Mannozzi also checks labels for trans-fats, saturated fats, and, like most of her fellow shoppers, salt.
“You’re only supposed to have so much.”
But how much is “so much?” The USDA recommends no more than one teaspoon daily for anyone, and half that for people over 40, blacks and people with high blood pressure. But the average adult consumes about one-third more than the recommended amount, which has serious consequences for our salt-loving society.
According to a study released last month in the New England Journal of Medicine, cutting salt intake by three grams per day, about one-half teaspoon, could reduce new cases of chronic heart disease and incidence of stroke by one-third and heart attacks by half.
But controlling salt is harder than it sounds. Tricky nutrition labels are just the beginning. Most of the salt in our food is added in a factory, not at the dinner table. And fresh foods are quickly being squeezed out of the budgets of more and more Americans.
Heart disease is the leading cause of death in Madison County, as in the nation at large, according to county nurse manager Beth Heath, R.N. Many of Heath’s patients are also being treated for hypertension. Heath advises these patients to cut salt, but “half a teaspoon is still a good bit,” she said. It is approximately one-third the average American’s daily intake.
Nurses advise patients to scrutinize labels, but serving sizes listed on the box, the basis for calculating the amount of each nutrient per serving, are usually much smaller than what most people eat at one sitting. The FDA is considering increasing portion sizes on labels to a more realistic size, but until then, confusion remains.
At the Ingles in Hull, Mike Manley reads the label on a box of Special K, a cereal he considers healthy, and marvels at the small portion size. According to the label, the box contains nearly 13 servings.
“I eat this box in about three or four days,” he said.
Serving sizes aren’t the only source of confusion.
“I try to buy salt free,” said Mannozzi.
However, Heath said many consumers take “no salt added” to mean “salt free.” In fact it means exactly what it says, namely that no salt was added during processing. The food itself might still be high in sodium.
Heath said many consumers also think foods labeled “no fat” or “low cholesterol” are automatically healthy. But those labels appear on high-sodium items like canned soup, cold cuts, ketchup, salsa and other processed foods.
In fact, three-fourths of salt eaten by a typical consumer is added at the factory.
“It’s in everything processed,” said Jimmie Scott, who was shopping in the baking aisle.
But high-salt processed foods are pushed on busy, cash-strapped Americans for their convenience and low price. As one Ingles shopper, who doesn’t read nutrition labels, said, “I’m just going by the price.”
Many of the health department’s clients “don’t know where their next meal is coming from. They just get what they can afford, which is usually unhealthy,” Heath said.
Nurses at the Madison County Health Department base their advice on federal guidelines, but Heath finds it unrealistic to expect low-income, uninsured patients to cut salt intake by half a teaspoon daily, not to mention meet federal recommendations.
“We have to put in a dose of reality,” said Heath. “So we say, ‘Work on it. Try not to add salt. Make that your first goal.’”
Heath then advises clients to replace a processed food with a canned vegetable.
“They can’t always buy fresh produce, so rinsing the salt off canned green beans is good, too.”
According to the New England Journal of Medicine, “working on it” is a healthy step. Even if Americans cut only one gram of salt per day over the next nine years, it “would be more cost-effective than using medications to lower blood pressure in all persons with hypertension,” the study revealed.
Ingles shopper Trudy Walters watches salt to control her blood pressure.
“I’ve learned how to read the labels over the years,” she said. “That little bit helps sometimes.”
Sonya Collins is a freelance health and medical journalist based in Athens.
