2 Hypertension Canada 2010 Hypertension The Silent Killer Sodium The Quiet Food Additive
3 Hypertension Canada 2010 Outline 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
4 Hypertension Canada 2010 Where do we get sodium? Salt Table salt, sea salt, seasoning salts Sodium additives such as Monosodium glutamate(MSG) Baking soda Processed, takeout / restaurant foods
6 Hypertension Canada 2010 Why is sodium in our food ? Prevents food from spoiling. Performs some chemical functions in baking and processing. Adds flavour.
7 Hypertension Canada 2010 What does sodium do? In your body: Helps regulate your bodys 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.
8 Hypertension Canada 2010 How is sodium a health risk? Increases blood pressure which increases risk for: Stroke Cardiovascular disease Kidney disease Dementia
9 Hypertension 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
10 Hypertension 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%.
11 Hypertension 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
12 Hypertension Canada 2010 How 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
13 Hypertension Canada 2010 Sodium Intake Recommendations Age (years)AI (mg/day)UL(mg/day) 1-310001500 4-812001900 9-1315002200 Dietary Reference Intakes, IM 2005
14 Hypertension Canada 2010 Sodium Intake Recommendations Age (years)AI (mg/day)UL(mg/day) 14-5015002300 50-7013002300 Over 7012002300 Dietary Reference Intakes, IM 2005
15 Hypertension Canada 2010 1500mg or 2300mg doesnt mean much to me…. 2300mg sodium = 1 level tsp table salt 1,500mg = ¾ tsp table salt Sodium Intake Recommendations
16 Hypertension Canada 2010 So how do you think were 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
17 Hypertension Canada 2010 Sodium Intake of Canadian Adults 2680 mgWomen 3575 mgMen Average Daily Sodium Intake Gender
18 Hypertension Canada 2010 Av. Sodium Intake* (mg/day) of Canadian Adults *Does not include sodium added at the table or during home cooking
19 Hypertension Canada 2010 The sodium intake of most Canadian children/youth exceeds the UL Health Reports, Vol. 18, No 2, May 2007 Upper Level 1500mg 1900 2200 2300 % above UL
20 Hypertension Canada 2010 Why is our sodium intake so high? 1. Less home-cooked meals Busy lifestyle! Want convenience Prepared food is always available
21 Hypertension Canada 2010 2. Bigger Portions 21 cups3 cups Food packages are bigger now than ever. The more we eat, the more sodium we consume.
22 Hypertension Canada 2010 3. Heavy Use Of Condiments Ketchup Mustard Soy sauce Salad dressing Relish and pickles Olives Sauces … are all high in sodium
23 Hypertension Canada 2010 4. More Processed Foods
24 Hypertension Canada 2010 Food industry must reduce sodium in its products 24
30 Hypertension Canada 2010 Sodium Content of Restaurant Foods Menu ItemSodium (mg) Breakfast Egg Sandwich840 Chicken Caesar Salad570 12 Pepperoni Pizza5960 Deluxe Cheeseburger & Medium Fries1910 Fried Chicken Dinner2280
31 Hypertension Canada 2010 Reduce 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.
32 Hypertension Canada 2010 Reduce 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.
33 Hypertension Canada 2010 Reduce 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.
34 Hypertension Canada 2010 Reduce 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
35 Hypertension Canada 2010 Reduce 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
36 Hypertension Canada 2010 Reduce 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.
37 Hypertension 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.
38 Hypertension Canada 2010 Lower 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.
39 Hypertension 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.
40 Hypertension 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.
41 Hypertension Canada 2010 Breakfast Menu Makeover Menu 1, Higher Sodium Sodium (mg) CFG Menu+ Lower Sodium Sodium (mg) Commercial raisin bran muffin – large Butter – 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 Total1175408
42 Hypertension Canada 2010 Lunch Menu Makeover Menu 1, High Sodium Sodium (mg) CFG MENU + Lower Sodium Sodium (mg) White pita bread – 1 small Deli meat – 2 oz. Cheese slice – 1 Mustard – 1 tsp. Dill pickle 322 765 332 56 385 Multigrain bread - 2 slices Leftover roast beef – 2 oz. Lettuce and cucumber Mustard – 1 tsp. Carrot sticks Low fat, fruit yogurt – 175g 300 37 0 56 60 123 Total1860576
43 Hypertension Canada 2010 Snack Menu Makeover 9460Total 0 4500 450 Apple Handful of natural almonds Air popped popcorn with low- sodium seasoning – 6 cups Water – 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
44 Hypertension Canada 2010 Dinner 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 – 75g Baked potato Plain Yogourt – 1 Tbsp. Tomato slices – 6 Steamed broccoli – 1 cup Canned peaches- 1/2 cup Milk 1% – 8 oz. 64 33 10 11 25 5 122 Total1990270
45 Hypertension Canada 2010 Sodium Comparison High sodium menu 5485 mg Lower sodium menu1258 mg
46 Hypertension Canada 2010 The 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
47 Hypertension Canada 2010 Recap: Healthy Eating for a Healthy Blood Pressure Eat a healthy diet according to Canadas Food Guide. CFG = DASH diet guidelines (Dietary Approaches to Stop Hypertension) Choose lower sodium foods every day
48 Hypertension Canada 2010 Dietary Sodium Questions 1. Reducing your intake of salt or sodium may help you lower your blood pressure. TRUE FALSE
49 Hypertension Canada 2010 Dietary Sodium Questions 2. Most Canadians have sodium intakes that exceed recommendations for health. TRUE FALSE
50 Hypertension Canada 2010 Dietary Sodium Questions 3. Most of the sodium in the North American diet is from salt added at the table. TRUE FALSE
51 Hypertension Canada 2010 Dietary Sodium Questions 4. The Nutrition Facts table tells you the number of milligrams (mg) of sodium in the whole package of food. TRUE FALSE
52 Hypertension Canada 2010 Dietary Sodium Questions 5. Instant packaged foods and fast food restaurant meals generally have a very high sodium content. TRUE FALSE
53 Hypertension Canada 2010 For More Information Go to the websites: www.mybpsite.ca www.lowersodium.ca www.healthcanada.gc.ca/foodguide www.dietitians.ca
54 Hypertension Canada 2010 DASH 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
55 Hypertension Canada 2010 For your patients – ask them to sign up at www.myBPSite.ca for free access to the latest Information & resources on HBPwww.myBPSite.ca For health care professionals – sign up at www.htnupdate.ca for automatic updates and on current hypertension educational resources.www.htnupdate.ca