Too much sodium is bad. Hidden sources of sodium are worse!

Sometimes in the hubbub of today, we miss simple things that can have a lasting impact. This is true for parents and for doctors. As part of my ongoing board certification as a pediatrician, I was thrilled recently to see an important nutrition question:

“A 5-year-old boy is brought to the physician for a health care supervision visit. The parents have no particular concerns. Which of the following interventions would be most likely to lead to a predicted decrease in mortality in a population of healthy 5-year-old children?”

  1. Decreased potassium intake
  2. Decreased sodium intake
  3. Increased caffeine intake
  4. Increased fluoride intake
  5. Increased magnesium intake

Correct Answer: Decreasing sodium in healthy kids’ diets is a tangible way to set them on a course for a longer, healthier life.

Most American kids get far too much sodium in what they eat every day. It’s not from the saltshaker: it’s an ingredient used to make processed foods and restaurant foods more compelling.

The Top Sources of Sodium in Kids’ Diets

Potato chips? French fries? Fritos? Decreasing sodium is tough to do, if you don’t know where it’s found. Sodium lurks in unseen places. McDonald’s shakes can have more sodium than their fries! Surprisingly, the top sources of sodium in the American diet are, in order:

  1. Bread
  2. Chicken and chicken dishes (Think nuggets)
  3. Pizza
  4. Pasta and pasta dishes (Mac and sodium)
  5. Cold cuts

The amount of sodium in bread is low, but kids eat a whole lot of it. But a single small box of Mac and Cheese, prepared, can have 2130 mg of sodium on its own.

Decreasing Sodium in Kids’ Diets

So what’s a busy parent with a finicky child to do?

  1. Know your numbers. The USDA says the most sodium anyone should get for a healthy life is 2300 mg per day. The American Heart Association says 1500 mg. For kids, I’d aim for only 1200 mg on average (1000 mg for kids under 4). The average American age 2 and above currently gets about 3400 mg per day!
  2. Do it together. Lowering sodium is good for the whole family (1200 mg would be healthier for all of us) – and far easier to do for kids if you do it together.
  3. Choose fresh. Fresh fruits and vegetables and lean meats and poultry are naturally low in sodium. Frozen, canned and processed foods and condiments tend to be the biggest culprits.
  4. Pay attention to poultry. Poultry is naturally low in sodium, but some providers like to plump your poultry with saltwater, increasing the sodium by as much as 700%, usually without parents knowing. You are paying for saltwater weight. Learn about plumping and choose alternatives. Maddeningly, plumped poultry can still carry the “All-Natural” or “100% Natural” label.
  5. Choose “one-to-one.”  Check every label for sodium. Aim for the sodium number per serving to be the same as the calorie number, or less. For extra credit, half the calorie number is even better – but I’d be happy if we just got to one-to-one.
  6. Spice it up! Learn to make good food tastier with other herbs and spices, sauces and marinades. Squeeze a lemon. Food without the added salt can taste far better than just relying on salt for flavor.
  7. Be patient. Tastes change – dramatically. As you become used to less added sodium, that food will taste better – and when you taste the old, super high sodium Mac and Cheese, it will taste just too salty. It’s worth the wait, to help your family live longer and happier.

By Alan If-I-Had-a-Magic-Wand-Sodium-Would-be-on-Restaurant-Menus Greene, MD

Published on: March 17, 2013
About the Author
Photo of Alan Greene MD
Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
Get Dr. Greene's Wellness RecommendationsSignup now to get Dr. Greene's healing philosophy, insight into medical trends, parenting tips, seasonal highlights, and health news delivered to your inbox every month.
Add your comment

Recent Comments

Dear Dr Greene,

My restaurant is called the Whole in the Wall in Binghamton,NY. We’ve been around for 32 years. We do also make 7 different kinds of all natural pestos that we ship nationwide, in case you had a hankering. That bamboo salt sounds intriguing to me as well.

I’m also a nutritional consultant, and the issue of children and nutrition that you focus on is so important, thank you. I’m curious if you’re familiar with the work of Dr Weston A Price, and the web site that carries on his discoveries. He was very focused on Cod liver oil, and another substance obtained from butter from grassfed cows fed rapidly growing spring grass, which he referred to as the X Factor. He discovered that the 2 substances worked synergistically, and the X factor has since been determined to be Vitamin K2. Of course we now know K2 is the missing link in directing calcium to the bones and teeth,a and away from the arteries.

Dear Dr Greene,
Thanks for your response. I never heard of bamboo salt, I’ll have to check that out. I use the brand RealSalt. Because if comes from an ancient seabed in Utah, its basically not subject to the pollutants that might be found in sea salt currently being made. Its also very cost effective compared to the more popular designer sea salts.

Running a natural foods restaurant, as I do, I just see so many people that knee-jerk “sodium is bad”, without actually understanding the details that we just discussed. They thus often avoid very healthy foods based on urban legend.

I’d love to eat at your restaurant sometime if I’m nearby!

I didn’t know RealSalt – sounds great and like a smart idea. And you’re right, the markups on some of the designer sea salts are pretty dramatic.

I first came across Bamboo Salt on Wikipedia (“in traditional Korean cuisine, jukyeom (죽염, 竹鹽), which means “bamboo salt”, is prepared by roasting salt at temperatures between 800 and 2000 °C[12] in a bamboo container plugged with mud at both ends. This product absorbs minerals from the bamboo and the mud, and has been shown to increase the anticlastogenic and antimutagenic properties of the fermented soybean paste known in Korea as doenjang.[13]”) and later at a restaurant in the Bay Area. I haven’t looked into it in depth – just intrigued by it as a traditional salt.

Dear Dr Greene,
Certainly no one could argue with reducing refined salt, (which is almost pure sodium chloride) in processed foods. But I’m surprised that you don’t differentiate between sodium and sodium chloride. Sodium, as I’m sure you are aware, is one of the most important minerals in the body. Some vegetables are high in sodium, and are in fact very good for us. For example celery is high in sodium, and in animal studies shows a clear ability to reduce high blood pressure.

Also surprised you don’t differentiate between table salt and high quality, unrefined sea salt, which has a balance of other minerals. In addition, on People’s Pharmacy (how I discovered you), they interviewed a European researcher who presented a number of studies showing that the who salt scare is in large part unfounded. By the way, I wholly support your mission and what you do overall.

Thanks so much for your comment!

As you suggest, and to be more clear, my concern is not at all about the sodium found naturally in whole foods – and not even much by the use of salt in cooking at home or added at the table — but with the extreme amounts of added sodium chloride in so many over-processed foods for kids.

The medical literature on the effects of sodium chloride in kids is indeed complex, with some studies reaching very different conclusions. My hunch is that this has to do with other factors, such as the ratio of potassium to sodium chloride in the diet. While the studies are being sorted out, it seems prudent to me to encourage delicious real foods made in ways humans have enjoyed for centuries, if not millennia.

As for sea salt versus refined table salt – I agree that the additional minerals could make a big difference. On the plus side, with sea salt you could get more calcium, iron, potassium, magnesium, selenium, and zinc. On the other side, in part because of industrial pollution, you might also end up with more mercury, lead, cadmium, and other heavy metals — though the amounts are very low. These levels vary from brand to brand, and I didn’t want to get too complicated.

Sel de Mer, Murray River, and Primordial Himalaya have been tested and have especially low levels of the toxic metals. I’ve also been intrigued by bamboo salt.

I love Joe and Terry Graedon! Thanks for getting in touch.

Salty Pancakes? McDonald’s Big Breakfast with Hotcakes has 2260 mg sodium – more than a child should get in a day.

Try ranking these McDonald’s menu items in order, from highest sodium to lowest: Side Salad with Low Fat Balsamic Vinaigrette Dressing; Large Chocolate Shake; or Large French Fries. What do you think?

Sodium hides in places that may not be intuitive. I put them in order already. The salad with Ranch Dressing would be even higher.

Thank goodness we don’t eat at McDonald’s and haven’t in many, many years.