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:
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.