Sodium looms as a dietary danger, but oh, how we love what it does to food

We seem to have a special connection to salt. This humble seasoning, technically sodium chloride, so ubiquitous in our kitchens, has held a premier position in human society since prehistoric times.

From piping hot French fries to the rim of a margarita glass, from expensive fleur de sel on a chef's signature rib dish to the shaker on our family dining table, salt is everywhere.

We connect to salt in a primal, elemental way. Not only would the flavor of many foods suffer without it, we would die without the sodium it contains.

But now the warnings to eat less salt are getting louder. Earlier this summer, the American Medical Association pushed the issue of salt onto center stage. The group called for salt to be stripped of its "generally recognized as safe" (GRAS) status and categorized as a food additive, allowing the Food and Drug Administration more power to limit salt in processed foods.

Salt is not a new health threat. For decades, doctors have been calling for Americans to cut back their intake. Yet our love of the crystalline substance grows unabated. Indeed, most of us consume twice the recommended daily amount of sodium - 2,300 milligrams, or about a teaspoon of salt - and our intake appears to be inching up.

New designer sea salts are one of today's most sought-after seasonings. It is one of the most asked-for items at the Penzeys Spices chain of stores, according to owner Bill Penzey.

"There's a romanticism about salt right now," said Penzey, who recently introduced a new line of sea salts including a fleur de sel ("flower of the salt" in French) and a French gray salt.

Salt has even become a celebrated showpiece on some restaurant menus, from salt-encrusted entrees to foods nestled in a bed of salt.

"Great salt is the building block of great food," said chef Rick Tramonto of Tru restaurant, a devoted fan of salt, calling it one of his most indispensable ingredients. "It brings the flavor to life."

Tramonto often accompanies his food at Tru with a table-top selection of sea salts. He'll soon be launching his own line of signature sea salts, in flavors including black olive, bay leaf, truffle and smoked.

But now salt may be poised to be the next "trans fat."

"We simply need to help people help themselves," said Dr. James Rohack, a cardiologist and member of the AMA's Board of Trustees, who believes new warning labels will help steer us away from major "salt loads" hidden in the foods we eat.

The AMA is calling for the food industry to slash sodium levels in half over the next decade, citing "overwhelming evidence" that excessive sodium intake is tied to hypertension, heart disease and stroke.

The Center for Science in the Public Interest, one of the country's most vocal food-watchdog groups, describes salt as the "forgotten killer." Heart disease is the nation's leading cause of death.

But why do Americans have a hard time giving up their favorite seasoning?

Dr. Gary Beauchamp has been trying to find out for the last 20 years. He is director and president of the Monell Chemical Senses Center in Philadelphia, a non-profit research institute that focuses on the science of taste and smell. His studies have explored how we detect salty tastes and the factors that influence how much we like salt.

Beauchamp said that we're likely born with a penchant for salt. An innate preference may not be evident in newborns but by 6 months - when "salt receptors" are more mature - babies have been shown to prefer a salty solution over plain water.

Some biological programming may be a factor but so is our environment. We learn to like a salty taste because that's what we're exposed to, Beauchamp said. But his studies have shown that you can retrain your palate to like less salt.

"If you are able to cut your intake of sodium in half, you will eventually find lower levels acceptable," he said.

However, this takes time. People often experience "taste shock" when they suddenly switch to a lower-sodium diet, but after several weeks they adjust. At that point, old favorites may taste too salty, Beauchamp said.

Unarguably, the body needs some salt. Both the sodium and chloride in salt are essential nutrients. The minerals help regulate the body's fluids and keep our muscles moving, including the heart.

Sodium and chloride are classified as electrolytes (along with potassium and a few other nutrients). That means they actually conduct electricity in the body, transmitting signals to muscles and nerves. Sports drinks contain electrolytes because these hard-working nutrients are lost in sweat.

Most table salt contains another nutrient: iodine. Salt was first fortified with iodine in the 1920s to help wipe out widespread iodine deficiencies, which can lead to the thyroid disease goiter. The use of iodized salt has virtually eliminated goiter in this country.

In food processing, salt does more than provide the salty taste we seem to crave; it serves as a preservative, regulates fermentation and enhances color, texture and "mouth feel" in foods. It also helps counter bitter tastes.

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For thousands of years humans have had a special attachment to salt, according to Mark Kurlansky, who chronicled this "obsession" in his eloquently written book, "Salt: A World History."

"Salt has played a central role throughout civilization, in every culture and every religion," Kurlansky said in a recent interview.

Ancient Egyptians, Greeks and Romans included salt in sacrifices and offerings, and they invoked gods with salt and water, he writes. Muslims and Jews believe salt helps ward off the evil eye. Even today, salt remains a part of many religious ceremonies and covenants.

Kurlansky said that salt's ability to preserve has given the mineral a broad metaphorical importance.

"Now we have the science to explain it, but for centuries salt was a mystical alchemic thing because it prevented foods from rotting or spoiling," he said.

People associated salt with longevity and permanence. After all, salt is what the Egyptians used to preserve mummies.

Salt once was literally worth its weight in gold, traded ounce for ounce. It served as a currency in many cultures and still is in some parts of the world. The word "salary" is derived from the Latin salarium, meaning "salt allowance."

Throughout history, salt has been the impetus of wars, Kurlansky said. It has been at the heart of the debate about the rights of government to tax and control economies.

In modern times, salt is at the center of one of the longest battles in medicine.

"Salt wars" is the sole topic of a recent issue of Journal of the American College of Nutrition, a leading scientific publication.

Its comprehensive overview of the salt debate seems to make one thing clear: Despite the 100 years of studies, doctors can't seem to agree on how important it is to restrict salt. You can find research to support both sides of the argument.

No one disagrees that salt can affect blood pressure. The dispute is to what degree - and whether other factors may play a more powerful role. Perhaps the biggest divide is over a blanket recommendation for the population in general to reduce sodium.

Dr. Michael Alderman, a professor at Albert Einstein College of Medicine in New York and president of the International Society of Hypertension, is one of the most vocal critics against a dietary restriction of salt.

"Why in the world should everyone eat the same amount of salt?" asked Alderman, who thinks the AMA's new call-to-action is a "reckless recommendation" and wants to see more research to demonstrate the health benefits of reducing sodium intake.

"We don't know if it's going to extend your life or improve its quality," he said.

Alderman has conducted studies suggesting that low-sodium diets may increase the risk of heart attacks in some people. He contends that only "salt-sensitive" individuals should be concerned about sodium intake and believes there are better tools for controlling blood pressure than reducing salt.

For example, a study dubbed DASH (Dietary Approaches to Stop Hypertension) found that increasing calcium, potassium and other nutrients helped bring down blood pressure regardless of the amount of salt in the diet. The DASH eating plan - rich in fruits, vegetables and low-fat dairy foods - was found to be just as effective as a low-sodium diet.

Yet, the majority of scientists and health organizations believe that cutting back on salt is good whether you have high blood pressure or not. It might be particularly important for African-Americans, adults over age 50 and people who have high blood pressure; these individuals are advised to limit sodium to 1,500 milligrams a day.

Dr. Jeremiah Stamler, emeritus professor of preventive medicine at Northwestern University Medical School in Chicago and one of the country's preeminent cardiovascular epidemiologists, thinks the salt controversy should be over.

"The salt debate is no longer valid from a scientific point of view," said Stamler, who believes Alderman's research is "flawed" and "scientifically inadequate." Stamler is fully supportive of the AMA's efforts to get some of the salt out of packaged foods and restaurant meals.

"The problem cannot be solved easily at the individual level," he said. "We need the cooperation of the food industry. In the era of modern refrigeration, salt is an unnecessary food additive."

But don't tell that to Penzey. "The salt shaker has been part of my life for as long as I can remember," he said. "It's part of my existence. The thought of giving up salt on a fresh sliced tomato or corn on the cob would be too tough, especially this time of year."

Penzey suggested cutting back by eating more fresh foods and only using salt to finish food.

"If you use just a sprinkling on the surface, you'll end up with less salt but you'll actually taste more of the salt."

How to reduce salt consumption

Hiding the shaker will barely make a dent because only a fraction of the salt we eat is added at the table. Most of the sodium in our diet comes from processed foods and restaurant meals. Here are ways to cut back:

• Eat fewer processed foods that come in boxes or cans.

• Buy fresh poultry, fish and lean meats instead of canned, cured, smoked or processed types.

• Do not add salt during cooking. Instead, sprinkle on a few grains of coarse sea salt or kosher salt at the table as a "finishing" salt. You'll likely be satisfied with less.

• Use primarily fresh vegetables or choose plain frozen more often than canned.

• Rinse canned vegetables, beans and meats to remove some of the sodium added in processing.

• Make your own salad dressing and marinades with vinegar, fresh-squeezed citrus juices, oil and herbs. Bottled versions are spiked with salt.

• Make your own stock and gravy instead of using bouillon cubes or granules.

• When eating out, order foods that have been grilled, baked, steamed or poached instead of fried, battered, smothered or gratineed. Visit the Web sites of fast-food and national chains to find the nutritional values of their dishes.

Sidestepping salt mines

Just because you didn't add salt when cooking, don't assume you kept the sodium levels low in your finished dish. Lots of sauces, marinades and ingredients contain sodium levels that can add up fast:

Dehydrated onion soup mix, 1 packet: 3,132 mg

Seasoned bread crumbs, 1 cup: 2,111 mg

Cooking wine, 1 cup: 1,452 mg

La Choy soy sauce, 1 tablespoon: 1,260 mg

Thai Kitchen fish sauce, 1 tablespoon:1,190 mg

Wyler's beef bouillon, 1 cube: 930 mg

At the restaurant

Maybe you skipped the burger and fries at lunch. That doesn't mean you're in the clear when it comes to sodium. Here are how some common menu items stack up:

Taco Bell Southwest Steak Border Bowl: 2,330 mg

McDonald's Crispy chicken club sandwich: 1,830 mg

Panera Bread French onion soup: 1,790 mg

Au Bon Pain chicken Caesar salad with Caesar dressing: 1,640 mg

Dunkin Donuts steak panini: 1,630 mg

McDonald's Asian grilled chicken salad with sesame ginger dressing: 1,570 mg

Wendy's roasted turkey and Swiss sandwich: 1,530 mg

Subway tuna and cheese wrap: 1,310 mg

(In The Morning)

Sodium pops up in some surprising places _ including your favorite coffee drinks and morning muffins.

Starbucks White Chocolate Frappuccino, venti: 540 mg

Starbucks reduced-fat banana nut soy muffin: 600 mg

Dunkin Donuts blueberry muffin: 500 mg

Au Bon Pain everything bagel: 760 mg

Starbucks cherry danish: 660 mg

Adding spark - without the salt

The "American Dietetic Association Complete Food and Nutrition Guide," by Roberta Larson Duyff, offers salt-free herb and spice blends to flavor food. The following blends each make cup. Simply combine ingredients in a jar, cover and shake. Keep in a cool, dark, dry place.

Mixed herb blend (for salads, pasta salads, steamed vegetables, vegetable soup or fish): Blend \ cup dried parsley flakes, 2 tablespoons dried tarragon, 1 tablespoon each dried oregano, dill weed and celery flakes.

Italian herb blend (for tomato-based soups and pasta dishes, chicken, pizza, focaccia and herbed bread): Blend 2 tablespoons each dried basil and dried marjoram, 1 tablespoon each garlic powder and dried oregano, and 2 teaspoons each thyme, crushed dried rosemary and crushed red pepper.

Mexican chili blend (for chili with beans, enchiladas, tacos, fajitas, chicken, pork and beef): Blend \ cup chili powder, 1 tablespoon each ground cumin and onion powder, 1 teaspoon each dried oregano, garlic powder and ground pepper, and teaspoon cinnamon.

Greek herb blend (for seafood, poultry and herbed bread): Blend 3 tablespoons each garlic powder and dried lemon peel, 2 tablespoons dried oregano and 1 teaspoon black pepper.

Sources of sodium

The relative amounts of sodium in the American diet.

Source: Dietary Guidelines for Americans

77 percent Restaurant cooking (processed)

12 percent Naturally occurring

6 percent Table salt

5 percent Home cooking

Helm is a Chicago dietitian and nutrition consultant.