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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?