Salt and your heart

Our review of the latest evidence shows how the salt we eat impacts our risk of heart disease. Whether it’s sea salt, rock salt or table salt, most of us could do with eating less. The good news is you can retrain your taste buds to enjoy less salt while still enjoying meals that are packed with flavour.

There is strong evidence that reducing sodium intake lowers blood pressure in people with both normal and raised blood pressure.

Our position statement

The Heart Foundation has reviewed the evidence on sodium (salt) to help you understand what’s best for your heart health.

Our position statement includes advice for:

• all adults (including home cooks, chefs and food preparers working in hospitality)
• people with high blood pressure and living with a heart condition (including heart failure)
• health professionals 
• people working in the food industry.

 

Sodium and heart health position statement

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Salt in our food

The words salt and sodium are often used interchangeably. Sodium is a mineral and you will see it listed on a food label. Salt is a combination of two minerals, sodium and chloride. Most of the sodium we eat is in the form of sodium chloride (or salt).

Around three-quarters (75%) of the salt we eat comes from processed and packaged foods. Salt is used by food manufacturers to improve the flavour, texture and shelf-life of food products.

Foods that can add a lot of salt to our diets are either high in salt like:

• ham and other processed meats
• salty snacks
• sauces and condiments

or contain varying amounts of salt but are eaten often like:

• bread
• cheese
• breakfast cereals.

Most people don’t realise food doesn’t need to taste salty for it to add salt to your diet.

How does salt affect heart health?

Sodium helps to keep the balance of fluids and electrolytes in our body¹. When we have too much sodium in our diet it can cause high blood pressure. When blood pressure is high, the blood flowing through our arteries puts more pressure on the artery walls. This causes the artery walls to stiffen and narrow over time and leads to heart disease².

The evidence shows that reducing sodium intake reduces our long-term heart disease risk².

There is strong evidence that a lower sodium diet reduces blood pressure (systolic and diastolic) in people with both normal and raised blood pressure, compared with a higher sodium diet². 

People who follow a sodium-reduced diet have a 26% lower risk of heart disease and a 21% lower risk of high blood pressure when compared to people who follow their usual diet².

What should my blood pressure be?

For most adults, ideal blood pressure is below 120 mmHg systolic and 80 mmHg diastolic⁴. Around one in five New Zealand adults are living with high blood pressure (also known as hypertension)³.

Many people with high blood pressure often don’t know it because they don’t have any symptoms. If you’ve been told you have high blood pressure lifestyle changes can help you to manage it.

More about managing high blood pressure

Recommended amount of salt

Adults should eat no more than 5g of salt a day (2,000mg sodium) – that’s about 1 teaspoon⁵.

This amount is recommended to reduce your risk of high blood pressure, heart disease and stroke.

New Zealand adults currently eat around 8.5g of salt a day (3,400mg sodium).

Children can develop taste preferences for salty foods from a young age. High blood pressure in childhood tracks into adulthood and increases the risk of heart disease⁶. Lowering your salt intake is important for all ages to reduce your risk of developing high blood pressure.

Is there a risk of having too little salt?

A very small amount of salt is important for good health as it helps to keep the fluids in our body balanced. However, it’s not common to have too little salt as most people in New Zealand eat more than their body needs. An adult body only needs around 1 to 2g of salt (460 to 920mg sodium) per day to function.

Three ways to eat less salt

A heart-healthy way of eating isn't about single foods or nutrients. It's about the quality of your whole diet and how it fits together. While we want to base our diet around as many whole foods as possible, many packaged foods like bread, cheese and hummus contain salt but still form part of a heart-healthy diet too. Given most New Zealanders have too much salt, it’s a good idea to think about the different foods you eat that add salt to your diet and how you can ease back. This could be as simple as swapping a few products you regularly buy for lower salt versions and using less salt while cooking dinner.

1. Eat more heart-healthy foods

Instead of cutting foods out, focus on all the delicious foods to enjoy. Base your meals around foods that are close to how they are found in nature like vegetables, fruit, whole grains, legumes, nuts, seeds, fish and seafood. These foods are usually lower in salt than processed foods and are packed with vitamins, minerals, fibre and other nutrients that protect your heart.

Remember: the more processing a food product has had, the more likely salt has been added along the way. A long ingredient list is a sign that a food is highly processed.

2. Small swaps make a big difference

Salt is ‘hidden’ in most processed and packaged foods like sauces, crackers, bread, breakfast cereals, processed meats, meat-free products and salty snacks.

Here’s a few simple swaps to get you started:

• Choose egg or tuna in your sandwich instead of sausages and ham.
• Swap to veggie sticks or unsalted nuts instead of chips and crackers.
• Swap from a standard soy sauce or chicken stock to a reduced-salt one.
• Choose plain meat, chicken or tofu instead of options sold in thick sauces or marinades.
• Use lemon, vinegar, herbs and spices instead of salt, dressings and cooking sauces.
• Make your favourite takeaway foods at home like pizza, burgers, Chinese food and fish and chips.

3. Shop for lower salt-foods

Learn how to read a food label where you will see salt listed as sodium. Look for the lowest amount of sodium per 100 grams and compare similar products. For example, compare two different brands of tomato sauce.

Look at the labels of foods you eat often as this will have the biggest impact on your salt intake.

What’s the difference between low-salt, salt-reduced and unsalted?

You may see the following terms on food labels. Here’s what they mean:

• ‘Low salt’ or ‘low sodium’ contains less than 120mg of sodium per 100g.
• ‘Reduced salt’ means that foods must be at least 25% lower in salt that the standard product. For example, a reduced-salt soy sauce may have 42% less salt than regular soy sauce.
• 'Unsalted' or 'no added salt' indicates that there has been no sodium or salt added to the food. There may be very small amounts of sodium found naturally in the food.

Remember, not all foods that are low in salt will be labelled in this way. There are plenty of products that are not labelled as low in salt that are still good choices. This is where reading the label can be helpful.

If you can't find a lower salt version of your favourite sauces, marinades and simmer sauces, then use a bit less.

Salt and taste buds

Our tongue is covered in taste buds. Most adults have between 2,000 and 8,000 taste buds and each taste bud has between 10 to 50 sensory cells which are renewed every week^7,8. The number of taste buds can vary widely from person to person which may explain why people experience different tastes.

Just like learning a new skill, you can gradually re-train your taste buds to enjoy less salt. It can take several weeks or even a few months for your taste buds to fully adapt to the taste of less salty food.

Will my food taste bland without salt?

Most of us add salt to our food out of habit. Cooking with less salt doesn’t mean you need to completely remove it or miss out on flavour! Instead, try easing off the amount of salt you use. Start with one dish you make often, such as mashed potatoes, and see how it tastes as you use less.

Think about your whole dish and where salt may be coming from. You may not need to add salt while you cook if you are already using ingredients like stock cubes, cooking sauces and cheese. You’ll be surprised at how quickly your taste buds adapt.

To help pack flavour into your food, stock up on: 

• dried and fresh herbs
• spices 
• pepper 
• chilli flakes 
• fresh garlic and onion
• citrus fruits (lemons, limes and oranges) 
• vinegar
• heart-healthy cooking oils like olive oil.

Just be mindful that some spice mixes will still contain salt as an ingredient so it pays to check the ingredients list.

Use our heart-healthy recipes for meal ideas and inspiration.

Different types of salt

Salt substitutes

Some products contain less sodium and more potassium than table salt and may be referred to as ‘salt substitutes’. There are a handful of products currently available and they cost more than table salt. These products may be best suited to people who use large amounts of salt during cooking and are unable to use less salt. However, they won’t help you to eat less salty foods.

Check with your doctor before using a salt substitute, as they contain potassium which isn’t suitable for some people with existing health conditions.

Is rock salt healthier?

Rock salt and Himalayan sea salt contain the same amount of sodium as regular table salt, and they often don’t contain iodine. It’s always best to choose an iodised salt because New Zealand soils are low in iodine. Some speciality salts claim to be a natural/unrefined source of minerals and trace elements however the amount of these nutrients is so low there is no benefit to your heart health.

What is the Heart Foundation doing to reduce salt in processed foods?

Given that 75% of our sodium intake comes from processed foods, the food industry has a key role to play in reducing the levels of sodium in all processed foods across the food supply. Since 2007, the Heart Foundation has been working with food companies to help them reduce the amount of sodium in supermarket foods.

Find out more about our work to reduce sodium and sugar in processed foods.

Where to start?

If you’re living with a heart condition, have high blood pressure or are eating more than the recommended amount of salt – it can be overwhelming to know where to start.

A first step could be to aim to serve yourself half a plate of vegetables at dinner time, take the saltshaker off your dining table or start to read food labels for the food products you buy often.

References

1. Strazzullo P, Leclercq C. Sodium. Advances in nutrition (Bethesda, Md). 2014;5(2):188-90.
2. National Academies of Sciences E, and Medicine. Dietary Reference Intakes for Sodium and Potassium. Washington, DC: The National Academies Press 2019.
3. Ministry of Health. Annual Data Explorer 2020/21: New Zealand Health Survey [Data File]. 2021.
4. Ministry of Health. Cardiovascular Disease Risk Assessment and Management for Primary Care. Wellington 2018.
5. National Health and Medical Research Council, New Zealand Ministry of Health. Nutrient Reference Values for Australia and New Zealand. 2017 Update: Fluoride and Sodium ed. Canberra: National Health and Medical Research Council; 2006.
6. Azegami T, Uchida K, Tokumura M, Mori M. Blood Pressure Tracking From Childhood to Adulthood. Frontiers in paediatrics. 2021;9:785356-.
7. Chapman R B, E. Taste bud. Encyclopedia Britannica 2016.
8. InformedHealth.org. How does our sense of taste work? Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2011.

 

Sodium and heart health position statement (PDF)

Eating for a healthy heart

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