Do You Need to Eat Less Sodium?
Has your doctor advised you to eat less sodium or salt? You might wonder: How will food taste good again? What should I do next? What if it is too hard to change how I eat?
These are the concerns that my patients bring to me regularly. Often they come feeling overwhelmed and unsure if they can even do anything different than what they already do. They don't know where to start. These tips for eating less sodium can help you make the change.
Sodium and Heart Failure
In heart failure, the heart is not as strong as it once was, and it does not pump the blood through the body as efficiently. A higher sodium intake leads to more sodium in the blood. The body compensates by holding on to extra fluid to help dilute the blood back to the original concentration. This higher blood volume puts more stress on a heart that already is not working as efficiently.
Sodium and High Blood Pressure
High blood pressure, also called hypertension, is when the force of the blood flowing through the blood vessels is too high. This can be caused by stiffening of the vessels from buildup of cholesterol plaques on the vessel walls. Other factors such as kidney issues and genetics can lead to high blood pressure. Excess sodium intake, which pulls more fluid into the bloodstream, puts more pressure on the blood vessels, which leads to high blood pressure.
What is Sodium
Sodium, commonly known as salt, is a mineral that is found in many foods. It is an essential nutrient--our bodies require it to function. Sodium is involved in fluid balance, maintaining homeostasis, muscle movement, and nerve function.
Sodium in Foods
Foods That are High in Sodium
Besides for the salt that we add to food ourselves, there are many foods that already have salt when we purchase them. Here are some foods that tend to be high in sodium.
condiments such as sauces, marinades, and dressings
spice mixes
frozen meals or TV dinners
canned meals such as canned meats and canned soups
instant soups
fast food including burgers, pizza, fries, sandwiches, and burritos
snack foods such as potato chips, pretzels, and salted nuts
processed meats such as salami, bologna, bacon, and sausage
A common theme amongst these foods is that they are all processed or prepared foods. Food manufacturers add sodium to help preserve the food and to increase palatability and likelihood you will come back to purchase more. The more processed the food, the more likely it is to have a higher sodium content.
Foods That are Low in Sodium
In general, simple, short ingredient list foods tend to be lower in sodium. Here are examples of low sodium foods.
raw fruits and vegetables
frozen fruits and vegetables
dried fruits, nuts, and seeds
grains such as oats, barley, quinoa, rice, and corn
dried legumes such as beans, chickpeas, and lentils
fresh or frozen poultry, meat, or pork
Food Preparation and Sodium Content: Tips for Eating Less Sodium
Once we bring our raw ingredients home and start preparing them is when their sodium content changes. Typically, we add salt to enhance the flavor of our meals. While avoiding salt completely is not necessary, learning other flavoring options can help minimize how much salt we add
Try New Condiments to Use Less Sodium
In the grocery store, look at various options of condiments and compare to choose a lower sodium option. You can find lower sodium BBQ sauce, marinades, soy sauce, salad dressing, spice mixes, tomato sauce, and hot sauce. Sometimes it will take experimenting with a few different options until you find one that appeals to your taste preference.
Expand Your Palate With New Spices, Herbs, and Flavors to Flavor Without Sodium
Look for spices, herbs, and flavors that you rarely use. Experiment with cuisine that uses spices and flavors you are not familiar with. Check your library to find cookbooks to guide your experimenting. Here are some great options for flavor.
cumin
bay leaf
mint
rosemary
coriander
nutmeg
za'atar
oregano
mace
curry powder
ginger
cayenne powder
citrus
turnip
parsnip
horseradish
Experiment With Different Food Preparation Methods to Vary Flavor With Less Sodium
Flavor is added to food from how it is combined and cooked. Roasting vegetables intensifies flavor. Stir frying adds a unique texture. The marks on food from grilling enhances visual appeal. Combining a crunchy topping to a softer food boosts the complexity of the mouthfeel. Tossing foods of various colors in a dish increases visual interest. Adding contrasting flavors to a single food improves the taste experience. Using aromatic herbs gives an enjoyable fragrance. These methods build on the enjoyment of the sensations of eating with taste, mouthfeel, visual appeal, and scent.
How to Approach the Change: Tips for Eating Less Sodium
For many people, the mental aspects of a change is harder than the practical aspects. You know all the high sodium foods you'd prefer to avoid. You learned what foods are low in sodium. You are proficient in reading nutrition facts and food labels. You even are good at cooking. But that does not equal change in behavior.
More Urgent Medical Issues Related to Sodium
For someone for whom the change is more pressing, such as someone who has again been hospitalized volume overloaded and in a heart failure exacerbation, I think it is wise to have a very targeted approach with the change.
In this case, it is helpful to identify what the salt "heavy hitters" are, or the foods that are the highest in sodium, for this person. For some, this is fast food, canned or instant soups, frozen meals, or snack foods. When these foods are regularly consumed by people whose heart failure has been exacerbated by high sodium intake, avoiding these foods can be life-saving.
Sometimes understanding the dramatic impact of food choices can be a strong instigator of change. Fear of health problems often can be a short-term motivator to change, but it is important to follow that with the mental work of a change in perspective.
Nutrition Changes with Sodium Once Critical Issues are Addressed
Once life-threatening problems are tackled, there is time to make mental changes. Those for whom the impact of high sodium is less imminent and are taking medications to manage medical issues can also use that time to have a shift in mindset.
A helpful exercise is to assess the pros and cons of making a change and the pros and cons of keeping things as they are. Some of the points to consider are desire to decrease medication burden, disruption in life due to medical treatments or hospitalizations, quality of life impacts of disability associated with medical issues, quality of life impacts of changing eating habits, one's openness to try new foods and flavors, one's age and life outlook, one's plans for the future, and one's values. But an individual will likely also have unique factors that they will consider.
For those who conclude through this exercise that they would like to adjust their habits, the path forward starts to be clearer. The next step is to choose a few priority areas to change. These will be different for everyone. The optimal areas to choose are those that are realistic to do starting nearly immediately.
For some that might mean taking a trip to the grocery store to purchase ingredients to make homemade soup instead of choosing instant soups. For others that might mean choosing two nights per week to cook at home instead of buying takeout. Another person might peruse the nutrition labels of foods they like to choose a lower sodium salad dressing, marinade, or TV dinner. Still another person might decide to discuss with their partner how to together bring more optimal foods into the home.
Expectations for Changing Habits
It is helpful to go into this stage with realistic expectations. Know that the normal path to change is not direct. There are times that people will find their preferred choice natural and easy, and there are times when they will end up choosing their original habits. With the mindset that these moments do not need to be defining and permanent, it is easier to make a different choice at the next opportunity.
Many people find that they have a hard time with making changes when they lack support. Reach out to your family and friends for encouragement and practical help. Find online support groups. They are a great resource for those who do not have people nearby to support them. Finding others who are experiencing similar medical issues and who understand the struggles can make the experience less lonely.
See a Registered Dietitian Nutritionist to Work on Eating Less Sodium
I can't stress enough how worthwhile it can be to work with a registered dietitian on making changes like this. Tips for eating less sodium, while helpful, may not meet your individual needs. Sometimes you may need more information that is specific to your unique combination of health concerns and personal circumstances. Or you need guidance on what to prioritize. Perhaps you need more practical suggestions and ideas. Definitely reach out!