Sodium is a mineral that exists in the body as the ion Na+. Sodium is acquired through diet, mainly in the form of salt (sodium chloride, NaCl). Regulating the amount of Na+ in the body is absolutely critical to life and health.

Purpose

Sodium is possibly the most important mineral in the body. It plays a major role in controlling the distribution of fluids, maintaining blood pressure and blood volume, creating an electrical gradient that allows nerve transmission and muscle contraction to occur, maintaining the mechanisms that allow wastes to leave cells, and regulating the acidity (pH) of the blood. Many different organ working together, including the kidneys, endocrine glands, and brain, tightly control the level of Na+ in the body. Researchers estimate that between 20% and 40% of an adult’s resting energy use goes toward regulating sodium. Sodium affects every cell in the body, and a major failure of sodium regulatory mechanisms means death.

Description

In the body, sodium exists as electrolyte. Electrolytes are ions that form when salts dissolve in water or fluids. These ions have an electric charge. Positively charged ions are called cations. Negatively charged ions are called anions. Electrolytes are not evenly distributed within the body, and their uneven distribution allows many important metabolic reactions to occur. Sodium (Na+), potassium (K+), calcium(Ca 2+), magnesium (Mg 2+), chloride (Cl-), phosphate

Sodium

Age	Adequate Intake (mg)
Children 0-6 mos.	120
Children 7-12 mos.	370
Children 1-3 yrs.	1,000
Children 4-8 yrs.	1,200
Children 9-13 yrs.	1,500
Adolescents 14-18 yrs.	1,500
Adults 19-50 yrs.	1,500
Adults 51-70 yrs.	1,300
Adults 71>yrs.	1,200
Pregnant women	1,500
Breastfeeding women	1,500
Food	Sodium (mg)
Table salt, 1 tsp.	2,300
Dill pickle, 1 large	1,731
Chicken noodle soup, canned, 1 cup	850-1,100
Ham, 3 oz.	1,000
Sauerkraut, 1/2; cup	780
Pretzels, 1 oz.	500
Turkey breast, deli, 1 oz.	335
Soy sauce, 1 tsp.	304
Potato chips, 1 oz.	165-185

mg =milligram

(Illustration by GGS Information Services/Thomson Gale.)

(HPO₄ 2-), bicarbonate (HCO₃-), and sulfate (SO₄ 2-) are important electrolytes in humans.

Na+ is ten times more concentrated in fluid outside cells (i.e. extracellular fluid and blood) than it is in fluid inside cells. This difference in concentration is maintained through the expenditure of cellular energy, and it is critical to many metabolic functions, including maintaining the proportion of water that exists inside and outside of cells. (See the entry on electrolytes for a more detailed explanation of how this occurs). When Na+ is too high or too low, it is almost never because an individual has eaten too much or too little salt. Instead, it is because organs such as the kidneys or endocrine glands that regulate the conservation or removal of sodium from the body have broken down.

Sodium requirements

Researchers estimate that humans can remain healthy taking in only 500 mg of sodium daily. Salt is 40% sodium by weight, and 500 mg is slightly less than the amount of sodium found in 1/4 teaspoon of salt. Humans almost never take in too little salt; their health problems result from too much salt in the diet.

The United States Institute of Medicine (IOM) of the National Academy of Sciences has developed values called Dietary Reference Intakes (DRIs) for many vitamins and minerals including sodium. The DRIs

KEY TERMS

Diuretic— a substance that removes water from the body by increasing urine production

Ion—an atom or molecule that has an electric charge. In the body ions are collectively referred to as electrolytes.

consist of three sets of numbers. The Recommended Dietary Allowance (RDA) defines the average daily amount of the nutrient needed to meet the health needs of 97-98% of the population. The Adequate Intake (AI) is an estimate set when there is not enough information to determine an RDA. The Tolerable Upper Intake Level (UL) is the average maximum amount that can be taken daily without risking negative side effects. The DRIs are calculated for children, adult men, adult women, pregnant women, and breastfeeding women.

The IOM has not set RDAs for sodium, but instead it has set AI levels for all age groups based on observed and experimental information about the amount of sodium needed to replace what is lost by a moderately active individual each day. Sodium is lost in both urine and sweat. IAs for sodium are measured in milligrams (mg). UL levels have not been set. However, the IOM recommends that adults limit their sodium intake to less than 2,400 mg per day, and the American Heart Association recommends an adult daily intake of 1,500-2,300 mg.

The following list gives the recommended daily AL levels of sodium for each age group.

children birth-6 months: AI 120 mg
children 7-12 months: AI 370 mg
children 1-3 years: AI 1,000 mg
children 4-8 years: AI 1,200 mg
children 9-13 years: AI 1,500 mg
adolescents 14-18 years: IA 1,500 mg
adults age 19-50: AI 1,500 mg
adults ages50-70 1,300 mg
adults 71 years or older: AI 1,200 mg
pregnant women: IA 1,500 mg
>breastfeeding women: AI 1,500 mg

Sources of sodium

Many people think that the main source of salt in their diet is what they add to food when they are cooking or at the table while eating. In reality, more than three-quarters of the sodium in the average American’s diet is added to food during processing. Another 12% is already naturally in the food. For example, 1 cup of low-fat milk contains 110 mg of sodium. About 6% of sodium in the diet is added as salt during cooking and another 5% from salting food while eating.

Although most sodium in diet comes from salt, other sources of sodium include preservatives and flavor enhancers added during processing. Sodium content is required to be listed on food labels of processed foods. Some common ‘‘hidden’’ sources of sodium include:

baking soda
baking powder
disodium phosphate
monosodium glutamate (MSG)
sodium nitrate or sodium nitrite

Below are some common foods and their sodium content.

table salt, 1 teaspoon:2,300 mg
dill pickle, large: 1731 mg
canned chicken noodle soup, 1 cup: 850-1,100 mg
ham, 3 ounces: 1,000 mg
sauerkraut, 1/2 cup: 780 mg
pretzels, 1 ounce: 500 mg
potato chips, 1 ounce: 165-185 mg
soy sauce, 1 teaspoon: 304
deli turkey breast, 1 ounce: 335 mg

Fresh fruits, vegetables, unsalted nuts, and rice, dried beans and peas are examples of foods that are low in sodium.

Sodium and health

Too high a concentration of sodium in the blood causes a condition called hypernatremia. Too much sodium in the diet almost never causes Hypernatremia. Causes include excessive water loss (e.g. severe diarrhea), restricted water intake, untreated diabetes (causes water loss), kidney disease, and hormonal imbalances. Symptoms include signs of dehydrationsuch as extreme thirst, dark urine, sunken eyes, fatigue, irregular heart beat, muscle twitching, seizures, and coma.

Hypernatremia and hyponatremia are at the extreme ends of sodium imbalance. However, high dietary intake of salt can cause less visible health damage in the form of high blood pressure (hypertension). Hypertension silently damages the heart, blood vessels, and kidney and increases the risk of stroke, heart attack, and kidney damage. A low-salt diet significantly lowers blood pressure in 30-60% of people with high blood pressure and a quarter to half of people with normal blood pressure. Some individuals are more sensitive to sodium than others. Those people who are most likely to see a rise in blood pressure with increased sodium intake include people who are obese, have type 2 diabetes, are elderly, female, and African American.

The American Heart Association recommends reducing sodium in the diet to between 1,500 mg and 2,300 mg daily. Below are some suggestions for cutting down on salt.

Eat more fresh fruits and vegetables.
Look for processed foods that say ‘‘no salt added’’
Limit or eliminate salty snacks such as chips and pretzels.
Restrict the amount processed meats such as hot dogs, pepperoni, and deli meats.
Avoid high salt canned soups; choose heart-healthy lower salt soups instead.
Use spices instead of salt to give foods flavor.

Precautions

People who are salt-sensitive may need to keep their salt intake at levels below the suggested daily amounts to control their blood pressure.

Interactions

Certain drugs cause large amounts of sodium to be excreted by the kidneys and removed from the body in urine. Diuretics (‘‘water pills’’) are among the best known of these drugs. Other types of drugs that may cause low sodium levels, especially in ill individuals, include non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil, Motrin, and Aleve, opiates such as codeine and morphine, selective serotonin-reuptake inhibitors (SSRIs) such as Prozac or Paxil, and tricyclic antidepres-sants such as Elavil and Tofranil.

Complications

Health concerns about sodium have been discussed above. Most problems related to high blood pressure are chronic, slow to develop disorders that do not cause serious complications until the second half of an individual’s lifetime. Kidney failure, heart attack, and stroke are all complications of high blood pressure and potentially of high sodium intake.

Parental concerns

Salt is an acquired taste. Parents can help their children control their salt intake and discourage the development of a craving for salt by substituting low-salt foods for high-salt foods.

Resources

BOOKS

American Heart Association. American Heart Association Low-Salt Cookbook: A Complete Guide to Reducing Sodium and Fat in Your Diet. 3rd ed. New York: Clarkson Potter Pubs., 2006.

Hawkins, W. Rex. Eat Right—Electrolyte: A Nutritional Guide to Minerals in Our Daily Diet. Amherst, NY: Prometheus Books, 2006.

James, Shelly V, The Complete Idiot’s Guide to Low-Sodium Meals. Indianapolis, IN: Alpha Books, 2006.

Pressman, Alan H. and Sheila Buff.The Complete Idiot’s Guide to Vitamins and Minerals. 3rd ed. Indianapolis, IN: Alpha Books, 2007.

ORGANIZATIONS

American Heart Association. 7272 Greenville Avenue, Dallas, TX 75231. Telephone: (800) 242-8721. Website: <http://www.americanheart.org>

International Food Information Council. 1100 Connecticut Avenue, NW Suite 430, Washington, DC 20036. Telephone: 02-296-6540. Fax: 202-296-6547. Website: <http://ific.org>

Linus Pauling Institute. Oregon State University, 571 Weniger Hall, Corvallis, OR 97331-6512. Telephone: (541) 717-5075. Fax: (541) 737-5077. Website:<http://lpi.oregonstate.edu>

OTHER

American Heart Association. ‘‘Sodium.’’ undated, accessed April 27, 2007, <http://www.americanheart.org/presenter.jhtml?identifier=4708>

Higdon, Jane. ‘‘Sodium.’’ Linus Pauling Institute-Oregon State University, February 16, 2004.<http://lpi.ore-gonstate.edu/infocenter/minerals/sodium>

Mayo Clinic Staff. ‘‘Sodium: Are You getting Too Much?’’ MayoClinic.com, May 24, 2006. <http://www.mayoclinic.com/health/sodium/NU00284>

Medline Plus. ‘‘Dietary Sodium.’’ U. S. National Library of Medicine, April 23, 2007. <http://www.nlm.nih/gov/medlineplus/dietarysodium.html>

Murray, Robert. ‘‘The Risk and Reality of Hyponatremia.’’ Gatorade Sports Science Institute, 2006. <http://www.gssiweb.com>

Northwesternutrition ‘‘Nutrition Fact Sheet: Sodium.’’ Northwestern University, September 21, 2006. <http://www.feinberg.northwestern.edu/nutrition/factsheets/sodium.html>

United States Department of Health and Human Services and the United States Department of Agriculture.

‘‘Dietary Guidelines for Americans 2005.’’ January 12, 2005. <http://www.healthierus.gov/dietaryguidelines>

Tish Davidson, A.M.