Sodium and Your CKD Diet

Show Notes

When most people think of sodium, they think of salt. In this episode of Let’s Talk About Kidneys, Dallas Nephrology Associates’ Senior Clinical Dietitian Carolyn Cochran breaks down what sodium is, how to identify it in common foods and ways to make lifestyle adjustments for healthier kidneys. 

What is sodium?

Sodium is one of three important electrolytes found in the body.  Electrolytes control the fluids going in and out of your body’s tissues and cells. 

“Sodium is essential for life,” Carolyn says. “It’s in animals, vegetables, minerals and is important for muscle function, nerve function, and for fluid balance.” 

Many types of salt are used to season food. A survey conducted by the American Heart Association found that more than 60 percent of respondents thought that sea salt was healthier than table salt. But whether you’re using kosher salt, table salt or Himalayan black salt, Carolyn says all salts are equal. 

“The bottom line is that they all contain sodium and the amount of sodium is comparable,” says Carolyn. 

Sodium and your kidneys

Sodium is an essential nutrient in your body. One of the jobs of the kidneys is to keep sodium in balance, Carolyn says. If sodium is out of balance, your body’s fluid balance is also affected. This can affect muscle and nerve function. 

How does sodium affect blood pressure? 

Many people have a sensitivity to salt, which can be exhibited in high blood pressure, also known as hypertension. High blood pressure is the number two cause of chronic kidney disease (CKD), second only to diabetes.

What is a low-sodium diet? 

In the U.S., 2,300 milligrams is considered a healthy target. Carolyn says that the average U.S. citizen will consume 3,500 to more than 5,000 milligrams of sodium per day, especially when dining out. A low-sodium diet is about 1,500 to 2,000 milligrams. 

Only a small percentage of the population who experience excessive sweat loss due to exercise–such as athletes–need more sodium. But Carolyn says most people could benefit from a low-sodium diet. 

Tracking your sodium intake

For people who want to track their sodium intake, Carolyn recommends starting with a base of about 500 milligrams to leave room for the sodium that naturally occurs in foods. 

Hidden sodium

A teaspoon of salt has 2,000 milligrams of sodium, but sodium isn’t just found in a salt shaker. Many foods have “hidden” sodium. 

“Sodium grows out of the ground. Sodium is in animals. It is just everywhere,” Carolyn says. “So you’ve got to give credit to those first 500, maybe even 600 milligrams of sodium, and then you can start counting (your sodium intake).”

Reading labels

Getting into the habit of reading labels is important for anyone who needs to track their sodium intake. At the top of the label, the serving size can be found. The size of the portions are determined by the manufacturer. The sodium content is found near the middle of the label and is measured in milligrams. 

To the right of the sodium is a percentage of the recommended amount of sodium in a diet, but Carolyn says to remember that this number might not be the percentage that you are aiming for if you’re on a low-sodium diet.

Medical Nutrition Therapy

If you need help managing your sodium intake, Carolyn suggests talking to your doctor about Medical Nutrition Therapy. Dallas Nephrology Associates has registered dietitian nutritionists who are experienced in helping patients who have renal disease.

“We realize that every person is complex and that many things need to be taken into account,” Carolyn says. 


Tiffany Archibald  00:01

Let’s talk about kidneys takes a deep dive into the chronic kidney disease patient journey. We’re here to inspire meaningful conversations and to help people living with CKD. Gain a full understanding of their disease. Tune in today to learn about the basics of sodium, what it is, how it relates to kidney disease, and how to make adjustments to your own sodium intake. Learn the importance of building a relationship with your dietician to assist you with your journey. Well, I want to first say thank you so much, Carolyn Cochran, for being on our podcast today. I am super excited about today’s topic, because it’s one that our listeners, our CKD patients or even individuals that want to learn more about nutrition can learn from so how are you today?

Carolyn Cochran  00:53

Well, I think I’m doing great.

Tiffany Archibald  00:56

So I think we’re gonna jump right into it. What is sodium?

Carolyn Cochran  01:02

Well, odium is essential for life. It’s an animal, vegetable, mineral, it is important for muscle function, nerve function, and for fluid balance. And, you know, the first evidence of the use of salt goes back over 6000 years BC. And that was found in different parts of the world, where salt was used primarily as a preservative.

Tiffany Archibald  01:29

So what types of salt contains sodium? Do they all contain sodium?

Carolyn Cochran  01:36

Well, there are so many types of salt used for cooking and seasoning. Course we all are familiar with table salt. There’s kosher salt, sea salt, Celtic sea salt, Florida salt, Himalayan pink salt, Himalayan black salt, red salt, black lava salt, with charcoal of all things. And it is really confusing when you think of all these different types of salt. But the bottom line is that they all contain sodium. In a study done by the American Heart Association, they found that more than 60% of people who responded to their survey thought that sea salt was healthier than table salt.

Tiffany Archibald  02:22

So you’re to dispel that myth. Of the salts that you mentioned, which is the healthiest?

Carolyn Cochran  02:30

Well, I consider them all equal because if you look at salt by weight, then they’re almost identical. Now the difference is in a fine grind versus a coarse grind more of a rock salt. So if you’re measuring by teaspoon or quarter teaspoon, more of a fine grind fits in the spoon than a rough grind. And they all you also have salt flakes. Many salts come in flakes, which are very light. But if you if you measure them equally, the sodium content is comparable.

Tiffany Archibald  03:08

So does everyone need to decrease their sodium intake?

Carolyn Cochran  03:12

Well, everyone is an individual. So everyone is different. But I could say that almost every one of us consumes too much sodium.

Tiffany Archibald  03:21

So what about the people that actually need a high sodium diet? Can you touch on those individuals?

Carolyn Cochran  03:28

Well, this is a rather small percentage of the population. It would be people who have excessive sweat losses due to exercise. I’m thinking of football players and athletes. It could be someone who has a certain disease, very specific diseases that are salt losing. So in general, I think the majority of people would benefit from a low sodium diet.

Tiffany Archibald  03:55

Okay. Can you talk about the relationship between sodium and the kidneys?

Carolyn Cochran  04:00

Well, one of the jobs of the kidney is to keep sodium in balance. So if sodium is out of balance, your fluid balance in your body is also affected. Kidneys, I mean, the sodium level of your body affects muscle function. It affects nerve function. And it really is an essential nutrient.

Tiffany Archibald  04:23

Can you talk to us about how sodium affects high blood pressure?

Carolyn Cochran  04:29

Well, many people have a sensitivity to salt. And it actually is exhibited, as you know, in high blood pressure. And high blood pressure, hypertension, is the number two cause of chronic kidney disease or CKD. Yes, in the world, only second to diabetes.

Tiffany Archibald  04:49

Yes, yes. What will be considered a low sodium diet?

Carolyn Cochran  04:53

Well, a low sodium diet is about 1500 to 2000 milligrams. For the US population 2300 milligrams has been targeted as the healthy target. However, you know, an average US citizen will consume 3500, 5000, more than 5000 milligrams of sodium per day. Oh, especially people who eat out.

Tiffany Archibald  05:20

I yeah, I was just getting ready to say individuals that may grab a quick breakfast out, and then grab lunch with coworkers, and then you know what I’m gonna feel like cooking dinner. So those of you that are listening that are eating out a lot, you know, you may not want to do that as often because you know, you can’t really measure the sodium content that these restaurants are cooking in. So that actually leads to my next question, how would a person track their daily intake of sodium?

Carolyn Cochran  05:50

Well, when it comes to restaurant and fast food meals, many of the larger or multiple restaurants or chains, have their menus online with a nutrient analysis.

Tiffany Archibald  06:02

I’ve seen that. I’ve seen that. Okay.

Carolyn Cochran  06:04

Now some people actually want to track their sodium intake. And for those people, I recommend that they start with a base of about 500 milligrams, because there’s sodium in food naturally. Sodium grows out of the ground. Sodium is in animals. It is just everywhere. So you’ve got to give credit to those first 500, maybe even 600 milligrams of sodium, and then you can start counting. And the reason I wanted to bring that up is that if you look online, you will see things like, Oh, well, you know, a teaspoon of salt has 2000 milligrams of sodium, o more or less, and so I can use a teaspoon of salt every day. Well, the problem is, you’re gonna have that teaspoon of salt, and then there was no food.

Tiffany Archibald  06:59

Okay, yeah. And so what you’re describing is hidden sodium, is that correct?

Carolyn Cochran  07:04

Right, sodium that is not shaken on ride, or added during cooking, that you know is added during cooking. It’s just naturally occurring. You know what, I wish that everybody could see this, because you know, what I would like you to do, I would like you to take a salt shaker, and just close your eyes. And I would fold a piece of paper and put it under you, and you salt a plate of food, perhaps not the way you would salt it. Because I know how careful you are Tiffany. I’ve no doubt about that. But the way you’ve seen people salt food, that if you shake the shaker, and then take that folded piece of paper, and let all the salt fall into a quarter teaspoon. And just see how much is it? Because a quarter teaspoon is almost 600 milligrams of sodium. And people will say, well, you know, I use to dada, dada, dada, dada, dada. And now I just dada dada dada, right? Well, my goodness, they’re still at, you know that sodium is just clicking up.

Tiffany Archibald  08:13

You know what that gave me a vision of. Sometimes when I’m out when I’m out, I see people shake the salt, like in their hand and kind of pour it over. So maybe is that like a visual aid that people do? Or is that just something I noticed?

Carolyn Cochran  08:28

Well, first of all, Tiffany, you said when they’re eating out. So there’s a good chance that they’re between 1000 and 2000 milligrams of sodium on the plate coming out of the kitchen. So they’re going to add another 500, 600?

Tiffany Archibald  08:43

I see it. I see it happen all the time. And so we talked about eating out. So if people aren’t eating out, there’s a lot of convenience meals. Can you talk about the frozen meals that people are consuming?

Carolyn Cochran  08:58

Well, there is the need for convenience. And I would be really ignoring reality, if I didn’t help people deal with having convenience. So my advice is to choose a frozen meal that is around 600 milligrams of sodium or less. So you remember we were talking about a daily sodium allowance of 1500 to 1000 milligrams per day being a good target. Well, if you had about 600 milligrams per meal, that gives you 1800 And that’s right in the middle. So say for instance, if a person chose a frozen, like a bowl, and say it was 580 milligrams of sodium, and they got an almost sodium free fruit to go with it, then you know they still have 1200 milligrams for the rest of the day.

Tiffany Archibald  09:57

That’s so funny. That’s a trick I definitely use when I’m going throughout the day and eating. I’m like, okay, this didn’t have that much sodium in it and this does, so by the end of the day, I have to really balance that out. So those individuals that are listening, it is about balancing. It is about kind of taking each meal for its sodium content. So if a person were to give up salty foods, and we’re never to add salt, or include sodium in the meals that they cook, how would they season their food? How would they continue to be able to get that flavor that everybody wants?

Carolyn Cochran  10:35

Well, flavor is out there. And salt is simply not the only flavor. But I’m sure that you know people, just like I do, that if it’s not salt and pepper, it’s nothing. You know, I mean, like, what else is there? So if people are trying to add different spices and different seasonings to their cooking and to their meals, then they’re going to have to be ready to know that they’rein  an adjustment period. And for some people, that’s only a couple of weeks, other people a month. I’ve known people that it took two months. And you know, the beginning of that some people are not very happy about it.

Tiffany Archibald  11:17

Right? And how would a person you talked about them transitioning where it can take a week, a couple of weeks, maybe even a month? How do people alter their own recipes? So say you got this recipe book that you’ve been, you know, cooking from from year for years, and someone meets with a nutritionist or dietitian and they say, hey, we got to cut the sodium. So how would a person alter their own recipes?

Carolyn Cochran  11:44

Well, first of all, I love that you said alter your own recipes. Because this is what people are used to eating, this is what they like to eat. This is what their grandmother cooked, what their, you know, mother cooked, whoever was cooking. And this is what they want. So number one would be to just decide that the salt in this recipe can be cut in half this time, and may be cut down more next time. And maybe the third time you make it the salt is gone. Now other ingredients could be salty in that recipe. One example might be can chicken broth. So chicken broth, or beef broth or vegetable broth comes in different levels of sodium. I’d like to talk about a food label. And so anyone who’s ever looked at the food label knows that there are a lot, there’s lots of information on there. So if a person is looking at a food label, then the first thing that they’re going to look at is at the top, and it is serving size. Now this serving size is determined by the manufacturer. It’s not the right size, or the wrong size, it’s simply the size that they chose, right? And then you have to decide, are you going to eat this portion? Are you going to double it? Are you going to triple it? Because every number on that food label will have to be doubled or tripled to match. The sodium content is about in the middle and it is in milligrams of sodium. Now, over to the right hand side of every food label is a percent and this is a percent of a recommended amount right and it may not be what you are hoping to target, it may not be your percent. But certainly the milligrams of sodium would be very important if you are tracking or if you are looking for alternatives in your recipes. So in terms of chicken broth. Chicken broth does come in multiple levels. It can be regular chicken broth, that could be 800 and some odd 800, 900 milligrams of sodium per cup. It could be reduced sodium like 33% less sodium. And so that’ll go down 500, 600. It can be unsalted chicken broth, which would bring it down into the hundreds. You see the chicken broth itself still has some sodium naturally.

Tiffany Archibald  14:25

Right. So we need to distinguish which level and, I do know that in the stores, the labels that have a lesser amount of sodium, the the label kind of stands out. So I think people can take away from this, not only reading the back of the food label, but sometimes some of the front if you’re using those canned sodium, you can see where it says 33% less sodium that stands out. Am I correct in that.

Carolyn Cochran  14:54

Right, but you know, I must say that a lot of times 33% less sodium is certainly not low sodium. Take for instance, a canned soup. You know, one can of soup a lot of people think of as a meal. But if you look at the portion size on the food label, one can make two and a half servings. So every number on that can is just a portion of that can. So if you ate the can of soup, it would, even if you added water, dilution doesn’t matter, you would be getting…

Tiffany Archibald  15:31

Can you pause? That is interesting.  So dilution doesn’t matter.

Carolyn Cochran  15:37

Well, let’s see what kind of an example could I use for that. Say you had a dozen marbles, and you put them in a glass, and you decided to cover them with water. And there were your dozen marbles with water on them, and you jiggle them around and you just, you know, we’re having fun with the colors. Then you decided to add more water and more water and more water. Well, you still have 12 marbles. And if you’re using that whole glass for your activity, then those 12 Marbles have not changed. Only their distribution has changed.

Tiffany Archibald  16:14

That’s so interesting. Everyone listening take note. Rewind that part because I have family members and friends that have both said, oh, I’ll just dilute, I’ll just add more water and I’m going to send them this podcast because that’s not true. So we talked earlier about eating out and at restaurants and how they prepare the food. So if someone was listening, and you know, eating out is something that people look forward to. It’s a way to build relationships. A lot of people have meetings, what would you recommend individuals eat that are trying to watch their sodium, and they’re at a restaurant?

Carolyn Cochran  16:54

Well, first of all, be prepared. If you know you’re going to a certain place, you can check out their menu, hopefully online. You could even call in advance and say, oh, my doctor is just really on to me about, you know, following a low sodium diet. You know, how can you help me? Do you think the cook could make my chicken and vegetables without salt? They may say yes, they may say no, but this is the kicker. And that is that even the cook might not realize that some of their mix seasonings are heavily salted already. You know. Now some mix seasonings are higher in sodium than others. Lemon Pepper is mixed with salt, but it’s not nearly as bad as some other seasoning salts. Now, speaking of choices. If you were counting sodium, then I would definitely recommend one of a couple of brands of lemon pepper that has no salt at all. If you look at the grocery store, and look at your different options, take for example, Creole seasoning. Creole seasoning could be very, very salty. Or it could be special recipe with no salt at all. And if you bring a magnifying glass, or for me reading glasses, to the grocery store, you can look at the ingredients and see if these are all herbs and spices and no salt is listed, you know you got a good product, even if they didn’t advertise that there was no sodium in their product. You can see that there is no salt.

Tiffany Archibald  18:31

Okay? And how about combining a low sodium diet with other nutrition that a person may need?

Carolyn Cochran  18:39

Well, you know, a low sodium diet can be a base. And many people start with that base. And almost anything can be added to that. Say for example, if a person has diabetes, they may be accustomed to managing their diet to manage their diabetes. They may be adding sodium control to that. So what they’ve been doing to manage their diabetes really doesn’t change. They’re just changing the seasonings that they’re using to those that are acceptable and getting used to new flavors. Yeah, absolutely. Or even anyone who is mindful about their eating sodium included. It can be helpful just thinking about food helps some people lose the weight they want to lose.

Tiffany Archibald  19:28

Okay. And so I know dietitians work closely with patients to individualize their needs. Can you talk about that dietitian patient relationship?

Carolyn Cochran  19:40

Well, Tiffany, I think this is so essential, because so many people are looking everywhere for nutrition information. And you can look on online and find very credible appearing people that have absolutely opposite views on the same topic, So a dietitian in consultation with a patient is going to collect information about their personal food preferences, their likes or dislikes, any problems, they may have, allergies, digestive issues, go through the medication list, discover if they’re taking any vitamin or mineral supplements or herbal products that could be interfering with some other medications that they’re taking. And they not even realize that that’s happening. And the combination of getting to know the patient, listening to how they eat, how they get their food, lets the dietitian know how they might guide that person in discovering a way to change in the way that they want to change or choose to change. You know, the patient’s goals. personal goals are always number one.

Tiffany Archibald  20:58

Okay. And so as we wrap this up, I wanted to see if there were one to two major things that you want to have the listeners leave here with, after, you know, listening to the first part of this podcast. Qhat’s the summary that you can give them?

Carolyn Cochran  21:17

Well, first of all, I want people to really respect salt. Salt is an amazing and wonderful element and it can be used for so many things. But if your doctor has suggested that a lower sodium diet could be helpful in managing your particular issues, then inquire about medical nutrition therapy, because it might be that this referral for MNT, we’ll get you connected with a dietitian. Like at Dallas nephrology associates, we have registered dietitian nutritionists who are experienced in renal disease, and realize that every person is complex. And all of these things have to be taken into account.

Tiffany Archibald  22:10

Well, I want to thank you once again, for coming on and discussing this topic of sodium, like you said in the beginning, it is all around us. It is rooted in the ground, it’s in what we eat, it’s how we prepare the food. So I think that this will be a super informative podcast that people can really gain some knowledge from and you did such a wonderful job.

Carolyn Cochran  22:31

Oh, Tiffany, and so did you.

Tiffany Archibald  22:33

Thanks for tuning in today learn more about Dallas Nephrology Associates at And if you found the information valuable, be sure to share with those who are impacted by chronic kidney disease.


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