Taste first! Take this quiz to see how much you know about salt

The World Health Organization, (WHO) based on peer-reviewed research and in concert with health experts throughout the world, writes that an estimated 2.5 million deaths could be prevented yearly if global salt consumption were limited to the recommended 2,000 mg daily.
Cultures across the globe have adopted the Standard American Diet (SAD) and the number one cause of death is consistently heart disease and stroke.
Here in Ecuador, it is no different. ‘Non-communicable diseases’ including hypertension and cardiovascular disease affect up to 40 percent of adults in Latin America and the Caribbean — 50 percent who are undiagnosed and untreated.

The Standard American Diet (SAD) is taking over the world.

We all need a certain amount of sodium — to balance fluids, transmit nerve impulses, contract and relax muscles, and regulate the flow of other fluids and substances into and out of cells. But too much sodium stresses the kidneys and contributes to high blood pressure, the leading cause of stroke, heart attack, heart failure, kidney disease, and more.

So, how to take charge of your diet and live a healthier life without sacrificing taste?

First: What’s your Na+ IQ? Answer these five questions — answers below. No peeking!

1. True or False: Salt and sodium are the same.
2. The minimum amount of sodium for most adults to stay healthy is 500 mg. Most Americans (and consumers of Western diets) consume on average per day:
   • More than 3,500 mg
   • More than 2,300 mg
   • About 1,500 mg
   • Less than 1,000 mg
3. Manufacturers use salt in foods as a:
   • Preservative
   • Flavor-enhancer
   • Binder
   • Color enhancer
   • All of the above.
4. Excess sodium in the blood can lead to high blood pressure because:
   • Sodium decreases blood volume
   • Sodium increases blood volume
5. We get most of the sodium in our diet from:
   • What we add during cooking
   • From the salt shaker at the table
   • From processed foods
   • Foods that naturally contain sodium

Answers:

1. True…and false — sodium is a component of what we know as “table salt.” Salt is composed of two minerals sodium (Na) and chloride (Cl): table salt is 40 percent sodium and 60 percent chloride. When reading the Nutrition Facts food label, “sodium” is listed because the sodium portion of the salt is what’s relevant for health.
2. According to the World Health Organization, most people consume on average 3,600 mg – 4,800 mg of sodium daily (9-12 grams of salt), more than double the recommended maximum intake.
3. All of the above. According to the Centers for Disease Control (CDC) more than 40 percent of the sodium we eat daily comes from only 10 types of foods! The top sources are:
   • Breads and rolls
   • Pizza
   • Sandwiches
   • Cold cuts and cured meats
   • Soups
   • Savory snacks: Chips, popcorn, pretzels, snack mixes, and crackers
   • Chicken
   • Cheese
   • Eggs and omelets
   • Medications including antacids (sodium bicarbonate) are often hidden sources of added sodium.
4. Sodium increases blood volume. Excessive serum (blood) sodium attracts and retains water, increasing the blood volume. This makes the heart pump harder to circulate the increased volume of blood around the body, increasing strain on blood vessels and boosting blood pressure to unhealthful levels. The American Heart Association also explains that sodium can affect blood pressure even more dramatically if you’re “salt sensitive”: factors such as age, weight, race/ethnicity, gender, and some medical conditions like diabetes or chronic kidney disease can influence how your body deals with excessive sodium in your diet.
5. Processed foods! By far! Most of the salt in our diet comes from processed foods, followed by restaurant foods. Only 15 percent of the salt we consume is added during home cooking or at your own hand, at the table. Only 10 percent occurs naturally in food — foods like beets, celery, chicken breast all contain sodium naturally. But it’s the packaged and processed foods that contribute the most, foods like bread, breakfast cereals, and bakery products; cold cuts and cured meats; and restaurant foods. Read more here.

Can eating more potassium make up for too much sodium?
Besides consuming excessive sodium, we consume insufficient potassium, and studies show that people who consume a lot of salt and very little potassium are more than twice as likely to die from a heart attack as those who ate about equal amounts of both nutrients. Potassium regulates fluid balance and the electrical activity of the heart and other muscles. Low potassium intake is linked to high blood pressure and heart disease.

And we’re slackers! Junk food junkies don’t get even close to eating the recommended 4,700 mg of potassium a day — less than two percent of people in the U.S. achieve this intake.

It is easy to eat more potassium!  And not from supplements. The main source of dietary potassium is from fruits and vegetables.

Diets high in natural sources of potassium are associated with better blood pressure control. In the DASH (Dietary Approaches to Stop Hypertension) diet trials, participants with high blood pressure who consumed an average of eight to 10 total servings of fresh fruits and vegetables per day experienced significant drops in their blood pressure level.

As noted in Harvard Health: For people with kidney problems, loading up on potassium may do harm. Do not take potassium supplements without consulting with your doctor: overly high blood levels of potassium can lead to dangerous irregular heart rhythms.

Make these high potassium foods a staple of your everyday diet

Where is the potassium in your diet?
When you think “potassium”, do you think “banana”? Bananas are good sources of potassium – about 422 mg in a medium-sized one, however, there are plenty of other sources, readily available at mercados and supermercados all around Cuenca.

Other high-potassium foods include:

White beans (829 mg of potassium per cup or 18 percent of the recommended daily intake) and legumes (760 mg). Both are also a very good source of fiber, thiamine, folate, iron, magnesium, and manganese.

Potatoes and sweet potatoes: Much of the potassium is found in the skin, so scrub and bake or roast. Potatoes are also a good source of vitamins C, B6, and manganese.

Beets: Besides potassium, beets are also rich in folate and manganese. Betalain (beet’s red pigment) acts as a potent antioxidant.

Parsnips: A white root vegetable like carrots, parsnips are rich in potassium and vitamin C and folate too.

Spinach and Swiss chard: Both are potent sources of vitamins A, K, and minerals calcium and manganese.

Tomatoes and more: Tomatoes and tomato sauce and paste are good sources of potassium, vitamins A, C, E, B6, and copper. Tomatoes are rich in lycopene, an antioxidant. Check out this easy tomato sauce recipe from TheKitchn.com.

Oranges and orange juice: Also rich in vitamin C, one whole orange has 179 mg of potassium and a cup of juice 496 mg.

Bananas: A medium banana has 422 mg of potassium, or 12 percent of the RDI and provides a good source of vitamins C, B6, minerals manganese and magnesium. Bananas are high in fiber (like most whole fruit) and antioxidants.

Other good potassium sources are nuts (180 mg per oz.), cabbage (167 mg per cup raw) and fruits such as papaya (one cup of 1” pieces has 264 mg). A cup of unsweetened coconut water (so freely available throughout Ecuador) has 600 mg. Read more about potassium in the World’s Healthiest Foods here.

We eat food, not nutrients. Focus on the big picture
As I mentioned, the sodium part of salt is absolutely essential — it’s an electrolyte that plays many important roles in our body’s chemistry — in water retention, muscle contraction, and enzyme activation, for starters.

However global consumption is staggeringly high. Excessive sodium in the diet can boost blood pressure into the unhealthy range, and lead to strokes, heart attacks, kidney disease, stomach cancer, osteoporosis, and other conditions.

Of course, it is possible to become deficient in sodium, but it’s highly unlikely unless you’re working out in high heat for a long time and sweating profusely. Some extreme athletes like marathoners can lose from 700 to 1,600 milligrams of sodium in just an hour!

This is why competitive athletes and sports teams typically have a Registered Dietitian/Nutritionist with advanced training in sports nutrition on staff. The Commission on Dietetic Registration awards a Board Certification in Sports Dietetics (CSDD). CSDDs are experts that provide effective and evidence-based nutrition services for health, fitness, and athletic performance.

Take charge of your ingredients — and remember, if you’re not making it, it’s salted.
Processed and restaurant foods supply 75 percent of the sodium in most people’s diets. A good example is a commercial pizza — just two slices of Papa John’s Original Crust Pizza with Cheese has 1520 mg of sodium, 64% of your daily recommended value (DV) for sodium. Why so high? The dough, the cheese, and the canned tomato sauce are all made with a lot of salt.

Make your own pizza! You don’t need a special mixer, or a special oven, or even a special pan.
Write to me for the recipe … I’m happy to share.  susanthedietitian@gmail.com

That’s “dietitian” spelled with two ‘t’s.

• Be a label sleuth — all packaged foods carry the Nutrition Facts panel and lists sodium per serving in milligrams (mg). Make high-sodium foods an occasional treat, and balance with fresh for flavor and health.
• Ecuador packages carry “traffic light” symbols on the front of the package — alta en sodio means high in sodium. Baking soda, “soda”, sodium bicarbonate, sodium nitrate, monosodium glutamate, or ‘Na’ all indicate added sodium.
• Fresh is best: Focus on naturally low-sodium, rich-in-potassium fresh fruits and vegetables, beans, and legumes. If using canned, drain and rinse to eliminate extra salt — a good idea for all canned foods. Fresh meats and fish contain little sodium. Dairy contains some sodium naturally, and cheese can have lots of added salt, but in the context of a menu full of other fresh foods, these foods fit.
• First taste your food! Are you the type who salts before tasting? Salt is an acquired taste and to overcome your expectations, it takes a deliberate effort. The more frequently you eat salted food, the more you expect it.
  • Start by reducing packaged and restaurant foods.
  • Cook with less salt but increase the flavor of food with herbs and spices, vinegar and lemon juice.
  • Taste the food before seasoning, then use high quality, highly flavored sea salt or other unrefined salts, just to flavor.

The AHA offers this quick reference to understand approximately how much sodium is in a given amount of table salt:

• 1/4 teaspoon salt = 575 mg sodium
• 1/2 teaspoon salt = 1,150 mg sodium
• 3/4 teaspoon salt = 1,725 mg sodium
• 1 teaspoon salt = 2,300 mg sodium

Sources:
American Heart Association. Get the scoop on sodium and salt.
American Heart Association. Top 25 foods that add the most sodium to your diet.
CDC.gov. Top 10 Sources of Sodium
Harvard Health. Potassium lowers blood pressure.
Harvard Health. Everyday foods are top 10 sources of sodium.
Healthline.com. 14 healthy foods that are high in potassium.
Mayo Clinic. DASH diet: healthy eating to lower your blood pressure.
The World’s Healthiest Foods. Potassium.
World Action On Salt and Health. Salt in the News 2018
World Health Organization. Salt Reduction.
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Food, Nutrition, and Your Health columnist Susan Burke March moved to Cuenca after 35 years as a Registered and Licensed Dietitian and Certified Diabetes Educator in the United States. She currently serves as the Country Representative from Ecuador for the Academy of Nutrition and Dietetics. 

Susan helps people attain better weight and health, and reduce the risk of heart disease, diabetes, and other conditions that can be improved with smart lifestyle modifications.

Susan is offering “Free” 20-minute consultations for just a $15 (or more – your choice!) donation to one of the important foundations here in Cuenca. It’s a perfect time to address issues such as cooking at home, strategies for weight loss, or boosting your immunity by improving your diet.

Contact her at SusantheDietitian@gmail.com