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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.