Sodium in Diet Issues

Some people can’t fathom eating a fungus and others can’t get enough of them -- whether white, button, portobello, crimini, oyster or shiitake.

Whatever your stance on mushrooms, the people at the Mushroom Council hope you will include more (or at least, some) of the humble little vegetables in their diets.

Nutrient source

Mushrooms have long been celebrated as a source of powerful nutrients, particularly those of public health interest such as vitamin D and potassium.

Plus, they can also help people meet the new 2010 Dietary Guidelines for Americans introduced Monday by the Departments of Health and Human Services (HHS) and Agriculture (USDA) which place continued emphasis on the importance of lowering sodium intake, eating plenty of vegetables, and choosing foods, like mushrooms, that provide nutrients of concern, like potassium and vitamin D.

Fresh mushrooms can be added to everyday dishes to provide an extra serving of vegetables and deliver additional important nutrients, like selenium, ergothionene and B vitamins.

Mushrooms’ hearty and meaty texture makes for a satiating main dish. They’re also an ideal accompaniment to salads, pastas, stir-fry and omelets; and a flavor-enhancing topper for meats, poultry and fish.

They pick up and complement subtle flavors, adding taste without weighing down the dish with calories, fat, cholesterol or sodium.

Recommendations

The 2010 Dietary Guidelines recommend that you reduce daily sodium intake to less than 2,300 mg; and that specific populations, including people who are 51 and older and those of any age who are black or have hypertension, diabetes or chronic kidney disease, reduce daily intake to 1,500 mg.

While consumers and the foodservice industry face the collective challenge to reduce sodium, there are certain foods, like mushrooms, that can help satiate the “craveability factor” they’re accustomed to with salty foods, but are ultimately low in sodium.

Mushrooms are rich in umami (the 5th taste known for its savory, brothy, rich or meaty taste sensation), which counterbalances saltiness and allows for less salt to be used in a dish without compromising taste. Umami-rich foods, like mushrooms, act as a flavor multiplier -- adding depth of flavor.

“Tasting Success with Cutting Salt,” a collaborative report from the department of nutrition at Harvard School of Public Health and the Culinary Institute of America, recognizes mushrooms as a tool to help decrease sodium.

Still not convinced?  Consider this: mushrooms are economical.  They tend to be one of the least expensive vegetables in the produce section and can last a few days in the fridge.

Cigarettes, scalding coffee, hot dogs: American consumers don't shy away from litigating fraudulent marketing or nondisclosure claims when the result is severe injury or health problems.

The newest culprit, apparently, is sodium. In a class action lawsuit, a Chicago man accuses Denny's of putting consumers at risk by serving meals with dangerously high levels of sodium, and by failing to properly warn diners of the risk. Jason Ciszewski, a Denny's regular, says in his complaint that he now suffers from high blood pressure, requiring him to reduce his salt consumption and take prescription medication.

According to Ciszewski's complaint, many of Denny's selections "contain more sodium than a human being should consume in 4 days." Ciszewski's attorneys charge Denny's with deceptive practices, alleging that the restaurant was not sufficiently forthcoming about the health risks presented by its food. The lawsuit also alleges unjust enrichment, breach of warranty, and breach of contract. Ciszewski is seeking $5 million in damages.

Hypertension, a serious consequence of excessive sodium intake, is a hidden epidemic. One in three Americans has high blood pressure, a figure that health officials blame on high-sodium diets lacking in magnesium, calcium, and potassium. The average healthy young adult can take in 2,300 milligrams of sodium in a day; individuals over 40 should keep it to 1,500 milligrams. Those with hypertension are generally urged to further limit their intake, as sodium consumption matched with high blood pressure leads to a higher risk of heart disease or a stroke.

Saying that Ciszewski's favorite dish exceeds the daily recommended limit would be an understatement. According to his complaint, Ciszewski is partial to the Meat Lover's Scramble, which Denny's online menu describes as, "Two eggs scrambled with bacon, diced ham and crumbled sausage, and topped with Cheddar cheese." In case you're still hungry, the omelet is served with two strips of bacon, two sausages, hash browns, and two pancakes. All in all, the gargantuan meal contains 5,600 milligrams of sodium, more than double the recommended intake for even the healthiest individuals. If that's not bad enough, the dish also boasts 1,960 calories and 112 grams of fat.

Ciszewski was also a fan of the "SuperBird" turkey sandwich and "Moons Over My Hammy," which consists of ham, scrambled eggs, and two kinds of cheese, stuffed between sourdough bread slices and served with hash browns or grits. The dishes contain 2,600 and 3,200 milligrams of sodium, respectively.

Lawsuits accusing restaurants of knowingly selling unhealthy food are hardly novel. In 2005, McDonald's settled a lawsuit alleging that the chain broke an earlier promise to reduce its use of trans fats, and failed to inform consumers. As part of the settlement, McDonald's was required to notify consumers that it was still using trans fats in its meals. In 2007, Burger King was slapped with a similar suit, which claimed that the fast food restaurant used partially hydrogenated oil despite the substance's link to heart disease.

As America's obesity epidemic grows, some municipalities are taking matters into their own hands. In 2006, the New York City Board of Health voted to ban trans fats from restaurant food; Philadelphia followed suit the following year. New York went a step further in 2008, requiring all fast food chains to display caloric content on their menus. The regulation was enacted with the hope that diners will forgo a Big Mac when its 540 calories are staring them in the face.

Even without legislative intervention, it is easier than ever for consumers to find the nutritional content of the foods they eat. Ciszewski's suit claims that Denny's nutrition-related disclosures are "indecipherable." However, Denny's online menu contains a prominently-placed "Nutrition/Allergens" link that leads visitors to a PDF file containing nutritional information for Denny's items. The chart includes total calories, grams of fat (including saturated and trans fats), cholesterol, and sodium for each menu item.

Cisewzki's lawsuit follows a similar one filed by Nick DiBenedetto of New Jersey, who also claimed that Denny's meals contained much more sodium than the average person can ingest healthily, and that Denny's did not do enough to disclose the sodium levels in its meals. DiBenedetto's lawsuit is being supported by the Center for Science in the Public Interest (CSPI).

Most Denny's meals are dangerously high in sodium, putting the restaurant chain's customers at greater risk of high blood pressure, heart attack and stroke, according to a class action lawsuit filed by a New Jersey man with the support of the Center for Science in the Public Interest (CSPI).

The lawsuit seeks to compel the restaurant chain to disclose on menus the amount of sodium in each of its meals and to place a notice on its menus warning about high sodium levels.

Guidelines from the Centers for Disease Control and Prevention (CDC) recommend that most people consume no more than 1,500 milligrams of sodium per day. But at Denny's, the great majority of its meals contain more, and in some cases, several times more.

Some meals at Denny's provide more than 4,000 or 5,000 mg of sodium -- more than most adults should consume in three days. Diets high in sodium are a major cause of high blood pressure, which in turn is a major cause of heart disease and stroke, the first- and third-leading causes of death in the United States.

"Denny's is slowly sickening its customers," said CSPI executive director Michael F. Jacobson. "For those Americans who should be most careful about limiting their sodium, such as people middle-aged and older, African-Americans, or people with existing high blood pressure, it's dangerous to eat at Denny's. Denny's customers deserve to be warned about the considerable health risk posed by many of these meals."

The plaintiff, Nick DeBenedetto, is a 48-year-old resident of Tinton Falls, NJ, who has eaten for many years at Denny's restaurants in East Brunswick and Brick, NJ. He takes a prescription medication to control his high blood pressure and at home does not cook with salt or use the salt shaker.

Some of his favorite Denny's items, such as Moons Over My Hammy or the Super Bird turkey sandwich, contain far more than 1,500 mg of sodium -- even without soup, salad, fried onion rings, or other side dishes.

"I was astonished -- I mean, literally floored -- to find that these simple sandwiches have more salt than someone in my condition should have in a whole day," DeBenedetto said. "It's as if Denny's is stacking the deck against people like me. I never would have selected those items had I known."

Moons Over My Hammy, a ham, egg, and cheese sandwich, has 2,580 mg of sodium by itself -- more than even a healthy young person should consume in a day. It's served with hash browns (adding 650 mg of sodium) or grits (an additional 840 mg).

The Super Bird sandwich, served with regular French fries, has 2,610 mg of sodium -- more than twice what someone with high blood pressure should consume in a day.

Denny's Meat Lover's Scramble, which has two eggs with chopped bacon, diced ham, crumbled sausage, Cheddar cheese, plus two bacon strips, two sausage links, hash browns, and two pancakes has 5,690 mg sodium, or 379 percent of the advised daily limit.

A full meal at Denny's consisting of a bowl of clam chowder, a Spicy Buffalo Chicken Melt, and a side of seasoned fries contains an alarmingly high 6,700 mg of sodium. It's a big meal, to be sure, with about 1,700 calories. But that's more sodium than what 70 percent of Americans should consume in four and a half days.

Even many of the smaller meals advertised for children and seniors have inappropriately high sodium levels.

Many health experts consider high dietary sodium levels to be one of the nation's top health threats. Dr. Stephen Havas, adjunct professor of preventive medicine at Northwestern University's Feinberg School of Medicine, says that reducing the sodium content of packaged and restaurant foods by half would save at least 150,000 lives per year.

For some people, particularly Denny's elderly patrons, getting several days' worth of sodium in a single meal might be enough to trigger congestive heart failure.

"As a physician, I have grave concerns about the sodium levels at Denny's, and grave concerns about an elderly person or someone with hypertension eating even one such meal," Havas said. "The body can have a hard time getting rid of that much salt, potentially leading to fluid retention and accumulation in the lungs. Consuming that much sodium can have severe consequences."

Denny's describes itself as the largest full-service family restaurant in the United States, with more than 1,500 restaurants and annual sales of $2.4 billion.

"By concealing an important material fact about its products -- namely, that that these foods have disease-promoting levels of sodium -- Denny's is failing its responsibility to its customers and is in violation of the laws of New Jersey and several other states," said CSPI litigation director Steve Gardner.

Denny's and CSPI had been in private negotiations over sodium, but those talks ended earlier this year. Shortly thereafter, the chain made small sodium reductions in a handful of items, like cheese sauce, shrimp skewers and kids' meals, but the chain did not make the kind of broad sodium reductions or menu disclosures urged by CSPI.

The lawsuit filed against Denny's is CSPI's first sodium-related lawsuit against a food company. Separately, CSPI has petitioned the Food and Drug Administration (FDA) to regulate salt as a food additive and to restrict sodium levels in various categories of food.

While on a business visit to the office of ConsumerAffairs.com's health adviser, Dr. Henry Fishman last summer, I spied a blood pressure cuff on a nearby table.

I had battled high blood pressure for years, but nothing I did resulted in acceptable readings. I had lost weight, started exercising, but wasn't yet on any medication.

"Hey, would you take my blood pressure?" I asked.

He applied the cuff to my left arm and squeezed the bulb, forcing air into it. As the air slowly escaped, he looked me in the eye and spoke, both as a doctor and a longtime friend.

"Do you have a will?" he asked.

I must have looked startled because he added, "look, you can do something about this or you can die of a heart attack in five years, it's up to you."

Lethal level

My blood pressure, he told me, was 160/101 a level he called "lethal." I took his advice and saw my doctor, who agreed I needed to do something and prescribed 40 minutes of exercise four days a week and put me on an ACE inhibitor.

He explained that my blood pressure should be no more than 130/80. Preferably, he said, it should be a lot less.

The higher number in a blood pressure reading is called the "systolic" pressure, and measures the pressure of the blood flowing through the veins when the heart beats. The lower number is called the "diastolic" number, and measures the pressure when the heart is at rest.

When the pressure is too great, it can cause the heart muscle to grow and enlarge, causing all kinds of problems, including heart failure. It also places strain on blood vessels, increasing the risk one of them could rupture, leading to a stroke.

I began taking the ACE inhibitor a drug that increases flexibility in blood vessels - and worked out four days a week. I also attempted to lose a few more pounds and began monitoring my blood pressure on a daily basis.

My blood pressure came down, but not enough. A typical reading, taken early in the morning, was around 146/89. During the day, especially after a meal, it would spike even higher into the red zone.

Sodium sensitivity

Then in early January, while researching a story for ConsumerAffairs.com, I came across some medical research that suggested some people have a hyper-sensitivity to sodium. Even normal levels of sodium consumption cause high blood pressure readings. It's unclear whether it's a genetic thing, or is triggered in other ways.

In these people, the body doesn't metabolize sodium very well, resulting in excess water in the blood stream, making the heart work harder. Removing the sodium seems to solve the problem, the research said.

Sodium. Salt. Sure, I'd heard that too much sodium could raise your blood pressure, but how much is too much and how much do you really need?

Unfortunately, there's conflicting information on the subject. The USDA minimum recommended daily amount is 2400 mg, but other sources suggest that could be excessive.

"Since the minimum physiological requirement for sodium is only 500 mg daily, Americans well exceed their sodium intake," say health experts at Northwestern University. The average adult can easily consume 3,000 milligrams or more a day if they aren't paying attention. There can be over 1,700 milligrams in one large dill pickle.

Maybe for most people, 2400 mg of sodium a day is just fine. But for me and perhaps many others it's way too much. I was about to reach that conclusion, and end the long, frustrating search for the cause of my high blood pressure.

A new year

On January 4, 2008 I cut as much sodium out of my diet as possible, trying to keep levels down to 500 mg or less. On the morning I started my regimen my blood pressure was 142/87. The next morning I was stunned to see it had fallen to 127/80, and 120/77 the following day.

The following week I was getting readings of 115/72. The only thing I was doing differently was drastically reducing sodium.

To do that I tried to avoid eating anything out of a box, a bag or a can. Breakfast now consists of oatmeal with raisins, walnuts and a banana. For lunch I have a salad or a baked potato. Dinner is grilled chicken or fish and steamed vegetables. I read labels, looking for products with the lowest amount of sodium.

If I go off my sodium-restricted diet for a day, usually by accident, my blood pressure spikes up again. As long as I keep sodium consumption to below 500 mg a day, I have the blood pressure of an 18-year-old.

Not for everyone

It bears repeating that my limited sodium intake may be too little for most people. But if you have a sodium sensitivity, very little sodium performs the tasks in your body that more sodium is required to perform in others. However, you shouldn't drastically alter your diet without first talking to your doctor.

Still, a sharply lower sodium intake may provide hope for many people who, like me, couldn't figure out why their blood pressure was off the chart. And more and more research emphasizes the sodium-blood pressure link.

In 2000, a study by the National Heart, Lung, and Blood Institute established a direct connection between lowering sodium intake and lowering blood pressure. In the study, the lowest sodium level tested, which produced the lowest blood pressure, was well below the currently recommended intake of 2,400 milligrams a day.

Why not eliminate sodium altogether from your diet? Because your body needs it.

Without sodium, nerves and muscles would cease to function, the absorption of major nutrients would be impaired, and the body would not be able to maintain adequate water and mineral balance.

High blood pressure can be a difficult disease to tame because there are so many factors that can influence it. But for millions of people who haven't been able to figure out what's causing it, curtailing sodium intake may provide results.

Their study, reported in the Journal of Human Hypertension, found that most popular snacks contain higher sodium levels than those recommended by health experts.

The study followed more than two thousand children between the ages of four and 18. The study monitored their salt consumption, but did not include salt added in cooked meals or at the table.

According to the study, the average four-year-old consumed 4.7g of salt a day. Recommendations call for only 2-3g of salt per day in that age group.

Whats wrong with salt consumption? The study found that each extra gram of salt consumed raised blood pressure significantly, leading to a higher risk of heart disease and stroke when they are adults. The children who consumed the most salt also had the highest blood pressure levels.

Excessive salt consumption has also been linked to ailments such as asthma, osteoporosis, and stomach cancer, according to the report.

Experts call for action

Last July, two dozen leading hypertension experts, physicians, and health groups urged urging Secretary of Health and Human Services Mike Leavitt to swing his agency into action to reduce Americans' salt consumption.

The high salt levels in countless processed foods and restaurant foods are a major factor in raising Americans' blood pressure, which in turn is a major contributor to heart disease and stroke. Blacks are disproportionately at risk for high blood pressure, the experts said.

"There is virtual unanimity within the scientific community regarding the contribution of excessive sodium consumption to cardiovascular disease," the experts wrote, pointing to various government-funded recommendations, including those of the Dietary Guidelines for Americans, the Institute of Medicine, and the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7).

Too much salt in the diet is boosting Americans' blood pressure and is prematurely killing roughly 150,000 people each year, according to a report issued by the nonprofit Center for Science in the Public Interest (CSPI).

Despite the pleas of health experts to cut back, salt consumption has drifted upward over the past 30 years to the point where Americans are now consuming about 4,000 milligrams of sodium per day -- about twice the recommended amount.

CSPI is filing a lawsuit against the FDA in federal court to compel the agency to classify salt as a food additive. Presently, FDA classifies salt as "GRAS," or Generally Recognized as Safe, which means that it is not closely regulated.

CSPI is also urgently recommending that consumers choose lower-sodium foods, and is proposing that the FDA phase in reasonable limits on the salt content of foods that provide the most salt to the diet.

"Americans spend more than $15 billion each year on drugs to treat hypertension, yet the government spends almost nothing to reduce salt consumption," said CSPI executive director Michael F. Jacobson. "And taking its cue from indifferent regulatory agencies, the food industry has done little to lower sodium levels in processed and restaurant foods."

The 2005 Dietary Guidelines for Americans recommends that young adults consume less than 2,300 mg of sodium per day. People with hypertension, African Americans, and middle-aged and elderly people -- almost half the population -- are advised to consume no more than 1,500 mg per day. Nevertheless, sodium intake has increased steadily since the 1970s.

"The medical community has reached a consensus that diets high in sodium are a major cause of high blood pressure as well as pre-hypertension, or blood pressure just short of high blood pressure," said Dr. Stephen Havas of the University of Maryland School of Medicine and a leading sodium expert.

"High blood pressure and pre-hypertension significantly increase the risk of having a heart attack or stroke. Today roughly 65 million Americans have high blood pressure and another 45 million have pre-hypertension. Unfortunately, a lifetime of eating too much salt is putting Americans' lives in jeopardy," he said.

Processed foods and restaurant foods contribute almost 80 percent of sodium to the diet, according to the 32-page report. Thousands of processed foods, such as frozen dinners and soups, contain between 500 and 1,000 mg of sodium per serving. Some Swanson Hungry Man XXL dinners contain more than 3,400 mg of sodium per package, and one, the Roasted Carved Turkey, contains 5,410 mg.

A package of Maruchan Instant Lunch ramen noodles with vegetables contains 1,400. And although a few companies offer reduced-sodium product lines (most notably ConAgras Healthy Choice products), CSPI says those are the exception rather than the rule.

Among different brands of similar foods, CSPI found wide variances in sodium content. A two-tablespoon serving of Ken's Light Caesar salad dressing has 600 mg of sodium, while the same amount of a similar product, Morgan's Caesar, has 170. Progresso Vegetable soup has 940 mg of sodium per serving, while Healthy Choice Garden Vegetable has 480 mg.

Ragu Traditional Old World Style pasta sauce has 756 mg of sodium per serving while Classico Tomato and Basil has 310 mg. Another pasta sauce, Enricos All Natural No-salt-added, has just 25 mg per serving.

Unlike packaged foods available in grocery stores, restaurant foods are not yet required to provide any nutrition labeling, and no major restaurant chain discloses sodium content on menus.

Plenty of restaurant meals, including many Chinese entres, deli sandwiches, and breakfasts, provide more than a whole days worth of sodium. Dennys Lumberjack Slam breakfast has 4,460 mg of sodium and a typical order of General Tsos chicken with rice has 3,150 mg, according to the report.

The bulk of Americans' salt intake is not coming from the salt shaker. Only about 11 percent percent of sodium in the diet comes from salt added while eating or cooking.

"The high sodium content of the American diet -- mostly from processed foods -- represents an enormous health problem," said Dr. Claude Lenfant, president of the World Hypertension League. "If we could reduce the sodium in processed and restaurant foods by half, we could save about 150,000 lives per year."

CSPI first sued the FDA over salt in 1983, when it asked a federal district court to direct the FDA to declare sodium a food additive -- a declaration that would have given the agency the authority to set limits for salt in foods.

The FDA, though, had just begun requiring sodium labeling on some packaged foods and convinced the court that that measure should be given a chance to work. FDA told the court "if there is no substantial reduction in the sodium content of processed foods .... the FDA will consider additional regulatory actions, including proposing a change in salt's GRAS status."

CSPI's new lawsuit, filed in the United States Court of Appeals for the District of Columbia, contends that since salt content in foods hasn't declined, the court should order the agency to finalize a decision on salt's regulatory status.

"There is no way the FDA can look at the science and say with a straight face that salt is 'generally recognized as safe,'" Jacobson said. "In fact, salt is generally recognized as unsafe, because it is a major cause of heart attacks and stroke. The federal government should require food manufacturers to gradually lower their sodium levels."

"When high-salt diets are turning so many Americans' hearts into ticking time bombs, American health policymakers are acting more like Keystone Kops than the bomb squad," Jacobson said.

CSPI says that the best way for consumers to cut back on salt is to eat more fresh fruits and vegetables (which are practically sodium-free) and fewer processed foods and restaurant meals.

The complete text of the report is available at http://cspinet.org/new/pdf/killer_salt_final.pdf (Adobe Acrobat required).