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Written by Albert C. Goldberg, MD, MS, FAAP, author of Feed Your Body Right. You can learn more on his website.
Salt, or sodium chloride, is one of our oldest food preservatives, used in commercially prepared foods as an inexpensive way to inhibit molds, retard spoilage, and provide smooth texture and quick-cooking properties. It’s also a necessary mineral in our diet.
On food labels, the words sodium, soda, monosodium glutamate, or the chemical symbol for sodium, Na, all signify salt. An infant’s preference for salt does not emerge until four months, but how much is innate and how much is learned remains uncertain—quite unlike our taste for sugar, with which we seem to be inborn*.
Too much salt in childhood is an extreme dietary hazard, and has been linked to the development of hypertension (high blood pressure) in teenagers and adults. A high-salt diet beginning in infancy is a major cause of high blood pressure in adulthood. In a Dutch study, newborns who were fed, in addition to breast milk, formula and foods providing 22mg of sodium a day had lower blood pressures than those fed diets with 58 mg a day. Fifteen years after the study ended, the difference in blood pressure was still there**.
While high blood pressure seems to run in some families genetically, lots of sodium helps encourage this undesirable family trait. Whether or not there is any history of high blood pressure or stroke in your family, I recommend you limit your child’s sodium intake—and your own.
The amount of sodium in a diet should approximate a ratio of sodium in milligrams (mg) to the amount of calories in your diet. In other words, a 700-calorie diet should have sodium limited to about 700mg while a 2000-calorie diet should limit sodium intake to 2000mg or two grams.
Avoid foods with more than 350 mg of sodium per serving. The right amount of sodium needed by children through adulthood can be found naturally in fresh vegetables, grains, meats, poultry, and fish. But in fact, many children consume over 5000 mg of sodium daily. Adults often consume from 10,000 to 12,000 milligrams daily between what’s natural in the food, what the food industry has added to the food, and what we add ourselves from the salt shaker in the kitchen and at the table!
Speaking of the Food industry, there have been a few studies, mostly subsidized by the Food Industry, claiming that the effect of sodium as a cause of high blood pressure has been greatly exaggerated.
The researchers are from reputable universities, but these seriously flawed
studies have been very short term. Totally ignored in these studies are
infants, children, and young adults. Newspapers, magazines, and “health
journals” have been complicit in publishing outrageous distortions under
headlines suggesting salt should be used more liberally and that our prior
understanding of salt or sodium is now, can you believe this, “obsolete
dogma.” No wonder most people are confused when presented with such
misinformation. Chefs from major restaurants are already featuring dishes “enhanced with flavors from exotic healthy salts.”
I have actually heard many pediatricians say, “Don’t worry about salt or sodium, it is an important part of the diet.” Then they cite only rare salt-losing diseases such as Addison’s disease, cystic fibrosis, or another rare problem found in some children and teenagers who suffer from fainting due to low blood pressure.
This nutritional perversion does not negate the truth of salt producing hypertension. This is what the Food Industry is promoting so effectively.
High blood pressure is a serious matter. What a child eats sets the stage for high blood pressure later in life. It can eventually lead to heart failure, a condition where the heart gets larger and weaker and is less able to pump blood. High blood pressure (hypertension) can also lead to aneurisms. Aneurisms are small blister-like areas in the blood vessels of the brain (leading to a stroke) or the aorta, which can burst (dissecting aortic artery), causing sudden rapid death or permanent disability.
Kidney failure is another result of high blood pressure. As blood vessels
in the kidney narrow, they are less able to supply the kidney with blood.
This could lead to permanent kidney damage. Hypertension also speeds
the hardening of arteries. Healthy arteries are elastic. When the arteries
to the brain, heart, and other organs in the body become less elastic or
hard, they are less able to carry blood and the result is early aging or
premature death of these organs.
A stroke is a “brain attack” and its mechanism is similar to a “heart at-
tack.” Blood to the brain either becomes blocked (the most common type)
and is referred to as an “ischemic stroke,” or bursts and is referred to as
a “hemorrhagic stroke.” In both cases, damage to the brain is caused by
lack of oxygen and blood glucose. Oxygen and glucose (sugar) are essential nutrients carried to the brain by blood vessels. Brain cells quickly begin to die without these nutrients.
The results may be impaired speech if the brain cells in the speech center die; paralysis of the arms or legs if the motor brain cells die; blindness if the vision center brain cells die; or coma and death if the stroke is severe enough to cause the death of enough vital brain cells. A diet low in sodium, saturated fat, and added sugar, plus regular exercise greatly reduces the risk of stroke. Although
stroke is usually an event that occurs in adulthood, its roots (poor food
choices and exercise habits) are developed during childhood.
When selecting a food, note the amount of calories. Then check the label for sodium content. If the sodium content in milligrams is far above the number of calories, search the shelves for a brand that contains less salt. There are many canned soups available now that have a reduced or low salt counterpart. Bread and cheese are very high salt foods. Check the labels—you’ll be surprised. Take time out one day to calculate how much salt you actually consume in a day. The figure may be shocking!
For most Americans, 10% of the sodium in their diet occurs naturally in food, 15% comes from the salt they shake on while cooking or at the table, and 75% is added to food during processing. A bowl of canned chicken noodle soup can deliver 900 mg of sodium—for a child, that’s over a day’s worth of sodium and that’s why it’s so important to check the Nutrition Facts label.
Children in a nationally representative sample consumed an average of 3,387 mgs of sodium per day, more than double the upper limit of 1500 mgs recommended.
The Recommended Dietary Allowance (RDA) of sodium for healthy adults is 2,300 mg daily. That is equivalent to one teaspoon (6375mg) of salt a day. The children’s RDA for sodium are the following:
Ages 2–3 are 1000 mgs
Ages 4–8 are 1200 mgs
Ages 9–18 are 1500 mgs
If you can save your child from the habit of craving a relatively high salt diet, you may save him or her from future heart disease or stroke, or an earlier death. I personally know many middle-aged men and women who ignored this advice and have suffered possibly preventable brain-damaging strokes.
A cup of cottage cheese, a small bag of pretzels, and a salad with Italian dressing contains more than the adult recommended daily limit of sodium—2400 mg! A glass serving of Campbell’s 100% tomato juice contains 980 mg of sodium and the parmesan cheese sprinkled on top of the pasta dinner adds about 500 mg.
Improve your odds by modifying your own salt intake. The following is a five-step program for the gradual reduction of salt in your family’s diet. It takes most adults about a year to withdraw from the salt craving.
Go slowly and you won’t feel deprived. It will take the children much less time, but in either case it’s a minor and brief deprivation in the big scheme of things, and worth it.
1. Empty the salt from the shaker on the table and refill with a non-
sodium herbal substitute.
2. Gradually use less salt in cooking—don’t use it at all in cooking
water. Start with half the salt a recipe calls for. After a few months, omit
salt from cooking entirely.
3. Notice sodium content on food labels. Decrease your sodium
intake to below 2,300 milligrams if you are an adult, or less if you are
younger (refer to the RDA above). Remember: if you consume 2,000
calories a day, your sodium intake should equal 2,000mg or less per day.
This is an easy “rule of thumb” to remember. Calories per day=Milligrams
of sodium per day. Canned foods are very high in sodium (unless specifi-
cally stated as, “reduced sodium, low sodium or no salt added”), followed
by frozen foods, but some fresh foods are too—like tomato and celery—
therefore don’t add salt to such dishes. Stop buying canned soups! These
are “hypertension in a can.” Eat fresh fruit daily to supply much needed
potassium to balance your sodium intake.
4. Don’t keep highly salted foods in the house. Avoid the temptation
of buying high sodium crackers, chips, salted nuts, bacon, sausages,
lunch meats, dehydrated soups, tomato or V-8 juice, most canned soups,
pickles, relishes, barbecue sauces, lox, herring, many processed cheeses
and especially cheddar cheeses, or Jell-O. Treat yourself to such foods
only on special occasions in small amounts, when you’re away from
home or at a Super Bowl party.
5. In a year’s time you won’t believe how different foods taste or that
you ever purposefully put salt on your corn on the cob! Restaurant food may
seem very salty, unless you ask the chef to use very little salt and no MSG.
There are other measures that help control hypertension. Exercise
regularly; make this a daily routine and keep it a part of your lifestyle as
you do with brushing your teeth. Lose weight and keep it off by eating
smaller portions. You may need to take medication for the rest of your life
to keep your blood pressure in a safe range. Do not despair! The earlier
you begin these lifestyle changes, the better chance those future “Golden
Years” will have to become truly Golden.