How To Eat a Low Sodium Diet

Jill jpegOne of the most common things I hear throughout the day when I talk about eating a low sodium diet is ‘I don’t use the salt shaker.’ Using salt shakers is the least of our problems. The message is: Salt is in everything we eat, from cereal to soda.

Salt is sodium chloride. When we talk about salt intake we will be talking about sodium because that is what is on all the labels. But the word ‘salt’ is what most of us say, so I use both sodium and salt.

Why Should You Care How Much Sodium You Eat?

First, the more salt you eat the higher the level of calcium you will find in your urine. When you have more calcium hanging around in the urine your chance of forming more stones increases. Then there are your bones. More salt will rob your bones of calcium and kidney stone formers are at risk to develop bone disease. Although blood pressure is not the main issue for this site, high salt diets do increase blood pressure and reducing salt intake is recommended by all authorities.

How Much Sodium Should You Eat?

We already have a very long article on this site about ‘how much‘. The CDC, and the AHA, and the science concerning calcium balance all point to one optimal level: 1500 mg daily. That is an ideal. The same two authorities say that 2000 mg/day is the upper limit for the US population. The CDC and AHA, incidentally, are not interested specifically in kidney stones or even bone disease, but in blood pressure – a major killer.

Eating a low sodium diet can be overwhelming and difficult to incorporate into your daily life. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.

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How Do You Know How Much Salt You are Eating?

The easiest way to know how much sodium is in your food is to read the nutrition label. campbell-s-tomato-soup-condensed-foodThe problem is that the information is sodium per serving, and servings per package.

The image on the left is a can of Campbell’s Tomato Soup. I like to use it as a classic example because we typically think this is a healthy lunch.

Mr Campbell says there are 2.5 servings in this one can. You and I eat it as one. Each serving – look at the label – is 480 mg of sodium. The whole can – 2.5 servings – is 1,200 mg – just about the whole day’s worth.

Anything in a bag, can, wrapper, or container will have lots of sodium in it unless it says ‘low sodium’ and even then you should look at the label and consider what the producer considers low sodium.

Here is the ‘Reduced Sodium’ version. Without looking at the numbers you would think this was healthy and a safe bet. But basically since we know there are 1,200 mg of sodium in a can of regular tomato soup, 25% less is still a lot of sodium: 900 mg of campbelltomfront reduced sodiumsodium.

There is nothing dishonest about what Campbell Soup is doing here. They are telling you exactly what is in their soup. It is up to you to calculate how much and remember you will probably use the whole can for your lunch, not 1/2 of the can which is ‘one serving’.

The message is this: You must do your homework. You have to realize how much sodium is in each food you eat by reading your labels, and you have to realize how many servings you are eating in one sitting. You can’t blame the food industry. They are doing their part and showing you what they do. It is up to you to do yours.

What About Dining Out?

There are no labels. Now what?

You can rest assured that eating out will cost you thousands of milligrams of sodium in most cases.

All meats, cheeses, salad dressings, even your vegetables will likely be salted – and buttered, that’s why dining out is so yummy.

You can always ask your server to request the chef not to put extra salt in or on your food. But even so it will be higher in sodium than if you cooked your food at home.

So, the only answer: Eat out less. Pack your lunches.

I work with business people who have to go out every night with clients. For breakfast and lunch they just have to watch their sodium carefully to make up for the huge loads at supper.

Some of you may not eat out on a regular basis, but when you do happen to have a high sodium day just drink a lot of water in the morning and watch the sodium for the next few days. It takes a few days to get rid of a salt load.

How To Cook At Home

First step: Don’t use any added sodium while you’re cooking.

Try finding recipes with different types of herbs that will add healthy flavor to your meal. Tarragon, basil, rosemary, garlic, and anything else that appeals to you – all good choices.

At first you are definitely going to notice a change in taste to your foods. But in my fifteen years of doing this work helping clients, I have found that even with my worst salt addicts it is only a few weeks before they start noticing when a food is super salty and they don’t like it.

If you do not cook with salt then you can add a little salt at the table. I like fancy sea salts because they taste better and a little bit goes a long way.

Hidden Salt in your Favorite Foods

Here is my list of food types that usually contain a lot of salt but you might not think about it or check out the label:

  • Olives
  • Bread
  • Canned foods – all kinds
  • All pickled foods
  • Cheeses
  • Deli meats
  • Cereals
  • Pizza
  • All fast foods
  • Condiments – Soy sauce even reduced sodium, mustard, ketchup, etc
  • Sauces
  • Salad dressings

Online Lists

In our long article on salt, we linked to several sites that give sodium content of foods by product. If you find others, please let us know and we will add them.

How to get Started

This isn’t as hard as you think.

The most important thing you can do to lower your salt is to understand where it is coming from. Once you realize that going out to eat and certain food categories are the main culprits, and that nutrition labels are your guides, it is all very doable.

After you eat a diet lower in salt, trust your taste buds.

They are going to be a very useful tool in recognizing what foods are high in salt. I promise you it really only takes a few weeks to notice the difference. Once you do you will always notice salty foods and probably won’t want to eat too much of them.

Salt and Water

When I look at a 24 hour urine result the first thing I notice is how much urine was produced. If the volume is low I then look at the sodium level. Many times I see a correlation between high sodium and low volume. This occurs because of peaks and valleys in salt intake.

When salt intake suddenly increases – a pizza for example – water is retained to dilute the sodium in the blood. A 24 hour urine collected on such a day will show a low volume even if you drank a lot of fluids. This is a good reason to keep salt intake low and constant.

On the other hand, when salt intake is successfully reduced, so is thirst so you have to be specially conscious about keeping up your fluids.

The best protection against stones is this combination: Low sodium and high fluid intake both at the same time.

I Have a Surprise For You

For those of you who are desperate to lose a few pounds, one of my most favorite things about eating low salt is that my tummy is flatter when I do. Eating a high salt diet will make your jeans not fit the next day and leave you feeling bloated and full.

If you weighed yourself before and after going out to dinner you will most likely find a few pounds added on the scale. It is not mostly the food, it is the water that the body must retain to dilute the extra sodium that goes into the blood as you eat it. It takes a few days to get rid of that sodium, and therefore the extra weight.

I have recently put together a private FB page called THE Kidney Stone Diet.  It is a group that helps educate you on your physician prescribed treatment plans. I moderate it to keep it clinically sound.  Come on over and join the discussion!

Eating a low sodium diet can be overwhelming and difficult to incorporate into your daily life. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.

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33 Responses to “How To Eat a Low Sodium Diet”

  1. Michelle

    I was recently told to intake little to no sodium by my physician, due to peripheral edema. I get kidney stones, but haven’t had a flare up in over a year. Reading this article has brought more insight and understanding. I guess I’m just not sure still. Should I only intake 1200mg of sodium per day?

    Reply
    • Fredric Coe, MD

      Hi Michelle, In general low sodium intake is a good idea if you do not have kidney or heart or liver disease. Usually leg swelling without any of these systemic diseases reflects venous drainage problems, and I do not know if low sodium diet will help. As I do not know why you have swelling I cannot comment on the low sodium diet. My general advice that favors it is aimed at people without significant diseases such as I mentioned, like stone formers, or people with high blood pressure. Regards, Fred Coe

      Reply
  2. Laura

    My mother was treated for severe hyponatremia of unknown etiology about 4 months after finishing treatment for head and neck cancer. Her treatment was to take 6 grams of sodium tablets daily to normalize the serum sodium (for 2 years) and to restrict her fluid intake to 1 liter/day. We gradually decreased her dose over the course of a year and weaned her off the sodium tablets (with a normal serum sodium). Unfortunately she developed kidney stones this year (incidental finding on a surveillance CT). Could the fluid restriction and sodium tablets have caused this?

    Reply
    • Fredric Coe, MD

      Hi Laura, The story sounds like inappropriate secretion of vasopressin incident to her cancer treatment, and the high sodium and low water intake were appropriate treatments. Her urine volume would have been exceedingly low and this indeed could have fostered stone formation. I would guess the stone was uric acid, but one can tell from the CT if it is that or calcium based. Treatment varies with this decision. Regards, Fred Coe

      Reply
  3. Paul

    I have cirrhosis with ascites, and am eating low sodium to shift the fluid. Kidney function is currently fine. I drink a lot of water thinking it will help move sodium out, but some online info says this can fool the body and cause serious problems including hyponatremia. How much water would you recommend in my case, if I eat 1000-1500mg sodium per day?

    Reply
    • Fredric Coe, MD

      Hi Paul, With cirrhosis and ascites low sodium diet is reasonable. Forcing water is not good as it can cause hyponatremia. Water cannot itself remove sodium. You may also be on diuretic drugs that increase the risk of hyponatremia. In a case like yours your physicians have to give you a fluid prescription. Your condition is one I know extremely well, and understand as very individual. Ask for a number from them, and use it. Best, Fred Coe

      Reply

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