Nutritional Pearls: Oversalting Meals

Roger is a 46-year-old man who has recently begun an effort to lower his blood pressure. He reports that although he has recently switched to low-sodium options for all of his favorite foods,  the "lack of flavor” has him adding salt back into the meals at the table.

How would you advise him?

What is the correct answer?
(Answer and discussion on next page)

 

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Answer: Cut the amount of salt in your diet gradually, and always measure the amount of salt you put in your foods as you cook them.

A couple of months ago I wrote about Dutch research in sodium reduction that showed that when people weren't informed that their meals had less sodium than they expected, they didn't notice.1

Generally speaking this does seem to be the case but being an evidence-based physician means considering all of the research, not just the studies that agree with your position.
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Researchers in South Africa invited 432 adults to eat a meal of chicken stew (a common South African dish) and give their opinion on the meal, first after an initial taste, then again after finishing however much of the meal they chose to eat.2

The participants were randomly assigned to 1 of 4 groups, and each group tasted a different version of the same stew: a commonly-used recipe, stew with 10% less sodium than the commonly-used recipe, stew with the sodium reduced to a level in line with South African government recommendations for 2016 (a reduction of about 26% from the original), or stew with the sodium reduced by about 47% of the original (the level of South African recommendations for 2019). Each participant only tasted 1 version of the chicken stew.

What is different about this study is that the authors placed salt and pepper shakers on the table for the participants to use if they wished. About 20% of all the participants did choose to add salt to their meals (meaning 80% did not, regardless of which version of the meal they were served). However, the lower the amount of salt in the meal they were served, the more likely they were to choose to add salt at the table—and the more they tended to add—with a few people putting enough salt on their food to bring their meal back up to (and even above) the amount of sodium in the standard version of the dish. Interestingly, at the initial taste they all liked their meal about the same amount, regardless of how much salt was in it. Those who chose to add salt after the initial taste ended up liking their meal less than those who chose not to add salt.

What’s the “Take Home”?

You might take this to mean that cutting salt in processed (pre-made) foods would be futile, because at least some people would just add more salt at the table. It's important to note, however, that in this study the authors simply reduced the amount of the salt in the dish. They made no effort to use other culinary techniques to balance the flavors in the dish, nor did they ask the participants to taste all of the different versions—those tasting the dishes with the least sodium were more likely to add salt at the table because they were used to a much greater amount of salt.

The take-home is two-fold: First, cut the amount of salt in your diet gradually, and always measure the amount of salt you put in your foods as you cook them. Second, do not add salt at the table. If your food has been cooked with the right amount of salt, you don't need it anyway.

References:

  1. Janssen AM, Kremer S, van Stripriaan WL, et al. Reduced-sodium lunches are well-accepted by uninformed consumers over a 3-week period and result in decreased daily dietary sodium intakes: a randomized controlled trial. Journal of the Academy of Nutrition and Dietetics. 2015;115(10):1614-1625.
  2. De Kock HL, Zandstra EH, Sayed N, Wentzel-Viljoen E. Liking, salt taste perception and use of table salt when consuming reduced-salt chicken stews in light of South Africa's new salt regulations. Appetite. 2016;96:383-390.