Download Document

Heart and
Stroke:
Sodium Update
2008
Sodium update: outline
Background
 Sodium and hypertension
 Dietary Reference Intake

 (AI and UL)
Canadian/NB Stats
 Game
 Sodium in our food
 What to tell our patients

Sodium:
History and usage
 Mineral
found in table salt
(NaCl - sodium chloride)
 Also combined with other
chemicals and added to
manufactured foods.
Sodium:
Examples of food additives






Monosodium
Glutamate (MSG)
Sodium Bicarbonate
(baking soda)
Sodium Phosphate
Sodium Carbonate
Sodium Benzoate
Sodium Caprate







Sodium Erythrobate
Sodium Proprinate
Sodium Nitrite/nitrate
Sodium Sulfite
Sodium Lactate
Sodium Diacetate
Sodium Caseinate
Sodium:
Essential role
Essential mineral required to maintain good
health.
 Sodium must be consumed regularly in
adequate amounts.
 Vital component of all fluids in the human
body.

Sodium:
Essential role
Electrolyte
 Possesses a mild electrical charge helping to
transmit nerve impulses throughout the body.
Kidneys work to regulate sodium balance
 Excess sodium passes through urine
 High sodium = more urine production
Sodium and hypertension
Excess sodium can cause:
 The
body to retain fluid
 Swelling of body tissues
 Increase in blood
pressure/hypertension
Sodium and hypertension
Salt sensitivity
 Present in 30% of non-hypertensive
individuals
 Present in greater then 50% of those
with hypertension
Sodium and hypertension
World Health Organization estimates:
 Hypertension to be the leading risk factor for
death in the world.
 One quarter of the world’s population has
hypertension.
 High blood pressure is the leading risk factor
for death in developed countries.
.
Sodium and hypertension
Blood Pressure Canada News
Hypertension is the leading risk factor for death in
Canada.
 It is estimated the 1 million Canadians have
hypertension caused by excess dietary sodium.
 Lowering sodium consumption could reduce the
incidence of stroke and heart disease by 30%.

Sodium and hypertension
One in three Canadians with
high blood pressure would
have normal blood pressure
if there was less sodium in
our food.
Definition and
limitations:
Dietary Reference Intake

Adequate Intake (AI)
 The recommended average
daily intake, based on
observations, testing or
approximate estimates of the
nutritional intake or one or
more groups of apparently
healthy people who appear to
maintain an adequate level of
nutrition.

Tolerable Upper
Intake Level (UL)
 The highest continuous daily
intake of a nutrient that does
not appear to carry risks of
adverse health affects in
most members of a given
group, defined by stage of
life and sex.
Recommendations:
Dietary Reference Intake
 Health
Canada’s
Dietary
Reference
Intakes for
Sodium
AI – Adequate
Intake
 UL – Tolerable
Upper Intake Level

Age*
1-3
4-8
9-50**
51-70
70+
AI
1000
1200
1500
1300
1200
UL
1500
1900
2300
2300
2300
*Male and Female
**Including Preganancy
and Lactation
Definition and
limitations:
Dietary Reference Intake
 Limitations
of Dietary Reference
Intakes (DRI) for Sodium
 Moderately active people
 May not apply to athletes who
participate in intense physical activity
How much sodium are we
getting?
2004 CCHS – Nutrition
 Regardless of age, Canadians’ average daily
sodium intake was far beyond the
recommended UL.
 Canadian average was 3,092mg sodium/day
 Average for NB was 3,183 mg/day
Percentage with usual
sodium intake above the
UL
100%
80%
60%
40%
20%
0%
1-3
4-8
9-13
Female
14 -50
Male
51-70
71+
Average sodium intake/day
vs.
Tolerable Upper Intake
Levels (UL)
4500
4000
3500
3000
2500
2000
1500
1000
0500
0000
1-3
4-8
Female
9-13
Male
14 -50
51-70
UL (mg/day)
71+
Average sodium intake by
province
Ont.
N.L.
P.E.I.
Alta.
Man.
N.S.
Sask.
N.B.
B.C.
Que.
Canada
2871
2994
3023
3041
3089
3115
3181
3183
3300
3350
3092
2008 Hypertension
Conference:
Sodium Games
 Question
#1: Of the two products
listed, which has the least sodium?
 Question
#2: How many milligrams of
sodium are in each of these products?
How many salt packages would that be?
 Hint: 1 salt package = 300 mg of
sodium
2008 Hypertension Conference:
Sodium Games - Answers

Question 2:
A: 1100 mg (4 salt pkg)
B: 1470 mg (5 salt pkg)
C: 1887 mg (6 1/3 salt pkg)
D: 900 mg (3 salt pkg)
E: 1680 mg (5 ½ salt pkg)
F: 812 mg (3 salt pkg)
G: 2375 mg (8 salt pkg)

Questions 1:
A: Plain oatmeal
B: Whole grain rice
C: Milk
D: Canned vegetables
E: Apple
F: Baked Ham
2008 Hypertension Conference:
Sodium Games - Answers
How well did your group
do?

9-12 Answers Correct:
 Congratulations! You’re Sodium Savvy!

5-8 Answers Correct:
 Good Job! Keep reading those nutrition
labels!

0-4 Answers Correct:
 Oh oh! See following slide…
Where’s the sodium
Processed
foods/restaurant meals
6%
5%
Occurring naturally in
food
12%
Added during cooking/at
the table
Remainder
77%
Percentage with
hypertension
who salt foods regularly.
13%
36%
36% Never
32% Rarely
19%
19% Occasionally
13% Very Often
32%
Where’s the sodium
In Processed Foods (77%)
19.1% - Pizza, sandwiches,
submarines, hamburgers and
hotdog.
 7.4% Soups
 5.7% Pasta
 4.0% Milk
 < 4% Poultry dishes, Potatoes,
Cheese, Cereals, Beef and
Sauces

How to council our
patients
on sodium intake
 Daily
dietary
sodium intake of
2300mg or less
 Choose
CFGHE
and encourage fresh
choices most of the
time.
Follow CFGHE:
http://www.hc-sc.gc.ca/fn-an/food-guidealiment/index_e.html
Choose:
 Fresh fruit and vegetables
 Low sodium whole grains
 Low fat dairy and alternatives
 Lean meats and alternatives
Limit:
 Processed cheeses and meats
 Extra fats
 Addition of salt and sugar
Tips to lower sodium
intake
Eat Fresh
 Read nutrition labels
 Pay attention to portion size
 Choose salt reduced or “no
salt added” versions
 Rely less on convenience
 Avoid salt at table

Tips to lower sodium
intake
Season with other herbs and
spices
 Be assertive when eating out
 Limit salted snacks
 Limit processed meats
 Use small amounts of
condiments

Read nutrition labels
Canadian Stroke
Network
Recommends:
High: 400+
Medium: 200-400
Low: 0-200
Sodium reduction
recommendations
World Health Organization
 Called on governments to introduce
regulations on sodium additives to foods.
American Heart Association and American
Public Health Association
 Called for a 50% reduction in foods
American Medical Association
 Called for the American government to
remove sodium from the GRAS category
Sodium reduction
recommendations
UK Scientific Advisory Committee on
Nutrition
 Recommended substantial reduction of sodium
in the food supply.
The Canadian and American governments
 Adopted the AI and UL for dietary sodium
intake as recommended by the IOM.
First steps towards a
national sodium reduction
strategy
 Health
Minister Tony Clement, formed
an expert Sodium Working Group.
 Look at ways to reduce sodium in
processed foods
 Educate Canadians on health risks
 Provide tips on how to reduce sodium
consumption
Sodium update
Thank you!
[email protected]
Questions?