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WEIGHT MANAGEMENT PROGRAM
Sodium, Hypertension: Instructor’s Guide
In this week’s session, we will look at factors that can have an influence on blood
pressure, electrolyte balance and fluid retention. We will also identify fluid needs and
guidelines for replacing fluids during exercise.
Background information:
Recent research has questioned sodium’s affect on blood pressure. Some scientists
believe that guidelines for sodium restriction are unnecessary. The American Heart
Association still recommends specific guidelines for sodium intake. More research is
needed before we can make a final ruling on sodium and its’ affect on health.
By the end of this session you will be able to:

Understand how sodium regulates fluid balance.

Understand the role that diet may play in controlling blood pressure.

Discover ways to prevent fluid loss and dehydration during exercise.
WEIGHT MANAGEMENT PROGRAM
Sodium, Hypertension and Weight Loss
Most Americans like salt. It is estimated that the typical American eats an average of 6 to 18
grams of salt daily (1 to 3 teaspoons). Your body needs only about ½ gram of salt (less than ½
tsp.) or 500 mg of sodium per day.
The role of salt in high blood pressure and heart disease is not as clear as it once seemed.
Many experts disagree about the importance of salt intake and current recommendations for salt
consumption. It is clear that some groups of patients need to carefully watch salt consumption,
but whether the entire population benefits from restriction is uncertain.
Newer research has shown there are other factors in blood pressure control which may be even
more important than salt. New studies have shown blood pressure is better regulated by
adopting the DASH (Dietary Approaches to Stop Hypertension) diet, which includes more fruits,
vegetables, and dairy products -- not just by reducing salt.
If you have high blood pressure and have been told by your physician to limit your sodium
intake, it is recommended to follow his advice until more research is done.
Dietary Approach to Stop Hypertension (DASH)
The research was funded by the National Heart, Lung, and Blood Institute (NHLBI), with
additional support by the National Center for Research Resources and the Office of Research
on Minority Health, and The National Institutes of Health. The results show that the DASH
"combination diet" lowered blood pressure and, so, may help prevent and control high blood
pressure. (More information on the DASH diet will be provided later.)
Sodium and Weight Loss
Salt is sodium chloride. Sodium is an element that’s needed for good health. You must have a
certain balance of sodium and water in your body at all times.
Sodium will not help or prevent you from losing body fat. But excess sodium can cause fluid
retention which can show up on the scale.
The human body retains enough water to maintain sodium at a propel level:

If excess sodium: kidneys will retain water to reach normal sodium level.

If excess water: kidneys will excrete the water to reach normal sodium level.
To decrease fluid retention, drink 8 glasses of fluid per day and decrease your sodium intake.
Identifying Sources of Salt
Most of the sodium in our diet comes from the processing of food. If you are concerned about
your sodium consumption, get in the habit of reading food labels and check for the sodium
content.
Sodium is found in:
 Salt
 Monosodium Glutamate (MSG)
 Baking Soda
 Baking Powder
 Disodium phosphate
 Garlic Salt, Seasoned Salt, etc. (any compound that has “salt or sodium” in its
name).
Sodium Claims on Food Labels
When trying to decide how much sodium you need, you can use the following guidelines.
Label Term
Definition
Sodium Free
Less than 5 mg. sodium per serving
Salt Free
Meets the requirements for sodium free
Very Low Sodium
35 mg. sodium or less per serving
Low Sodium
140 mg. sodium or less per serving
Reduced Sodium
At least 25% less sodium when compared with a reference
food
Light in Sodium
50% less sodium per serving; restricted to foods with more
than 40 calories per serving or more than 3 g of fat per serving
(if pertaining to sodium content)
Unsalted, without added salt, no
salt added
1. No salt added during processing
2. The product it resembles and substitutes for is normally
processed with salt.
3. The label bears the statement “not a sodium-free food” or
“not for control of sodium in the diet” if the food is not
sodium free.
A Healthier Diet
The more balanced overview is that salt is one component of a diet that affects blood pressure.
Despite differences, researchers agree on one thing: the need for Americans to adopt a
healthier diet.
The positive message, in terms of both blood pressure and overall [heart] health, is people
should pay attention to their overall diet; avoid obesity, avoid eating too much salt, and make
sure they eat plenty of fruits and vegetables.
Important Information:

The American Heart Association recommends a healthy adult consume no more than six
grams of salt each day. Research shows most Americans get about nine grams of salt a
day.

Experts may disagree on the exact relationship between salt intake and one's blood
pressure and many feel that the importance of salt has been overemphasized.

Experts agree that there are other important contributors to consider, such as eating a
balanced, low-fat diet that includes calcium rich foods and an abundance of fruits and
vegetables.
Guidelines for Sodium Intake
Health Factor
Sodium Level
Guidelines
Healthy Adult who
wants to control
sodium for
preventative health
No more than 6
grams (6000 mg)
per day
Limit high sodium processed and
convenience foods such as bacon, hot
dogs, ham or other smoked, salted meats
and regular canned foods.
Limit salt in cooking and at the table.
Sodium Restricted
Diet
2,000 mg per day
Limit processed and prepared foods and
beverages high in sodium. Do not use salt
in preparation of foods or at the table.
Check labels of canned and instant
products for sodium content and replace
with low-sodium versions when available.
See a Registered Dietitian for addition
guidelines.
1,000 mg per day
Eliminate processed and prepared food and
beverages high in sodium. Read the
nutrition facts on all food labels carefully for
sodium content. Do not use any salt in
preparation of food or at the table. See a
Registered Dietitian for specific guidelines.
Often
recommended as
part of treatment for
Kidney Disease,
Heart Disease or
Edema
Severe Sodium
Restriction
DASH Diet (The Dietary Approach to Stop Hypertension)
The "combination diet" is rich in fruits, vegetables, and low fat dairy foods, and low in saturated
and total fat. It also is low in cholesterol, high in dietary fiber, potassium, calcium, and
magnesium, and moderately high in protein.
The DASH eating plan shown below is based on 2,000 calories a day. Depending on your
caloric needs, your number of daily servings in a food group may vary from those listed.
Food
Group
Daily
Servings
Serving Sizes
Examples and Notes
Significance of each Food
Group to the DASH Diet
Pattern
Grains &
grain
products
7-8
1 slice bread
1/2 C dry cereal
1/2 C cooked rice,
pasta, or cereal
whole wheat bread, English muffin,
pita bread, bagel, cereals, grits,
oatmeal
major sources of energy and
fiber
Vegetables
4-5
1 C raw leafy
vegetable
1/2 C cooked
vegetable
6 oz vegetable juice
tomatoes, potatoes, carrots, peas,
squash, broccoli, turnip greens,
collards, kale, spinach, artichokes,
sweet potatoes, beans
rich sources of potassium,
magnesium, and fiber
Fruits
4-5
6 oz fruit juice
1 medium fruit
1/4 C dried fruit
1/2 C fresh, frozen, or
canned fruit
apricots, bananas, dates, oranges,
orange juice, grapefruit, grapefruit
juice, mangoes, melons, peaches,
pineapples, prunes, raisins,
strawberries, tangerines
important sources of potassium,
magnesium, and fiber
Low fat or
nonfat dairy
foods
2-3
8 oz milk
1 C yogurt
1.5 oz cheese
skim or 1% milk, skim or low fat
buttermilk, nonfat or low fat yogurt,
part skim mozzarella cheese, nonfat
cheese
major sources of calcium and
protein
2
3 oz cooked meats,
poultry, or fish
select only lean; trim away visible
fats; broil, roast, or boil, instead of
frying; remove skin from poultry
rich sources of protein and
magnesium
4-5
servings
per week
1.5 oz or 1/3 C nuts
1/2 oz or 2 Tbsp
seeds
1/2 C cooked
legumes
almonds, filberts, mixed nuts,
peanuts, walnuts, sunflower seeds,
kidney beans, lentils
rich sources of energy,
magnesium, potassium, protein,
and fiber
Meats,
poultry,
and fish
Nuts,
seeds, and
legumes
Tips for Eating the DASH diet




Start small. Make gradual changes in your eating habits.
Center your meals around vegetables and treat meat as one part of the whole meal, instead of the
focus.
Include low fat dairy sources at meals or for snacks with fruit.
Use fruits or low fat, low calorie foods such as sugar free gelatin for desserts and snacks.
REMEMBER!
If you use the DASH diet to help prevent or control high blood pressure, make it part of a lifestyle that
includes choosing foods lower in salt and sodium, keeping a healthy weight, being physically active, and,
if you drink alcohol, doing so in moderation.
WEIGHT MANAGEMENT PROGRAM
Sodium and Fluid Needs for Exercise
Fluid Loss During Exercise
An average person may lose as much as 1 qt (1 L) to 2 qt (1.9 L) of fluid during 1
hour of exercise. If you exercise strenuously or are an athlete, you can lose as
much as 3 qt (2.8 L) of fluid per hour during an intense workout.
Dehydration can occur if you do not drink enough fluids. Without adequate fluid,
muscles quickly begin to tire and leg cramps may develop while walking or
running.
Fluid loss in endurance activities such as distance running, cycling, strenuous
hiking, or cross-country skiing can be severe. These types of activities can
quickly lead to heat exhaustion. During long duration (60 minutes or more) high
intensity exercise, dehydration can cause a variety of symptoms called postextreme endurance syndrome (PEES). Symptoms of PEES include decreased
body temperature, nausea, vomiting, diarrhea, dizziness, headache, muscle
cramps, and an inability to drink fluids.
Guidelines to Prevent Dehydration:

Drink 8 to 10 glasses of water every day to replace daily losses.

Drink extra water before, during, and after exercise.

Bring a container of water or fluid replacement drink with you when you exercise.
Take a drink every 15 to 20 minutes during exercise. It is recommended to use a
fluid replacement drink (sports drink) if you will be exercising for longer than 1
hour or if you sweat excessively.

Avoid carbonated and caffeinated drinks, such as coffee and colas, which
increase urine output and may contribute to dehydration.

Avoid alcoholic drinks, which increase dehydration and make it difficult to make
good decisions.

Do not take salt tablets. Most people get plenty of salt in their diets. If you are
worried about replacing minerals lost through sweating, use a fluid replacement
drink which is designed to replace sodium and potassium.

Stop working outdoors or exercising at the first sign of dizziness,
lightheadedness, or fatigue.
It is particularly important to guard against dehydration in extremely hot or dry
weather and at high elevations. Exercise earlier in the day or later in the evening
when it is cooler.
Muscle Cramps
Although there are many causes of muscle cramps, large losses of sodium and
fluid can be key factors that predispose athletes and serious exercisers to run-ofthe-mill muscle cramps. Sodium is an important mineral for muscle contraction,
so a deficit of this element and fluid may make muscles "irritable." Under such
conditions, a slight stress, such as a subsequent movement, may cause the
muscle to contract and twitch uncontrollably.
Preventing Cramps
1. Drink plenty of fluids to stay hydrated during exercise.
2. Replenish sodium levels during times of heavy exercise and profuse
sweating with a sports drink like Gatorade.
3. Ensure adequate nutritional recovery (particularly for salt) and rest for
muscles after hard training.
Quick Fixes for Cramps
When cramps strike during a workout or competition, take immediate action with
the following:
1. Stretch the muscle. Remember to hold the stretch and don’t rush through
it. Always take time to stretch before and after a workout.
2. Massage the area. Rubbing the cramped muscle may help alleviate pain
as well as help stimulate blood flow and fluid movement into the area.
3. Stimulate recovery. Rest and adequate rehydration with fluids containing
electrolytes, particularly sodium, will quickly bring improvement.
Can You Drink Too Much Fluid?
Endurance athletes, especially inexperienced marathoners who tend to run
slowly and stop for more fluid breaks may consume more water than needed,
which can lead to a dangerous condition called "hyponatremia".
Hyponatremia can occur when an athlete takes in too much water and the
sodium level in the blood drops too low. Using a sports replacement drink and
consuming salt at meals can help prevent hyponatremia from occurring.