After a diagnosis of heart failure, "reduce salt intake" is one of the first pieces of advice doctors offer. Sodium contributes to fluid retention, and too much sodium is one of the most common triggers for exacerbation. For this reason, doctors recommend that those with heart failure limit salt intake to 1,500 to 2,000 milligrams of sodium per day.
But how to do that? Start by following recommendations for managing diet for heart failure. Putting away the salt shaker helps, as does learning to cook with other flavors, such as garlic, citrus, and herbs. However, many people find it's much harder than they expected to reduce sodium intake, and the culprit is often hidden salt. Here's a list of some of the biggest "salt traps" to avoid.
1. The condiment shelf
Many people are surprised to discover that many salad dressings, sauces, dips, and condiments such as ketchup, mustard, and relish rely on high sodium content to achieve a concentrated flavor. Soy sauce, for example, has about 1,160 milligrams of sodium per tablespoon, while ordinary chicken bouillon has about 1,100 milligrams per packet. But while bouillon and soy sauce taste recognizably salty, this is not true of many other condiments. Your taste buds may not recognize the flavor as salty despite high quantities of sodium. Some examples:
Italian salad dressing: 430 milligrams in 2 tablespoons
Spaghetti sauce: 850 milligrams in a half-cup
Alfredo pasta sauce: 1,080 milligrams in a half-cup
Pickle relish: 240 milligrams in 1 tablespoon
Sun-dried tomatoes: 1,050 milligrams per cup
Barbecue sauce, store-bought gravies, meat tenderizers, and steak sauce are also offenders; almost all brands contain extremely high levels of sodium. Olives, capers, and anything pickled are on the bad list too, because pickling requires salty brine. It's also important to realize that the salt content in condiments is often listed for small quantities, so those who eat ketchup on everything or like their pasta with lots of sauce could be eating double or triple the dose of the sodium listed. And that dehydrated onion soup mix used to make so many party dips? It's one of the worst traps of all, with more than 3,000 mg of sodium in one packet.
2. Cheese and other dairy products
Salt is used in the making and preserving of many cheeses and cheese products, yet often we don't think of them as salty. Rich, piquant cheeses like blue cheese, gorgonzola, and Roquefort are among the saltiest, all of them coming in between 350 and 500 milligrams per serving. Cheese spreads and dips often have as much as 500 milligrams of salt per serving, as can good old cheddar cheese. Parmesan, Romano, feta, and many of the other cheeses used in cooking are high in salt.
Milk itself has 120 milligrams of sodium per half-cup serving; choose buttermilk or chocolate milk instead and the level rises to150 milligrams. And a half-cup serving of a low-fat cottage cheese has twice as much sodium (360 milligrams) as a serving of potato chips.
3. Canned soups, stews, and vegetables
The Campbell Soup Company made headlines recently by putting the sodium back into some of the company's canned soups that had previously had the salt content reduced. The reason? Consumers weren't buying the products because they didn't taste as good -- and therein lies the problem.
Many flavors of canned soup, from home-style chicken to simple tomato, contain 700-1,300 milligrams of sodium per serving. French onion soup is one of the worst, with 1,300 mg per serving. Canned beef stew and chili both have 1,000 to 1,200 milligrams per serving, and vegetable soups, like minestrone and split pea, contain 800-1,000 milligrams per serving. It's also important to realize that a serving is often just half a cup, much less than the average person eats at a sitting.
One last surprise lurks in some types of canned vegetables. One can of kidney beans contains 440 milligrams of sodium, and canned tomatoes with spices added ("Italian style," for instance) can contain up to 600 milligrams of sodium per half cup.
4. Breakfast cereals
Store-bought breakfast cereals vary widely in salt content, so read labels carefully. Some of the most popular brands -- including Chex, Total, and Wheaties -- contain between 250 and 300 milligrams of sodium in a one-cup serving, though many people eat double that much at breakfast. And beware the "healthy" label; some of the highest-sodium cereals are those we consider healthiest, such as raisin bran. Kellogg's Raisin Bran has 340 milligrams per cup; instant oatmeal has as much as 350 milligrams per three-fourths cup serving, depending on the flavor.
5. Baked goods and bake mixes
A bagel might not taste particularly salty, but one bagel can contain 500-700 milligrams of sodium, depending on the size and flavor, while one piece of whole-wheat pita bread has 340 milligrams of sodium. Baked goods made with white flour aren't necessarily worse than those made with whole wheat; one slice of whole-wheat bread contains 132 milligrams of sodium, and a sandwich doubles that.
Sweet baked goods can be loaded with hidden salt. One doughnut contains close to 300 milligrams of sodium, and a blueberry muffin is close behind at 250 milligrams. But an even bigger surprise lurks in baking mixes: One box of self-rising cornmeal contains a startling 1,860 milligrams of sodium, or 440 milligrams per one 3-tablespoon serving; a single corn muffin made from a mix has 400 milligrams of sodium; and one slice of yellow cake made from a mix has 220 milligrams of sodium.
More hidden sources of salt
6. Cured, smoked, and deli meats
Three ounces of sausage -- a very small serving -- contains 600-900 milligrams of sodium, while one hot dog has 600 to 800 milligrams. And that's just the beginning. Bacon? 621 milligrams per 3 ounces. One piece of beef jerky has more than 400 milligrams, while two slices of salami tops 600 milligrams. There are low-sodium deli meats available, but read labels carefully for the actual amount of sodium per serving rather than the percent reduced.
7. Products labeled "reduced salt" or "less sodium"
The key word here is "reduced" -- the definition of this term is that any product labeled "reduced sodium" must contain at least 25 percent less sodium than the regular version of the same product. The problem is that if the original product had a high sodium content, then reducing that by 25 percent may not in fact result in a low-salt food.
8. Fast food, including "healthy" choices
It's probably no surprise that French fries aren't the best choice for those trying to avoid salt, but where many go wrong is in choosing supposedly healthier choices such as salads and sandwiches, which can be loaded with salt hidden in sauces and dressings. At McDonald's, a premium bacon ranch salad with grilled chicken has 1,010 milligrams of sodium, while a grilled chicken ranch BLT sandwich has 1,190 milligrams of sodium. Compare that to a large order of McDonald's fries, which contains 350 milligrams. Hamburgers are also big offenders, particularly once you add cheese; a double Whopper with cheese from Burger King or a Wendy's double cheeseburger with everything both weigh in with approximately 1,450 mg of sodium -- pretty much a full day's maximum for someone on a low-salt diet.
9. Products labeled "low fat" or "heart healthy"
This one's seriously counterintuitive; wouldn't you think products that make health claims, particularly regarding heart health, would be low in sodium? Not necessarily. An investigation by Consumer Reports found that low-fat processed foods are often higher in salt than their full-fat counterparts, probably because salt is added to compensate for the lost flavor that comes with reducing fat.
For example, Newman's Own low-fat Family Recipe Italian salad dressing has a whopping 730 milligrams of sodium per each 1.5-ounce serving. And Ruffles Original potato chips have 10 grams of fat and 160 milligrams of sodium, compared to the baked version with just 3 grams of fat but 200 milligrams of sodium. Specific heart-healthy claims can be misleading as well: Prego "Heart Smart" pasta sauce, which carries the American Heart Association logo, contains 430 milligrams of sodium in a half-cup serving; it's allowed to carry the AHA logo because it's low in saturated fat and cholesterol.
10. Salty sweets
We don't usually associate sweets with sodium. In fact, we think of them as just the opposite. But many prepared desserts are high in sodium, often from preservatives. Puddings and cream pie fillings can contain as much as 285 milligrams of sodium per serving, for example. One piece of gingerbread has 240 milligrams of sodium, cake has between 250 and 300 milligrams per piece, and even a crumb piecrust adds 180 milligrams of sodium to a slice of fruit pie.
Home baking uses sodium, too; one teaspoon of baking powder has 488 milligrams of sodium, and one teaspoon of baking soda (the amount used in classic chocolate chip cookies) introduces 1,259 milligrams of sodium per batch. Of course, that's not so much when you consider it on a per-cookie basis, but if you eat the whole batch over a couple of days, it's important to keep the sodium content in mind.