Los Angeles Jewish Home's Blog

Salt and Water: How Much is Too Much?

We are all exposed to research findings in the media that present prevailing wisdom on health and dietary issues only to reverse itself six months later with the publication of a new finding.

Coffee, alcohol, wine, and chocolate have been hot topics over the past several years. But the most common confusion I encounter in the clinical setting results from misinformation patients and families receive regarding the amount of salt and water we should consume on a daily basis.

Most Americans understand that adding extra salt to food is not healthy for them, and that excess salt can contribute to high blood pressure and heart disease. Unfortunately most people do not understand that the normal American diet already contains an extremely high amount of sodium, as salt is measured in most prepared foods, averaging 4,000 mg per day. This is much higher than the American Heart Association guideline of 1,500 mg per day.

It is estimated that limiting sodium intake to recommended levels could save 150,000 lives each year by reducing complications from high blood pressure and heart disease.

Surprise — It's Not the Salt Shaker

Many patients feel they are not at risk for excess sodium if they don't add extra salt to their foods at the table. However, sodium added to foods from a salt shaker only accounts for 5% of the sodium consumed in the regular American diet. Ninety-five percent comes from processed foods themselves.

It comes as a surprise to most of my patients that many common foods contribute to high sodium intake. Most canned soups have nearly 1,000 mg of sodium in one serving, which is two-thirds of the daily limit in one meal. One small package of soy sauce also contains nearly 1,000 mg of sodium.

With such a high sodium content in everyday foods, many patients exceed their daily limit before lunchtime. Patients with the diagnosis of heart failure are often the most vulnerable to excess sodium intake, which commonly leads to excess water retention in the legs and lungs and is a common reason for heart failure admissions to the hospital.

By eating fewer processed foods, and adding more fresh fruits, vegetables, and whole grains to your diet, you can help keep your sodium intake well within the recommended guidelines.

Water — Large Quantities are Not for Everyone

Water consumption is another dilemma for patients. It is generally assumed true that drinking several large bottles of water a day may be good for a young, healthy person. But for patients with certain medical conditions, such as heart failure or kidney disease, large amounts of water can actually compromise their conditions.

Depending on the severity of their particular condition, physicians often limit patients daily water intake to one-two liters (two-four 500ml bottles) per day. The American Heart Association recommends less than two liters of fluids per day for patients with heart failure and patients with end stage kidney disease often are recommended to drink about one liter per day.

Well-informed about the benefits of hydration, patients are often surprised that they are drinking more fluids than the recommended amount and that drinking too much fluid can make them sicker.

It is always advisable to discuss your particular fluid and sodium restrictions with your physician because these two essential nutritional elements can have an enormous impact on your health.

Dr. Esiquio CasillasAs a Jewish Home clinic physician, Dr. Esiquio Casillas helps seniors learn to better control their chronic diseases by incorporating social determinants of health with high-quality primary care services. Dr. Casillas completed a year-long Health Policy Fellowship at Harvard Medical School, where he analyzed the role private community physicians play in stabilizing the healthcare safety net in Los Angeles. Dr. Casillas received his medical degree in 2001 from Harvard Medical School and completed his residency in family practice in 2004 at White Memorial Medical Center, where he served as Chief Resident. He was born in Los Angeles and enjoys traveling, outdoor activities, and running.

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