Salt and sodium

A diet that is high in salt can cause raised blood pressure, which increases the risk of stroke and premature death from cardiovascular disease (CVD). High blood pressure can have no symptoms and it is estimated that in England about one in every three people who have high blood pressure are unaware that they do (NHS Choices, 2014). Cutting down on salt lowers blood pressure, which in turn lowers the risk of CVD.

In 1994, the Committee on Medical Aspects of Food and Nutrition Policy (COMA) recommended a reduction in the daily average salt intake of the population from 9g to 6g because of its role in CVD. A report was prepared in response to the request, for a risk assessment of salt by the Scientific Advisory Committee on Nutrition (SACN). In the 2003 SACN report, the evidence published since 1994 was appraised and the recommendation for a reduction in the population average intake of salt to 6g per day for adults was accepted and targets were also set for children (SACN, 2003). The UK daily recommended maximum intake of salt is:

  • 1-3 years – 2g salt a day (0.8g sodium)
  • 4-6 years – 3g salt a day (1.2g sodium)
  • 7-10 years – 5g salt a day (2g sodium)
  • 11 years and above – 6g salt a day (2.4g sodium)

(SACN, 2003). 

You might think that salty snacks (like crisps and salted peanuts) contribute most salt to the diets of many. However, the SACN report found that cereals and cereal products (which include bread, breakfast cereals, biscuits, cakes and pastries) provided nearly 40 per cent of average intake and meat and meat products contributed over a fifth of the average salt intake (SACN, 2003). 

The 2014 NDNS also found that cereals and cereal products were the largest contributor to sodium intake from food for all age groups (providing 31-37 per cent of which 16-19 per cent came from bread). Meat and meat products were also the second largest contributor for all age groups, providing 19-28 per cent of salt intake from food. Milk and milk products contributed 18 per cent for children aged 1.5-3 and 8-11 per cent for other age groups (Bates et al., 2014).

The findings of these reports were mirrored in those of a recent study of salt intake among children in South London that found savoury snacks only contributed five per cent of the salt intake compared to 36 per cent from cereals (15 per cent of which was from bread) and 18 per cent from meat and meat products (Marrero et al., 2014).  

Cutting back on added salt (in cooking and at the table) can help, but 75 per cent of the salt we eat is already in everyday foods such as bread, breakfast cereal and ready meals (NHS Choices, 2014). To really cut down, you need at least to become aware of the salt that is already in the foods you buy and switch to lower-salt or salt-free varieties. You can use the nutrition labels on pre-packed food to see how much salt it contains. Preferably, switch to a wholefood, varied vegan diet to effectively manage your salt intake.

Salt is also called sodium chloride. Sometimes, food labels only give the figure for sodium. The NHS Choices website provides a simple way to work out how much salt you are eating from the sodium figure:

Salt = sodium x 2.5

So, adults should eat no more than 2.4g of sodium per day, which is equal to 6g of salt.

Some foods (such as bread, breakfast cereals), can contribute a lot of salt to our diet, not because these foods are high in salt but because we eat a lot of them. Other foods are high in salt because of the way they are made.

High-salt foods include:

  • anchovies
  • bacon
  • cheese
  • gravy granules
  • ham
  • olives
  • pickles
  • prawns
  • salami
  • salted and dry-roasted nuts
  • salt fish
  • smoked meat and fish
  • soya sauce
  • stock cubes
  • yeast extract

Foods that can be high in salt include:

  • bread products such as crumpets, bagels and ciabatta
  • pasta sauces
  • crisps
  • pizza
  • ready meals
  • soup
  • sandwiches
  • sausages
  • tomato ketchup, mayonnaise, other sauces and condiments
  • breakfast cereals
  • Soluble vitamin supplements or painkillers

Source: NHS Choices, 2014.

Populations eating mainly vegetarian diets have lower blood pressure than those eating meat and epidemiologic findings suggest that eating fruits and vegetables lowers blood pressure (Sacks et al., 1999).

A recent study investigated the effects of a healthy vegan diet for seven days on the risk factors for CVD and type 2 diabetes (McDougall et al., 2014). Over 1,600 patients were recruited for the study. Those taking medication for high blood pressure and/or diabetes reduced or stopped taking their medication for the duration of the study to reduce the risk of a huge drop in blood pressure and glucose. They followed a low-fat, high-carbohydrate, moderate-sodium, vegan diet. The kitchen staff used minimal salt, mostly in the form of soya sauce, when preparing meals. The basic meal plan provided roughly one gram of sodium (equivalent to 2.5g salt) per day. However, saltshakers were provided at mealtimes and participants were allowed to use as much table salt as they wanted. The results were remarkable, in just seven days there were statistically significant decreases in cholesterol, weight and blood pressure – despite the fact that many of the participants had stopped taking their medication. The authors suggest that this type of diet could provide a model for a cost-effective therapy to offer patients commonly seen in medical practices and health centres today.

Another study comparing nutritional quality of different diets (vegan, vegetarian, fish- and meat-eaters), found that vegans consumed the least salt; less than half the amount the meat-eaters consumed (Clarys et al., 2014). The authors of this study concluded that the indexing system, which estimates the overall diet quality based on different aspects of healthful dietary models, indicated consistently the vegan diet as the healthiest one. A wordy way of saying a vegan diet is best!

In general, a vegan diet contains less salt or sodium and this is another reason why it is the healthiest diet.