Amy Campbell is a registered dietitian and Certified Diabetes Educator who has been working in the field of diabetes for many years. She is the author of several books about diabetes, including 16 Myths of a Diabetic Diet and Staying Healthy with Diabetes: Nutrition and Meal Planning. In addition, Amy is a lecturer and frequent contributor to several diabetes-related websites.

When it comes to nutrition, everyone has an opinion. Debates continue to rage on about carbohydrate, protein and gluten, but let’s not forget about sodium, which has also come under the microscope lately. Is it really okay to shake salt all over your food? Does sodium no longer affect blood pressure? And will following a low-sodium diet shorten one’s lifespan?

What is salt?

Salt is the common name for sodium chloride, a substance that’s found naturally in seawater. Sodium itself isn’t a bad thing because as humans, we need it to survive. This mineral regulates fluid balance in the body and also helps to control blood pressure. In addition, muscles and nerves depend on sodium to function properly.

Why is too much sodium harmful?

The kidneys are the body’s sodium gatekeepers: they hold on to sodium if the level in the body is low, and excrete excesses in the urine if levels start to climb. However, too much sodium in the body causes the body to retain fluid. Extra fluid can raise blood pressure levels, which, in turn, increases the risk for a stroke, heart attack, or kidney disease. Too much sodium can also worsen conditions like congestive heart failure and liver and kidney disease.

How much sodium do we need?

According to the Dietary Guidelines for Americans (stay tuned for a new version of the guidelines, coming out later this year), healthy people should aim for no more than 2300 milligrams (mg) of sodium each day. However, if you’re age 51 or older, if you’re black, or if you have high blood pressure, kidney disease or diabetes, the goal is no more than 1500 mg per day. The American Heart Association is a bit stricter: they believe that all Americans, healthy or not, should not exceed 1500 mg of sodium on a daily basis. On average, most people in the U.S. consume about 3400 mg of sodium daily, which is obviously much more than guidelines recommend.

Where do we get most of our sodium?

You might be surprised to learn that most of our sodium intake doesn’t come from the saltshaker. Rather, the majority of the sodium we ingest comes from processed foods, including bread, pizza, frozen dinners, cold cuts, cheese and fast foods. Sodium occurs naturally in some foods, too: for example, 4 ounces of cooked salmon has 70 mg of sodium. And yes, a portion of our sodium intake certainly does come from the saltshaker (one teaspoon of salt has 2300 mg of sodium).

What’s the sodium controversy?

In 2013, the Institute of Medicine issued a controversial report, stating that there was no evidence to support lowering sodium intake to below 2300 mg per day. Consuming less than this amount of sodium each day, the report claimed, neither harms nor improves cardiovascular outcomes and mortality. Their report further stated that people who have diabetes, heart disease or kidney disease did not need to aim for less than 2300 mg of sodium per day. Then, to add fuel to the fire, last summer, three controversial articles about sodium were published in the prestigious New England Journal of Medicine. None of the articles disputed the fact that too high of a sodium intake is harmful. But one of the studies argued that too low of a sodium intake could also be harmful, actually raising the risk of heart disease and death, oddly enough. The issue with this study is the method the researchers used to assess sodium intake, which was by a single urine sample collected each morning.

While the controversy continues and while health experts and organizations can’t seem to agree on upper or lower sodium recommendations, most agree that Americans consume too much. Those 3400-plus milligrams that we siphon in every day are not doing us any favors, and the big culprits in our diets are the processed and fast foods.

Slashing the sodium

If you have diabetes, you’re likely well aware that your risk for having high blood pressure, a heart attack, a stroke and kidney disease is higher compared to people without the condition. Given this, taking steps to lower your sodium intake seems to make good sense. Of course, it’s always wise to talk with your healthcare provider about what’s best for you, and how much sodium to aim for each day. In the meantime, consider following these tips to keep your sodium intake in check:
• Eat whole foods as often as possible – this means choosing fresh, unprocessed foods rather than packaged or canned foods.
• If you eat canned foods, rinse them well. Canned beans, vegetables and tuna are convenient but they tend to be high in sodium. Rinsing these foods before eating can lower the sodium content by about 40 percent.
• Read the nutrition facts panel. By definition, a low-sodium food has no more than 140 mg of sodium per serving. A “reduced-sodium” food must have 25% less sodium than its regular counterpart, but it’s not necessarily low in sodium.
• Leave out the salt. You really don’t need salt in most recipes. If you’re concerned about flavor, rely on herbs and spices. And if you must use salt, just use less than what the recipe calls for – a pinch should do you!

More about healthy eating with diabetes:
Diet and Exercise
Start Small: Learning to Carb Count and Follow a Diabetes Meal Plan
Your Diabetes Diet: How Exchange Lists Work