
A light, refreshing, beautiful salad that can be served as a side dish or dessert. The dressing for this salad also works well on salads made with mild-flavored baby greens, like baby spinach.Get the recipe
For additional ideas, download Tasting Success with Cutting Salt: Twenty-Five Science-Based Strategies & Culinary Insights developed by the Department of Nutrition and The Culinary Institute of America. With the shared vision that healthy eating and lifestyles are fully compatible with delicious, flavorful food and cooking, the guide combines nutrition science and public health with culinary insight to promote sodium reduction strategies.
- Salt and Sodium: Overview and Health Risks
- Public Health Concerns: Salt and Sodium
- Centers for Disease Control and Prevention. Sodium and Food Sources. https://www.cdc.gov/salt/food.htm Accessed 3/18/2019
The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.
Sometimes, those fries are calling your name and you can’t say no – but the bloated feeling you get from the sodium overload isn’t fun. The next time you feel like you’ve overdone it on the weekend, get rid of the bloat with these tips that flush out salt from your body.
- Drink up: The best way to debloat is to flush out excess salt by refilling that water bottle all day. Add extra help – and taste – by throwing a few fresh ingredients into your water to help get rid of those toxins. Detoxifying additions to water like ginger or lemon slices are delicious and effective at helping you feel your best.
- Eat these foods: Look for foods rich in potassium, since this electrolyte will help your kidneys flush out excess salt. When in doubt, think fresh fruit and veggies, since many have high levels of potassium. Bananas, strawberries, leafy greens, melons, citrus fruits – all of these are great sources of potassium. Here are more foods that are high in potassium; make sure you eat some of these to help get rid of that bloat fast.
- Stay on the move: Even if you don’t feel like sweating out that excess salt, making sure you aren’t being sedentary will help move things along and make you feel lighter on your feet. Keep your energy up and that excess salt moving out by taking frequent breaks from your couch or desk for a walk or stretch. Just be sure to stay hydrated no matter how long your workout.
What to Do After Eating Too Much Salt
A few weeks ago, I tried a new restaurant where I ate the Nashville-style hot chicken and a side of fries. The meal was not exactly Cooking Light-approved, but, hey, we all have our occasional indulgences.
I usually have no problems winding down at night, so I thought it was odd that my heart was racing, my body felt swollen, and I couldn’t fall asleep a few hours after dinner. After some late-night Googling (which is rarely a good idea, but in this case it actually helped), I found out that my body was probably reacting to the excess salt from my meal. It turns out in three pieces of hot chicken, there’s over 3,000 mg of sodium — well over the health target of 2,300 mg per day — and I wasn’t even counting the fries I had.
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95 percent of the sodium you eat is absorbed into your body — even if you don’t frequently overdo it on the salt, it still has the potential for negative impact. A study from the Center for Disease Control showed that 90 percent of Americans eat too much salt, and the average adult has an average daily intake of 3,592 mg.
Over time, your kidneys have trouble keeping up with excess sodium, so your body holds onto water to dilute it (hence why you might feel bloated and puffy). This process increases the fluid around the cells and the volume of blood in your body. Increased blood volume means that your heart has to work extra hard — over time, this could lead to high blood pressure, heart attack, and stroke.
Cooking Light’s Nutrition Director, Brierley Horton, MS, RD, says, “Overdoing it on sodium can easily happen when you’re consuming prepackaged foods or eating out at restaurants, especially if you have a salt sensitivity. The best thing you can do is listen to your body.”
While we definitely don’t encourage you to regularly have a salt fest, eating too much sodium happens. Here are the best ways to bounce back.
Drink a Ton of Water
Drinking lots of water helps flush sodium from your kidneys; staying hydrated will also help you feel less bloated.
Hop on the Treadmill
Exercise will help you lose a little sodium through your sweat. Again, just make sure you’re staying hydrated.
Eat a Banana
Potassium helps counteract sodium. Foods like bananas, white beans, leafy greens, and potatoes are all great sources of potassium. Horton says, “Eating high-potassium foods is good because they are usually whole foods that are also naturally lower in sodium. However, those with kidney disease should monitor potassium intake and talk to their doctor.”
Talk to Your Doctor
Certain people run a higher risk of being sensitive to salt, including those over the age of 51, African Americans, and those with cardiovascular disease or high blood pressure. If you’re concerned about your salt intake or think you may be sensitive to salt, it’s definitely worth calling your doctor.
If you are concerned about how much salt is in your body, then you’re probably searching for ways on how to get rid of salt. Here’s a great place to start! If you’re not concerned with your salt intake, then you should be!
Really? Regardless if you have a chronic disease like heart disease, diabetes or high blood pressure (or are a healthy person), everyone should be concerned with how much salt is in your body.
In this article, we will get to the bottom of why components of salt are both essential and harmful to your health. We’ll break down the salt molecule so that you can better understand what happens when we eat salt and if salt is the main culprit of your health problems. Finally, we will give you several tips on how to flush salt out of your body so you can start living a healthier life.
Is Salt Bad for You?
When you think of a healthy diet, you may think that salt is bad for you. As salt breaks down in your body, however, it breaks into 2 minerals called sodium and chloride. These 2 minerals are essential for maintaining normal body functions, so we do need them in our diet. However, when we have an imbalance of these minerals, especially sodium, then that is when we start seeing health issues.
Your body works hard to tightly control your blood sodium levels regardless of your sodium intake, however, there are several problems that are possible when someone’s blood sodium levels are abnormal.
|Problems Linked with Too Much Sodium in the Body||Problems Linked with Not Enough Sodium in the Body|
|Fluid retention, bloating, edema or potential weight gain||Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)|
|Increased risk of hypertension, heart failure and stroke||Seizures
Above all, while salt consumption needs to be controlled, nutrition professionals are most concerned with your sodium intake. So, watch your sodium intake! For most adults, sodium intake should be limited to 1500mg to 2300mg per day. If you have high blood pressure, then reduce your sodium intake to 1500mg per day (1).
Keep the Sodium Out (Before It Gets In)
One of the first steps you can take to get rid of sodium from your body is to reduce consumption of it in the first place. Here are some tips on how to do that:
1. Avoid Adding Salt to Your Foods
Perhaps one of the easiest and clear-cut ways to reduce your sodium is to get that salt shaker off the table and out of your food! Just about 1 teaspoon of salt contains all the recommended sodium you need in a day! To add flavor to your foods without sodium and salt, try the Mrs. Dash flavor packets.
2. Read the Nutrition Label for Sodium
When you are trying to reduce your sodium intake, it is essential that you read the nutrition label so that you understand how much sodium is in the food you are buying. Remember to keep it to less than 2300mg per day (and less than 1500mg if you have hypertension). For information about labeling and how to understand the food label for sodium, .
3. Recognize the Patterns of Sodium in Food
Do you think at the salt in a salt shaker is where we get most of our sodium? Think again! There are various types of foods that are typically high in sodium and types of foods that are typically low in sodium. Overall, try to decrease the amount of high sodium foods in the diet while increasing the low sodium foods.
*While these foods can be part of a healthy diet to manage hypertension, portion control should be conducted.
Fun Fact: Try rinsing your canned goods (i.e. canned green beans, beans, corn) in a colander under cool water because you can rinse a little bit of the sodium off that way!
Flush the Sodium Out (Once It’s Already In)
Monitoring your sodium intake is a lifelong process that we all must work on in order to stay healthy. However, there are some ways to help your body process and flush out sodium when it is in your body.
1. Keep Your Kidneys Healthy
Your kidneys process fluid, sodium and other substances based on what your body needs (and what it doesn’t). Make sure you visit your doctor regularly so that he or she can monitor how well your kidneys are working. Check out this article to learn more about keeping your kidneys healthy and how to detox naturally.
2. Drink Enough Water
Remember this: Where water goes, sodium will follow. Drinking water will hydrate your body and help you flush out sodium, especially if there is too much sodium circulating in the body. When we do not drink enough water, our kidneys can’t work correctly, and ultimately, can’t flush out excess sodium.
3. Get Your Sweat On
We lose some sodium via sweat when we exercise, so get your sweat on with this fun workout DVD package (2)! While this is not as effective as eliminating sodium via diet, perhaps this can be yet another reason for you to exercise. One thing to keep in mind, however, is that you should stay adequately hydrated before, during and after a sweat session. If you sweat profusely (for no apparent reason), then you may have an underlying medical condition. So, always check in with your doctor!
What Do the Results Mean?
Abnormal levels on a sodium blood test can point to various conditions.
If your sodium levels are too high for the amount of water in your body, it’s called hypernatremia. If the levels are too low, that’s called hyponatremia.
Hypernatremia might indicate several things, including:
- A problem with your adrenal glands, which sit atop your kidneys and help with all kinds of things including your immune system and response to stress
- A type of diabetes in which your kidneys don’t conserve water
- A loss of too much fluid through sweating, diarrhea, diuretics, or another issue
- Too much salt in your diet
- Overuse of certain medications, including NSAIDs, birth control pills, or laxatives
Hyponatremia might suggest conditions including:
- Adrenal glands not producing enough hormones
- Severe vomiting and/or diarrhea
- Increase in fluid in your body from conditions such as cirrhosis, congestive heart failure, and kidney failure
- A problem with the way your body releases an antidiuretic hormone
- Too much of a hormone called vasopressin, which helps keep your body’s water level in balance
- Use of certain medicines, including diuretics, certain antidepressants, and opioids
Patients hospitalized with abnormal sodium levels can run the gamut, from elderly patients who can’t get to a glass of water to athletes who exercise so hard they sweat out needed sodium.
At the annual meeting of the American Academy of Family Physicians, held in San Diego in September, Eddie Needham, MD, gave advice on treating patients at both ends of the sodium spectrum, from hypernatremia to hyponatremia. Dr. Needham, who is the program director of the family medicine residency program at Florida Hospital in Winter Park, Fla., has seen his share of sodium abnormalities.
“I joke with my residents… a patient getting admitted from a nursing home who has a sodium greater than 135, there must be something wrong,” he said. “I don’t see normal sodium on a regular basis.”
The prevalence of hyponatremia, especially among elderly patients, is an issue to consider when deciding on treatment, he noted. “If the patient’s presenting for something totally different, and their sodium is in the high 120s, low 130s, that might be OK,” Dr. Needham said. “We see 126 and we want to fluid restrict them and correct it up to 135, then we send them home and they come back at 126.” Illnesses such as pneumonia can also cause fluctuations in sodium that correct themselves when the patient is well again, he added.
By definition, hyponatremia is any sodium level below 135 mEq/L, with a level between 120 and 130 considered moderate hyponatremia, and anything under 120 severe. Patients with mild or moderate cases often don’t show symptoms, and even if they do, the most common symptoms—headache, lethargy/fatigue and nausea—have a wide differential, Dr. Needham noted. “The specificity is probably like 1% or 2%,” he said.
However, some hyponatremic patients present with severe neurologic and/or gastrointestinal symptoms. “Where we see symptoms is when there’s an acute change in a patient’s sodium level,” he said. “That gives you the massive alterations in your mental status.”
Such patients require urgent treatment, although the rush to treat low sodium shouldn’t distract you from the need to collect useful data. “The first thing you want to do, anytime you want to cure a lab that’s not normal, is to repeat the lab,” said Dr. Needham. In addition to blood, he said, you want to collect patients’ urine, as soon as possible.
“Pardon the pun, but that first urine is golden,” said Dr. Needham. Analysis of urine sodium can help establish the role of the kidneys in the patient’s hyponatremia. “If the urine sodium is less than 20 , the kidneys are attempting to absorb as much sodium as they can. If it’s higher than 30, they’re letting the sodium bleed through and you want to look at the kidneys,” he said. Serum osmolality can also be useful, he added. “It’s 320, 330 —it’s more concentrated. If it’s perhaps 250, 270—that’s fluid overload with free water.”
Dilutional hyponatremia is often associated with failure of the heart, liver or kidneys. “You have an increase in your total body water that exceeds the increase you might have in sodium. This results in edema,” said Dr. Needham. He also told an anecdote of a psychiatric patient who developed dilutional hyponatremia after drinking vast quantities of water from a hospital showerhead, due to psychogenic polydipsia.
Depletional hyponatremia, on the other hand, could happen to that athlete who worked out too hard and drank only water. “Athletes should be replacing not just with free water, but at least every other drink with a hypotonic solution,” said Dr. Needham.
The depletional variety can also result from fluid loss from the gastrointestinal system (vomiting, diarrhea) or the third space (severe burns, sepsis). There are also several renal causes: Addison’s disease, salt-losing renal diseases (polycystic kidney disease, pyelonephritis), and diuretic medications. “We have to remember when we give those to our patients, we should follow up and see how they are doing,” Dr. Needham said of the final category.
Regular follow-up is key to successful treatment of hyponatremia, too. “Whatever you do, whether the sodium is really, really low or really, really high, you only want to do it for a brief interval and then you want to come back to look to see what happened,” said Dr. Needham.
There are dire consequences to both under- and overtreatment of hyponatremia. Patients whose sodium drop is not corrected can suffer hyponatremic encephalopathy. “If you put more fluid in the cells in your brain, that can cause edema, and if it gets too severe, that can cause things like respiratory depression, tentorial herniation and death,” Dr. Needham said. “That’s why if you have an acute change in mental status and someone’s got really, really low sodium, those are people you should look at correcting acutely.”
On the other end, excessively rapid correction of hyponatremia can cause osmotic demyelination syndrome (formerly known as central pontine myelinolysis). The happy medium is to correct hyponatremia by 10 mEq/L per day.
“Your goal is no more than a 10-mEq/L rise in 24 hours,” said Dr. Needham. There are a number of ways to achieve this goal. In less acute dilutional cases, simple fluid restriction, or loop diuretics combined with salt tablets, may be sufficient.
Intravenous saline is often the best solution, however. When calculating how much saline a patient needs, remember that 0.9% normal saline has 154 mEq/L of sodium, Dr. Needham said. In patients with severe deficiencies, it may be tempting to use 3% saline, but be very cautious with such rapid corrections, he advised. “Hot salts—I’ve done it once,” he said.
Whichever saline you choose, check back soon to assess its effects. “I repeat the electrolytes in another couple of hours,” Dr. Needham said. Keep in mind that a patient who is hyperglycemic will have very different osmolality, he advised.
If none of these strategies fix the problem, the antidiuretic hormone (ADH) antagonists conivaptan and tolvaptan are both approved for treatment of hyponatremia, although Dr. Needham has never used them for this indication. “There are people who are repetitively symptomatic and that’s where use of the drugs can be useful,” he said. The treatment of last resort is renal replacement therapy.
Finally, Dr. Needham offered some formulas useful in hyponatremia treatment (see box, above), and also suggested that physicians check the Internet for more resources. “There are excellent Web calculators,” he said.
Those calculators could also be helpful in treating patients with hypernatremia. High sodium levels can be caused by too little access to water and too much access to salt. It could also be a complication of gastrointestinal illness or a symptom of a hypothalamic lesion or diabetes insipidus, he said.
As with hyponatremia, a patient’s free water deficit should be corrected at no more than 10 mEq/L per day, Dr. Needham noted. “When you’re correcting these things, always guess low,” he said. Obviously, he noted, the correction should be made using 5% dextrose in water (D5W) rather than saline. “It’s also important to allow access to water,” Dr. Needham said.
To determine whether diabetes insipidus is the cause of hypernatremia, he recommends collecting the patient’s first urine of the day. “If you can concentrate that first urine, you probably don’t have diabetes insipidus,” he said.
If it is diabetes insipidus, you’ll need to distinguish whether the problem is central or nephrogenic. That can be accomplished with a trial of desmopressin. If the patient responds, that’s central; if not, it’s nephrogenic. That result will then guide further treatment, Dr. Needham said.
Salt and athletes: Shake it or leave it?
Some athletes sweat so much they end up crusted with salt; they wonder if they need to eat extra salt to replace what was lost in sweat. Other athletes avoid salt like the plague; they see no need to add it to their food because the typical American diet already contains way too much.
And then there are marathoners and triathletes who read about their peers who have died of hyponatremia (low blood sodium). They wonder if they should start eating salty foods as a part of their daily sports diet.
Perhaps you too have wondered about the role of salt, or more correctly, sodium (the part of salt associated with high blood pressure) in your diet. This article can help you figure out if you should shake it or leave it.
Salt: What it is and does
Salt is made up of two electrically charged particles: sodium and chloride — also called electrolytes. In your body, sodium helps keep the right amount of water inside and outside your cells and in your blood.
During exercise, if excessive water intake dilutes the sodium outside the cells, too much water seeps into cells and they swell — including brain cells. The symptoms progressively appear and the athlete feels weak, groggy, nauseous, incoherent, and then may experience stumbling, seizures, coma and death.
Athletes at risk of developing hyponatremia include slow marathoners, triathletes and others who exercise for more than four hours and are highly vigilant about hydration, to the extent they drink more fluid than they lose in sweat. Over time, they accumulate a large enough intake of water to dilute the blood sodium.
Consuming sodium-containing sports drinks helps, but it doesn’t protect against hyponatremia because sports drinks offer far more water than sodium. The typical sports drink may have only 1/5 the concentration of normal blood serum.
While dehydration is a far more common concern than overhydration, all athletes can avoid either problem by knowing their sweat rates. To learn your sweat rate, weigh yourself naked before and after exercise. A one-pound drop equates to losing 16 ounces of sweat and means you should target drinking 16 ounces of fluid during similar exercise bouts. Knowing your sweat rate takes the guesswork out of drinking during exercise, and reduces the risk of health problems associated with consuming too much or too little water.
Sodium in sweat
The average male’s body contains about 75,000 milligrams of sodium, the equivalent of 11 tablespoons of salt. When you exercise, you lose some sodium via sweat. The amount you lose depends on:
1. How much salt you sweat. Some athletes have saltier sweat than others. Salty sweaters tend to develop a crust of salt on their skin after a hard workout. Other athletes, in comparison, have a low sodium content in their sweat — and no white salt stains on their skin or exercise clothing.
2. How much you sweat. Athletes who sweat heavily lose more sodium than light sweaters. The amount of sodium in sweat averages about 500 mg sodium/lb sweat (and ranges from 220 to 1,100 mg) If you lose two pounds of sweat per hour for four hours of intense biking, tennis, football practices, etc., your sodium losses become significant (4,000 mg). You should eat salty foods to replace the losses.
3. How much you exercise in the heat. If you aren’t used to exercising in heat, you may lose 1,100 mg sodium/lb of sweat. But if you’re acclimatized, you may lose only 300 mg. This means if you are training in the winter for a marathon that happens on an exceptionally warm spring day, you might need extra sodium during the marathon (such as Gatorade’s Endurance Formula).
Salt and blood pressure
The kidneys regulate sodium balance. That is, if you overconsume 200 mg sodium, your body will get rid of those 200 mg through urine — unless you have salt-sensitive high blood pressure. In that case, the body retains too much salt; which means extra fluid is retained in the blood and blood pressure rises.
As you age, your sensitivity to sodium increases, as does blood pressure and the associated risks of stroke, heart and kidney disease. An estimated two to five percent of people aged 25 to 34 have high blood pressure, as do 31 to 36 percent of 55- to 65-year-olds. Of these, about 1/3 to 1/2 are salt-sensitive.
To reduce your risk of developing high blood pressure, you should not only eat a low-sodium diet, but boost your intake of calcium, magnesium and potassium –three minerals that help counter the negative effects of sodium.
Instead of simply subtracting salty foods, you should also:
- Consume extra fruits, vegetables and low-fat dairy foods for potassium, magnesium and calcium.
- Exercise (and lose weight if you have weight to lose).
- Limit your intake of alcohol and fatty meats.
- Moderate your salt intake by eating less processed food.
Having parents with low blood pressure also helps …
How much salt does an athlete actually need?
For non-athletes, the body only needs 500 mg sodium and the U.S. Dietary Guidelines recommend no more than 2,400 mg sodium/day. Most Americans easily consume 3,000 to 5,000 mg daily, mostly through processed foods (ramen noodles: 1,700 mg/package, spaghetti sauce: 600 mg/half-cup, cold cereal: 250-350 mg/serving). Sodium enhances flavor and helps prevent spoilage.
Most active people consume adequate sodium, even without adding salt to their food. For example, you get sodium from bread (150 mg/slice), cheese (220 mg/oz), eggs (60 mg each), and yogurt (125 mg/8 oz). Athletes who are extreme sweaters probably need more sodium, but generally consume more, particularly if they eat fast foods. Just two slices of cheese pizza (1,200 mg) or a Whopper (1,400 mg) can easily replace sodium losses; no sweat!
Sports Nutritionist Nancy Clark, M.S., R.D., counsels both casual exercisers and competitive athletes in her private practice at Healthworks (617-383-6100), the premier fitness center in Chestnut Hill, MA. Her popular Sports Nutrition Guidebook, 3rd Edition, Food Guide for Marathoners, and Cyclist’s Food Guide are available at www.nancyclarkrd.com.
Copyright Nancy Clark, M.S., R.D., May 2005