Reduced Sodium Diet

Author:  Frank W. Jackson, M.D.

Purpose

Sodium is essential to the body. It is a mineral that helps the body regulate fluid balance. Under certain conditions, excess sodium can cause the body to retain too much fluid. This could be harmful for people with conditions such as high blood pressure or heart disease. These conditions are often managed by reducing sodium in the diet. For many patients, restricting the total amount of sodium to 4 grams a day is enough to reduce harmful fluid retention. However, some patients will have to restrict their total sodium intake to 2 grams a day.

Nutrition

If the patient follows the prescribed sodium limitations and chooses a variety of foods from each of the basic food groups (breads and grains, fruits, vegetables, meat alternatives, dairy products), these diets are nutritionally adequate.

Special Considerations
  1. Table salt: This is a large source of sodium in the everyday diet. It is used in the kitchen in food preparation and added at the table. It is also added to many commercially canned and frozen foods. Table salt is about one-half sodium, so its use must be restricted in these diets.
  2. Finding the Sodium in a Diet: Sodium occurs naturally in many foods, and some foods contain more sodium than others.
    On food labels, the sodium content of foods is usually listed in milligrams (mg) per serving. One gram = 1000 mg. So, on a 2 gram sodium diet, a person should have no more than 2000 mg of sodium each day; and on a 4 gram sodium diet, no more than 4000 mg a day. As a helpful guide: for the 4 gram diet, purchase products with no more than 300 mg of sodium per serving. For the 2 gram diet, purchase products with no more than 200 mg of sodium per serving.
    Sodium compounds, in addition to table salt, are often added to commercially processed foods. Some of those more commonly used are baking soda, brine, monosodium glutamate (MSG), baking powder, disodium phosphate, or sodium benzoate. Read food labels on all items before purchasing or using.
  3. Common medications:Antacids, laxatives, and cough remedies often contain sodium compounds. Check with a physician or pharmacist if there is a question about prescription or over-the-counter medications.
  4. Fast food restaurants:Avoid them because the foods they serve tend to be very high in sodium. When dining in other restaurants, ask that no salt be used in the preparation of your meal.
  5. Salt substitutes: Never use these unless the physician has approved it. They may replace the sodium with another mineral that could also be harmful to certain patients. Herbs and spices may be used in place of salt to add flavor and variety to meals.
  6. Water softeners: They exchange the calcium in hard water with sodium from a salt brine. Avoid drinking home or commercially softened water. When purchasing bottled water, check the label to be sure it contains no sodium. Do not use softened water to prepare foods or beverages.
  7. Diet Differences: A few things that are allowed on the 4 gram diet are not permitted on the 2 gram diet. Follow the guide below:
Sample Menu 2 Gram

Breakfast

Lunch

Dinner

  • orange sections 1/2 cup
  • whole wheat toast 1 slice
  • cereal 3/4 cup
  • unsalted margarine 2 tsp
  • jelly 2 tsp
  • skim milk 1 cup
  • coffee
  • creamer/sugar 1 tsp

 
Snack
unsalted soft pretzel 1
apple juice
*Low Sodium

  • chicken noodle soup* 1/2 cup
  • lean hamburger 3 oz
  • hamburger bun 1
  • sliced tomato 2 oz
  • lettuce
  • mayonnaise 1 tsp
  • unsalted crackers 3
  • vanilla wafers 3
  • canned peaches 1/2 cup
  • skim milk 1/2 cup
  • coffee
  • creamer/sugar 1 tsp
  • baked chicken breast
    3 oz
  • baked potato 1 med
  • green beans 1/2 cup
  • tossed salad
  • diet Italian dressing
    1 Tbsp
  • whole wheat bread
    1 slice
  • unsalted margarine 2 tsp
  • angel food cake 1 slice
  • strawberries 1/2 cup
  • skim milk 1 cup
  • coffee
  • creamer/sugar 1 tsp
This Sample Diet Provides the Following
Calories

2090

Fat

55 gm

Protein

105 gm

Sodium

1850 mg

Carbohydrates

300 gm

Potassium

4450 mg

Sample Menu 4 Gram

Breakfast

Lunch

Dinner

  • grapefruit 1/2
  • cereal 3/4 cup
  • banana 1/2
  • whole wheat toast 2 slices
  • margarine 2 tsp
  • jelly or jam 1 Tbsp
  • 2% milk 1 cup
  • coffee/tea
  • vegetable soup 1 cup
  • lean hamburger 2 oz
  • swiss cheese 1 oz
  • hamburger bun 1
  • sliced tomato 2 oz
  • lettuce
  • fresh fruit salad 1/2 cup
  • oatmeal cookie 1
  • 2% milk 1 cup
  • low sodium tomato juice 1/2 cup
  • broiled chicken breast
    3 oz
  • brown rice 1/2 cup
  • broccoli spears 2
  • hard dinner roll 1
  • margarine 2 tsp
  • carrot/raisin salad
    1/2 cup
  • frozen strawberry yogurt 1/2 cup
  • 2% milk 1 cup
  • coffee/tea
This Sample Diet Provides the Following
Calories

2170

Fat

69 gm

Protein

119 gm

Sodium

4040 mg

Carbohydrates

294 gm

Potassium

3950 mg

Diet Differences

4 Gram

2 Gram

Use a total of 1/2 teaspoon of table salt per day in cooking and food preparation. Do not add salt at the table. Use no table salt in cooking and food preparation. Do not add salt at the table.
Limit prepared salad dressings and condiments such as mustard or catsup to a total of 3 tablespoons per day. Do not use commercially prepared salad dressings or condiments such as mustard or catsup.
Do not eat Bleu, Roquefort, Stilton, or Gorgonzola cheeses. Limit other natural or aged cheeses to 2 oz. per day. Do not eat any natural or aged cheeses.
Limit buttermilk to 8 oz. per week. Do not drink buttermilk.
Limit regular peanut butter to 3 teaspoons per week. Do not eat regular peanut butter.
Choosing Foods For A Reduced Sodium Diet

Choose

Avoid

Breads: English muffin; white, wheat, pumpernickel, other types of regular or unsalted bread and rolls sweet rolls, breads or rolls with salted tops, packaged cracker or bread crumb coatings, packaged stuffing mixes, biscuits, corn bread
Cereals: regular cooked cereals such as oats, cream of wheat, rice, or farina; puffed wheat; puffed rice; shredded wheat instant hot cereals, any other regular ready-to-eat cereals
Crackers and snack foods: all unsalted crackers and snack foods, unsalted peanut butter salted crackers and snack items, regular peanut butter, party spreads and dips
Pasta, rice and potatoes: all types of pastas such as macaroni, spaghetti, rigatoni, ziti; potatoes, rice macaroni and cheese mix; seasoned rice, noodle, and spaghetti mixes; canned spaghetti; frozen lasagna, macaroni and cheese, rice, and pasta dishes; instant potatoes; seasoned potato mixes
Dried beans and peas: pinto beans, white northern beans, black-eyed peas, lima beans, lentils, split peas, etc. any beans or peas prepared with ham, bacon, salt pork, or bacon grease; all canned beans
Meats and alternatives: fresh or frozen meat, poultry, and fish; low sodium canned tuna and salmon; eggs salted, smoked, canned, spiced, and pickled meats, poultry and fish; bacon; ham; sausage; scrapple; regular canned tuna or salmon; cold cuts; luncheon meats; hot dogs; pre-breaded frozen meats, fish, and poultry; TV dinners; meat pies; kosher meats
Fruits and vegetables: fresh, frozen, or low-sodium canned vegetables or vegetable juices; low sodium tomato paste and sauce; fresh, canned, or frozen fruit and juices regular canned vegetables and vegetable juices, regular tomato sauce and tomato paste, olives, pickles, relishes, sauerkraut or vegetables packed in brine, frozen vegetables in butter or sauces, crystallized and glazed fruit, maraschino cherries, fruit dried with sodium sulfite
Dairy products: milk, cream, sour cream, non-dairy creamer, yogurt, low-sodium cottage cheese, low sodium cheese buttermilk, Dutch processed chocolate milk, processed cheese slices and spreads, regular cheese, cottage cheese
Fats and oils: margarine regular butter, or mayonnaise limited to 4 teaspoons per day; unsalted butter, margarine, cooking oils, or shortenings; salt free gravies, cream sauces, and salad dressings bacon grease; salt pork; commercially prepared sauces, gravies, and salad dressings
Soups: salt-free soups and low-sodium bouillon cubes regular commercially canned or prepared soups, stews, broths, or bouillon; packaged and frozen soups
Desserts: gelatin, sherbet, fruit ices, pudding and ice cream as part of milk allowance, angel food cake, salt-free baked goods, sugar, honey, jam, jelly, marmalade, syrup regular commercially prepared and packaged baked goods, chocolate candy
Beverages: coffee, tea, soft drinks, fruit flavored drinks that do not contain sodium softened water; carbonated beverages with sodium or salt added; check with physician about alcoholic beverages
Condiments: fresh and dried herbs; lemon juice; low-sodium mustard, vinegar, Tabasco sauce; low-sodium or no-salt-added ketchup; extracts (almond, lemon, vanilla); baking chocolate and cocoa; seasoning blends that do not contain salt table salt, lite salt, bouillon cubes, meat extract, Worcestershire sauce, tartar sauce, ketchup, chili sauce, cooking wines, onion salt, prepared mustard, garlic salt, meat flavorings, meat tenderizers, steak and barbecue sauce, seasoned salt, monosodium glutamate (MSG), Dutch processed cocoa
Flavoring Food Without Salt
Onion, garlic, lemon, vinegar, black pepper, and parsley improve the flavor of many kinds of food. For gourmet-type dishes, use fruit, fruit juices, or sweet and sour sauce. Use fresh or dried herbs and spices to flavor foods. Remember that two teaspoons of chopped fresh herbs equals 1/2 teaspoon of the dried form. Always store dried herbs and spices in a cool, dry place in airtight containers. When flavoring, start with small amounts (1/4 tsp for four servings) and increase to taste. Don’t use more than three herbs or spices in one dish. Certain herbs and spices blend better with some foods than with others, so experiment and use the suggestions below as a guide.

Vegetables

Meats, Poultry, Fish and Eggs

Asparagus: lemon, chives Beef: bay leaf, dry mustard, nutmeg (in meat loaf), sage, dill, green pepper, fresh mushrooms, tomatoes
Broccoli: lemon, oregano, rosemary Veal: bay leaf, curry, ginger, apricot or current jelly, fresh mushrooms, tomatoes, tarragon, dry mustard
Carrots: lemon, orange, nutmeg, mint, basil, marjoram, oregano, thyme, brown sugar, ginger, cinnamon, mace, anise, dry mustard Pork: sage, caraway, nutmeg, apples, applesauce, cranberry sauce, tarragon, dry mustard
Corn: green pepper, fresh tomatoes, paprika, hot pepper sauce Lamb: curry, mint, dill,sage
Peas: mint, dill, fresh mushrooms, basil, marjoram, savory Poultry sage, tarragon, fresh mushrooms, poultry seasoning, curry, peach, apricot, pineapple, lemon, hot pepper sauce, bay leaf
Potatoes: mace, chives, rosemary, dill Fish & Eggs: dill, basil, tarragon, curry, dry mustard, paprika, cayenne, thyme, green pepper, fresh mushrooms, tomatoes, hot pepper sauce, chives, Bay leaf adds flavor to fish chowders
Sweet Potatoes: mace, ginger, basil, cinnamon, cloves, brown sugar, nutmeg, allspice, oregano, lemon, orange    
Spinach: nutmeg, oregano, basil, marjoram, rosemary, thyme, allspice, mace, lemon    
Tomatoes: basil, oregano, thyme, sugar, dill, marjoram, vinegar    

© Frank W. Jackson, M.D.