With a bit of time, even things like the COVID virus are accommodated by our fears and broader concerns bubble back up.  One of the challenges faced by a lot of people with serious chronic illness is that they are alone physically or emotionally.

As I think about these past weeks and staying at home I realize that I am so very fortunate. My wife Rosemary makes my days in isolation a joy rather than a burden but I see messages in our patient forums that break my heart from people who are literally dying deaths of despair.  If you are well enough, reach out to those you know who are lonely. Chronic illness is difficult enough without having to do it alone.

Click the picture below for a link to a bit of fun on the subject of introspection. Many of you are old enough to remember this but it may be meaningful to our younger folks as well. (The picture isn't related, I just like it)

The USDA and groups like the American Heart Association recommend no more than 2,300 milligrams (mgs) a day and an ideal limit of no more than 1,500 mg per day for most adults, especially for those with high blood pressure. Even cutting back by 1,000 mg a day can improve blood pressure and heart health. This information discusses salt from the perspective of the general population and not specifically someone with liver disease but it provides an excellent overview of salt and its management.

Salt vs. Sodium Equivalents
Sodium chloride or table salt is approximately 40 percent sodium. It’s important to understand just how much sodium is in salt so you can take measures to control your intake. These amounts are approximate.

1/4 teaspoon salt = 575 mg sodium
1/2 teaspoon salt = 1,150 mg sodium
3/4 teaspoon salt = 1,725 mg sodium
1 teaspoon salt = 2,300 mg sodium

Sodium Sources
Sodium can be sneaky! Taking control of your sodium means checking labels and reducing preservatives. Other foods to be aware of include:

• Processed foods
• Natural foods with a higher-than-average sodium content, including cheese, seafood, olives and some legumes
• Table salt, sea salt and kosher salt (sodium chloride)
• Some over-the-counter drugs
• Some prescription medications

Shopping and Cooking
From the grocery aisles to your dinner table, here are some tips for reducing the amount of sodium that finds its way into your body.

Shop smart, cook smart

• Choose lower-sodium foods or low-sodium versions of your favorites.
  Although it may take some time for your taste buds to adjust to a lower sodium diet, there are delicious options for very flavorful low-sodium meals. Once the adjustment to healthier dining is made, many people report they would not choose to go back to the highly processed, sodium-rich foods.
• When buying prepared and prepackaged foods, read the labels.
  Americans consume up to 75 percent of their sodium from processed foods like soups, tomato sauce, condiments and canned goods. Watch for the words “soda” and “sodium” and the symbol “Na” on labels, which warn you that these products contain sodium compounds. Many canned and frozen food labels help the consumer by printing “low salt” or “low sodium” boldly on the packaging.
• Eat more fruits and vegetables.
  When buying canned or frozen varieties, be sure to choose the no-salt added versions, and look for the choices without added sauces.
• Use fruit and raw vegetables as snacks.
• Select unsalted nuts or seeds, dried beans, peas and lentils.
• Select unsalted or low-sodium fat-free broths, bouillons or soups.
• Avoid adding salt and canned vegetables with added salt to homemade dishes.
• Don’t use salt during cooking and remove the salt shaker from your table.
  Certain salt substitutes contain a large amount of potassium and very little sodium. They are not expensive and may be used freely by most people, except those with kidney disease. Talk with your healthcare professional about whether a salt substitute is right for you.
• Learn to use spices and herbs to enhance the natural flavor of food.
  Ditch salt for healthier, delicious salt-free seasoning alternatives.
• Don’t salt food before you taste it; enjoy the natural taste of food.

Reduce Sodium When Dining Out
Americans eat more restaurant-prepared meals now than ever, and restaurant food is often high in sodium. But controlling your sodium intake doesn’t have to spoil the pleasure of dining out. It just means adopting new habits into your current lifestyle. So if you love dining out, follow these tips.

When dining out:

• Be familiar with low-sodium foods and look for them on the menu.
• When ordering, be specific about what you want and how you want it prepared. Request that your dish be prepared without salt.
• Don’t use the salt shaker. Instead, use the pepper shaker or mill.
• Add fresh lemon juice instead of salt to season fish and vegetables.

Seasoning Alternatives — Spice It Up!
There is a rich world of creative and flavorful alternatives to salt. Get started with this guide to spices, herbs and flavorings and the food items with which they are a particularly good flavor match. Then get creative and experiment! Here are some seasonings to add variety:

• Allspice: Lean meats, stews, tomatoes, peaches, applesauce, cranberry sauce, gravies, lean meat
• Almond extract: Puddings, fruits
• Basil: Fish, lamb, lean ground meats, stews, salads, soups, sauces, fish cocktails
• Bay leaves: Lean meats, stews, poultry, soups, tomatoes
• Caraway seeds: Lean meats, stews, soups, salads, breads, cabbage, asparagus, noodles
• Chives: Salads, sauces, soups, lean meat dishes, vegetables
• Cider vinegar: Salads, vegetables, sauces
• Cinnamon: Fruits (especially apples), breads
• Curry powder: Lean meats (especially lamb), veal, chicken, fish, tomatoes, tomato soup
• Dill: Fish sauces, soups, tomatoes, cabbages, carrots, cauliflower, green beans, cucumbers, potatoes, salads, macaroni, lean beef, lamb, chicken, fish
• Garlic (not garlic salt): Lean meats, fish, soups, salads, vegetables, tomatoes, potatoes
• Ginger: Chicken, fruits
• Lemon juice: Lean meats, fish, poultry, salads, vegetables
• Mace: Hot breads, apples, fruit salads, carrots, cauliflower, squash, potatoes, veal, lamb
• Mustard (dry): Lean meats, chicken, fish, salads, asparagus, broccoli, Brussels sprouts, cabbage, sauces
• Nutmeg: Fruits, potatoes, chicken, fish, lean meat loaf, toast, veal, pudding
• Onion powder (not onion salt): Lean meats, stews, vegetables, salads, soups
• Paprika: Lean meats, fish, soups, salads, sauces, vegetables
• Parsley: Lean meats, fish, soups, salads, sauces, vegetables
• Peppermint extract: Puddings, fruits
• Pimiento: Salads, vegetables, casserole dishes
• Rosemary: Chicken, veal, lean meat loaf, lean beef, lean pork, sauces, stuffings, potatoes, peas, lima beans
• Sage: Lean meats, stews, biscuits, tomatoes, green beans, fish, lima beans, onions, lean pork
• Savory: Salads, lean pork, lean ground meats, soups, green beans, squash, tomatoes, lima beans, peas
• Thyme: Lean meats (especially veal and lean pork), sauces, soups, onions, peas, tomatoes, salads
• Turmeric: Lean meats, fish, sauces, rice

A fuller discussion of diets

EAT LESS SALT --- BOOORING

• You hear that every day and your doctors have said it for years. 
• It is a challenge to actually do a low salt diet.
• How important is it really and what is the best goal?

Sodium is a vital element. You really can't live without salt as it is part of the process of moving electrical nerve impulses in cells. is critical to controlling the water balance in the body, is essential for a number of metabolic processes, and a long list of other functions.  It is so vital to life that the body has developed exquisitely sensitive ways to control the amount of sodium circulating in the blood and maintains it in a surprisingly narrow range.

From a health perspective, you want to understand the consequences of having your sodium out of balance. Suppose you eat too much salt. Think of it this way. When you force the body to constantly manage a big oversupply of sodium what do you suppose the consequences might be?

• Your body must retain extra water to dilute the salt so fluid collects in your tissues. Do you enjoy edema?
• Your kidneys go into overdrive to dump excess salt. Any concern about always stressing your kidneys?
• Excess sodium increases blood volume with increasing blood pressure. High blood pressure anyone?
• Excess sodium disrupts the electrical flow through cell membranes. Brain fog or heart attack appeal to you?
• Sodium can cause pathological alterations in the structure and function of large elastic arteries. Bad arteries?
• How about heart attack and stroke? High sodium raises your risk for sudden death.  Interested?
• Salt can damage the lining of the stomach.  How about a little gastric cancer to improve your day?
• Bad bones OK with you? Sodium affect calcium loss and may contribute to osteoporosis.
• Kidney stones are fun.  High salt can increase the growth of kidney stones by altering urine content.

Eating the typical American diet you are consuming far more salt than you need. Why do we do that? We require salt and we really like the taste.  The food industry caters to our likes and they add salt to virtually every product.  We also have developed a taste for salt carriers such as potato chips. The result, on average we eat several times as much salt as we need.  Do you wonder why your health is affected?  Do you care if you are ill? Perhaps it might be time to think about your lifestyle dietary choices.

A lot of liver patients are told to follow a low salt diet, but it is difficult to do. Salt is everywhere and it is so easy to cheat, just a little, particularly if you are not yet ill.  But if you can take away one message here it is that managing your salt is vitally important if you want to give your body the best chance to keep you alive.  Stability is your friend. Stable blood chemistry is good.  Be kind to yourself even though you really would like to have those chips.

An important idea is that you would like to have a stable salt level.  The big swings that come from eating those salty treats puts a strain on your organs so a little regularly is better than a shot of salt.

Experts disagree on how much salt is best and writers frequently confuse things by interchanging salt and sodium.  Salt is 40% sodium so the 1,500 mg of salt often quoted is actually 600 mg of sodium.  The biological need is typically said to be about 500 mg of sodium so in our society it is very difficult to get too little.

More information about salt