Which has more sodium?

1) A single-serving-size can of Starkist tuna.
2) A teaspoon of baking soda.
3) Two tablespoons of Hidden Valley Ranch dressing.
4) A glazed Krispy Kreme doughnut.

It's baking soda, at a whopping 1,259 milligrams. High levels of sodium are not found just in salty pretzels, chips and smoked seafood and meats and frozen dinners. They're also hidden in seemingly innocuous foods such as breaded and bakery products and even some medicines and toothpastes. That's what makes following a low-salt diet so confounding.

	Tony Tye, Post-Gazette Gayle Michler, a registered nurse, learned how hard it is to follow a low-salt diet when she started caring for her father after he was hospitalized with congestive heart failure. Low-salt products were so difficult to find that she started her own company, saltwatcher.com, to meet the need. Click photo for larger image.

Forget low-carb, reduced-fat or sugar-free diets. The latest focus of the federal government is cutting down on sodium. The Institute of Medicine last month issued new guidelines urging most adults to limit total daily sodium intake to 1,500 milligrams -- an amount easily eclipsed by just one frozen TV dinner. Moreover, people 50 and over should eat even less, 1,300 milligrams, and over age 70, 1,200 milligrams.

Until now, concerns over the escalating consumption of sodium have largely been ignored by most consumers and food providers for the simple reason that it's hard to find tasty low-salt products. And because of our busy lifestyles, more Americans are getting the bulk of their calories from processed and restaurant foods that are packed with sodium.

But health experts say excess sodium intake can be a major contributor to high blood pressure, which afflicts 50 million Americans and puts them at higher risk for heart attacks, strokes and kidney disease. Another 45 million are pre-hypertensive.

Gayle Michler, a registered nurse who worked at UPMC South Side, learned how hard it is to follow a low-salt diet when she started caring for her father after he was hospitalized in the fall of 2002 with congestive heart failure.

		How much salt is in that? Here are some salt-saving tips from SaltWatcher.com's Gayle Michler: A quarter cup of regular Gold Medal flour has no sodium; the same measurement of self-rising Gold Medal flour has 400 milligrams. Ricotta cheese has 80 milligrams per half cup; cottage cheese has 420 milligrams for the same amount. Prepared chocolate milk in the dairy case has 220 milligrams of salt per serving; mix it up yourself with white milk and 2 tablespoons of Hershey's chocolate syrup (there's no sodium in chocolate) and your total is 25 milligrams. Fresh mozzarella cheese has 40 milligrams per serving; regular deli mozzarella 240. One serving of plain frozen chicken is 380 milligrams, the same serving of fresh chicken is 40 milligrams because of the difference in how frozen food is processed. Reduced or low-fat products don't mean low salt. In fact, they often contain more salt than the original products to improve taste. Medicines are not immune; two antacid pills may have more than 1,000 milligrams of sodium.

Five million Americans have this condition, in which a weakened heart doesn't pump as well as it should, robbing the body of sufficient blood flow to carry the needed oxygen. It can be managed with medication and lifestyle changes, such as cutting dietary salt, although one in five people die within a year of diagnosis.

"I spent 10 years in the coronary care unit, educating people about a low-sodium diet," says Michler, 48, who also worked as a health consultant. "But I myself had never tried it. I never realized how difficult it is to follow, and it's even more difficult if you're not healthy.

She got frustrated over confusing food labels or packages that failed to list the sodium content at all. In November 2003, she started SaltWatcher.com, an Internet company that sells low-salt products and dispenses health information, practical shopping tips and tasty, low-salt recipes.

Michler has built a small warehouse next to her family home in Carrick that stocks more than 250 products, ranging from hard-to-find, low-salt salad dressings, breads and bread crumbs, dessert mixes, sauces, crackers, cereals and even a special baking soda with zero sodium. No products have more than 140 milligrams of sodium per serving (the federal definition of a low-salt item), and most have far less.

Additionally, she's well-versed in finding the low-salt alternative for most foods in grocery stores. Corn tortillas, for example, have far less salt than flour tortillas -- 5 milligrams of sodium for two Pepito corn tortillas vs. 270 milligrams for the flour version.

Michler has also noticed larger grocery stores expanding their inventory of lower-salt products.

"From a consumer perspective, I do know we have taken a much closer look at providing specialized products for people with special needs, and that includes low sodium," said Judy Dodd, a registered dietitian who is food and nutrition advisor for Giant Eagle Corp., the region's largest grocery store chain.

The larger Giant Eagles have Nature's Basket, a section of organic foods that are free of preservatives and other additives, such as monosodium glutamate or MSG, that boost the salt content. All the store bakery breads are now made without sodium propionate, a freshness additive.

More store-brand soups and vegetables without salt are being introduced. Some of these soups are good for "scratch" cooking, providing a prepared base on which cooks can assemble recipes, she said.

		Understanding labels What's the difference between salt and sodium? Sodium is a mineral that combines with chlorine to form salt. It is a nutrient that helps your body maintain water balance, transmit nerve impulses and contract muscles. Salt is typically used to season food and is the main source of sodium in many people's diets. Below are FDA guidelines for sodium claims: Sodium free: Less than 5 milligrams of sodium per serving. Very low sodium: 35 mg or less per serving Low sodium: 140 mg or less per serving Reduced sodium: 25 percent less than original item Light in sodium: 50 percent less sodium than original item Unsalted, no salt added: No salt is added to a food normally processed with salt Source: SaltWatcher.com

Years ago, such specialty products retailed for twice the cost of regular foods, but store brands, at least, are now priced the same, Dodd said. The store also has a page on its Web site, that discusses reducing sodium levels and lists lower-sodium products available.

Despite these efforts, Dodd said the new federal recommendations on sodium present an unrealistic goal for consumers.

"The daily value has been set at 2,400 milligrams [of sodium] a day, and we've gotten nowhere close to that," she said. "Achieving 1,500 is going to truly limit some of the eating styles. The question comes back, in fact, on whether they're necessary for the entire population. The whole population is not at risk for high blood pressure."

Dodd also said that the Dietary Approaches to Stop Hypertension or DASH diet, which is promoted by the National Heart Lung and Blood Institute, is not a low-salt diet, but one based on fruits, vegetables, whole grains and low-fat products. It's high in potassium, calcium and magnesium, as well as protein and fiber.

Leslie Bonci, director of UPMC Sports Medicine Nutrition, noted that the Institute of Medicine's recommendations also emphasized that people need to increase their intake of potassium, which naturally lowers blood pressure and reduces the risk of kidney stones and bone loss. It urges people to consume 4,700 milligrams a day -- roughly double the current consumption.

Potassium is found in bananas, spinach, cantaloupe, orange juice and numerous other fruits and vegetables.

Bonci praised the new sodium guidelines because they'll prompt people to pay attention to what they're eating. "The best that will come out of it is that people will start to limit and cut back on salty snacks, which are also the high-calorie items."

But she suggested a less draconian approach on salt consumption.

"I really like pretzels, so I might eat a few less pretzels and have a glass of orange juice with it [8 ounces has 350 milligrams of potassium]. Or I might throw in some unsalted nuts with my cereal. Unsalted nuts don't have salt, but they're high in potassium."

Fruits and vegetables are naturally low in sodium and can help consumers meet the guidleines. "It's not always a message of what foods we're taking away, but what we can add," she said.

	Tony Tye, Post-Gazette Desserts snacks and sauces available through Saltwatcher.com include Guiltless Gourmet baked unsalted yellow corn chips. Click photo for larger image.

For Michler, the biggest triumph in following the low-salt diet has been keeping her father out of the hospital for a condition that has a high readmission rate. Since November 2002, Buzz Michler, 72, a retired engineer, has lost 100 pounds and has adapted to his daughter's healthier cooking.

Among his favorite dishes is her breakfast taco -- scrambled eggs in a corn tortilla with low-salt bean salsa and lorraine Swiss cheese -- which contains 123 milligrams of sodium.

She's dug out her mother's bread machine to make homemade, low-salt bread, and they bought a rotisserie to help prepare chicken and other meats.

Other foods may be seasoned with Mrs. Dash products, which have no salt; jerk and other low-salt products.

"They all add flavor to the stuff," he said. "It's different tasting, but it's good."