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Salt & Sodium

About Sodium and Health

Key points

Your body needs a small amount of sodium to work properly, but too much sodium is bad for your health.

While sodium has many forms, most sodium we consume is from salt.

Most Americans consume too much sodium.

Most sodium comes from processed and restaurant foods.

Eating too much sodium can increase blood pressure and the risk of heart disease and stroke.

Most sodium in our diets comes from packaged and restaurant food, not the salt shaker.

You can reduce sodium intake by following the tips below at the grocery store, at home, and in restaurants.

Sodium and potassium are electrolytes that help your body maintain fluid and blood volume.

Consuming too much sodium and too little potassium can raise your blood pressure.

High blood pressure increases your risk of heart disease and stroke.

Health risks

Eating too much sodium can increase your blood pressure and your risk for heart disease and stroke. Together, heart disease and stroke kill more Americans each year than any other cause.

Deficiency

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.

Types of Salt

Finely ground salts are dense, so they tend to contain more sodium than coarser salts. Note that sodium content can vary widely among brands, so check the Nutrition Facts label for exact amounts.

Type	Approximate amount of sodium (1 teaspoon)
Iodized table salt, fine	2,300 mg
Kosher salt, coarse	1,920 mg
Kosher salt, fine, Diamond Crystal®†	1,120 mg
Sea salt, fine	2,120 mg
Sea salt, coarse	1,560 mg
Pink (Himalayan) salt	2,200 mg
Black salt	1,150-2,200 mg
Fleur de sel	1,560-2,320 mg
Potassium salt (salt substitute)	0 mg (contains 2,760-3,180 mg potassium)

† The inclusion of brand-names on this list is for reference only and does not constitute an endorsement. The Nutrition Source does not endorse specific brands.

Sodium in everyday foods adds up

Most people eat too much sodium

Your body needs a small amount of sodium to work properly, but too much sodium is bad for your health. Americans consume more than 3,300 milligrams (mg) of sodium per day, on average. This is well above the federal recommendation of less than 2,300 mg of sodium daily for teens and adults as part of a healthy eating pattern.

Sodium is found in foods from almost all food categories. Some of the top sources of sodium for U.S. adults and children ages 1 and older include:

Sandwiches.

Rice, pasta, and other grain-based dishes.

Starchy and non-starchy vegetables.

Meat, poultry, and seafood dishes.

Pizza.

Soups.

Chips, crackers, and savory snacks.

Desserts and sweet snacks.

Condiments and gravies.

Cold cuts and cured meats.

Breads and tortillas.

Source: Dietary Guidelines for Americans, 2020-2025

Sodium or salt?

Salt and sodium are not the same. Salt is sodium chloride which is table salt. Sodium chloride is 40% sodium and 60% chloride. One teaspoon of table salt contains about 2,400 mg of sodium.

Sodium is a mineral found in many ingredients in common foods:

Monosodium glutamate (MSG).

Sodium bicarbonate (baking soda).

Sodium nitrate (a preservative).

Reducing Sodium Intake

Why it's important

Eating too much sodium can increase blood pressure and the risk for heart disease and stroke. Together, heart disease and stroke kill more Americans each year than any other cause.

Even foods that may not taste salty can be major sources of sodium. Foods with only moderate amounts of sodium, such as bread, can be major sources of sodium because they’re eaten so frequently.

Toxicity

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.

At the grocery store

Buy fresh, frozen, or canned vegetables with no salt or sauce added.

Choose packaged foods labeled "low sodium," "reduced sodium," or "no salt added" when available.

Compare the amount of sodium in different products by reading Nutrition Facts labels. Check the amount of sodium per serving and the number of servings per container. Choose the options with the lowest amounts of sodium.

When possible, purchase fresh poultry, fish, pork, and lean meat, rather than cured, salted, smoked, and other processed meats.

For fresh items, check to see whether saline or salt solution has been added—if so, choose another brand.

Ask your grocer if they have a low sodium shopping list available.

Tip‎: Some grocery stores have a registered dietitian who can help you find low-sodium products. If your grocer doesn't have a registered dietitian, ask your doctor for a referral. A registered dietitian can provide valuable guidance on reducing your family's sodium intake and managing blood pressure.

At home

When cooking, replace or reduce the amount of salt you use. Alternatives could be garlic, citrus juice, salt-free seasonings, or spices.

Prepare rice, pasta, beans, and meats from their most basic forms (dry and fresh) when possible.

Eat more fruits and vegetables.

Limit sauces, mixes, and instant products, including flavored rice and ready-made pasta.

At restaurants

Ask for nutrition information before you order, and select a lower sodium meal.

Ask that no salt be added to your meal.

Order vegetables with no salt added or fruit as a side item.

Split a meal with a friend or family member.

Keep takeout and fast food to an occasional treat.

Choose a heart-healthy diet

The Dietary Approaches to Stop Hypertension (DASH) eating plan is a simple, heart-healthy diet that can help prevent or lower high blood pressure.

The DASH diet is low in sodium, cholesterol, and saturated and total fats. The diet is high in fruits and vegetables, fiber, potassium, and low-fat dairy products.
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:

Cardiovascular disease

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. [5,6] 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.

Assessing people’s sodium intakes can be tricky, and the most accurate method known is to measure 24-urine samples over several days. This is the method Harvard researchers used when pooling data from 10,709 generally healthy adults from six prospective cohorts including the Nurses Health Studies I and II, the Health Professionals Follow-up Study, the Prevention of Renal and Vascular End-Stage Disease study, and the Trials of Hypertension Prevention Follow-up studies. They looked at both sodium and potassium intakes in relation to cardiovascular disease (CVD) risk (as noted by a heart attack, stroke, or procedure or surgery needed to repair heart damage), and measured two or more urine samples per participant. After controlling for CVD risk factors, they found that a higher sodium intake was associated with higher CVD risk. For every 1,000 mg increase of urinary sodium per day, there was an 18% increased risk of CVD. But for every 1,000 mg increase of potassium, there was an 18% lower risk of CVD. They also found that a higher sodium-to-potassium ratio was associated with higher CVD risk, that is, eating a higher proportion of salty foods to potassium-rich foods such as fruits, vegetables, legumes, and low-fat dairy.

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.
Osteoporosis

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.
Cancer

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.”

Effects of Sodium and Potassium

Why it's important

Sodium and potassium are electrolytes needed for your body to function properly, including hydration, blood volume, and the functioning of your nerves and muscles. We get electrolytes from our food and drinks.

Consuming too much sodium can raise your blood pressure. Limiting sodium intake is especially important if you have high blood pressure, also known as hypertension.

Increasing potassium intake can help decrease your blood pressure if you have high blood pressure. By lowering blood pressure, increasing potassium intake can also reduce your risk for heart disease and stroke.

Terms to know

Though the words "salt" and "sodium" are often used interchangeably, they do not mean the same thing. Salt is also known by its chemical name, sodium chloride. Salt is a crystal-like compound that is common in nature. Sodium is a mineral, and it is a chemical element found in salt.

Check the Package for Nutrient Claims

You can also check for nutrient claims on food and beverage packages to quickly identify those that may contain less sodium.

Here’s a guide to common claims and what they mean:

What It Says	What It Means
Salt/Sodium-Free	Less than 5 mg of sodium per serving
Very Low Sodium	35 mg of sodium or less per serving
Low Sodium	140 mg of sodium or less per serving
Reduced Sodium	At least 25% less sodium than the regular product
Light in Sodium or Lightly Salted	At least 50% less sodium than the regular product
No-Salt-Added or Unsalted	No salt is added during processing – but these products may not be salt/sodium-free unless stated

Food sources of sodium and potassium

Most Americans eat too much sodium and too little potassium. Americans consume more than 3,400 milligrams (mg) of sodium each day, on average. This is well above the federal recommendation of less than 2,300 mg of sodium daily for teens and adults as part of a healthy eating pattern.

Most sodium in our diets comes from packaged and restaurant food. Foods with moderate amounts of sodium, such as bread, can be major sources of sodium because they're eaten so frequently.

Most potassium we eat naturally occurs in vegetables, fruit, seafood, and dairy products. Some good sources of potassium include bananas, oranges, melons, potatoes, sweet potatoes, and cooked spinach and broccoli.

Foods High in Sodium

More than 40% of the sodium Americans get comes from the following foods:

Bread and rolls

Pizza

Sandwiches

Smoked or cured meats (bacon, cold cuts, ham, frankfurters, sausage, sardines, and anchovies)

Soups

Burritos and tacos

Savory snacks (chips, popcorn, pretzels, snack mixes, and crackers)

Chicken

Cheese and cheese spreads

Eggs and omelets

Other sources high in sodium include:

Salted nuts

Canned beans and vegetables

Olives, pickles, sauerkraut, and other pickled vegetables

Commercially prepared pasta and tomato sauces and salsa

Condiments such as mustard, ketchup, BBQ sauce, and salad dressings

Soy sauce and other sauces

Health Risks

Consuming excessive amounts of sodium can be a risk factor for high blood pressure in some people, which can lead to serious health issues, such as heart disease and stroke.

To avoid those risks, experts recommend most healthy adults take in no more than 2,300 milligrams (mg) of sodium per day; 1,500 mg per day is even better. For some context, the Food and Drug Administration (FDA) estimates that the average American consumes about 3,400 mg of sodium per day—much more than is generally recommended.

Since most diets are too high in sodium, it’s important to pay attention to how much salt and added sodium are present in your food—especially in processed foods like pizza, deli meats, soups, salad dressings, and cheese. But as experts point out, you can’t always count on your taste buds to sound the alarm. Keep in mind that foods high in sodium don’t always taste salty, so watch out for sweet offenders like cereals and pastries too.

One Final Note..

Roughly 90% of Americans ages 2 and older consume too much sodium and don’t even realize it, which can be bad for your health. It's a good idea to check with your healthcare provider if you have any concerns about your sodium intake and how it may be affecting your health.

In the meantime, you can become aware of how much sodium you’re consuming by actively seeking out lower-sodium foods, checking the Nutrition Facts labels and ingredient lists on packaged foods, and cooking at home more often—just try to keep the salt shaker use to a minimum.

The FDA has been working with the food industry to gradually reduce sodium levels in food in the short and long term. While there’s no quick fix, federal regulators are aiming for a broad reduction in the next several years.

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