Menus should not be minefields: It's time for sodium regulation

Dr Melissa Walton-Shirley


February 02, 2010

On postpartum day 5, I was rushed to the hospital with a numb left lower extremity and a headache. My blood pressure was 230/130. I was on a magnesium drip for five days while my husband was left to care for a four-pound newborn with the help of my mom and my sister-in-law. When I returned home, I dug through the trash to check the sodium content on the cans of my favorite soup. I was astounded to learn that I'd eaten around 8000 mg of sodium daily for several days. Although I had toxemia with an odd postpartum presentation, my unintentional sodium binge certainly didn't help things and probably pushed me right into hypertensive urgency. At that time, 17 years ago, I ascribed my demise to my own ignorance and felt that since I should have known better, I deserved what I got. Now I look at things much differently.

I greatly admired a presenter at the latest European Society of Cardiology meeting in Barcelona who championed his country's quest to lower the sodium content for his population. It seemed like such a small thing to do for such a huge payoff. I agreed that human beings who are making an effort to lead a healthy lifestyle should not have to work so hard to avoid being killed by their food choices. I wondered when such a movement would take place in America. It seems that the time is now.

Patients are often indignant when I suggest they could do better at limiting their sodium intake. "Why, I never touch a saltshaker!" one patient told me as she sat in my exam room, ankles spilling over the tops of her shoes. "You don't have to," I responded, "because someone is already adding the salt for you." Her diet consisted almost entirely of packaged meats and canned foods. I spent the rest of the appointment explaining the virtues of fresh preparation and frozen vegetables and the importance of reading labels.

For those who are offended by organized efforts to lower the sodium content in foods, claiming "yet another government regulation," consider the hypocrisy of that attitude. Some of those folks who protest most vehemently about government overregulation yelled the loudest when peanut butter was tainted with salmonella a few years back. They are the first to demand food safety but are far more concerned about the short-term consequences of diarrhea (and a real but small risk of death) than the staggering toll of debilitation and death due to stroke and congestive heart failure caused by sodium intoxication.

Some practices in medicine are just common sense. We don't need a trial to show how well a patient who is desiccated from dehydration will do with or without IV saline. The wealth of information about the consequences of sodium overload is inherent to what we do every single day of our lives as physicians. If we need pressure in a hurry, we deliver saltwater. If we leave our patient on a saline drip for days, they'll complain about big legs and shortness of breath. If we take sodium out of their diet, their heart failure and blood pressure improve, and their shoes fit comfortably again.

Those of us who understand the global threat of sodium excess should make an effort to have an impact on regulation in the interest of preserving the health of humankind. We need to better educate our patients and our children about salt intake, and we need to make manufacturers and legislators share in the responsibility and the opportunity to make our world a healthier place.

Menus should not be minefields. We should insist upon it.

See also: 

Ripe for change: US ponders populationwide salt-reduction policies

New data prompt renewed calls for public-health initiative to cut salt in US diet



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