Despite improvements, salt in restaurant meals remains high, can hurt the heart

NEW YORK, Oct. 21 (UPI) -- Consumers thinking of dining out for their next meal may want to consider one instruction for the server when possible -- hold the salt.

Although research suggests that sodium content in restaurant foods, including those served in sit-down eateries and fast-food chains, has declined in recent years as the detrimental health effects of high-salt intake become better known, the levels remain high overall, experts say.

"There have been inconsistent reductions across different categories and restaurant types," nutritionist Raedeh Basiri told UPI in an email.

"Consumers can request low-sodium options at restaurants, but the ability to fulfill these requests varies greatly," said Basiri, an assistant professor of nutrition and food studies at George Mason University in Fairfax, Va.

Salt on the wound

So how significant a problem is salt content in restaurant foods, and what can consumers do to protect themselves?

Excess salt in the diet can increase a person's blood pressure, boosting the risk for heart disease and stroke, both of which can be fatal, the American Heart Association says.

Yet, major restaurant chains in the United States serve meals with salt or sodium levels as high as 2,300 milligrams, or about a full teaspoon, according to a recent report from the Center for Science in the Public Interest.

Some restaurants are worse than others, the report suggests, with some well-advertised meals approaching 10,000 mg. of added salt.

For example, at one chain restaurant specializing in Italian cuisine, an entree has more than 2,000 mg of sodium, according to the menu.

Sandwiches available at a large fast-food chain, meanwhile, have sodium levels that range from 1,100 to 1,800 mg, but for less food, as measured by portion size.

As a result, people in the United States consume about 3,500 mg., or about 1.5 teaspoons, of salt per day -- more than twice the recommended amount, the American Heart Association estimates.

People, especially those with high blood pressure or heart conditions, should limit salt intake to no more than 1,500 mg. a day, the heart association says.

More than 70% of the sodium consumed nationally comes from "packaged, prepared and restaurant foods," the Center for Science on the Public Interest says.

A 2018 study found that, from 2012 to 2016, calorie-adjusted sodium content "in newly introduced menu items" at U.S. chain restaurants decreased by an average 104 mg. Basiri said.

"However, the changes varied by restaurant type and menu category," she added.

For example, while sodium levels decreased by 83 mg. in fast food restaurant menu items during that four-year period, and by 163 mg. for menu items in full-service restaurants, they actually increased for foods listed as appetizers and sides, she said.

Meanwhile, a report issued by the Food and Drug Administration in August found that salt content increased in menu items in 49% of restaurant food categories between 2010 and 2022.

"While there has been some progress in reducing sodium levels in restaurant foods, overall sodium content remains high in many menu items," Basiri said.

Hold the salt

Based on the findings in its latest report, the FDA issued a draft guidance document for the food-service industry, with new, voluntary targets for sodium reduction in the food supply.

The guidance, called Voluntary Sodium Reduction Goals: Target Mean and Upper Bound Concentrations for Sodium in Commercially Processed, Packaged and Prepared Foods, offers three-year sodium reduction targets for 163 food categories that, if met, would reduce sodium intake to about 2,750 mg. per day -- still way above the heart association's 1,500 mg. target.

For packaged foods, the association recommends that consumers review the Nutrition Facts label on the back or side of packaging for the amount of sodium per serving, in milligrams.

It advises that consumers look for words "sodium," "salt" and "soda" to get a true sense of the content, though on most labels "total sodium" reflects the sodium from salt, plus the sodium from any other sodium-containing ingredient in the product.

However, that does not help with salty foods purchased at restaurants, said Pasquale Rummo, a researcher on population health at NYU Grossman School of Medicine.

"Consumers often do not have any recourse, especially at chain restaurants," Rummo told UPI in an email.

Making matters more challenging is that the servers at these restaurants may not know the salt content of the foods, he said.

"Chain restaurants typically have menu items made from processed ingredients prepared at a central supply facility and then ship those items to individual retail locations," he added.

That said, several large chain restaurants do list the sodium contents of their foods, either on the menu or online, so the information may be available, with some research.

To address this issue and make it easier for consumers to know what they're eating, a handful of cities across the country -- including New York and Philadelphia -- have enacted laws requiring restaurants to including warnings next to menu items high in sodium, Rummo said.

A study published last year found that the warnings on restaurant labels in New York City contributed to a 16% reduction, on average, in the amount of sodium consumed per transaction, as diners avoided items containing high levels, he said.

"Local law changes requiring sodium warning labels have shown promising results in reducing sodium content, but their impact is still limited," added George Mason University's Basiri.

"More widespread implementation of sodium reduction policies and continued monitoring of their effects could help further reduce sodium intake from restaurant meals," she said.