Learn About Sodium & CKD
When diagnosed with kidney disease, one of the first things your doctor may tell you is to follow a low-sodium diet. Healthy kidneys can filter out too much sodium in our bodies through urine. But when our kidneys aren’t working well, sodium can build up in our bodies. Too much sodium causes fluid retention and can lead to high blood pressure and fluid weight gain. [1]
Throughout this guide, you will learn what sodium is and how to manage it to optimize your health. Although sodium is a common seasoning that brings out the flavor in food, it is not the only way to make food tasty. You can still have meals that are full of flavor and low in sodium.
What is Sodium vs. Salt?
You may think that salt and sodium are the same. But there is a difference.
Sodium
Sodium is a part of salt, and sodium is the component of salt that can cause high blood pressure in people with kidney disease. However, your body still needs some sodium for nerve function, muscle contraction, and fluid balance. You now have to practice awareness of how much you are eating. [2]
Salt
Salt is a mineral composed of sodium and chloride. Table salt is the most common type of salt you may know. [2]
Sodium Recommendations For Kidney Disease
A low sodium diet helps protect your kidneys from high blood pressure. When you carry extra fluid in your body, your heart works harder, increasing your blood pressure. By limiting the amount of sodium, you will be able to control the fluid surrounding your heart, lungs, and legs.
Numbers to Understand
- On average, Americans are eating 3,400mg of sodium per day [2]
- The daily recommendation according to The Dietary Guidelines for Americans is less than 2,300mg per day [2]
- 1 teaspoons of salt = 2300mg
For people with kidney disease, having no more than 2,300mg of sodium per day is recommended. However, your doctor may recommend a lower goal of 1500-2000mg per day, depending on your individual health needs. [3]
Types of salt
There are many salt varieties worldwide to know about when starting a low sodium diet. You are probably familiar with very fine salt and salt that is very coarse, like sea salt. The milligrams of sodium in each salt will vary slightly depending on the size of the salt crystal. However, even though a coarser salt may have less sodium per teaspoon, it is still a good source of sodium.
One teaspoon per day is still recommended for all types of salt. It’s also important to note that sea salts can also contain traces of minerals like potassium, phosphorus, magnesium, and calcium. [4]
Here Are Some of The Most Common Types of Salt
- Table Salt
- Sea Salt
- Pink Himalayan salt
- Kosher Salt
- Sel Gris
- Fleur de Sel
- Truffle Salt
- Kala Manek
- Hawaiian Black Lava Salt
- Hawaiian Alaea Red Salt
What About Salt Substitutes?
Salt substitutes are readily available for people following a low sodium diet. Salt substitutes are not recommended for people with kidney disease because potassium is often added to these products. [5] Potassium is another mineral closely monitored by your kidney doctor. Talk to your doctor or dietician about your daily potassium recommendation before trying any salt substitutes. For more information on potassium, check out our low potassium guide.
Types of Salt Substitutes
- Morton’s Salt Substitute
- Morton’s Lite Salt
- Nu-Salt
- No Salt
- My Salt
- Fit Salt
How To Reduce Sodium in Your Diet
Canned, packaged, and processed foods have the most sodium. Fresh fruits, vegetables, and meats have little to no sodium. Choosing fresh foods and cooking food from scratch is a better way to manage your sodium intake. You may think that most of the sodium we eat comes from table salt or is added to food at the table after cooking. Generally not true; most sodium we eat comes from packaged, processed, or restaurant foods.
Sodium preserves taste and freshness in many foods. Listed below are foods commonly high in sodium to consider when evaluating your sodium intake. You can become aware of these common foods in your grocery store and look for better alternatives, like low sodium or no added salt versions.
Foods High in Sodium
Processed Foods
- Canned soups
- Tomato products
- Vegetable juices
- Buttermilk
- Cheese
- Canned vegetables
- TV Dinners
- Canned ravioli
- Chili
- Frozen or fresh pizza
- Macaroni & Cheese
- Commercial mixes
- Frozen prepared foods
- Fast food
- Bread and bagels
Sauces and Snacks
- Ketchup
- Barbecue sauce
- Steak Sauce
- Soy sauce
- Teriyaki sauce
- Oyster sauce
- Pasta sauces
- Crackers
- Pretzels
- Various chips
- Nuts
- Popcorn
- Sunflower seeds
Salt & Salt Seasonings
- Table salt
- Seasoning salt
- Garlic salt
- Onion salt
- Celery salt
- Lemon pepper
- Lite salt
- Meat tenderizer
- Bouillon cubes
- Some spice mixes
- Some spice rubs
Cured Foods
- Ham
- Salt pork
- Bacon
- Sauerkraut
- Pickled foods
- Lox & Herring
- Olives
Cold-Cuts/Lunch Meats
- Hot Dogs
- Cold cuts, deli meats
- Pastrami
- Sausage
- Corned beef
- Spam
Foods Low in Sodium
Vegetables & Fruits
- Fresh fruits
- Fresh vegetables
- Plain frozen vegetables without added butter, salt, or sauce
- Low sodium canned vegetables
- Low-sodium vegetable juice
- Frozen, canned, or dried fruit
Dressings, Oils, and Condiments
- Unsalted margarine and spreads (soft, tub, or liquid)
- Vegetable oils (canola, corn, olive, peanut, safflower, soybean, or sunflower)
- Low-sodium salad dressing
- Low-sodium ketchup
- Low-sodium salsa or hot sauce
Dairy
- Fat-free or low-fat (1%) milk
- Fat-free or low-fat plain yogurt
- Low-sodium or reduced-sodium cheese
- Soymilk
- Rice milk
Protein Food
- Seafood*
- Poultry*
- Beef*
- Pork*
- Unsalted nuts and seeds
- Dried beans and peas
- Low sodium canned beans labeled
- Eggs
*Bought plain and unmarinated
Cereals, & Other Grains
- Whole grains (read the label to find the sodium content)
- Whole-wheat pasta
- Oatmeal
- Cream of wheat
- Some cold cereals (read the label to find the sodium content)
- Unsalted popcorn
- Unsalted chips
- Unsalted pretzels
Using a Food Label To Find Sodium
When following a low sodium diet, you can use The Nutrition Facts Label as a tool to help you make informed decisions. You cannot tell whether a food is high in sodium simply by tasting it. When reading the nutrition label to compare products, check the serving size and amount of servings per package. Use the % Daily Value (%DV) to identify the sodium content in foods. [2] To learn more about reading sodium on The Nutrition Facts Label check out our guide.
Quick Tips
- 5% DV or less of sodium per serving for a snack is considered low
- 20% DV or more of sodium per serving for a meal is considered high
- Aim to pick packaged foods with a sodium content of 140mg or less per serving [2]
The Food and Drug Administration monitors specific sodium-related terms for food companies to use on their food labels. You can use these food claims on the package to quickly find options that work for you.
Sodium Claims on a Packaged Food or Drink
Salt/sodium-Free
Less than 5mg of sodium per serving
Very Low Sodium
35 mg of sodium or less per serving
Low Sodium
140 mg of sodium or less per serving
Reduced Sodium
At least 25% less sodium than the regular product
Light in Sodium or Lightly Salted
At least 50% less sodium than the standard product
No Salt Added or Unsalted
No salt is added during processing. These products may not be salt/sodium-free unless stated. [2]
Cooking on a Low Sodium Diet
Eating salty foods is a taste that you have learned and a preference you can change. It may take a few months to adjust to eating a low sodium diet. But with time, you will notice that some salty foods you used to enjoy may now taste too salty. To help your taste buds adjust, you will need to make most, if not all, of your meals and snacks low sodium.
When you begin cooking without salt, it may seem a little overwhelming. Some people have become habitual salters, adding salt without tasting the food first or adding it because it is what they have always done. Below are some of our strategies to stop you from constantly reaching for the salt. In general, remember that fresh foods are best!
Quick Tips
- Remove the salt shaker from the stove and table.
- Do not salt cooking water or add salt while cooking.
- Use half or less of the salt called for in recipes.
- Use basic spices and seasonings instead of salted versions.
- Prepare rice, pasta, beans, and meats fresh when possible.
- Limit sauces, mixes, and “instant” products, like flavored rice and ready-made pasta.
- Season with garlic, onion, lemon, lime, or fresh herbs and spices.
- Rinse canned vegetables, beans, meats, and fish with water to remove extra sodium. [6]
Add Flavor Without Salt
Seasonings that are kidney-friendly are vinegar, fresh and dried herbs and spices, and citrus. These options are perfect for boosting your food’s flavor and giving you a better experience on your low sodium diet. When you use fresh spices, this sensation is even better than something from the grocery store, as these spices are usually not the newest. Learning what seasonings work well together will take some practice and experimenting, but the amount of flavor may surprise you!
Tips for Using Herbs and Spices
- Use fresh lemon, lime, and orange zest with cold soups, asparagus, chicken, fish, or broccoli.
- Use citrus (lemon, lime, orange juice) and vinegar to elevate the flavor of salads.
- Purchase powdered spices in small amounts! When they sit on the shelf for years, they lose their flavor.
- Use no more than ¼ teaspoon of dried spice (¾ of fresh) per pound of meat.
- Combine herbs with oil or butter, let them sit for 30 minutes to bring out their flavor, brush on food while it cooks, or brush the mixture on meat and marinate for one hour before cooking.
- Use whole spices when possible, and use a spice grinder for fresh seasoning. [6]
Seasoning Food Pairings
- Basil: Squash, tomato, eggplant, soups
- Garlic: Salsa, sauces, vegetables
- Ginger: Carrots, white sauces
- Mint: cold sous, salads, fruit dishes
- Thyme: soups, stews
- Sesame: Vegetables, tofu [6]
How Do I Dine Out on a Low Sodium Diet?
Managing your sodium intake is easier to do at home. But that doesn’t mean that you can’t enjoy meals out. The key is to start asking restaurants for what you need to continue your low sodium diet. Restaurants are now more conscious and considerate of people who need to make substitutions for allergies and diet limitations. Many restaurants will prepare foods without added salt or offer lower-sodium options. Don’t be afraid to ask for what you want!
Tips For Eating Out
- Choose restaurants that are made to order vs. fast-food restaurants with processed food.
- Ask for no salt when ordering grilled, sauteed, or baked entrees.
- Ask for sauces and dressings to be omitted or served on the side
- Oil and vinegar is a low sodium alternative instead of salad dressing.
- Choose plain steamed veggies, rice, or fruit as sides.
- Have fresh veggies in a sandwich and ask for no salt or salty condiments like pickles
- Chain restaurants often put nutritional information online. Check to find lower sodium options.
- Reduce your portion size by taking half of your meal home for later or split an entree with someone else
- Ask your server if nutrition information is available for a low sodium option.
- Request no MSG, soy sauce, or fish sauce when ordering Asian foods. Low sodium soy sauce still has a significant amount of sodium.
- Balance getting takeout and fast food as an occasional treat you enjoy [7]
We hope you found this guide helpful as you journey to adopt a low sodium diet. Check out our low-sodium recipes here on Cukebook.
References
- Borrelli, S., Provenzano, M., Gagliardi, I., Michael, A., Liberti, M. E., De Nicola, L., Conte, G., Garofalo, C., & Andreucci, M. (2020). Sodium Intake and Chronic Kidney Disease. International journal of molecular sciences, 21(13), 4744. https://doi.org/10.3390/ijms21134744
- Center for Food Safety and Applied Nutrition. (n.d.). Sodium in your diet. U.S. Food and Drug Administration. Retrieved April 17, 2022, from https://www.fda.gov/food/nutrition-education-resources-materials/sodium-your-diet
- McCann, L. (2015). Hypertension in CKD (not dialysis dependent). In Pocket guide to nutrition assessment of the patient with kidney disease: A concise, Practical Resource for Comprehensive Nutrition Care in kidney disease. essay, National Kidney Foundation.
- Katherine Zeratsky, R. D. (2021, September 14). Is sea salt healthier than table salt? Mayo Clinic. Retrieved May 11, 2022, from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/sea-salt/faq-20058512
- Banman, C. (2012). A look at Salt Substitutes. Journal of Renal Nutrition, 22(2). https://doi.org/10.1053/j.jrn.2011.12.003
- National Kidney Foundation. (2022, March 1). Sodium and your CKD diet: How to spice up your cooking. National Kidney Foundation. Retrieved April 17, 2022, from https://www.kidney.org/atoz/content/sodiumckd
- Dining out with confidence – on dialysis. National Kidney Foundation. (2022, January 13). Retrieved May 11, 2022, from https://www.kidney.org/atoz/content/diningout
