Editor's note: This popular story from the Daily Briefing's archives was republished on June 9, 2023.

Americans eat a lot of sandwiches, which can often be loaded with sodium, saturated fats, added sugars, and preservatives. But experts say there are changes you can make to your sandwiches to improve your health, Andrea Petersen reports for the Wall Street Journal.

'You're literally eating a heart bomb'

Nearly half of Americans eat a sandwich on any given day, Petersen reports. Sandwiches are common because they're portable, typically inexpensive, and all over the place, making it very convenient for Americans to eat, Petersen reports.

"Americans eat so much of their meals not sitting down at a table," said Erica Kenney, assistant professor of public health nutrition at the Harvard T.H. Chan School of Public Health. "They are eating in their cars or at their desks, so sandwiches are easy."

But according to an analysis of federal data, sandwiches make up a fifth of the average American's sodium intake, 19% of their daily saturated fat calories, and 7% of daily added sugars — the same percentage as cereals and breakfast bars.

"The standard deli sandwich with processed meat and cheese, you're literally eating a heart bomb," said Dariush Mozaffarian, a cardiologist and professor of nutrition at Tufts University.

Sandwiches have also gotten unhealthier over the past 40 years, according to Mozaffarian, thanks to highly processed grains in bread, and the push to eat foods low in fat that started in the 1980s, which experts say led more people to eat deli meats which were marketed as low-fat.

The size of sandwiches has increased over time too. According to the National Heart, Lung, and Blood Institute, a typical turkey sandwich contained about 320 calories in the 1980s but by the 2000s, that number increased to around 820 calories.

Research from the University of Illinois at Urbana-Champaign has also found that people eat nearly 100 extra calories on the days they eat sandwiches.

How to make your sandwiches healthier

Experts say there are small changes you can make to ensure your sandwiches are healthier.

First, you could change the type of bread you're using. Classic white break, submarine buns, or French baguettes are mostly carbohydrates in the form of highly processed white flour.

"It turns into sugar as soon as it hits your tongue," said Eric Rimm, a professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health.

A rush of sugar causes your blood glucose to increase, which leads insulin to spike in order to compensate. Then, your blood glucose crashes and you quickly become hungry again, Petersen reports.

Instead, try using whole grain bread, said Christina Roberto, an associate professor of health policy at the University of Pennsylvania's Perelman School of Medicine. Whole grains have a lot of fiber, which can help regulate the processing of carbohydrates and prevent blood sugar spikes to keep your fuller longer, she said.

Rimm suggests looking for bread made from 100% whole wheat or whole grain, noting that visible grains and seeds are good as well, since they signal less processing and more fiber. Rimm also said you should check the label for any added sugars or sodium content, preferable less than 150 milligrams of sodium per slice.

Experts also say you should avoid processed meats like roast beef, ham, or bacon on your sandwiches. According to research co-authored by Mozaffarian, each daily serving of processed meat is associated with a 42% increased risk of heart disease and a 19% increased risk of diabetes.

And while processed turkey slices do have less saturated fat and calories than red meat, Kenney notes that turkey sandwiches are still often too high in sodium and preservatives.

Instead, Kenney recommends using fresh chicken breast or fresh turkey on your sandwiches, and if you prefer red meat, sliced fresh steak or a hamburger is better than processed roast beef or salami, since it doesn't have the sodium and preservatives processed meat does, Mozaffarian said. He added that canned or fresh tuna is also a better choice.

You should also pay close attention to how much you're using condiments, especially ketchup and mustard, which Rimm calls "salt vehicles." Ketchup can also be high in added sugars, Petersen reports.

According to Rimm, mayonnaise is a good option, since it's typically made from eggs and canola or soybean oil, which are high in mono- and polyunsaturated fats associated with a lower risk of heart disease.

After putting your sandwich together, experts recommend you load it with tomato, lettuce, and other vegetables to get fiber and important nutrients.

One type of sandwich that's a good health alternative — a peanut butter and jam sandwich, Roberto said, provided you use 100% whole wheat bread and the right peanut butter and jam.

Peanut butter has protein and healthy fats that can help you stay full. Roberto advises using 100% whole wheat bread, peanut butter without added sugars, and jam that's low in added sugar.

And since most people don't like a soggy PB&J, Roberto said it's fairly easy to make sure you're not using too much jam.

"There's a built-in mechanism against overjellying," she said. "It's a really nice type of sandwich." (Petersen, Wall Street Journal, 3/14)