2010 dietary sodium shaking the habit. 2 hypertension canada 2010 hypertension the silent killer...
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2010
Dietary Sodium
”Shaking the Habit”
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2Hypertension Canada
2010
HypertensionThe Silent Killer
SodiumThe Quiet Food Additive
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3Hypertension Canada
2010Outline
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
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4Hypertension Canada
2010Where do we get sodium?
Salt Table salt, sea salt, seasoning salts
Sodium additives such as Monosodium glutamate(MSG) Baking soda
Processed, takeout / restaurant foods
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5Hypertension Canada
2010Sources Of Sodium
5
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6Hypertension Canada
2010Why is sodium in our food ?
Prevents food from spoiling.
Performs some chemical functions in baking and processing.
Adds flavour.
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7Hypertension Canada
2010What 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.
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8Hypertension Canada
2010How is sodium a health risk?
Increases blood pressure which increases risk for: Stroke Cardiovascular disease Kidney disease Dementia
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9Hypertension Canada
2010
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
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10Hypertension Canada
2010
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%.
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11Hypertension Canada
2010 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
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12Hypertension Canada
2010How 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
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13Hypertension Canada
2010
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
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14Hypertension Canada
2010
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
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15Hypertension Canada
2010
1500mg or 2300mg doesn’t mean much to me….
2300mg sodium = 1 level tsp table salt
1,500mg = ¾ tsp table salt
Sodium Intake Recommendations
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16Hypertension Canada
2010
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
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17Hypertension Canada
2010Sodium Intake
of Canadian Adults
2680 mgWomen
3575 mgMen
Average Daily Sodium Intake
Gender
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18Hypertension Canada
2010Av. Sodium Intake* (mg/day)
of Canadian Adults
0500
1000150020002500300035004000
20-39yr 40-59yr
60 yr +
Men Women Total
*Does not include sodium added at the table or during home cooking
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19Hypertension Canada
2010
The sodium intake of most Canadian children/youth
exceeds the UL
Health Reports, Vol. 18, No 2, May 2007
0
20
40
60
80
100
1-3 yr 4-8 yr 9- 13yr 14-18 yr
Male
Female
M & F
Upper Level 1500mg 1900 2200 2300
% above UL
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20Hypertension Canada
2010
Why is our sodium intake so high?
1. Less home-cooked
meals Busy lifestyle! Want convenience Prepared food is always
available
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21Hypertension Canada
20102. Bigger Portions
21 cups3 cups
Food packages are bigger now than ever. The more we eat, the more sodium we consume.
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22Hypertension Canada
20103. Heavy Use Of Condiments
Ketchup Mustard Soy sauce Salad dressing Relish and pickles Olives Sauces
… are all high in sodium
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23Hypertension Canada
20104. More Processed Foods
0100200300400500600700800900
1000
freshtomato
tomatopaste
cannedtomato
tomatosauce
tomatosoup
sodium (mg)
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24Hypertension Canada
2010
Food industry must reduce sodium in its products
24
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25Hypertension Canada
2010Processing 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
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26Hypertension Canada
2010Processing Adds Sodium
1 cup plain pasta
5 mg sodium1 cup pasta & sauce
800 mg sodium
0100200300400500600700800
Pasta Pasta&Sc
mg Sodium
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27Hypertension Canada
2010Processing Adds Sodium
Medium cucumber
2 mg sodium
Medium dill pickle
385 mg sodium
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28Hypertension Canada
2010Processing Adds Sodium
1 oz. hard cheese
176 mg sodium
1 oz. processed cheese
407 mg sodium
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29Hypertension Canada
2010Processing Adds Sodium
Coffee-milk & sugar15 mg sodium
Cappuccino from mix
250 mg sodium
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30Hypertension Canada
2010
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
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31Hypertension Canada
2010Reduce 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.
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32Hypertension Canada
2010Reduce 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.
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33Hypertension Canada
2010Reduce 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.
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34Hypertension Canada
2010Reduce 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
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35Hypertension Canada
2010Reduce Your Sodium Intake
Check the Nutrition Facts table for:
The mg sodium per serving (the lower, the better) Choose foods with 200 mg of sodium or less Choose foods with 10% or less Daily Value
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36Hypertension Canada
2010Reduce 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.
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37Hypertension Canada
2010
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.
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38Hypertension Canada
2010Lower 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.
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39Hypertension Canada
2010
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.
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40Hypertension Canada
2010
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.
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41Hypertension Canada
2010Breakfast 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
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42Hypertension Canada
2010Lunch Menu Makeover
Menu 1 ,High Sodium
Sodium (mg)
CFG MENU +Lower Sodium
Sodium (mg)
White pita bread – 1 smallDeli meat – 2 oz.Cheese slice – 1
Mustard – 1 tsp.Dill pickle
322
765332
56385
Multigrain bread -2 slicesLeftover roast beef – 2 oz.Lettuce and cucumberMustard – 1 tsp.Carrot sticksLow fat, fruit yogurt – 175g
300
37 0 56 60
123
Total 1860 576
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43Hypertension Canada
2010 Snack Menu Makeover
9460Total
0 4
50
Apple Handful of natural almonds
Air popped popcorn with low-sodium seasoning – 6 cupsWater – 12 oz.
100
345
15
Chocolate chip cookies – 2
Nacho chips – 20
Cola – 12 oz.
Sodium (mg)
CFG MENU +Lower Sodium
Sodium (mg)
MENU 1 +Higher Sodium
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44Hypertension Canada
2010Dinner Menu Makeover
MENU 1 +Higher Sodium
Sodium (mg)
CFG MENU +Lower Sodium
Sodium (mg)
Fast food chicken burger
Medium 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
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45Hypertension Canada
2010Sodium Comparison
High sodium menu 5485 mg
Lower sodium menu 1258 mg
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46Hypertension Canada
2010The 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
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47Hypertension Canada
2010
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
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48Hypertension Canada
2010Dietary Sodium Questions
1. Reducing your intake of salt or sodium may help you lower your blood pressure.
• TRUE • FALSE
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49Hypertension Canada
2010Dietary Sodium Questions
2. Most Canadians have sodium intakes that exceed recommendations for health.
• TRUE• FALSE
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50Hypertension Canada
2010Dietary Sodium Questions
3. Most of the sodium in the North American diet is from salt added at the table.
• TRUE• FALSE
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51Hypertension Canada
2010Dietary Sodium Questions
4. The Nutrition Facts table tells you the number of milligrams (mg) of sodium in the whole package of food.
• TRUE• FALSE
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52Hypertension Canada
2010Dietary Sodium Questions
5. “Instant” packaged foods and fast food restaurant meals generally have a very high sodium content.
• TRUE• FALSE
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53Hypertension Canada
2010For More Information
Go to the websites:
www.mybpsite.cawww.lowersodium.ca
www.healthcanada.gc.ca/foodguidewww.dietitians.ca
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54Hypertension Canada
2010DASH 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
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55Hypertension Canada
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For your patients – ask them to sign up at www.myBPSite.ca for free access to the latest Information & resources on HBP
For health care professionals – sign up at www.htnupdate.ca for automatic updates and on current hypertension educational resources.