Dietary Sodium

”Shaking the Habit”

• Hypertension– The Silent Killer

• Sodium– The Quiet Food Additive

Outline

• Sodium– Where do we get it?– What does it do?– How is it a health risk?

• Sodium and blood pressure• Recommended sodium intake• How to reduce your sodium intake• Meal makeovers

Where do we get sodium?

• Salt– Table salt, sea salt,

seasoning salts

• Sodium additives such as– Monosodium glutamate (MSG)

– Baking soda

• Processed, takeout / restaurant foods

Sources Of Sodium

5

Why is sodium in our food ?

• Prevents food from spoiling.• Performs some chemical functions in baking and

processing.• Adds flavour.

What does sodium do?

• In your body:– Helps regulate your body’s fluid balance.– Too much sodium can increase the amount of

water or fluid held in your body.– Excess fluid puts extra pressure on your

blood vessels causing damage.

How is sodium a health risk?

• Increases blood pressure which increases risk for:– Stroke– Cardiovascular disease– Kidney disease– Dementia

Lifestyle risk factors for high blood pressure

• Obesity• High alcohol intake• Inactivity• Smoking• Inadequate vegetable and fruit intake• Inadequate milk product intake• High dietary sodium intake

Reducing Sodium Can Lower Blood Pressure and Risk

• Reducing sodium intake will lower blood pressure.– 1 in 3 Canadians with hypertension could have

normal pressure if they lowered their sodium intake.

– Following a low-sodium diet could reduce the risk of heart attack or stroke by 25-30%.

The lower your sodium intake, the lower your blood pressure will be

• Sodium restriction is especially important for people…– Of African descent

– Over 45 years of age

– With conditions such as• Diabetes• Kidney disease• Heart failure

How much sodium do we need?

There are 2 reference points for sodium intake*• Adequate Daily Intake (AI)

– recommended average daily intake

• Tolerable Upper lntake Level (UL) – the highest average daily intake level that is likely

to pose no adverse health effects

*Set by Canadian and US panel for Dietary Reference Intakes, 2005

Sodium Intake Recommendations

Age (years) AI (mg/day) UL(mg/day)

1-3 1000 1500

4-8 1200 1900

9-13 1500 2200

Dietary Reference Intakes, IM 2005

Dietary Reference Intakes, IM 2005

Sodium Intake Recommendations

Age (years) AI (mg/day) UL(mg/day)

14-50 1500 2300

50-70 1300 2300

Over 70 1200 2300

Dietary Reference Intakes, IM 2005

Sodium Intake Recommendations

• 1500mg or 2300mg doesn’t mean much to me….

2300mg sodium = 1 level tsp table salt

1,500mg = ¾ tsp table salt

Sodium Intake of Canadian Adults

• So how do you think we’re doing meeting those recommendations?– What would you guess is the average daily

sodium intake for a Canadian adults and children?

Sodium Intake of Canadian Adults

2680 mgWomen

3575 mgMen

Average Daily Sodium IntakeGender

Av. Sodium Intake* (mg/day) of Canadian Adults

*Does not include sodium added at the table or during home cooking

The sodium intake of most Canadian children/youth exceeds the UL

Health Reports, Vol. 18, No 2, May 2007

% above UL

L’apport suffisant 1500mg 1900 2200 2200

Why is our sodium intake so high?

• Less home-cooked meals

– Busy lifestyle!

– Want convenience

– Prepared food is always available

2. Bigger Portions

21 cups3 cups

Food packages are bigger now than ever. The more we eat, the more sodium we consume.

3. Heavy Use Of Condiments

• Ketchup• Mustard• Soy sauce• Salad dressing• Relish and pickles• Olives• Sauces

… are all high in sodium

4. More Processed Foods

Food industry must reduce sodium in its products

24

Processing Adds Sodium To Food

Natural Food Sodium (mg)

Processed Food Sodium (mg)

Plain pasta 5 Pasta & sauce 800

Cucumber 2 Dill Pickle 385

Fresh salmon 56 Canned salmon 272

Cheddar cheese 176 Processed cheese 407

Coffee – milk & sugar

15 Cappuccino – from mix 250

Processing Adds Sodium

1 cup plain pasta5 mg sodium

1 cup pasta & sauce800 mg sodium

Processing Adds Sodium

Medium cucumber2 mg sodium

Medium dill pickle385 mg sodium

Processing Adds Sodium

1 oz. hard cheese176 mg sodium

1 oz. processed cheese407 mg sodium

Processing Adds Sodium

Coffee-milk & sugar15 mg sodium

Cappuccino from mix250 mg sodium

Sodium Content of Restaurant Foods

Menu Item Sodium (mg)

Breakfast Egg Sandwich 840

Chicken Caesar Salad 570

12” Pepperoni Pizza 5960

Deluxe Cheeseburger & Medium Fries 1910

Fried Chicken Dinner 2280

Reduce Your Sodium Intake

• At home– Plan meals at least a day in advance.– Make more meals from unprocessed foods.– Gradually decrease the amount of salt used in

cooking and at the table (this includes sea salt).

– Use condiments sparingly.

Reduce Your Sodium Intake

• At home– Flavour food with lemon juice, fresh garlic,

spices, herbs and flavoured vinegars.– Try low-sodium seasoning mixes.– Cook and bake with vegetable oil rather than

butter or margarine.– Use tomato paste instead of tomato sauce or

soup in recipes.

Reduce Your Sodium Intake

• At the grocery store– Buy pre-prepared, convenience foods that are

low in sodium such as frozen vegetables, frozen shrimp, skinless & boneless chicken breasts and pre-cut salads and fruit.

– Choose unsalted snack foods such as pretzels, nuts, seeds and crackers.

Reduce Your Sodium Intake

• At the grocery store

– Read food labels and compare sodium content between similar foods

– Look for foods labelled salt-free, no added salt, low in sodium, or reduced in sodium.

– Always check the Nutrition Facts table

Reduce Your Sodium Intake

• Check the Nutrition Facts table for:– The mg sodium per serving

(the lower, the better)

– Choose foods with 200 mgof sodium or less

– Choose foods with 10% or less Daily Value

Reduce Your Sodium Intake

• When eating or “taking” out– Choose salads and meals made with foods low in

sodium

– Ask for no salt or MSG to be added during cooking

– Ask for sauces, spreads or dressings on the side and use sparingly

– Limit fast foods and take-out meals.

Lower Sodium Vegetables and Fruit

• Adults need 8 to 10 servings a day• For lower sodium:

– Choose fresh or frozen vegetables.

– Limit vegetables with sauce or instant mixes.

– Try making homemade salad dressing, or use commercial dressings sparingly.

– Choose low sodium vegetable juices and soups.

– Enjoy fresh, frozen, canned or dried fruit as a snack and dessert.

Lower Sodium Grain Products

• Eat 6 to 8 servings a day– 3 servings should be whole grain

• For lower sodium:– Limit pastas and rice with prepared

sauces or seasonings.

– Choose cereals, breads, crackers and pre-packaged baked goods with the lower mg sodium per serving.

• Use quick-cooking, rather than instant oatmeal.

Lower Sodium Milk and Alternatives

• Have 2 to 3 servings a day.– Choose lower fat milk and yogurt.

• For lower sodium:– Be aware of higher sodium content

of instant puddings, hot chocolate and flavoured coffee mixes.

– Limit your cheese intake, especially processed cheese slices or spreads.

Lower Sodium Meat and Alternatives

• 2-3 servings per day– Choose lean meat, fish, poultry

– Eat legumes, nuts and seeds often

• For lower sodium:– Limit processed, cured, deli,

smoked or breaded meats and poultry.

– Choose fresh, frozen or low-sodium canned fish.

– Rinse canned lentils, chick peas or beans, or cook your own.

– Enjoy unsalted nuts and seeds.

Breakfast Menu Makeover

Menu 1,

Higher Sodium

Sodium

(mg)

CFG Menu + Lower Sodium

Sodium

(mg)

Commercial raisin bran muffin – largeButter – 2 pats

Flavoured coffee – 16 oz.

800

75

300

Multigrain bread – 2 slices

Peanut butter – 1 Tbsp

Banana

Coffee with 2oz 1% milk

300

75

1 32

Total 1175 408

Lunch Menu Makeover

Menu 1 ,

High Sodium

Sodium (mg)

CFG MENU +Lower Sodium

Sodium (mg)

White pita bread – 1 smallDeli meat – 2 oz.Cheese slice – 1Mustard – 1 tsp.Dill pickle

32276533256385

Multigrain bread -2 slicesLeftover roast beef – 2 oz.Lettuce and cucumberMustard – 1 tsp.Carrot sticksLow fat, fruit yogurt – 175g

300 37 0

5660123

Total 1860 576

Snack Menu Makeover

MENU 1 +Higher Sodium

Sodium (mg)

CFG MENU + Lower Sodium

Sodium (mg)

Chocolate chip cookies – 2

Nacho chips – 20

Cola – 12 oz.

100

345

15

Apple Handful of natural almonds

Air popped popcorn with low-sodium seasoning – 6 cups

Water – 12 oz

04

5

0

Total 460 9

Dinner Menu Makeover

MENU 1 +

Higher Sodium

Sodium (mg)

CFG MENU +

Lower Sodium

Sodium (mg)

Fast food chicken burgerMedium french fries

Ketchup – 1 Tbsp.

Milkshake – 16 oz.

990 540

110

350

Grilled chicken breast – 75gBaked potato Plain Yogourt – 1 Tbsp.Tomato slices – 6Steamed broccoli – 1 cupCanned peaches-1/2 cupMilk 1% – 8 oz.

6433

10 11

25 5

122

Total 1990 270

Sodium Comparison

• High sodium menu

• Lower sodium menu

5485 mg

1258 mg

The Sodium Challenge

• It requires effort and commitment to eat the recommended sodium levels.

• If the current trend for convenience continues, the food industry needs to gradually lower sodium/salt content of foods.

• Health Canada has a Sodium Working Group to develop and implement a Strategy to reduce sodium intake

Recap: Healthy Eating for a Healthy Blood Pressure

• Eat a healthy diet according to Canada’s Food Guide.– CFG = DASH diet guidelines

(Dietary Approaches to Stop Hypertension)

• Choose lower sodium foods every day

Dietary Sodium Questions

1. Reducing your intake of salt or sodium may help you lower your blood pressure.

• TRUE • FALSE

Dietary Sodium Questions

2. Most Canadians have sodium intakes that exceed recommendations for health.

• TRUE• FALSE

Dietary Sodium Questions

3. Most of the sodium in the North American diet is from salt added at the table.

• TRUE• FALSE

Dietary Sodium Questions

4. The Nutrition Facts table tells you the number of milligrams (mg) of sodium in the whole package of food.

• TRUE• FALSE

Dietary Sodium Questions

5. “Instant” packaged foods and fast food restaurant meals generally have a very high sodium content.

• TRUE• FALSE

For More Information

Go to the websites:

www.hypertension.ca www.sodium101.ca

www.healthcanada.gc.ca/foodguidewww.dietitians.ca

DASH Diet Booklet

• To download or order a copy of the Dietary Approach to Stop Hypertension (DASH) Diet booklet, go to :

www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf