Sodium added to almost everything processed, yet experts say to cut back
Robert Zacher's breathing became progressively more difficult over several days. Finally, he had trouble even catching his breath and began to feel faint.
He took an ambulance ride to the emergency room, where a doctor immediately put him on diuretics, medication to eliminate excess water from his system.
The diagnosis: Too much sodium - that's salt - in his diet caused fluid to accumulate in his body, making his lower legs swell and causing his lungs to fill with fluid.
"You're actually drowning in your own fluids," Zacher says. "It's like pneumonia."
Zacher, who is 68 years old and has heart problems, is a severe example of the health problems that can develop over time from too much sodium.
But as the Fargo man's trip to the ER dramatically pointed out, controlling his sodium consumption has become vital to staying healthy.
"From now on," the ER doctor told Zacher as he was being sent home, "salt is not your friend."
Most people are eating a lot more sodium than they realize, experts say. Many processed foods - everything from canned soup to frozen dinners, bread and luncheon meats - have sodium.
Sometimes a lot of sodium. A can of soup billed as "reduced sodium" can have 410 milligrams per serving. But because many people eat the whole can, nominally two servings, that becomes 820 milligrams.
How much is that? It's more than 35 percent of the recommended daily allowance of 2,300 milligrams.
"That would be about a teaspoon of salt from all sources," says Julie Garden-Robinson, an associate professor and food and nutrition specialist at North Dakota State University. "That is not an easy thing."
But for those who are susceptible to problems from sodium - those 51 and older, with high blood pressure, diabetes or chronic kidney disease, African Americans - 820 milligrams is almost 55 percent of the recommended 1,500 milligrams a day.
"If you were to eat a primarily processed food diet, it would be virtually impossible to meet that guideline," Garden-Robinson says.
The average sodium intake in the United States is about 3,300 milligrams, a study by the Centers for Disease Control found. Only 1 in 10 Americans meet the recommended teaspoon a day guideline.
For those like Zacher who must carefully watch their sodium intake, cooking and preparing your own meals becomes critical.
Zacher sticks mostly to fresh meats and bakes his own bread so he can control the amount of sodium in his diet.
"It's quite simple now," he says. "I watch my food. You can become your own best friend if you cook your own food."
Got a hankering for a hamburger? Better avoid a fast food restaurant, Zacher says. "You can't get a hamburger with less than a thousand milligrams of sodium."
As a nutrition expert, Garden-Robinson has always prepared her own meals. She's long watched her sodium intake. So much so that she used to keep her salt shaker in the cupboard and away from the dining room table.
Not anymore. People need some sodium in their diet. In fact, there is some concern that inadequate sodium intake could result in iodine deficiency, which can cause a goiter.
For most people, the vast majority of their salt intake comes from processed or prepared foods, Garden-Robinson says. Not what they sprinkle on as a condiment.
In the case of meats, sodium often is added as a preservative. But most food manufacturers, she says, add sodium for a simple reason:
"We like salt. When manufacturers have made attempts to lower it, people don't like it much and people don't eat those products."
So, not surprisingly when that happens, food makers start adding more salt.
Less expensive prepared foods commonly contain more sodium because it's a cheap flavor enhancer, Garden-Robinson says.
"That's why my main tip is consumers really need to be comparison shoppers and compare those labels," taking note of nutrition as well as value, she adds.
Those who read the labels carefully are in for some surprises. Just last week the Centers for Disease Control and Prevention concluded that bread and rolls are the leading source of salt in the American diet.
Surprisingly, bread and rolls contribute more than twice as much sodium in the American diet as potato chips and pretzels. Bread and rolls aren't saltier than pretzels or chips, but people eat more of them.
Bread and rolls account for about 7 percent of the salt consumed by the average American, according to the CDC study.
In order, the other leading salt contributors: cold cuts and cured meats, pizza, fresh and processed poultry, soups, fast-food hamburgers, sandwiches and cheese.
Allen Lee has been reading nutrition labels carefully at the grocery store for the past couple of years. But the 35-year-old Fargo man recently started paying attention to sodium.
Fit and in good general health, Lee's blood pressure has crept up to the borderline of concern, so he's restricting his sodium.
"I just realized for myself how much salt there is in food," he says. He has found, for example, that one of the two brands of Greek yogurt he and his wife like to eat has half the sodium content, 65 milligrams instead of 125.
So the Lees now eat the lower sodium variety. "It was a very minor choice but that cumulatively could add up over the course of a week," he says.
"We don't buy a lot of processed stuff," he adds. He also watches sauces and condiments. He might skip the ketchup on the roast beef, for instance.
Mainstream medicine groups have lined up solidly in the watch-your-sodium camp. The CDC, Institute of Medicine, and National Heart, Lung, and Blood Institute all recommend restricting salt in the diet.
The Institute of Medicine two years ago concluded that national action is imperative to reduce the sodium content in foods.
But the industry Salt Institute, which represents manufacturers of processed foods and others, argue that widespread salt restrictions would be unsound policy, and perhaps detrimental to health.
Research indicates that some people have a greater sensitivity to salt than others, and some doctors say more study is needed before any sweeping action is taken.
Officials of the Food and Drug Administration have applauded food manufacturers that have voluntarily reduced sodium. Success in sodium reduction, the agency said, will take "coordinated national action, with participation by all."
In the meantime, the FDA advises, consumers can start lowering sodium intake immediately by purchasing foods low in sodium, and asking for low-sodium options in restaurants.
That's a message Robert Zacher now takes very seriously.
"I've been through the ringer on it," he says. "Now I'm watching my salt very carefully."
Steps you can take to reduce salt
<> Eat more fruits and vegetables.
<> Eat foods rich in potassium, which help offset the effects of sodium. Potassium rich foods include leafy, green vegetables, bananas and fruits from vines.
<> Flavor food with pepper and other herbs and spices as salt substitutes.
<> Pick unsalted snacks.
<> Read food labels and select foods low in sodium.
<> Frozen vegetables without prepared sauces are lower in sodium than canned vegetables. If you use canned vegetables, rinse in a strainer to wash away added salt.
Sources: Food and Drug Administration, NDSU Extension