Other Books in This Series by Ann Louise Gittleman
Get the Fat Out
Get the Sugar Out
Acknowledgments
Preface: The Facts about Salt and Sodium
Using This Book
CHAPTER 1 Get the Salt Out of Your Kitchen
CHAPTER 2 Get the Salt Out of Your Water
CHAPTER 3 Get the Salt Out of Breakfast
CHAPTER 4 Get the Salt Out of Soups and Salads
CHAPTER 5 Get the Salt Out of Entrees and Side Dishes
CHAPTER 6 Get the Salt Out of Sandwiches and Snacks
CHAPTER 7 Get the Salt Out of Drinks and Party Foods
CHAPTER 8 Get the Salt Out of Baked Goods, Desserts, and Treats
CHAPTER 9 Get the Salt Out When You Eat Out
CHAPTER 10 Get the Salt Out of Your Life
Afterword
Appendix: A Week of Sample Menus
Resources
Bibliography
Permissions
My sincere thanks to Leslie Meredith of Crown Publishers, who commissioned me to do this project in the first place. Also many thanks to Karin Wood and Andrew Stuart, who were extremely helpful in editing and finetuning the manuscript. Thanks to Elizabeth Keeler Love, whose dedicated office assistance made my job that much easier. Many thanks also to Helen Smith for her continual support and to Holly Sollars, whose culinary expertise helped this book immensely. And last but not least, my most grateful appreciation to Melissa Diane Smith, whose talent, devotion, and creativity allowed this book to materialize in its present form.
The Facts about Salt and Sodium
All of us should restrict our intake of common table salt. This is one recommendation on which health experts agree. Every major medical and nutritional organization—from the American Heart Association to the American Medical Association to the United States Department of Agriculture—says the same thing: salt, in the amount we currently consume, seriously jeopardizes our health.
Just how much salt do we consume? According to The Sodium Counter (Pocket Books, 1993), the average Americans salt intake is two to three teaspoons a day. This may not sound like a lot, but it provides 4,000 to 6,000 milligrams of sodium a day—which can be double the Food and Drug Administration’s maximum recommended daily quantity of 2,400 milligrams.
No other mammal eats this much salt, and no other mammal has the health problems we do. High blood pressure, for example, was never even seen in animals until researchers found they could induce it either by surgery or by introducing large amounts of salt into animals’ diets.
If salt added to your food seems like a natural and necessary part of life to you, consider that the human race is about fifty thousand years old and we discovered salt only about six thousand years ago. (Sanskrit, one of the oldest human languages, does not even have a word for salt.) Throughout history, most human cultures have not used salt; the sodium that occurred naturally in their diets provided all they required.
In The Paleolithic Prescription (Harper & Row, 1988), anthropological researchers S. Boyd Eaton, M.D., Marjorie Shostak, and Melvin Konner, Ph.D., point out that our hunter-gatherer ancestors consumed approximately 700 milligrams of sodium a day—the equivalent found in one-third of a teaspoon of salt. While the amount of stress that we experience in our modern-day lives may require us to consume slightly more sodium than our ancestors did, it is clear that today we consume far more than we need.
We unknowingly absorb excessive salt not only from food, but also from an unsuspected source: the salt-softened water in which we bathe. Since the American Heart Association now warns that salt-softened water can cause an elevated sodium level, many health-conscious Americans no longer drink salt-softened water. Few of us, however, realize that we receive a lot of unwanted sodium every time we take a shower or a bath or wash clothes in softened water. Sodium is very efficiently absorbed through the skin, and topically ingested salt has become a common culprit of excess sodium.
The sodium we consume from food and water is only part of the problem. The highly refined nature of common table salt is the other part. Although our bodies are not designed to handle large amounts of sodium, healthy individuals usually can tolerate some excess sodium if it is in a naturally occurring form that our bodies can readily use or excrete. Commercial table salt used in our food and to soften water, however, is the furthest thing from this ideal. During the refining of table salt, natural sea salt or rock salt is stripped of more than sixty trace minerals and essential macro-nutrients, leaving a single chemical compound: sodium chloride. This minerally unbalanced salt is then treated with chemicals such as bleaches, conditioners, and anti-caking agents, rendering a difficult-to-absorb salt that stresses our systems and invariably causes severe health problems.
Most of us already know that excessive salt consumption contributes to the development of high blood pressure, but recent research shows that it is also associated with strokes, migraine headaches, and osteoporosis among other health problems. (For a complete listing of the ailments associated with salt consumption, see the section The Problems with Salt and Sodium in this Preface.)
Some of you might be well aware of the hazards of refined salt and are eager to move on to the tips for reducing your intake. If you are, please understand this: like fat, sodium is misunderstood by the public. Sodium and fat are nutrients we need for health, but not all forms of them are healthy. Refined or common table salt is an unhealthy form of sodium we all should avoid.
If you would like to understand better the vital distinction between sodium and refined salt, keep reading. If, however, you decide to skip the next section and move directly to the tips, I strongly suggest that when you have more time you come back to the crucial following information. Understanding the role sodium plays in the body and the difference between “good” and “bad” sources of sodium will help you get the salt out of your diet while you still meet your sodium needs.
UNDERSTANDING SALT AND
SODIUM
Sodium is essential to life.
Sodium is so important, in fact, that humans have a specific sensor on the tongue that can detect salt. Thousands of years ago, when the diet of humans was potassium-rich and sodium-poor, this sensor for salt was a crucial survival tool. Nature, in her infinite wisdom, devised a way to help humans (as well as animals) seek out salty foods so they could be assured of receiving adequate sodium from their diets. This is important because sodium—often found in the form of sodium chloride or salt—plays countless roles in the body.
To begin with, sodium’ is crucial for maintaining the health of every cell in the human system. It permeates the fluid between cells (often called the “extracellular fluid”) and potassium exists mainly on the inside of the cells (in the “intracellular fluid”). These two minerals need to be in constant dynamic balance so nutrient and waste exchange can take place across cell membranes. If either of these minerals is deficient or in excess, cell permeability becomes compromised and the health of all our cells suffers.
Besides being a component of the extracellular fluid that bathes every living cell, sodium is important in two other “salty oceans” in the body—our blood and our lymphatic fluid. It also is necessary for the production of hydrochloric acid, the digestive enzyme secreted by the stomach in order to digest protein. Along with potassium, sodium is required for the proper functioning of our nerves and the contraction of our muscles. (The heart, as you may know, is our hardest-working muscle.) Finally, sodium is necessary to maintain several kinds of equilibrium—fluid balance, electrolyte balance, and pH (acid/alkaline) balance—which are all of utmost importance to the body.
With the many crucial roles sodium plays, it’s clear tha
t if we had no sodium, we would cease to exist. Obtaining adequate, easily absorbable sodium from foods, then, is important for maintaining health, but obtaining too much of the wrong kinds of sodium is harmful.
To understand why this is true, you first need to understand that humans evolved on a diet that was high in potassium and low in sodium. All unprocessed natural foods—with the exception of just a few kinds of shellfish—contain more potassium than sodium. A diet consisting exclusively of these foods caused our ancestors to consume about ten times more potassium than sodium, and over thousands of years, the human body developed mechanisms so that it could survive and actually thrive under these dietary conditions. Since potassium was abundant at every meal, the human body adapted by learning that it did not need to retain much potassium and could, in a sense, afford to waste it.
Sodium, on the other hand, was a different story. Because the sodium content of the Paleolithic diet was quite low, the human body developed a taste for salt just to ensure adequate sodium intake. In addition, the body became adept at absorbing sodium and conserving every precious milligram it consumed. This function continues today, even though the standard American diet is now low in potassium and exceedingly high in sodium. What once was an evolutionary adaptation that served humans well for tens of thousands of years is now a hazard because we have dramatically changed our diet and, consequently, our intake of these important minerals.
Simply put, the human body evolved to thrive on minimal amounts of sodium and much more potassium than sodium.
Today, however, because we are faced with a growing number of environmental, emotional, and psychological stresses, many of us actually require more sodium than our Paleolithic ancestors consumed. Although few people realize it, sodium plays a key role in our body’s ability to adapt to stress (which I will explain later in this preface in the section How Much Sodium Do We Need?). For that reason, I recommend that most individuals consume about 2,000 milligrams of sodium a day—an amount still far below the typical American’s intake and well within the FDA’s current guidelines. This recommendation is a general rule of thumb; remember that individual requirements vary based on many factors.
As you have read, adequate sodium is tremendously important to our health. Equally as important, however, is the kind of sodium we consume. Just as there are “good” fats and “bad” fats, so, too, there are “good” sodium sources and “bad” sodium sources. As you might guess, sodium that occurs naturally in foods is good, but commercial table salt is bad. It bears repeating that refined salt is a harmful source of sodium that the body needs to detoxify rather than a source the body can readily use.
Commercial refined salt is not only stripped of all its minerals besides sodium and chloride, but it also is heated at such high temperatures that the chemical structure of salt changes. In addition, it is chemically cleaned and bleached and treated with anticaking agents, which prevent salt from mixing with water in the salt container. Unfortunately, the anticaking agents perform the same function in the human body, so refined salt does not dissolve and combine with the water and fluids present in our system. Instead, it builds up in the body and leaves deposits in organs and tissue, causing severe health problems.
Two of the most common anticaking agents used in the mass production of salt are sodium alumino-silicate and alumino-calcium silicate. These are both sources of aluminum, a toxic metal that has been implicated in the development of Alzheimer’s disease and that certainly does not belong in a healthy diet. To make matters worse, the aluminum used in salt production leaves a bitter taste in salt, so manufacturers usually add sugar in the form of dextrose to hide the taste of the aluminum. Refined sugar—as I explained in my previous book, Get the Sugar Out (Harmony Books, 1996)—severely disrupts the equilibrium of the body and is associated with the development of more than sixty diseases.
Whether you consider the minerally unbalanced condition of the salt we use, the anticaking agents that prevent salt from doing some of its most important jobs in the body, or the chemicals and sugar that are added to it, table salt should be avoided because it is, without a doubt, hazardous to human health. The next section will show you just what kinds of health problems refined salt can cause.
THE PROBLEMS WITH
SALT AND SODIUM
Current research is uncovering dozens of connections between disease and excess use of salt, but hypertension remains the most serious, the most prevalent, and the most recognized condition associated with a high intake of salt.
HYPERTENSION Hypertension, which is defined as consistent blood pressure readings above 140/90, affects about one in every four adults, making it the most common medical problem in the United States today. High blood pressure is especially dangerous because it is a “silent killer.” It can cause tissue damage for up to twenty years before any discernible symptoms arise, and all too often, people become aware of their condition only when they suddenly and unexpectedly suffer one of the often life-threatening complications of hypertension:
heart attack
stroke
arteriosclerosis (hardening of the arteries)
serious kidney damage or kidney failure
bleeding in the eyes, impaired sight, or blindness
enlarged heart
congestive heart failure
With devastating consequences like these, we should do everything in our power to prevent or control high blood pressure. Cutting back on salt is one of the easiest things we can do. Over the last fifty years, exhaustive research from both animal studies and human epidemiological studies (those that compare populations and their incidence of disease) support the salt-hypertension connection. Here are some highlights of that research:
No other animal besides man develops high blood pressure in its natural habit. By 1953, however, scientists found that mice, kangaroo rats, albino rats, rabbits, dogs, and cows all develop high blood pressure if they eat a lot of salt.
A recent study involving chimpanzees, the species genetically closest to humans, has provided even more definitive proof that a high intake of salt can cause hypertension. In the results reported in the October 1995 issue of Nature Medicine, chimps ate their typical diet, which is low in sodium, until halfway through the study, when half of them received salt supplements equivalent to the amount of salt consumed by the average human. Shortly thereafter, the blood pressures of the chimps in the test group rose dramatically, but their blood pressures went back to normal when the added salt was removed.
Intersalt, a 1988 international study of more than ten thousand people in thirty-two countries, found that high blood pressure is exceedingly rare in places where the diet is low in sodium. As sodium intakes increase, however, blood pressure readings tend to rise.
The Japanese provide proof of the real-life dangers of too much sodium in the diet. They consume more sodium than the citizens of any other nation in the world: the average intake is 6,000 to 10,000 milligrams of sodium per person per day, and some residents consume as much as 20,000 milligrams. With so much sodium, the Japanese have a hypertension rate that is almost double the hypertension rate in the United States. In addition, their rate of stroke (a common consequence of high blood pressure) is the leading cause of death in their society.
Sensitivity to salt—and the high blood pressure that usually results—is partly hereditary. Not all animals fed a diet high in salt develop hypertension; those who do are often genetically predisposed to the disease. In the late 1950s, though, researcher Lewis K. Dahl found that a diet low in salt could keep rats free of hypertension even in rats that were genetically programmed to develop it
Subsequent studies on humans have shown that lowering sodium intake does not always lower blood pressure in hypertensive patients, but it does so in about half of the people who have the condition.
Part of the problem with identifying the true relationship between sodium and hypertension is that many factors besides sodium play a part in the development of the condition. Other
contributing factors to hypertension include:
Heredity (whether one or both parents had
hypertension or were salt-sensitive)
Being a male or being a female past menopause
Excessive consumption of alcohol
Smoking
Obesity
Lack of physical exercise
Stress
Arteriosclerosis (hardening of the arteries)
Insulin resistance or elevated blood glucose levels
Excessive sugar and nonessential fat intake
Deficiencies of potassium, magnesium, and calcium
The last factor is not understood well by the American public, but it is particularly interesting. Recent research shows that obtaining adequate potassium, magnesium, and calcium may be as significant for blood pressure prevention and control as lowering salt consumption. The typical American diet is as high in sodium as it is low in these other essential nutrients. The Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure now admits that potassium, magnesium, and calcium play a role in reducing the risk of high blood pressure. Numerous studies have revealed that these often-overlooked minerals not only help lower blood pressure but they also prevent heart attacks. Therefore, it is important to realize that while reducing sodium intake is crucial for the prevention and treatment of hypertension (especially for saltsensitive individuals), other dietary and lifestyle factors also need to be considered. The evidence against salt and sodium is certainly convincing enough to warrant a consensus among health organizations and nutrition experts that our intake should be reduced.
CALCIUM DEFICIENCY AND OSTEOPOROSIS Too much dietary sodium also increases the risk for osteoporosis and probably for kidney stones as well. Excess sodium causes calcium to be lost from the body through the urine, and then the blood level of calcium falls. The hormone system then responds to low levels of calcium in the blood by prompting the withdrawal of calcium from the bones. A study reported in the June 1995 Journal of Human Hypertension confirms that when more sodium is ingested than we need, there is a rise in urine hydroxyproline levels—which indicates that bone is being broken down.
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