The latest big bad wolf in the American diet - salt - seems like a tamable adversary.

Recent research, after all, shows that overall health in the United States could be significantly improved with only a modest reduction in the annual consumption of salt.

The study - conducted by the University of California, San Francisco, and Columbia and Stanford universities; and published in January by the New England Journal of Medicine - calculated the benefits of a 3-grams-a-day decrease: 155,000 fewer heart attacks and strokes annually. (High levels of sodium are linked to hypertension, which leads to heart disease.)

Given the upside, which would translate into lower health-care costs, what are people waiting for? The challenge comes in the sacrifice.

Avoiding the saltshaker at home, according to dietitians, means barely making a dent in sodium intake: Seventy-five percent of the salt consumed by Americans is derived from processed foods and from foods served at restaurants.

 "Americans eat too much salt, fat and sugar," said Steve Smith, a registered dietitian. "Every health-care professional agrees on that."

Reducing salt in the diet alone, then, is only part of the solution, Smith said.

 "It's a total lifestyle modification."

 A more-sweeping change in the diet, said Gina Casagrande, a registered dietitian with the workplace-wellness company Imagination To Burn in Plain City, begins with the basics: eating a lot of fresh fruits and vegetables, low-fat dairy and whole grains. (Yet she also cautioned that some supposedly healthful items - whole-grain cereals and breads, for example - can be packed with sodium.)

 "If you cut back on processed foods, you'll cut down on calories and fat," Casagrande said. "You'll eat more fresh produce. The more fresh produce you use, the less sodium you'll consume.

 "You'll just be healthier."

Smith, who knows personally the dangers of an unhealthful diet, takes a more extreme approach.

Before returning to school to become a dietitian last year, the South Side resident traded his chef toque for a lucrative online business. In just a few years, his weight ballooned to 240 pounds because he ate often at Wendy's, Steak 'n Shake and Waffle House.

In July 2003, he walked into Grant Medical Center with all the signs of a heart attack. While he had experienced a cardiac "episode," not a full-blown heart attack, he knew he needed to make lifestyle changes to avoid more costly medical bills.

 After much research, he decided to focus on a plant-based diet centered on whole grains and beans - no meat, no dairy, no oil and no processed foods.
Such changes, Smith said, naturally reduce the amount of sodium that a person consumes.

Besides vegetable broth, he eats nothing processed. He spends one day a week cooking meals from scratch for the next week - rice and beans, soups, homemade oatmeal (starting with the whole oat berry, not processed rolled oats).

Since his emergency-room visit seven years ago, he has lost 70 pounds and watched his cholesterol drop from 403 to 161.

He teaches cooking classes at Whole Foods Market and offers instruction in homes. (His Web site:www.foodcanheal.com.)

 "If we return to the pillars of health - a plant-based diet - that will almost inevitably get rid of salt, fat and sugar," he said. "You don't need to know how to read a nutrition label. You shouldn't eat things that need a nutrition label. You just need common sense."

Casagrande, meanwhile, encourages people to pay close attention to labels and shy away from foods that have greater than 10 percent of the recommended daily allowance for sodium.

Both dietitians agree that the best way to reduce sodium is to prepare your own meals.

 "The most important two aspects of good health are learning how to move your body and learning how to cook," Smith said. "Once you start learning how to cook, you can move away from processed foods."

robin.davis@dispatch.com

Salty sources

Here's a list of some commonly purchased processed foods and their sodium content:

>> Breads: wheat, 220 milligrams per 2 slices; hot-dog bun, 220 mg

>> Buttermilk: 380 mg per 1 cup

>> Cake mix: chocolate, 370 mg per 1/2 of box prepared

>> Canned fish: salmon, 280 mg per 2-ounce serving; tuna, 240 per 2-ounce serving

>> Canned soups: chicken noodle, 480 mg per 1 2-cup serving; beef-vegetable, 880 mg per 1 2-cup serving

>> Canned vegetables: peas, 390 mg per 1 /2 cup

>> Cereals: Raisin Bran, 350 mg per 1 cup; cornflakes, 200 mg per 1 cup

>> Dressings: ranch, 260 mg per 2-tablespoon serving

>> Frozen dinners: Lean Cuisine chicken parmesan, 660 mg per serving

>> Ketchup: 190 mg per 1 tablespoon

>> Pasta sauce: 540 mg per 1/2 cup

>> Prepackaged rice, potatoes, pastas: prepared mashed potatoes, 540 per 1 /2 cup; boxed macaroni and cheese, 580 mg per 2.5-ounce serving; Rice-a-Roni rice pilaf, 970 mg per 2.5-ounce serving

>> Pizza: cheese pizza: 880 mg per 1/4 pie

>> Processed cheeses: Velveeta, 420 mg per 1-ounce serving

>> Processed meats: salami, 480 mg per 2-ounce serving; deli turkey, 400 mg per 2-ounce serving; ham, 440 mg per 2-ounce serving; one hot dog, 540 mg

>> Salty snacks: pretzels, 380 mg per 1-ounce serving; potato chips, 149 mg per 1-ounce serving

>> Sauces: barbecue sauce, 300 mg per 2-tablespoon serving; teriyaki sauce, 490 per 1-tablespoon serving

Label language

Food labels give shoppers a clue as to how much, if any, sodium is contained in the product:

>> Sodium-free: less than 5 milligrams per serving

>> Very low sodium: 35 mg or less

>> Low sodium: 140 mg or less

>> Reduced sodium: reduced by at least 25 percent but still might not meet low-sodium guidelines

>> Unsalted or no salt added: made without salt but still contains any naturally occurring salt
Source: American Heart Association