Mind Your Decisions

Food Fridays: A Health Choice You Do Not Want to Take with a Grain of Salt

Since I know a lot of doctors, I get to hear many interesting health stories. Today I share one story that got me thinking. I’ve changed some identifying information, but otherwise the story is true.

One patient, whom I’ll call Sandy, was taking a prescription steroid to reduce inflammation. I am told that steroids are commonly given for this purpose because they are effective.

But the benefit of a steroid is always moderated by its strong side-effects. In Sandy’s case, the steroid reduced the pain from inflammation, but it simultaneously induced weight gain. She had an increased appetite coupled with a more prominent side-effect: water retention. Sandy’s feet and hands were swelling up so much that she found it hard to make a fist and put on her shoes.

Sandy was told to reduce her weight by limiting caloric intake and exercising whenever possible. The water retention was so bad that the doctor recommended she limit her salt intake and take a prescription diuretic. The diuretic would be uncomfortable because it caused frequent urination, but it was needed as long as the swelling persisted.

At the next checkup, the doctor was happy to see that Sandy had lost some weight. But the swelling from water retention had persisted. He inquired whether she was taking the diuretic and about how much salt she was eating.

Sandy explained she took the diuretic daily, and was overall doing as much as she could to eat well. She admitted her only indulgence was potato chips, which are loaded with salt. She considered buying low-sodium chips, but they were slightly more expensive and so she opted for the regular chips.

I was so stunned at this point of the story that I interrupted my friend. I mean, this patient is in serious trouble, taking a strong diuretic, and she’s cheap about spending money on low-sodium potato chips? It’s a medical need! I could not believe it.

My doctor friend told me not to criticize her so harshly. She was doing a lot of other things like exercising. It is always easy to find faults.

I was thinking about Sandy’s story later and it kept me curious.

I wondered, how much salt should one eat? Am I eating too much? And what are the effects of excess salt intake?

After some research, I found guidelines about salt and was surprised at how low they were.

The U.S. government recommends a mere teaspoon of salt per day (2,300 mg). One report I saw even suggested that three-fourths of a teaspoon should be the upper limit. It took me aback when I thought about how the Food Network chefs generously sprinkle salt by the handful. I mean, these are the chefs that people and restaurants copy from…

Sure enough, most restaurant and processed food is filled with salt. Here are some common food items and their salt content:

1.32 teaspoons = A chicken burrito (with fixings) from Chipotle’s
0.88 teaspoons = Two slices of pepperoni pizza from Pizza Hut
0.59 teaspoons = A 7-layer burrito from Taco Bell
0.36 teaspoons = One cup of canned black beans from Trader Joe’s
0.17 teaspoons = Two-ounces of Doritos

Even though I mostly cook at home, I’m sure I accumulate a lot of salt through convenience products (like canned beans) and eating at restaurants. And salt seems to be worse for us than previously thought.

Kevin Willis of the Canadian Stroke Network believes that salt contributes to 25 to 30 percent of the burden of cardiovascular disease, one of the largest killers in America. And the American Medical Association estimates that cutting salt by one-half in processed and restaurant foods could save 150,000 lives over the next ten years by reducing hypertension and heart disease.

I think the worst part is that we could cut back on salt without even realizing it.

“We could fairly easily take 18 to 20 percent out of food without consumers knowing,” says Patty Packard, nutrition manager at giant ConAgra Foods.

ConAgra has started doing that, beginning with kid-popular brands. Chef Boyardee, for instance, went from an average of 1,100 mg of sodium per serving in 2003 to 900 mg today. Over four years, ConAgra estimates it has removed 2.8 million pounds of salt from a list of products — kids brands, Banquet, Marie Callender’s — without consumer complaint, possibly because it hasn’t publicized the change.

“We know consumer perception is, if it’s lower in sodium it doesn’t taste good,” Packard says. “If you told people … they’re going, ‘Ooh, what’d you do to my Chef Boyardee?’ ”

From Times Leader

We are eating so much salt that we cannot notice small reductions—that is, we are eating salt at a point where diminishing returns have set in. At a point like that, it is pretty clear that you can cut back and be happier.

It was easy to sit back and criticize Sandy because the effects of her salt intake are obvious.

Why shouldn’t all of us take action too?

What is your take on salt?