A Dietitian’s View of CDC Sodium Consumption Report
This week, the Centers for Disease Control and Prevention released a report about the top contributing foods to Americans’ sodium consumption. Leading the list of the top 10 foods was a surprising finding. Breads and rolls beat out chips and canned food for contributing the most salt in the daily diet. But digging deeper, we see that there is a bigger issue at hand – what we truly eat, and what we perceive that we eat.
According to data reported in the “What We Eat in America” portion of the National Health and Nutrition Examination Survey, 10 foods account for nearly half of the nation’s excessive sodium intake. These include breads and rolls, cold cuts/cured meats, pizza, poultry, soups, sandwiches, cheese, pasta dishes, meat dishes, and snack foods. For most of these categories, more than 70% of sodium consumed came from foods obtained at a store – supermarkets and convenience stores versus food served at a restaurant.
As dietitian’s counsel patients about the dangers of consuming too much sodium, we often cite the obvious sources. Foods highest in sodium tend to be processed and canned foods, such as canned soups and vegetables, chips and salty crackers, deli meats such as bologna and salami, and cheese. So how did bread make the top spot on the list of foods that contribute to our salt intake?
First, consider that NHANES data comes from surveys where participants recall what they have eaten over a specific period of time – not direct objective measurement. People’s perception of their food consumptions is often very different from what they actually eat. The most common categories for underreporting include fats, oils, and sweets. We often over-estimate the “healthy” foods we are supposed to eat, such as fruit, vegetables, beans, and lean protein.
Bread, for example, often comes with a meal. We eat toast for breakfast (hopefully whole grain), a sandwich for lunch, and rolls with our dinner. Generally, when reporting meals, we are fairly accurate. However, between meal snacks – chips, sweets, and other junk food – are foods that we tend to eat without thinking about, while watching television or working at our desk, for example. So these foods groups are often missed when providing information for a self-reported survey.
Second, bread on its own is probably a low sodium food, depending upon the brand. A slice of bread can range from 80 to 230 mg in sodium content. According to FDA food label guidelines, any food that contains 140 mg or less per serving is considered a low sodium food. How often do we view these health claims on labels without considering the serving size?
According to the old Food Guide Pyramid, which suggests the recommended amount of each food category we should consume daily based on our age, gender and activity level, adults should consume about 6 servings of grains per day. Remember that a slice of bread is one serving, so for every sandwich consumed, a person is eating two servings. Bottom line – while a slice of bread or one roll is considered a low sodium food, we just eat too much of it, contributing significantly to our total daily salt intake.
Third, the survey did not take into account salt added to foods during cooking or at the table. Depending on how heavy the cook’s or diner’s hand is with the salt shaker, this could potentially contribute even more sodium to the daily diet.
The American Heart Association recommends consuming less than 1500 mg of sodium per day. Most Americans (90%) consume over 3,200 mg. Excessive sodium intake contributes to high blood pressure, increasing the risk for cardiovascular disease and stroke. Heart disease is the nation’s leading cause of death; stroke is fourth.
Studies show that if Americans would slash their sodium intake by about a third – down to 1,200 mg per day – we could save about $20 million in medical costs each year. It could also prevent up to 28,000 deaths annually, says CDC Director Thomas R. Frieden MD MPH.
To reduce salt in your diet, this dietitian recommends that you read labels carefully. Pay close attention to sodium per serving. That can of chicken noodle soup you eat for lunch is probably two servings at around 800 mg each. The extra slice of cheese on your sandwich – possibly between 300 and 400 mg. Remember that that innocent, healthy-looking chicken breast may have been injected with salt by the manufacturer.
Begin your quest for a lower sodium diet by consciously eliminating processed foods and highly salted fast foods. When choosing grains, for example, skip the “instant rice” box, and take the extra 20 minutes to cook brown rice from scratch and add your own herbs and spices. When selecting brands, frequent those manufacturers who have made an effort to lessen the amount of salt added to their foods. Eat more fresh fruits and vegetables instead of snack foods.
And bottom line – most of us could probably stand to eat less overall. Monitor portion sizes carefully and choose wisely.
Moshfegh AJ, et al "Vital Signs: Food categories contributing the most to sodium consumption -- United States, 2007-2008" MMWR 2012; 61.