Salt: It's Everywhere

Q:  I know we are not to overdo our consumption of salt, but there seems to be sodium in everything we buy. It's even in my powdered creamer!

Is one kind of salt better than another? I see a lot of television programs where cooks use kosher salt or sea salt instead of usual table salt. Is there really a difference?

And to what should I pay attention in the nutrition facts label: the number of milligrams (mg) or the percentage?

A:  In general, Americans consume too much salt, which can lead to problems with high blood pressure. If you are watching your salt intake, the best salt at the table is "salt substitute," which contains potassium instead of sodium.

Salt (sodium chloride) is typically added as a flavor enhancer. Sodium is also added to foods as a preservative (you may see sodium benzoate or sodium nitrate on labels) or to balance pH (e.g., sodium citrate). Milk and cream naturally contain sodium, but your creamer may have additional sodium added.

It's a good idea to limit sodium to 2,400 mg (about one teaspoon) or less per day. People with high blood pressure may be better off with less than 2,000 mg or 1,000 mg of sodium per day. On nutrition facts labels, the percentage is calculated from the 2,400 mg recommended daily allowance, and so you could instead count percentage points with a goal of staying under 100.

Coarse salts, such as coarse sea salt or kosher salts, will not fit through the holes of a salt shaker but can be used for cooking. Because they are coarse, a teaspoonful of these salts contains less sodium than ordinary table salt, and so they make it easier to reduce sodium in home-cooked or baked foods. (The fine granules of table salt fill the volume of the teaspoon more completely.)

I think cooking experts sometimes specify kosher salt or sea salt for reasons of taste, as these salts generally do not contain additives. Often, table salt contains ingredients to prevent salt granules from caking together, as well as iodine, which may or may not affect taste (I defer to the chefs on this one).

Note that iodine is necessary for normal thyroid function, and iodine deficiency can lead to goiter, hypothyroidism or problems in newborns, particularly in inland areas such as Wisconsin, where we eat less fish (a good source of iodine). If you have iodized table salt but cook with kosher salt, you will likely get enough iodine.

Incidentally, you did challenge me to go looking in my own cupboard. Although I found far more foods with plenty of sodium, I did manage to find organic peanut butter, strawberry fruit spread and a can of pineapple all without any sodium. So, there's hope.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.