Salt Wars: Why America Should Start Cutting Back on Sodium STAT

Public Health Icon Puts an End to the Battle with New Definitive Book

Tom Rifai, MD, FACP
Salt Wars: The Battle Over the Biggest Killer in the American Diet by Michael F. Jacobson book sleeve

If you want to know why we should be cutting back on sodium for our health, a new book by Dr. Michael Jacobson, co-founder of the Center for Science in the Public Interest, puts it all together. “SALT WARS: The Battle Over the Biggest Killer in the American Diet” offers a paleo historical perspective, a look at modern science and public (or lack of) policy, controversies surrounding sodium, where it can be found, tips on how to start cutting back on sodium, salt-free seasonings, truths about “sexy salts” and more. SALT WARS is readable, down to earth and comprehensive. If you want to put any questions of “salt” to rest in your mind, read this book.

I recently interviewed Dr. Jacobson to ask him more about SALT WARS:

Video of Dr. Tom Rifai on right interviewing Dr. Michael Jacobson on left about Dr. Jacobson's new book, "Salt Wars."

Here are some topics SALT WARS covers:

Is a High Sodium Diet Healthy?

For hundreds of thousands of years, until maybe around 5000 years ago, no salt was added to our foods. People’s natural sodium intake was less than 1000mg/day, because there is natural sodium in foods. Of course, we do need some sodium. But we were able to survive on under 1000mg/day of salt for millennia. So for someone to argue we need more than that intake/day, they must believe that we need to process food with sodium to be healthy. Does that even make sense?

Hypertension, or high blood pressure, is the absolute number one metabolic risk factor for early mortality in this country, and cutting back on sodium in our food (and even some beverages) is a critical aspect of controlling hypertension.

Powerful, Drug-Free Way to Lower Blood Pressure

My clinical experience is very consistent with respected studies (including the NIH Dietary Approaches to Stop Hypertension – DASH – trials) and known physiology of sodium in raising blood pressure. In a very practical sense, one of the most powerful ways people are able to lower – or avoid – needing prescription blood pressure medications includes lowering their sodium intake. They can increase the positive effects of cutting back on sodium intake by increasing their dietary potassium intake (think lots of whole fruits and no-salt-added vegetables, people…mix some no- to light-sodium beans and lentils in there too!), which helps block the effects of sodium to some degree and helps keep blood vessels from getting “stiff.”

The combination of cutting back on sodium (from our US average of over 3400 mg/day!…well over the 2300mg noted on US Nutrition Facts labels as our recommended daily limit, let alone the <1500 mg that The American Heart Association and Pritikin recommend) while increasing potassium, plus engaging in regular physical activity, has been remarkable for my patients at lowering blood pressure. Add losing even a modest amount excess weight and “Voila!” something akin to a “magic medicine” (aka lifestyle medicine taken to heart!) occurs. Of course, talk with your doctor first before beginning any major changes in food intake or physical activity because, I’m not kidding, as one of my “skeptic-turned-convert” ex-military patients once told me: “this lifestyle sh*t REALLY works!”

Tips to Cutting Back on Sodium and Lowering Your Salt Intake

If you’re really attached to salt in your food, it can be daunting to think you have to lower your sodium intake. Small goals help. Cutting down on salt by just 10-15% (~500mg), we begin to see an improvement on a population level. And good news! Our taste buds WILL adjust.

Here are some tips to help you cut back on your sodium intake:

• Be realistic:

If you like salt that much, find areas where you’re willing to negotiate a lesser salt intake. For example, consider cooking without any salt. Then do two things:

  1. Enhance your foods’ flavor with spices and herbs like Dr. Jacobson discusses in his book.
  2. Then, as needed and carefully, try sprinkling a sodium/potassium salt blend to the top of your already-cooked meal as needed to “just enough” (tip: I dial the top of my Morton Lite Salt shaker so that only one or two of the many holes available are open). Notably, “Sea Salt” and other “sexy salts” are poor sources of iodine whereas Morton Lite Salt still has the added iodine.

• When dining out:

Favor scratch cooking restaurants and then ask your server if their chef can cook your meal with no salt added wherever possible. Then, taste the food first before adding a sprinkle of the salt at the table, if needed. Remember: your taste buds ARE adjusting to less salt and you will actually want less salt over time. Put a little salt on your palm instead of shaking directly from the shaker and sprinkle it on top of your foods from there.

• Dilution is the Solution:

Blend store- or restaurant-bought items with flavor-compatible, no-salt-added items from home. For instance, mixing your favorite hummus with an equal serving size amount of no-salt-added chickpeas and stirring them together cuts sodium, increases potassium, increases fiber, and all for fewer calories than straight hummus.
  • When cooking recipes, use the Morton Lite or Lo Salt rather than straight sodium salt (Lo Salt is another brand option with even more potassium salt than sodium salt) and use for example a quarter of a teaspoon rather than a half teaspoon in the recipe;
  • Instead of pouring dressing on your salad, use the “fork dip” method. Dip your fork in your salad dressing and skewer a whole bunch of salad, rather than dumping the dressing on top of the salad;
  • Here’s another “dilution is the solution tip”: a 50:50 mix of no salt added low-fat cottage cheese (brand-name Friendship) and your favorite low fat cottage cheese mixed together.

Once you’re committed to why it’s so important, you will discover more very easy ways to cut down on your sodium intake. And that’s where Dr. Jacobson’s SALT WARS plays a significant role: when you read the argument for cutting sodium, you will even enjoy food more because you won’t be so overwhelmed with salt. The other flavors will have a chance to come out.

BOTTOM LINE: Shave Salt to Save Life

You can add quality and longevity to your life by reducing your blood pressure. You can reduce your blood pressure by cutting back on sodium, increasing potassium and physical activity as well as, for many of us, shedding a few unneeded pounds. Eating healthier, minimally and unprocessed foods that get us full on less calories (and high-fiber foods that also contain little sodium and lots of potassium as well as a lot of natural or cooked-in water weight, like whole fruits, vegetables, beans, lentils and peas) is the ultimate in “food as medicine!”

Dr. Jacobson’s SALT WARS is a great book to help guide you with all of it, especially the stealth sodium part, which is worth your while to really understand. And again, lifestyle is powerful medicine so don’t forget to check with your doctor before starting any new eating plan or activity regimen.

To get ongoing nutrition information in the same spirit as SALT WARS, consider subscribing to The Nutrition Action Health Letter, an advertisement-free publication from the nonprofit Center for Science in the Public Interest. As a bonus to its great content, each of the 10 issues per year has great, light sodium recipes from Chef Kate Sherwood (and you can easily switch the salt in the recipes to Morton Lite salt or Lo Salt). Hope that helps you find where Reality Meets Science.®