In my work as a registered dietitian for kidney patients on dialysis, I’ve been advocating for reduced salt intake for more than 40 years. The best way to avoid the tragedy of kidney failure is to follow a healthy, low-sodium diet.
There is a strong relationship between salt intake and high blood pressure: Eating more salt raises blood pressure. Prolonged high blood pressure causes heart disease, stroke and kidney failure, tying people to a lifetime of invasive medical therapy and consuming more than $28 billion in Medicare costs for dialysis alone.
Finally, after years of research, study, and input, on Oct. 13, the Food and Drug Administration released new guidelines aimed at reducing the amount of salt Americans consume at restaurants, in schools and in packaged and prepared foods.
It’s about time! All this salt is literally killing us, and it has worsened over time. Today, a slice of bread has twice the salt it had when I was a student. Chicken is often “enhanced” with up to 15 percent saltwater. In addition to salty frozen and packaged meals, grocery stores are stocking ready-to-eat foods that are much higher in salt than homemade. Fast food, which is notorious for the high amounts of sodium it contains, has become a way of life for some.
It’s challenging to limit salt when you are not cooking your own food. Some 75 percent of the salt you eat comes from someone else (restaurants or food manufacturers) adding it to your food. As fewer people cook from scratch and instead use ultra-processed foods, cutting out salt becomes harder.
The new FDA guidelines recommend that average daily sodium intake be reduced by 12% over the next 2½ years. These guidelines encourage food manufacturers to reduce sodium in 163 categories of commercially processed, packaged, and prepared foods. That means reducing the daily intake of salt from 3,400 milligrams to 3,000 milligrams, (slightly more than one teaspoon).
For example, white bread that currently has 250 milligrams of salt would drop to 229 milligrams. Chicken broth, at about 700 milligrams of salt today, would drop to 642 milligrams.
Because these changes are small, no one will likely taste a difference. However, these little decreases in salt can save lives and money. Since nine out of 10 of us eat more than the recommended level of salt, reducing sodium intake a small amount is expected to lower the rate of high blood pressure in the United States. Over 10 years, this modest change could save 500,000 lives and more than $100 billion in health care costs.
There is an important equity element in these guidelines as well. Persons of color have much higher rates of high blood pressure, diabetes and heart disease — all of which are exacerbated by eating excess salt and all of which increase the risk for kidney disease. Black Americans are almost 4 times more likely and Hispanic Americans are 1.3 times more likely to have kidney failure compared to white Americans.
Because processed foods tend to be cheaper and easier to prepare than fresh foods, and poor Americans often live in food deserts devoid of fresh foods, they tend to consume more salt than is recommended, which adversely affects their health.
These new guidelines are a good start to making our population healthier. I encourage food manufacturers and preparers to follow these guidelines to help improve people’s health and save health care costs. Along with guidelines, we need a dialogue that includes teaching people — particularly children and teens — how to cook whole foods. Everyone should try to eat further down the processed food ladder because we are what we eat. Let’s literally save lives one salt shaker at a time.