More salt in many holiday meals, cardiologist warns

There can be far more salt in many holiday meals than people realize, and the proof can be found at hospital emergency rooms. Heart problems aggravated or unmasked after ingestion of a significant amount of salt tend to make holidays such as Thanksgiving, Passover and Christmas very busy times for health providers like University of Medicine and Dentistry of New Jersey (UMDNJ) cardiologist Marc Klapholz, M.D., F.A.C.C.

"Thanksgiving is one of the holidays around which this occurs, and it predominantly is related to salt intake from holiday meals," Klapholz said.

"People tend not to watch their diets as well."

For persons who have heart failure, for example, salt can be a very dangerous component of the foods that they ingest, said Klapholz, a professor of medicine at UMDNJ-New Jersey Medical School. "Salt promotes additional water retention, and people who have weak hearts can be very sensitive to water retention and develop decompensated heart failure if they ingest significant amounts of salt," he explained. "They often experience shortness of breath, chest pains and sweating, which, in a very severe state, almost feels like they're drowning."

Even those who have no known history may unmask underlying cardiac disease after ingesting a significant amount of salt.

Klapholz encourages anyone experiencing such symptoms to seek medical attention. "During the holiday time, we sometimes tend to minimize our symptoms. We don't want to burden family and friends with medical problems, but it's always important to acknowledge symptoms when they are occurring and to get medical attention quickly," suggests Klapholz, who is director of the division of cardiology at UMDNJ-The University Hospital. "The sooner one gets medical attention, the less likelihood there is that the problem will get worse. You'll get better faster and get back to having a good time with friends or family."

There are over a million admissions in the U.S. every year of patients with acute decompensated heart failure, costing the country more than $20 billion annually on hospitalization, according to Klapholz. "When we look at the reason for that, we often find medical or dietary indiscretion," he explained. "So patients may have had a large salt meal, a precipitant for acute decompensated heart failure, or may have run out of or forgot to take medications for a period of time and gradually accumulated fluid that developed into an episode of acute decompensated heart failure."

To prevent illness that may result in a trip to the ER, take precautions when preparing and ingesting holiday meals.

One way to reduce salt intake: use herbs, spices or other natural flavorings instead of table salt when cooking or condiments like relish, mustard, and ketchup, which also can be loaded with sodium, suggests Lauren Kolesa, R.D., clinical instructor at the Institute for Nutrition Interventions at the UMDNJ-School of Health Related Professions and coordinator of "Live Well," UMDNJ's worksite wellness program. "One thing we forget is there is often a significant amount of salt in food already," Kolesa says. "Allow individuals, if they choose, to add salt to food on their plates, but avoid adding it while you're preparing food."

Kolesa suggests making food more tasty in other ways. "To add flavor to stuffing, for example, there are many different types of herbs you can add, like thyme or sage, or you can stir-fry a little bit of garlic to spice it up."

She also suggests avoiding processed and canned foods, which can contain significant amounts of sodium. "Preparing meals from scratch allows us better control over the amount of salt that's in there," she says.

Klapholz encourages use of heart-friendly monounsaturated or polyunsaturated oils, like olive, canola or vegetable oils. "Not all oils are the same," he cautions. "Those are important to use throughout the year and, certainly, around holiday times."

Another tip: spread your food intake out a little more over the day rather than having one large meal, Klapholz said. Large meals can increase workload on the heart as increased circulation is required to metabolize and digest all that food. "Eat smaller portions, smaller meals," he recommends, especially for people who have underlying heart disease, whether it be heart failure, where their pumps are weak, or coronary artery disease, where they have blockages in arteries around the heart.

Generally avoid smoked meats, which tend to contain heavy amounts of salt, and stick to meats such as chicken and turkey, which have lower fat content, Klapholz suggests.

How do you enjoy dessert without gaining the weight or feeling bad after eating it? "Share dessert with a fellow family member or friend, or take little sample bites of each dessert," Kolesa says, "or watch the starches at dinner. Have smaller portions of potatoes, bread, and biscuits. That opens to door for having dessert without feeling guilty or feeling like you overdid it."

Moderation and balance are key, Kolesa reminds us.

So is remembering that while eating is one of the main pleasures of a big holiday, it is not the only one.

"Enjoy the meal, but enjoy the people more," Klapholz says.