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Low-Salt Diet

Low-Salt Diet

Illustration

The basics

A low-salt diet may benefit certain people with cardiovascular disease, high blood pressure, kidney disease, and other medical problems. Most physicians will prescribe a low-sodium diet for these people (or, more specifically, they recommend a low-salt diet, as nonchloride sources of sodium do no increase blood pressure).

Studies that have looked at the relationship between sodium and disease have primarily looked at salt. Therefore, the problem of high sodium intake as it relates to disease may really be a problem of high salt intake.

  • The American Heart Association and other organizations advise people to limit their salt intake to the equivalent of no more than 1 teaspoon (2.3 grams) of sodium each day.
  • Avoid processed or packaged foods, unless they are labeled “low sodium,” and read the nutrition facts panel to find out the exact amount of sodium they contain.
  • Generally, a food is considered “low sodium” if it has less than 140 mg of sodium cloride per serving.
  • Ask for your meals to be prepared without salt when you eat out.

Shake the salt habit: Choose fresh or frozen foods, and prepare them without salt. Don’t keep a salt shaker at the table—instead use herbs and spices to naturally flavor your foods. Eat unsalted nuts and pretzels instead of the salted versions. Give your taste buds a few weeks to adjust to the lower salt and appreciate the new, more complex flavors.

Why do people follow this diet?

A low-salt diet is beneficial for certain people with cardiovascular disease. Preliminary evidence has linked salt consumption with increased cardiovascular disease incidence and death among overweight people. Low-salt diets seem to be especially important for people with hypertension (high blood pressure). Salt intake has been definitively linked to hypertension in Western societies, and minimizing salt consumption lowers blood pressure in many people.

Research studies consistently find that increased dietary salt aggravates asthma symptoms, especially in men. In a small, preliminary trial, men with asthma who doubled their salt intake for one month experienced a worsening of their lung function. Although not all of the observed effects were conclusive, several double-blind trials have provided evidence of clinical improvement following a period of salt restriction.

Other conditions that may benefit from a low-salt diet include Ménière’s disease, migraine headaches, kidney stones, gastritis, and ulcers caused by H. pylori infection. Preliminary evidence also suggests that restricting dietary salt may play a role in the prevention of certain types of cancer, including stomach, colorectal, and head and neck cancers.

Restricted levels of salt may help to preserve bone density. Short-term increases in dietary salt result in increased urinary calcium loss, which suggests that over time, salt intake may cause bone loss. Increasing dietary salt has increased markers of bone loss in post- (though not pre-) menopausal women.

Lower salt intake may also help to protect against the development of reduced insulin sensitivity, a physiological process that can lead to blood sugar regulation problems in certain people. Preliminary studies suggest that high salt intake decreases insulin sensitivity in young, healthy people, but not in older people with hypertension. Moderate restriction of salt, however, also decreased insulin sensitivity in one preliminary study of healthy people, but had no effect in other studies of people either with or without hypertension.

Salt restriction also may be helpful in reducing edema in some people. High salt intake tends to lead to water retention that may promote the further accumulation of fluid beneath the skin.

Pregnant women who are experiencing hypertension of pregnancy should not follow a low-salt diet. A low-salt diet has not been shown to have a significant effect in reducing blood pressure during pregnancy, so salt restriction is not recommended to women with gestational hypertension and preeclampsia. Additionally, unlike other conditions that cause high blood pressure, salt restriction (and use of diuretics) can worsen preeclampsia by reducing blood flow to the kidneys and placenta. In preeclampsia, unrestricted use of salt and an increased consumption of water are needed to maintain normal blood volume and circulation to the placenta.

People with certain conditions have been found to benefit from salt intake and should not follow a low-salt diet. Children with cystic fibrosis lose a large amount of salt in their sweat and thus should be encouraged to salt their food liberally. Chronic fatigue syndrome sufferers who have a form of low blood pressure triggered by changes in position (called orthostatic hypotension) have been reported to be helped by additional salt intake. Additionally, people with goiter or hypothyroid condition should not restrict intake of iodized salt if it is their only major source of iodine.

What do I need to avoid?

To avoid salt ask about ingredients at restaurants and others’ homes, and read food labels. The following list is not complete. Consult with a healthcare professional before making any significant changes to your diet.

  • Canned soups, juices, and vegetables
  • Cereals: cornflakes, bran flakes
  • Cheese
  • Cottage cheese
  • Hydrolyzed vegetable protein
  • Ketchup
  • Lite soy sauce
  • Microwave popcorn
  • Miso
  • Olives
  • Pickles
  • Processed meats: bologna, cured ham, frankfurters, etc.
  • Salad dressings (prepared)
  • Salted butter and margarine
  • Salted nuts
  • Seaweeds
  • Smoked or cured fish
  • Snack foods: potato chips, pretzels, tortilla chips
  • Soy sauce
  • Table salt
  • Worcestershire sauce

Best bets

  • Fresh foods such fruits, meats, vegetables
  • Oats
  • Packaged or prepared foods: look for labels stating “low-sodium,” “salt-free,” or “unsalted”
  • Pasta
  • Rice
  • Seasonings and marinades such as dried herbs, garlic, lemon juice, and/or vinegar (in place of salt)
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Are there any groups or books associated with this diet?

American Heart Association
1615 Stemmons Freeway
Dallas, TX 75207–8806
www.americanheart.org

The No Salt, Lowest-Sodium Cookbook: Hundreds of Favorite Recipes Created to Combat Congestive Heart Failure and Dangerous Hypertension by Donald A. Gazzaniga, New York: St. Martin’s Press, 2001

Get the Salt Out: 501 Simple Ways to Cut the Salt Out of Any Diet by Ann Louise Gittleman, New York: Crown Trade Paperbacks, 1996.

Cooking Without a Grain of Salt by Elma W. Bagg, New York: Bantam Books, 1998.

USDA Nutrient Database for Standard Reference (on-line search for sodium content)
www.nal.usda.gov/fnic/cgi-bin/nut_search.pl

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De Lorenzo F, Hargreaves J, Kakkar VV. Pathogenesis and management of delayed orthostatic hypotension in patients with chronic fatigue syndrome. Clin Auton Res 1997;7:185–90.

Dengel DR, Hogikyan RV, Brown MD, et al. Insulin sensitivity is associated with blood pressure response to sodium in older hypertensives. Am J Physiol 1998;274:E403–9.

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