Why Is It So Hard to Cut Back on Sodium?

On average, people with heart disease consume twice the recommended amount of daily sodium, regardless of their socioeconomic status, new research shows.

The study, which has not yet been published in a peer-reviewed journal, was presented at The American College of Cardiology’s Annual Scientific Session earlier this month.

“The significance of this research lies in its focus on a group of adults with cardiovascular disease, a population likely motivated to adhere to sodium guidelines and potentially educated on recommended intake due to healthcare interactions,” lead study author Elsie Kodjoe, MD, MPH, an internal medicine resident at Piedmont Athens Regional Hospital in Athens, Georgia, told Verywell. Nevertheless, the study found nearly 90% of people in this category often consume excess sodium.

There are many reasons why it’s difficult to reduce sodium intake, even among people with health conditions exacerbated by the essential nutrient, Kodjoe said. She added that while it’s important for individuals to take steps to manage their sodium intake, it’s also essential for policymakers to launch initiatives to reduce the sodium content in pre-packaged foods.

How Excess Sodium Affects People With Heart Disease

Eating too much sodium can raise your blood pressure, which can raise the risk of a heart attack and stroke. Because of this, the American Heart Association (AHA) recommends an ideal limit of 1,500 milligrams of sodium each day, Kodjoe said.

For the new study, Kodjoe and her team analyzed data from more than 3,100 people with heart issues enrolled in the National Health and Nutrition Examination Survey (NHANES), which is run by the Centers for Disease Control and Prevention (CDC) and has been operational since the 1960s. The data was collected from 2009 to 2018.

The participants had all been diagnosed with heart failure, a heart attack, angina, or coronary artery disease, and they completed questionnaires on how much sodium they consumed. (It’s important to note that “sodium” and “salt” aren’t interchangeable, Jim Liu, MD, a cardiologist at The Ohio State University Wexner Medical Center, told Verywell. “The salt that we consume and are familiar with is made up of sodium and chloride,” Liu said. “When we ingest salt, the sodium and chloride are broken down and get absorbed separately.”)

The researchers found that 89% of the participants consumed too much sodium. The average intake among study participants was about 3,000 milligrams a day—or double the AHA’s ideal recommended limit. Though the study focused only on people with heart disease, sodium intake has been reported to be high among all Americans aged 14 and older.

Kodjoe’s team also wanted to assess whether socioeconomic status influenced sodium intake among the study participants. “Surprisingly, there was no correlation found between income-to-poverty ratio and sodium intake, indicating a universal challenge across socioeconomic groups in adhering to guidelines,” Kodjoe said.

The researchers behind the new report noted that a limitation of the study was that the data they used came from questionnaires. Therefore, the data may have been subject to recall bias—or, in other words, the study participants may not have remembered and reported exactly how much sodium they consumed.

Future studies on the topic should include data from 24-hour urine sodium measurements, which are considered the gold standard for analyzing a person’s sodium levels, per the researchers.

Which Foods Are High in Sodium?

The top 10 sources of sodium for Americans include:

• Breads and rolls
• Pizza
• Sandwiches
• Cold cuts and cured meats
• Soups
• Burritos and tacos
• Savory snacks (like chips, popcorn, pretzels, snack mixes, and crackers)
• Chicken
• Cheese
• Eggs and omelets

However, the amounts of sodium found in these foods can vary widely depending on what types of ingredients are used and where they’re prepared, experts said.

Food prepared outside the home often accounts for the majority of a person’s sodium intake. Seventy-one percent of sodium consumed by Americans comes from processed foods/restaurant foods; 14% comes from naturally occurring foods; 6% comes from foods cooked and prepared at home; and 5% is added at the table (for instance, when people heavily salt their foods).

Challenges in Reducing Sodium Intake

Though sodium intake may not be influenced by socioeconomic status, there are many other reasons why people have difficulty consuming less.

“For one, sodium is prevalent in so many foods,” Liu said. “Most processed foods and drinks have some degree of sodium in them. Some of them are the ones that people may not typically realize as having sodium, such as soft drinks, [and] salt is used in seasoning to improve taste, so a lot of people are used to consuming it to help their food taste better.”

It can be difficult for people to change their behavior (and feed themselves in ways that reduce sodium intake) even after a heart disease diagnosis, Susan Albers-Bowling, PsyD, a psychologist at Cleveland Clinic, told Verywell. “It’s not a lack of willpower [that causes us to] struggle to change behavior,” she said. “Our bodies are wired to stick to the status quo…For many of us, the biggest challenge is dealing with the inner voice that puts up the stop sign such as ‘What’s the point?’ or ‘It doesn’t matter’ or ‘I can’t do it.’”

But it’s important for all people to manage their sodium intake, not just those at risk of heart issues. “It’s crucial for everyone, whether they have hypertension or not, to be vigilant about their consumption to mitigate risk of developing hypertension and worsening heart conditions,” Kodjoe said.

She recommended the following tips for reducing sodium intake:

• Try to avoid highly processed foods, preparing meals at home when possible.
• Read food labels while grocery shopping, and try to avoid products that have more than 140 milligrams of sodium per serving.
• Reduce the amount of added salt you use when cooking; consider using spices, herbs, and seasonings to flavor dishes instead.
• Eat more fruits and vegetables.

Fruits and vegetables are key because some—including bananas—are rich in potassium, which may contribute to lowering blood pressure, Kodjoe said. Some research suggests drinking coffee and/or water with foods high in sodium might also be beneficial, as you might excrete sodium through urine, but experts said the most important tactic in reducing sodium intake is aiming to consume less of the nutrient, rather than consuming more of certain foods and beverages to counteract its effects.

Policymakers should do their part to address this public health issue too, Kodjoe said. They should “implement policies to reduce sodium levels in processed and packaged foods during production,” she explained. “Collaborating with food manufacturers to reformulate products and restaurants to reduce sodium contents in meals can have a significant impact on population-wide sodium intake and improve cardiovascular health outcomes.”