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Is Eating a Low-Sodium Diet Realistic?

By Sharon Salomon, MS, RD

I recently was diagnosed with Meniere’s disease, a vestibular (balance) disorder of the inner ear. Doctors say there’s no definitive known cause, and there are few treatments. However, the treatment my doctor recommended was to reduce my sodium intake to 1,500 mg/day because a low-sodium diet would equalize the pressure in my inner ear.

Meniere’s disease almost always is a progressive set of symptoms that includes vertigo (dizziness that often results in uncontrollable vomiting), constant tinnitus (a ringing or buzzing sound in the ears), aural fullness (a clogged or stuffy sensation in the ears), and possible hearing loss. These symptoms are not fun to live with, so if eliminating salt from my diet mitigates these symptoms, I’m all for it.

But is adhering to a reduced sodium diet of 1,500 mg/day realistic? Before I was diagnosed with Meniere’s, I never gave it much thought when I counseled clients and patients to follow such a restrictive dietary plan. Boy, have my eyes been opened.

Eating Low Sodium
I initially jumped at the opportunity to practice what I knew as a dietitian and began eating a very low-sodium diet. How hard could it be? I never eat fast food. I like potato chips and many other high-sodium snacks, but I can count on one hand the number of times I ate chips, pickles, or other common salty foods within the last year. Piece of cake, right?

I cook most of my meals from scratch, and I don’t buy packaged or processed foods. However, despite all of this, I realized that eating a very low-sodium diet is no easy task.

As a dietitian, when was the last time you poured 1 tsp of salt into your palm and really looked at it? That teeny pile of white crystals, which contains 2,300 mg of sodium, is what we tell clients and patients who have hypertension, type 2 diabetes, and other heart disease risk factors they can consume in one day from all their meals and snacks. What I’m learning from my experience is how cavalier I was in the past when I counseled clients about drastically reducing their sodium.

Restaurant Trap
Following a very low-sodium diet becomes even more difficult when dining out. Every chef knows that salt makes food taste good.

I once heard a television chef tell viewers to make the water in which they cook pasta taste like the sea, as she placed two handfuls (not pinches) of salt into the boiling water. Any culinary school graduate will tell you how important salt is to the taste of a dish. Students are taught to salt the components of a meal before they begin cooking, salt again during cooking, and often again before serving.

You can ask a chef not to add salt to your food, but unless he or she is cooking with unsalted ingredients and components, it’s almost impossible to order a low-sodium meal in a restaurant.

Sodium Alternatives
Dietitians often tell clients that if they want to reduce sodium in their diets they should use lemon, herbs, and spices to flavor their food. In my opinion, these ingredients do add flavor, but without salt most dishes fall flat.

I’ve been struggling with adjusting to the flat taste of my food for three months. According to research by Gary Beauchamp, PhD, director and a member of the Monell Chemical Senses Center in Philadelphia, most people adjust to lower-sodium diets in about two to four months. I’m getting close to the four-month mark, but so far all I can think about when I’m eating is how good the food would taste if it just had a little sprinkling of salt. Nevertheless, my palate is adjusting in that I know when something has been salted. It tastes delicious.

Removing salt from a dish doesn’t just affect its saltiness. Bitter flavors may become more pronounced, and sweetness may become less apparent.1

Beauchamp says nothing activates the receptors on the tongue like sodium does. Potassium chloride, the most common sodium substitute, can leave a bitter aftertaste, so it isn’t a palatable alternative for everyone.

Food manufacturers and home cooks once used monosodium glutamate (MSG) extensively in processed foods and recipes. MSG is a good way to reduce sodium because glutamate can significantly enhance the flavor of a dish and thereby decrease the desire for saltiness.2 Research shows that when MSG is used in place of some salt, it can reduce the amount of sodium in a dish by 40%.3 The problem is that MSG’s safety was called into question in recent years, leaving many people wary about using it. But I’m going to give it a shot.

Aside from MSG, there are low-sodium, plant-based umami ingredients that can help improve the palatability of a low-salt meal. Desperate to find out what these ingredients are, I turned to my dietitian colleagues for advice.

Chef Michele Redmond, MS, RD, has been successfully experimenting with Chinese black vinegar to help boost the flavor of foods when salt is removed. She adds the vinegar to braised dishes, soups, and sauces. Redmond says the vinegar adds a mellow sweetness and somewhat smoky flavor.

I can admit that many of the meals I’ve made in which I’ve used aged balsamic vinegar, which is similar to aged Chinese black vinegar, were flavorful. Like Redmond, I add a few drops to soups, sauces, and especially tomato sauce.

Jill Nussinow, MS, RD, known as “The Veggie Queen,” judiciously sprinkles kombu seaweed on food, especially bean dishes, to add saltiness. Kombu isn’t sodium free, but it’s lower in sodium than an equal quantity of salt.

Kate Campbell, RD, a clinical dietitian at Commonwealth Health Corporation in the Northern Mariana Islands, recommends using Bragg’s Amino Acids instead of soy sauce. They don’t contain table salt, although they do contain a small amount of naturally occurring sodium. Because they add a bolder flavor to foods than soy sauce, you’ll use less of it. Even reduced-sodium soy sauce is too high in sodium for those following a low-sodium diet, especially since most recipes call for more than 1 tsp per serving.

Final Thoughts
Regardless of the obstacles I face, I’ll continue to try to eat a very low-sodium diet because my health and my hearing depend on it. The best lesson learned from this experience, though, is to be less arrogant and more understanding with my clients and patients when I counsel them about making such a major dietary change.

— Sharon Salomon, MS, RD, is a professionally trained culinary expert living in Phoenix and a freelance writer of food, nutrition, and health topics.

References

Liem DG, Miremadi F, Keast RSJ. Reducing sodium in foods: the effects on flavor. Nutrients. 2011;3(6):694-711.
Yamaguchi S, Ninomiya K. Umami and food palatability. J Nutr. 2000;130(4 Suppl):921S-926S.
MSG can help to reduce sodium intake. The Glutamate Association website. http://www.msgfacts.com/news/msg_can_help_to_reduce_sodium_intake.aspx. September 2010. Accessed January 2, 2014.