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Kym Sosolik of Dallas was just 43, but already her doctor was sounding alarm bells. She was 50 pounds overweight and her blood pressure was a sky-high 190/102. She dutifully took the drugs he prescribed, but her pressure only dropped to 140/92 . Even after she lost 20 pounds by exercising two to three times a week and eating better, her blood pressure was still above normal.
So last year Sosolik hired a personal trainer for an exercise and lifestyle overhaul. Among other things, he suggested she try cutting back on sodium. "I thought I had," she says. "I'd stopped salting my food."
Then she checked the label on the turkey in her lunchtime wrap: 380 milligrams of sodium. "I was shocked to find that much sodium in two slices of turkey," she says. And two flavored rice cakes, her supposedly safe diet snack, turned out to have more than 200 milligrams.
Sosolik had run up against one of the nation's most overlooked nutritional traps: salt you never see. Though adults are supposed to eat no more than 2,300 milligrams a day (around a teaspoon of table salt), according to the Department of Health and Human Services they get more than 3,400. Americans' sodium intake rose 55 percent between the early 1970s and 2000 and shows no sign of falling. The vast majority of that sodium -- close to 80 percent -- is hidden inside processed and restaurant foods. You don't notice it, you may not even taste it, but it can undermine your health.
Doctors worry most about the 73 million Americans (more than half of them women) who already have high blood pressure, as well as the countless more on the cusp of developing it who could be pushed over the edge by eating too much salt. In 2007 the American Medical Association called reducing sodium consumption an "urgent" public health need. Just this March, researchers from the University of California, San Francisco, concluded that if Americans cut just 40 milligrams of sodium per day, about 250,000 fewer cases of heart disease would occur over the next decade.
Even if your blood pressure isn't hypertension high, it may be higher than it should be because of the salt in your diet, says Linda Van Horn, PhD, of Northwestern University's Feinberg School of Medicine. Scientists have found that even people who don't have high blood pressure may reduce their risk of heart disease by eating less sodium. And when Harvard Medical School studied what happened when people with scores only on the high side of normal cut back, their risk of cardiovascular disease decreased by 25 percent, says associate professor Nancy Cook, ScD.
Based on such findings, in January 2009 the New York City health commissioner began an initiative to pressure the food industry and restaurant chains to use less sodium (the city had already banned trans fats). In the United Kingdom, government health authorities have printed salt content on food packaging since 2004, using color-coded labels (stoplight red is high salt; yellow is medium; green, low). Some U.S. physician groups want similar labels here.
Industry reps respond that sodium content is clearly listed on products and that more products come in low-sodium versions. "Total diet over time matters more than the sodium content of a single food," adds Robert Earl, MPh, RD, vice president of science policy for nutrition and health at the Grocery Manufacturers Association.
To escape from salt, you have to rethink how you cook and take the time to check food labels. A couple of tablespoons of soy sauce will add almost an entire day's sodium to your stir-fry, explains Marisa Moore, RD, of Atlanta, spokesperson for the American Dietetic Association. And some salad dressings deliver as much as 300 milligrams of sodium in a single serving. Try these simple ways to remake your diet.
Choose frozen (or fresh) over canned vegetables.
Sodium is used in canned foods to enhance taste and to act as a preservative. A can of sweet peas has close to 400 milligrams of sodium, but fresh and some brands of frozen peas have little or none. If you do use canned, buy those labeled "less sodium" or rinse the contents before heating to remove some salt.
Think outside the box.
Prepackaged rice and pasta mixes are often swimming in sodium. Since you have to boil the noodles anyway, "You're better off sprinkling parmesan and a little olive oil on your own pasta than using that box," says dietitian and anesthesiologist Christine Gerbstadt, MD, RD, of Sarasota, Florida. Other good flavor boosters? Herbs and spices, wine, balsamic vinegar, and real (not cooking) sherry. If your family insists on the mix, use just half the seasoning packet.
Only salt the surface.
Cook your meal salt-free, then lightly sprinkle salt where you can easily taste it -- on top of your cooked food. You'll get enough to please your palate but much less than if you cooked with salt.
Ketchup or mustard that doesn't taste salty can be loaded with sodium. Added sugar or other flavors may mask the salt. Check labels: A serving of honey mustard may have 5 milligrams of sodium -- or 300.
Eat foods high in potassium.
While sodium can raise blood pressure, potassium lowers it. The average American woman gets just 2,300 or so daily milligrams of potassium but needs 4,700. As low potassium contributes to sodium retention, a deficit may put you at risk for high blood pressure. Fight back with fruits, veggies, and other foods naturally high in potassium. Supplements are not good substitutes since they don't have the same effect and can cause nausea and diarrhea.
Cutting way back on processed foods -- plus spending three days a week with the trainer -- finally brought Kym Sosolik's blood pressure down to 117/63, normal at last. She's also been able to go from taking three blood-pressure drugs to just one and is working to whittle her weight further.
Her low-salt diet should help, as other women are also finding. Tucson mother of two Nanette Morrow lost 40 pounds after weaning herself off sodium. She had a heart attack in 2007 at the shockingly young age of 36. Afterwards her doctor insisted she reduce her sodium. She cut back on processed and restaurant foods and she and her family turned to healthier alternatives, which also happened to have fewer calories and less fat.
And while Morrow's taste buds initially craved salt, she says her palate retrained itself after a few weeks. This is common, explains Dr. Van Horn. People who go on lower-salt diets for research studies often find they can't go back to their old foods. "Craving salt is a learned behavior," she says.
That has been Morrow's experience. Foods that seemed fine now taste salty. When she does use salt, she can get by with a light sprinkle. "I don't miss it," she says. Chances are, you won't either. But your heart will notice.
Originally published in Ladies' Home Journal, August 2009.