Should We Put the Salt Shaker Down?

Transcription

1 Should We Put the Salt Shaker Down? How Much is Too Much? New Sodium Recommendations Barbara Fletcher, RN, MN, FAHA, FPCNA, FAAN Clinical Associate Professor Brooks College of Health School of Nursing

2 Declaration of conflict of interest Nothing to declare

3 History of Salt Salt s ability to preserve food was a foundation of civilization It eliminated dependence of seasonal foods & allowed travel over long distances It was difficult to obtain and a highly valued trade item Roman soldiers were paid with salt

4 History of Salt Two main sources of salt Rock Salt and Sea Water Occurs in vast beds of sedimentary evaporite minerals that result from drying up of lakes, playas and seas Salzburg Austria named the city of salt for its mines Salt is extracted from underground beds by mining or by solution mining In solution mining salt reaches the surface as brine and is turned into salt crystals by evaporation Bloch, D; salt.org.il/frame_econ.html

5 History of salt iodization Ancient Greeks and others used iodine-rich seaweed to combat goiters, but it was not until 1821 that French nutritional chemist Jean Baptiste Boussingault discovered iodine-rich salts could be used to treat goiters , Dr. David Marine, a young doctor in Cleveland, OH, USA, began working explicitly on using iodine-fortified salt to prevent goiters 1924 iodized salt was commonly available in the U.S. In less than a decade, 90+% of the salt consumed in the U.S. "goiter belt" was iodized. Goiter incidence plummeted Journal of Nutrition, 135; (2005)

6 sodium naturally present in food (12%) salt added at the table (6%) sodium in home cooking (5%) sodium in processed and restaurant foods (77%) *

7 Sources of Dietary Salt ESC Council for Cardiology Practice, Vol 10, No 24, March 26, 2012.

8 Top Ten High Sodium Foods 1. Breads and rolls 2. Cold cuts/ cured meats 3. Pizza 4. Poultry 5. Soups 6. Sandwiches 7. Cheese 8. Pasta mixed dishes 9. Meat mixed dishes 10. Savory snacks CDC MMWR/February 10, 2012/ Vol. 61/No. 5

9 UK Salt Restriction Initiatives May 2003, Science Advisory Committee on Nutrition (SACN) recommended Salt Intake be reduced from current levels of 9.5 G to 6 G per day Reformulation work which entails working with all sectors of food industry An ongoing public awareness campaign to inform consumers of issues & provide guidance on reducing salt intake

10 Institute of Medicine (IOM) Current level of sodium in food is too high to be safe. Recommended strategies set a new course for reducing sodium intake with an innovative approach to gradually reducing sodium levels in foods. Current focus on instructing consumers to reduce dietary sodium intake and to select lower-sodium foods cannot result in intakes consistent with public health recommendations.

11 Institute of Medicine (IOM) A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension Released:February 22, 2010 Strategies to Reduce Sodium Intake in the United States Released:April 20, 2010

12 National Sodium Reduction Initiative (NSRI) Inspired from UK Salt Restriction Initiatives NSRI Packaged Food Database was created to track sales and nutrition information NSRI Restaurant Food Database also created to obtain nutrition data from 50 largest quickservice restaurants Developed sodium targets for years 2012 & 2014 for 62 packaged food & 25 restaurant food categories

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14 NSRI A promising voluntary process 28 companies have committed to NSRI targets Achieving broad scale sodium reductions will require commitments from many more food manufacturers and restaurants

15 Is it Salt or Sodium 1 gram salt = 400 mg sodium ¼ teaspoon Morton regular salt = 590 mg sodium ¼ teaspoon Morton lite salt = 290 mg sodium ¼ teaspoon Sea Salt = 590 mg sodium

16 Dietary Guidelines for America 2010 Recommended maximum sodium intake = 2300 mg A maximum daily intake of 1,500 milligrams of sodium is recommended for people who are 51 and older, African Americans, and anyone with hypertension, diabetes or chronic kidney disease Current daily intake is 3700 mg. Intake has increased by 50% last 30 years AJCN.org 2012

17 Pan American Health Organization The Regional Office for the Americas of the WHO Has International Recognition as part of the United Nations Consist of Countries of the Americas and Caribbean Key message on Salt distributed at the UN Summit on Non-Communicable Diseases 2011: Salt Reduction, through food product reformulation and public awareness

18 Salt/Sodium Intake in Germany 80% of daily sodium intake comes from processed foods, fast food, and restaurants Recommended reduction of daily salt intake from present level of 8-10 G to 5-6 G From mg to mg Sodium intake To achieve this target, an interdisciplinary task force called less salt for all has been established

19 How Much Sodium do Organizations Recommend? Sodium Recommendations: WCC/WHF 5.0 Grams per Day ACC 1.5 Grams adequate 2.3 Grams upper level AHA 1.5 Grams per Day IOM 2.3 Grams Tolerable upper level ESC < 5Grams per Day PCNA 2.3 Grams per Day

20 How Much Sodium do Organizations Recommend? The Academy of Nutrition and Dietetics (AND) supports 2010 Dietary Guidelines of: Maximum sodium intake = 2300 mg Maximum daily intake of 1,500 milligrams of sodium is recommended for people who are 51 and older, African Americans, and anyone with hypertension, diabetes or chronic kidney disease

21 Why Sodium Reduction Stands Apart As An Effective Public Health Intervention Sodium excess is a leading contributor to high blood pressure Sodium reduction is amenable to intervention with: Behavior change Massive public education initiative Food industry actions to reduce sodium in their products Low cost intervention

22 Lifestyle change: What difference does it make in BP? Weight loss: 5-20 mmhg lower SBP for a 20# loss DASH diet: 8-14 mmhg lower SBP Reducing salt in the diet: 2-8 mmhg lower SBP Physical activity: 4-9 mmhg lower SBP Reducing alcohol: 2-4 mmhg lower SBP

23 Global Atlas on CVD Prevention and Control, WHO, WHF, World Stroke Organization, 2011.

24 Global Atlas on CVD Prevention and Control, WHO, WHF, World Stroke Organization, 2011

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26 Unhealthy Diet Dietary salt: Increases BP in most with HBP Aggravates the age-related rise in BP High intake of saturated fats, trans-fats, cholesterol and salt, and low intake of fruits, vegetables and fish increase CVD risk

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28 Total U.S. Food Expenditures % 36% 62% 2% 3% 1% 4% 51% 5% % 2% 2% 2% 3% Eating and drinking places Retail stores, direct selling Schools and colleges Foods at Home Hotels and motels Recreational places All other foods away from home US Dept of Agriculture Economic Research Service

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32 Low Sodium Diet Adherence Taste buds acclimate to high sodium levels in the diet When sodium levels are reduced, it takes about 4-6 weeks for the taste buds to re-acclimate to the lower levels In the meantime, foods taste very bland and most patients give up Education Point: Use alternative seasonings to spice up the taste until the taste buds reacclimate. FOOD WILL TASTE GOOD AGAIN!

33 What to do about high sodium in diets A. Do nothing and wait for more evidence B. Individual approach to educating about sodium reduction C. Public Health Approach Answer: B & C

34 Conclusion What will make the biggest difference in achieving Sodium targets is creating environments that offer people access to healthy low sodium foods This must be accompanied with strong consumer education

35 Low Sodium Foods