Shaking Up Salt

Rachel Johnson, R.D., Ph.D., M.P.H.

Can we live with the low-sodium guidelines? Can we live well without them?

We stood amidst the bustle and riotous colors of a Seoul outdoor marketplace, surrounded by mountains of exotic fruits, unfamiliar vegetables and vats of spicy, pickled cabbage known as kimchi. Our guide, a young nutrition professor named Jayong, politely asked my husband and me if we would like to go to McDonald’s for a hamburger. As graciously as possible, we said we would much prefer to try local fare. Visibly relieved, Jayong took us to one of her favorite spots, where we sat cross-legged at a low table and ordered pibimbap. A piping hot, heavy iron pot appeared, filled with rice and topped with vegetables and a raw egg. Jayong showed us how to use chopsticks to stir and cook the egg in the hot pot and then add condiments—the wildly popular kimchi among them—to suit our own tastes.

Although we had avoided the American fast-food meal notorious for its high sodium and saturated-fat content, our typical Korean meal, filled with fresh vegetables and rooted in centuries-old tradition, carried its own health challenges. Hypertension and stroke are major killers in Korea, and the beloved kimchi can take some of the blame, along with fermented soy sauce, soybean paste and chile paste, all contributing to a national diet extraordinarily high in sodium.

I gasped when I learned that one of Korea’s public health goals is to reduce the average salt intake by at least 40 percent—to 4,000 milligrams (mg) of sodium per day. To put this in perspective, 4,000 mg is the current average intake of sodium in the U.S., and that number is widely regarded as perilously high. Sodium is a major culprit in the growing epidemic of high blood pressure in our country, with one in five adults believed to have borderline or prehypertension and more than two-thirds of Americans over the age of 65 diagnosed with high blood pressure. This in turn contributes to heart disease and strokes, the number one and number three killers in our society.

Like the Koreans, we are in trouble with salt, and consumers are about to start hearing even more warnings about their sodium intake: the National Academy of Sciences recently declared that, for optimal health, Americans should aim for no more than 1,500 mg of sodium per day—down from the former limit of 2,400 mg and drastically lower than our actual consumption.

The new guideline has caused an uproar among dietitians, especially those who work with patients to construct realistic diets using available foods. They point to restaurant meals that deliver more than a full day’s sodium in a single sitting—a Burger King Chicken Whopper Sandwich with large fries, for example, contains a massive 2,350 mg. And in the supermarket, sodium abounds in canned soup, cold cuts, many vegetable juices, spaghetti sauce, ketchup, chips, pretzels, popcorn, pickles and relish. Given all this hidden salt, many dietitians are skeptical about most people’s ability to comply with the 1,500-mg limit. Without major changes in the food supply, they ask, how can they steer patients toward success?