Americans seeking to follow new federal recommendations to limit daily sodium consumption will have to start cutting out some unexpected items in their diets.
Most consumers understand that table salt, which is 40% sodium, is an obvious candidate for the cutbacks, recommended to help prevent high blood pressure. But what they may not recognize is that at least 70 other compounds commonly used in foods contain sodium, says Food and Drug Administration spokesman Chris Lecos.
Among the best known are monosodium glutamate (MSG), sodium bicarbonate, sodium nitrate and sodium nitrite, both of which are often used in preserving meat.
"The key point for people to know is that the overwhelming amount of sodium in the diet comes from processed food, not from the saltshaker at the table or from what you add in cooking," said Bonnie Liebman, director of nutrition for the Center for Science in the Public Interest, a Washington-based consumer group.
The average American consumes about 4,000 to 5,000 milligrams of sodium a day, the equivalent of about five to six teaspoons of salt. That is roughly twice as much as the 2,400 milligrams a day called for by the new federal guidelines.
High blood pressure afflicts roughly 50 million Americans, according to the National Heart, Lung and Blood Institute. While medications can control high blood pressure, these drugs must often be taken for a lifetime. They are expensive and can have undesirable side effects--the reason that emphasis is shifting from high-blood-pressure detection and treatment to prevention.
Population studies show that the more sodium is consumed, the higher blood pressure rises with age. In China, for example, where sodium intake is higher than in the United States, rates of high blood pressure and stroke jump dramatically for adults 40 and older, says Jeremiah Stamler, professor emeritus of medicine at Northwestern University School of Medicine in Chicago. By comparison, members of primitive tribes in Brazil consume a very low-sodium diet and show no increase in blood pressure with age, Stamler said.
At least 80% of sodium intake in the United States comes from eating processed foods, such as cheese, crackers, cereals, luncheon meats, fast foods and frozen dinners, according to the National High Blood Pressure Education program, which recently issued the recommendations.
"The good news is that the food industry has really been working to lower the sodium content," said Evelyn Tribole, a registered dietitian in private practice in Beverly Hills and a national spokeswoman for the American Dietetic Assn. "But there's still a lot of room for improvement."
What makes it difficult for consumers, however, is that food doesn't have to taste salty to be high in sodium. "That's one of the biggest misconceptions," said Tribole.
Take instant chocolate pudding, for example. One cup contains 880 milligrams of sodium--nearly a third of the new daily recommendations.
Low-fat and non-fat foods, such as salad dressing, are also frequently very high in sodium. "Sometimes, they are even higher in sodium than their higher-fat counterparts," said Mindy Hermann, a registered dietitian in Mount Kisco, N.Y., and a spokeswoman for the American Dietetic Assn. "In part, this is to keep the flavor and moisture at acceptable levels."
Fast food can also be deceiving. The French fries may seem like they would be the highest in sodium. But at McDonald's, the chocolate milkshake and the apple pie each contain more sodium than the French fries.
FDA regulations now require that if a food product has a nutrition label, it must include the sodium content. As a result, about two-thirds of all the foods now on the market contain these labels, says spokesman Lecos.
New FDA labeling regulations mandated by the Nutrition Labeling and Education Act of 1990 will make the sodium hunt even easier for consumers. Next year, all foods must show their sodium content.