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Salt: how low should you go?

Diets that are low in salt are associated with a decrease in the risk of' heart disease, stroke and kidney disease--an association that has led government experts to advise that Americans lower their sodium intake to less than 2,300 milligrams (mg) per day, and that certain subgroups of people--including those who are African American, age 50 and older, or have hypertension, diabetes or chronic kidney disease--reduce their intake to less than 1,500 mg daily. The American Heart Association (AHA) supports this recommendation, but states that everyone should aim for 1,500 mg.

Presently, most Americans consume considerably more than the recommended sodium levels--in fact, average consumption is 3,400 mg of salt (about 1 1/2 teaspoons) per day. Data from the National Health and Nutrition Examination Survey (NHANES) also suggests that more than 95 percent of adults over age 50 consume more than the daily 1,500 mg of salt recommended by the U. S. Dietary Guidelines.

However, a recent report from the Institute of Medicine (TOM) seems to contradict the latest dietary guidelines, indicating that salt in the quantities consumed by most Americans is not a substantial health hazard. What should your policy be on monitoring your salt intake?

Benefits and risks of less salt Contrary to the recommendations, the IOM report did not find that studies that lowered salt intake to between 1,500 mg and 2,300 mg daily decreased the risk of heart disease, stroke, or mortality. Furthermore, there were no benefits but some harms in those who were advised to reduce their intake to less than 1,500 mg. The harms occurred most often in those with moderate to severe systolic heart failure.

There is good evidence that high levels of sodium intake increase the risk of cardiovascular disease, but the IOM experts highlighted the fact that there is no clear-cut definition for what counts as a high intake, and what counts as low. The studies it evaluated came from around the world, and "high" salt ranged from 2,700 mg to over 10,000 mg per day. In the U.S., most experts consider over 3,500 to 4,000 mg to be high.

Mount Sinai nutrition consultant Fran Grossman, RD, MS, CDE, CDN, notes that most of the received wisdom about salt's effects on our health is based on research indicating that blood pressure falls in many people when less salt is consumed. Grossman notes that, "Mere is ample evidence that there are some people who have salt-sensitive--hypertension that fluctuates more dramatically than normal in response to increased or decreased sodium, and these people in particular should watch their sodium intake.

Keeping track of your intake Grossman recommends that you check nutrition labels for the sodium content of the foods you eat. "Keep in mind that salt is listed 'per serving,' and take into account how many servings you eat," she says. "You also should avoid eating highly salted processed foods, such as processed cheeses, canned, pickled or smoked meat, deli meat, canned soup, and other snack foods."

Grossman also acknowledges that low-salt diets can be particularly difficult for older adults, especially those whose appetite is poor. With aging, one's sense of smell and taste diminish, making food taste especially bland and unappetizing. "Seasonings can help with this, but when cooking, replace salt with salt-free seasoning blends and/or herbs and spices," Grossman says. If salting your food means you eat better overall, one way to decrease your total salt intake yet be able to enjoy its effect on taste is to keep it out of your cooking--instead, add it at the table after first tasting your food.
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Title Annotation:NUTRITION
Publication:Focus on Healthy Aging
Date:Sep 1, 2013
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