Sodium is the main ingredient in table salt. It is also found in lots of foods, and even in water. The body needs a very small amount of sodium to work normally, but most people eat much more sodium than their body needs.
Nearly everyone eats too much sodium. The average American takes in 3,400 milligrams of sodium each day. Experts say that most people should have no more than 2,300 milligrams a day.
Ask your doctor how much sodium you should have.
Reducing the amount of sodium you eat can have lots of health benefits:
- It can lower your blood pressure, which means it can help reduce your risk of stroke, heart attack, kidney damage, and lots of other health problems.
- It can reduce the amount of fluid in your body, which means that your heart doesn’t have to work as hard to push a lot of fluid around.
- It can keep the kidneys from having to work too hard. This is especially important in people who have kidney disease.
- It can reduce swelling in the ankles and belly, which can be uncomfortable and make it hard to move.
- It can reduce the chances of forming kidney stones.
- It can help keep your bones strong.
Processed foods have the most sodium. These foods usually come in cans, boxes, jars, and bags. They tend to have a lot of sodium even if they don’t taste salty. In fact, many sweet foods have a lot of sodium in them. The only way to know for sure how much sodium you are getting is to check the label.
Here are some examples of foods that often have too much sodium:
- Canned soups
- Rice and noodle mixes
- Sauces, dressings, and condiments (such as ketchup and mustard)
- Pre-made frozen meals (also called “TV dinners”)
- Deli meats, hot dogs, and cheeses
- Smoked, cured, or pickled foods
- Restaurant meals
Many people think that avoiding the salt shaker and not adding salt to their food means that they are eating a low-sodium diet. This is not true. Not adding salt at the table or when cooking will help a little. But almost all of the sodium you eat is already in the food you buy at the grocery store or at restaurants
The most important thing you can do to cut down on sodium is to eat less processed food. That means that you should avoid most foods that are sold in cans, boxes, jars, and bags. You should also eat in restaurants less often.
Instead of buying pre-made, processed foods, buy fresh or fresh-frozen fruits and vegetables. (Fresh-frozen foods are foods that are frozen without anything added to them.) Buy meats, fish, chicken, and turkey that are fresh instead of canned or sold at the deli counter. (Meats sold at the deli counter are high in sodium). Then try making meals from scratch at home using these low-sodium ingredients.
If you must buy canned or packaged foods, choose ones that are labeled “sodium free” or “very low sodium”. Or choose foods that have less than 400 milligrams of sodium in each serving. The amount of sodium in each serving appears on the nutrition label that is printed on canned or packaged foods.
Also, whatever changes you make, make them slowly. Choose one thing to do differently, and do that for a while. If that change sticks, add another change. For instance, if you usually eat green beans from a can, try buying fresh or fresh-frozen green beans and cooking them at home without adding salt. If that works for you, keep doing it. Then choose another thing to change. If it doesn’t work, don’t give up. See if you can cut down on sodium another way. The important thing is to take small steps and to stick with the changes that work for you.
Although it is difficult initially to cut back on the amount of sodium in the diet, most people find that their taste adjusts quickly to reduced sodium. Salt is an acquired taste, and taste can be retrained in 10 to 14 days if people stick with the lower-sodium diet. Fresh herbs, spice blends without sodium, citrus, and flavored vinegar make tasty alternatives to the salt shaker.
It may be helpful to keep a detailed food record and add up sodium intake. Within a short period of time (less than a week), the main sources of sodium can be identified and daily intake can be calculated.
Suggestions to decrease sodium include the following:
- Be aware that you may experience a perceived decrease in food flavor in the beginning, but other pleasurable tastes and flavors will emerge within two weeks.
- Consider cutting back further on the sodium in your meals to allow for the sodium in your snacks. Many online food tracking apps can help you achieve this goal.
- Put away the salt shaker and reduce or eliminate salt used in cooking. Experiment with adding flavor with herbs, spices, garlic, onions, or lemon instead.
- Look for low-sodium products such as spice blends and read labels for serving size and sodium content on canned, bottled, and frozen foods.
- Make a list of healthy low-sodium foods to substitute. Many grocery stores now supply this information.
- When dining out, request that the food be prepared without salt, ask for dressings or sauces to be put on the side, and avoid bacon bits, cheese, and croutons at the salad bar.
- Do not add salt to your food before eating. Teach family members to taste food before adding salt.
- Avoid fast food. If this is not possible, choose restaurants that offer fruits or vegetables without sauces or dressings. Ask that no salt be used to prepare food, when possible.
- Do not use salt substitutes that are high in potassium unless a health care provider tells you to do this. Herb and spice combinations that are salt-free are widely available and can be used to flavor foods.
- Water softeners remove calcium and add sodium to drinking water. Do not drink softened water. When purchasing bottled water, check the label to ensure that it does not contain sodium.
- Look at labels for over-the-counter medications. Avoid products that contain sodium carbonate or sodium bicarbonate. (Sodium bicarbonate is another name for baking soda.)
- Fresh fruits and vegetables are naturally low in sodium. In addition, a diet rich in fruits and vegetables provides additional benefits in lowering blood pressure. The DASH diet (Dietary Approaches to Stop Hypertension) is a well-known intervention to treat high blood pressure. The DASH diet requires the person to eat four to five servings of fruit, four to five servings of vegetables, and two to three servings of low-fat dairy, and all foods must contain less than 25 percent total fat per serving.
Foods to choose — The following are examples of foods that may be lower in sodium. It is essential, however, to check the labels to determine the actual amount of sodium present (figure 1), as amounts can vary widely from one brand to another.
- Breads – Whole-grain breads, English muffins, bagels, corn and flour tortillas, biscuits, most muffins
- Cereals – Many cooked low-salt (read the label to determine sodium content) hot cereals (not instant) such as oatmeal, cream of wheat, rice, or farina, puffed wheat, puffed rice, shredded wheat
- Crackers and snack foods – All unsalted crackers and snack foods, unsalted peanut butter, unsalted nuts or seeds, unsalted popcorn
- Pasta, rice, and potatoes – Any type of pasta (cooked in unsalted water), potatoes, white or brown rice
- Dried peas and beans – Any cooked dried beans or peas (without seasoning packet), or low-salt canned beans and peas
- Meats and protein – Fresh or frozen beef, poultry, and fish; low-sodium canned tuna and salmon; eggs or egg substitutes
- Fruits and vegetables – Any fresh, frozen, or canned fruit, any fresh or frozen vegetables without sauce, canned vegetables without salt, low-salt tomato sauce/paste
- Dairy products – Milk, cream, sour cream, non-dairy creamer, yogurt (be sure to read labels for serving size)
- Fats and oils – Plant oils (olive, canola, corn, peanut), unsalted butter or margarine
- Soups – Salt-free soups and low-sodium bouillon cubes, unsalted broth, homemade soup without added salt
- Sweets – Gelatin, sherbet, pudding, ice cream, some baked goods, sugar, honey, jam, jelly, marmalade, syrup
- Beverages – Coffee, tea, soft drinks, fruit-flavored drinks, low-salt tomato juice, any fruit juice
- Condiments – Fresh and dried herbs; lemon juice; low-salt mustard (not commercially available but can be made at home), vinegar, and “hot” sauce; low- or no-salt ketchup; seasoning blends that do not contain salt
Foods to avoid — Many foods, especially those that are processed, have a high sodium content. Items that can be substituted for high-sodium foods are listed in the following table (table 2).
- Breads – Biscuits, prepared mixes (pancake, muffin, cornbread), instant hot cereals, many boxed cold cereals, self-rising flour
- Crackers and snack foods – Salted crackers and snack items (chips, pretzels, popcorn), regular peanut butter, prepared dips/spreads, salted nuts or seeds
- Pasta, rice, and potatoes (processed or from restaurants) – Macaroni and cheese mix; rice, noodle, or spaghetti mixes; canned spaghetti; frozen lasagna; instant potatoes; seasoned potato mixes
- Beans and peas – Beans or peas prepared with ham, bacon, salt pork, or bacon grease; most canned beans and peas unless labeled as low-sodium
- Meats and proteins – Salted, smoked, canned, spiced, and cured meat, poultry, or fish; many deli meats and poultry, unless stated to be low salt; bacon; ham; sausage; lunch meats; hot dogs; breaded frozen meat, fish, or poultry; frozen dinners and other frozen meals; pizza
- Fruits and vegetables – Regular canned vegetables and vegetable juices, regular tomato sauce and tomato paste, olives, pickles, relishes, sauerkraut, frozen vegetables in butter or sauces, crystallized and glazed fruit, maraschino cherries, fruit dried with sodium sulfite
- Dairy products – Buttermilk, Dutch-processed chocolate milk, processed cheese slices and spreads, most cottage cheese, aged or natural cheeses
- Fats and oils – Prepared salad dressings, bacon, salt pork, fatback, salted butter or margarine
- Soups – Regular canned or prepared soups, stews, broths, or bouillon; packaged and frozen soups
- Desserts – Packaged baked goods
- Beverages – Softened water; carbonated beverages with sodium or salt added; regular tomato or vegetable juice; some alcoholic beverages (variable sodium content)
- Sauces, dressings, and condiments –Table salt, lite salt, bouillon cubes, meat extract, taco seasoning, Worcestershire sauce, tartar sauce, ketchup, tomato and chili sauces, cooking sherry and wine, onion salt, mustard, garlic salt, soy sauce, tamari, meat flavoring or tenderizer, steak and barbecue sauces, seasoned salt, monosodium glutamate (MSG), Dutch-processed cocoa, many salad dressings
You can still eat in restaurants once in a while. But choose places that offer healthier choices. Fast-food places are almost always a bad idea. As an example, a typical meal of a hamburger and french fries from a popular fast-food chain has about 1,600 milligrams of sodium. That’s more sodium than some people should eat in a day!
When choosing what to order:
- Ask your server if your meal can be made without salt
- Avoid foods that come with sauces or dips
- Choose plain grilled meats or fish and steamed vegetables
●Ask for oil and vinegar for your salad, rather than dressing
First of all, give it time. Your taste buds can get used to having less sodium, but you have to give them a chance to adjust. Also try other flavorings, such as herbs and spices, lemon juice, and vinegar.
Do not use salt substitutes unless your doctor or nurse approves. Some salt substitutes can be dangerous to your health, especially if you take certain medicines.
Yes, some medicines have sodium. If you are buying medicines you can get without a prescription, look to see how much sodium they have. Avoid products that have “sodium carbonate” or “sodium bicarbonate” unless your doctor prescribes them. (Sodium bicarbonate is baking soda.)
Dialysis and diet
Yes. Most people on dialysis need to watch what they eat and drink. Your doctor, nurse, or dietitian (food expert) will tell you if there are foods or drinks that you should limit or avoid. The diet that is right for you will depend on:
- The type of dialysis you have – There are 2 types of dialysis, called hemodialysis and peritoneal dialysis. People who get hemodialysis at a dialysis center (in a hospital or clinic) need to watch their diet the most. They need to limit or avoid more foods than those who do peritoneal dialysis, or hemodialysis at home.
- How often you have dialysis
- Your health and other medical conditions
People on dialysis need to watch their diet because their kidneys aren’t working. Normally, the kidneys work to filter the blood. They remove excess water, salt, and other minerals and nutrients that people eat and drink.
Dialysis is a treatment that takes over the job of the kidneys. But dialysis doesn’t filter the blood as well as healthy kidneys do. Plus, normal kidneys work all day, every day. People usually have hemodialysis at a center only 3 times a week. So if a person on dialysis gets too much water, salt, or other nutrients through eating and drinking, these things can build up in the body. This can make people feel sick and cause problems.
When you watch your diet, you can help make sure that:
- Too much fluid doesn’t build up in your body between treatments – Having too much fluid can raise your blood pressure, which makes the heart work harder. Extra fluid can also cause weight gain, swelling, or trouble breathing.
- Your body has the right amount of nutrients – Some foods have high levels of certain nutrients. Eating those foods can raise the level of certain nutrients in your body between treatments. This can lead to problems.
- You stay as healthy as possible and don’t gain too much weight
You will probably need to watch:
- Fluids – Most people on dialysis need to limit the fluids they eat and drink. Any food that is a liquid at room temperature (such as ice cream) is a fluid. Some fruits and vegetables have a lot of fluid in them, including melons, grapes, apples, and lettuce.
- Sodium – This is the main ingredient in table salt. Most people on dialysis need to limit the amount of sodium they eat. That’s because eating a lot of sodium can raise your blood pressure. It can also make you thirsty and cause you to drink more than you should. To know how much sodium is in a food, you need to look at the food’s label. Try to eat foods that are normally low in sodium or foods that say “sodium-free” or “very low in sodium”.
- Potassium – This is a nutrient that affects your heartbeat. Most people on dialysis need to limit the potassium they eat. If too much potassium builds up in your body, it can cause problems with your heart rhythm. Try to eat foods that are low in potassium and avoidfoods that are high in potassium.
- Phosphorus – This is a nutrient found in many foods. Foods such as milk, other dairy foods, nuts, beans, liver, and chocolate have high levels of phosphorus. Most people on dialysis need to avoid foods with high levels of phosphorus. That’s because if phosphorus builds up in your body, it can cause weak bones and other problems. Your doctor might also prescribe a medicine for you to take with your meals and snacks. This medicine can help keep your phosphorus level low.
- Protein – Protein helps your muscles stay strong. Foods with a lot of protein include meat, chicken, fish, and eggs. People who do peritoneal dialysis might need extra protein, because the body loses protein with each peritoneal dialysis treatment.
Your doctor will probably prescribe a vitamin for you to take every day. That way, your body can get the vitamins and minerals that might be missing in your diet.
If you get thirsty but need to limit your fluids, try these tips:
- Suck on ice instead of having a drink, because ice lasts longer. (But remember that ice is also a fluid.)
- Chew gum or suck on hard candy.
- Eat low-potassium fruit that is very cold, such as frozen grapes.
- Rinse your mouth out with water or mouthwash, but don’t swallow.
Potassium is a mineral found in most foods. The body needs potassium to work normally. It keeps the heart beating and helps the nerves and muscles work. But people need only a certain amount of potassium. Too much or too little potassium in the body can cause problems.
Having too much potassium in the blood is called “hyperkalemia.” This can cause heart rhythm problems and muscle weakness.
People usually need to be on a low-potassium diet to treat or prevent hyperkalemia.
The most common causes of hyperkalemia are:
- Certain medicines – Some medicines, including certain ones for high blood pressure and heart problems, might raise the level of potassium in the body.
- Kidney disease – Normally, the kidneys filter the blood and remove excess salt and water through urination. They keep the level of potassium in the blood normal. When the kidneys don’t work well or stop working, they can’t get rid of the potassium in the urine. Then, too much potassium builds up in the blood.
Many people who get a treatment called “dialysis” for kidney disease need to be on a low-potassium diet. Dialysis is a treatment that takes over the job of the kidneys.
Almost all foods have potassium. So the key is to:
- Choose foods with low levels of potassium
Some foods that are low in potassium
Apples and applesauce
Grapes and grape juice
- Avoid or eat only small amounts of foods with high levels of potassium
Some foods that are high in potassium
Cantaloupe and honeydew melons
Soups that are salt-free or low-sodium
Potatoes (white and sweet)
Wheat bran and bran products
Oranges and orange juice
Prunes and prune juice
Squash (acorn, butternut, hubbard)
Tomatoes and tomato juice
Your doctor will probably recommend that you work with a dietitian (food expert) to help plan your meals. They will tell you how much potassium you should eat each day.
To figure out how much potassium you are eating, you will need to look at the food’s nutrition label. You will need to look at the:
- “Potassium” number – This tells you how much potassium is in 1 serving of the food. If you eat 1 serving, then you are eating this amount of potassium.
- “Serving size” – This tells you how big a serving is. If you eat 2 servings, then you are eating 2 times the amount of potassium listed.
Here are some other ways to cut down on potassium:
- Drain the liquid from canned fruits, vegetables, or meats before eating.
- If you eat foods that have a lot of potassium, eat only small portions.
- Reduce the amount of potassium in the vegetables you eat. You can do this for both frozen and raw vegetables. (If the vegetables are raw, peel and cut them up first.) To reduce the amount of potassium, soak the vegetables in warm unsalted water for at least 2 hours. Then drain the water and rinse the vegetables in warm water. If you cook the vegetables, cook them in unsalted water.