1 Low Sodium Talk back
This video is to provide instruction in a low sodium diet
for patients with high blood pressure.
My name is Dr. Eric Roehm.
I am a board certified cardiologist and I retired from my
practice last year.
I am creating this video in order to make more information
available for those patients with hypertension who are trying to limit their
salt intake.
Decreasing salt intake is important for several reasons.
Lowering salt intake results in lower blood pressure in and
of itself.
In addition, taking in less sodium makes the body more
responsive to the blood pressure medications that may be required.
Though most patients still require blood pressure
medications in addition to dietary changes, they may need fewer medications or
lower dosages of medications than otherwise would be the case.
A low sodium when used together with the DASH dietary
guidelines is as effective as a mild blood pressure medication.
An outline of the DASH dietary recommendations is reviewed
on a separate video on this site.
Ideally, each patient should have detailed individual
instruction with a dietician and this is recommended to you.
However, as a cardiologist, I have seen hundreds of
patients sent to me by referring physicians because the blood pressure was
difficult to control.
Only a minority of these said they had received instruction
in both a low sodium diet and DASH dietary recommendations.
Unfortunately, insurance coverage for dietary instruction
is variable and at times lacking.
The bad news is that food tastes very bland for the first
6-8 weeks.
Many people during this period think that there food does
not taste as it should.
The good news though, is that by 8 weeks food will taste
just fine.
Your taste buds adjust and become more sensitive to salt.
You won’t believe this 2 weeks into the diet, but by 8
weeks you will experience this change.
In fact, some foods that tasted just fine before, will now
taste too salty.
Water on the body is salt
water and restricting salt helps reduce this type of swelling.
Effects begin to be apparent
within 24-48 hours when they occur.
A visit to your physician is
also important in this situation to make sure that a significant medical
condition is not present as the cause.
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Most Americans eat a diet with at least 3-4 times more salt or sodium than is
ideal.
But less than one fifth of
the sodium in the average diet comes from salt added at the table.
The vast majority of the
sodium or salt is already in the food.
A general approach to a low
sodium diet will be reviewed, followed by more specifics.
In a general approach, first
stop adding…
2.
The second step is to avoid high
sodium foods. This will be discussed shortly.
3.
Decreasing the amount of salt used
in cooking is quite beneficial. Particularly after your taste buds become more
sensitive to salt, you can cut the salt at least by half in most recipes and the
food will taste just fine.
4.
Eating out is difficult and making
the best available choices will be discussed briefly later.
General Approach to a low
sodium diet
1.
Stop adding salt at the table.
2.
Avoid high sodium foods.
3.
Decrease the amount of salt used in
cooking.
4.
Eating out. Decrease frequency of eating out & make best available choices.
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When one tries to follow a low sodium diet, knowing the quantity of sodium in
the food is useful.
However, trying to count how much sodium is in every single item of food that is
eaten is too much trouble for most people.
Regardless, the information on sodium content is still useful.
Knowing the sodium content in foods can help identify foods to be avoided which
are high in salt as well as finding foods that have good levels of sodium.
Sodium
restriction- Counting the milligrams
Sodium= Na
Table salt is NaCl
Goal: 2000mg sodium
restriction.
(DASH diet 1500mg-2300mg Na restriction)
Using food labels
1.
How much Na (sodium)?
2.
What is the serving size?
Salt or sodium in
the diet can be measured in mg of sodium.
Sodium is
represented by the symbol Na.
Table salt is sodium chloride or NaCl.
Food labels give information in terms of the amount of sodium.
The goal for sodium restriction in a patientt with high blood pressure is
approximately 2000mg of sodium daily.
The DASH diet is usually coupled with a 1500-2300mg sodium restriction.
The lower sodium intake is somewhat more effective for lowering blood pressure
but harder to follow.
For most people
with a tendency for high blood pressure, a restriction of 2000mg of Na
represents a substantial improvement from baseline.
So how does one
limit salt intake?
One important fist
step is to look at food labels.
The food labels
give two equally important pieces of information regarding sodium intake.
How much Na is present and what is the serving size.
The amount of sodium present that is taken in with any food is of course
directly proportional to how much of that food is eaten.
If you eat twice the quantity, naturally twice the sodium will be taken in.
Some manufacturers try to game the system. They use an unrealistically small
serving size in order to make the salt or fat content appear low.
Now, let’s look at a label.
This label is from a relatively low salt beef broth.
The sodium content is listed as 120mg. The serving size is one cup which is
reasonable.
However, if the
serving size said ½ cup and you usually use one cup, you would need to double
the quantity of sodium listed to know what your intake will really be for
accuracy.
The labels on foods in the grocery store are a quite helpful guide regarding Na
content.
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Let’s now examine what foods tend to be high in sodium
and what foods are usually acceptable in regards to sodium.
There are exceptions to what I am about to review that you can find by checking product labels or looking in books.
And when foods are listed as being foods “to avoid” that doe not mean you can never eat those foods, but rather that these foods should not be a regular part of your diet.
At this point, If you haven’t already printed what is listed as “handouts for low sodium video”, please pause the video and print these now.
First for meat, poultry and fish.
Unseasoned meaning unsalted meat, poultry and fish are fine.
For meat and poultry use lean meats without added salt.
There are a number of low salt meat marinades that can be used, as well as no salt meat rubs. Using some olive oil along with a low salt meat rub can result in very tasty and well seasoned meats
Frozen meat is fine unless the meat has been salted or seasoned with salt.
As far as what foods to avoid in this class,
Salted, smoked, cured, or canned meats are usually high in salt.
Smoked turkey, ham, salmon, and other smoked fish tend to be quite high in salt.
There are some notable exceptions including some canned meats.
There are several major brands of canned tuna and salmon labeled as very low salt which are packed in water and are quite good in regards to salt content.
Luncheon meats unfortunately tend to be very high in salt content.
The whole aisle of luncheon meats in the grocery store consists primarily meats high in sodium.
At the deli counter, there may be some lower salt selections of luncheon meat. Ask to see information about the sodium content of these meats at your deli counter to see what is available.
Meats typically high in salt include: bologna, bacon, …
Frozen precooked meals tend to be high in salt. You can check labels for exceptions.
Precooked meats tend to be high in salt.
The chickens precooked in most grocery stores tend to be very high in salt.
A solitary chicken breast at
And when you talk of the complete McDonald’s Big Mac or Burger King Whopper including bun and seasonings, you will receive over 1000mg of sodium.
What about shellfish?
Shellfish tends to be higher in salt than fresh fish. Choices of some shellfish such as 3 ounces of unsalted shrimp or oysters in modest quantities are acceptable, but much of the precooked shellfish including boiled shrimp frequently has already been heavily salted.
AS for artificial crab and scallops, these are routinely heavily salted as well.
Most cheeses tend to be salty. There are some low salt cheeses and Swiss cheese in general, though not always tends to be lower in salt. By looking at the grocery store, it is often possible to find slices of Swiss cheese with only 50mg of salt.
Breads
Look for a whole grain bread with 125mg Na or less per slice. You will look for a good while at the grocery store but will probably be able to find one. Whole grain is not lower in salt but is healthier than simple white breads.
Most breads are much higher in salt.
Quantity is important.
Four slices of bread even with 125mg/ slice will add up to 500mg.
Avoid salted crackers and choose unsalted crackers. Avoid salted chips and get chips made without salt.
For cereals and starches, uncooked noodles and rice which are close to zero in salt.
You control how much salt is added at time of cooking. Plain potatoes are fine as well, you just have to be careful what you put on them..
Instant seasoned rice and noodles are quite high in salt.
As far as cereals, some brands of shredded wheat are quite low in sodium.
Regular oatmeal and lightly cooked oatmeal are acceptable in regards to salt.
Instant oatmeal is higher in salt.
As far as fresh fruits and vegetables:
All fresh fruits and vegetables are fine in regards to salt content.
All frozen vegetables are fine as well unless they have been salted.
You may have heard that some vegetables such as celery are high in salt.
But single a medium stick of celery has only 6 calories and 35 mg of sodium.
Now, of course if you eat 16 pieces of celery that is a high intake of salt, but that is not a typical portion.
If you eat a varied diet of fresh fruits and vegetables without added salt, you will not be getting excessive sodium from this source.
In fact a high intake of fresh fruits and vegetables is associated with lower blood pressure, fewer heart attacks, and a reduction in your risk of cancer.
Salads can be low in salt or very high in salt.
The salad leaves and vegetables in a salad are low in salt.
But the salads people eat out while trying to be healthy frequently have a 1000mg of sodium which is half a day’s sodium.
Just 2 tablespoons of salad dressing frequently has over 500mg of sodium.
However, fortunately there is a wonderful no salt alternative.
Olive oil and vinegar, including balsamic vinegar can be mixed together and give a great tasting no salt salad dressing. The vinegar has a salty taste to it, but has no sodium in it.
When eating out makes for a great low salt choice.
Ask for a salad with lots of vegetables. Ask them to cut the croutons and luncheon meat from the salad. Tell them to put the cheese from the salad in a side bowl and then you can perhaps put just a bit of that on the top of the salad as a condiment.
Ask for olive oil and vinegar in separate bottles and then mix to taste. If they bring a premixed balsamic vinegar dressing this isn’t OK because this will have 500mg sodium for just a small amount. Get the separate bottles of oil and vinegar.
Looking at high salt foods, canned vegetables and bean are usually quite high in salt. Vegetables served while eating out are frequently high in sodium, though not always.
Pickled vegetables, sauerkraut, tomato juice and V8 juice are high in sodium.
Most salad dressings are very high in salt with 500mg of sodium for just 2 tablespoons.
There are some exceptions if you look for them long enough at the store.
Remember that olive oil and vinegar is an excellent tasting healthy alternative.
In regards to fats, oils and fats do not inherently have salt in them.
Healthy choices for oil include olive oil, canola oil, and unsalted nuts.
Fatty foods typically high in salt include bacon fat, salt pork and gravies are. That includes gravies made with bouillon or prepackaged mixes.
Fried foods are often heavily salted in addition to the frying.
Soups are a bit of a disappointing topic because most canned soups and soups made in restaurants are very high in salt.
A bowl of soup can give nearly half the day’s sodium.
Check the labels on what are called lower salt soups because even these are often quite high per serving.
A good alternative is to use the relatively low salt beef and chicken broths that are available as a starter and then create your own soup by adding whatever you would like in the soup.
As far as seasonings, avoid salt and sea salt. Sea salt and designer salts are no different from regular salt and have the same sodium content as regular salt. Avoid “Lite” salt, onion salt, garlic salt, lemon pepper, BBQ sauce, soy sauce, including low salt soy sauce which is quite high in sodium. Avoid mustard, ketchup, meat tenderizers, olives pickles, salted nuts.
There are some lower salt versions of some of these, check the labels and quantity of a serving size if you are trying to find something to use on a regular basis.
What seasonings can be used
without restriction?
Black pepper.
Almost any plain herb:
Basil, oregano, cilantro, rosemary, thyme.
Mrs. DASH is a brand no salt
herbal seasonings and marinades, multiple flavors. Get a couple of flavors to
try.
Dried chili peppers are fine
if you like hot foods.
Cosalt is potassium salt.
Potassium salts can lower BP. Lite salt if half potassium salt.
Use these only with the
specific OK of the physician treating your hypertension.
Kidney status should be know
before starting these K salts which takes only a simple blood test your doctor
has probably already done.
Also, certain blood pressure
medications raise K and can be dangerous using these for some, but not all
patients.
What about water softeners?
Water softeners add sodium to the water.
On the average, only 13 mg
of Na added to the water per glass
However, areas that have
very hard water add much more sodium with water softeners,
Check locally if you have
very hard water. There is also a web link provided for more information.
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Eating out- and following a low sodium diet
Fast Food
Restaurant:
Sodium
McDonalds Big Mac- 1040mg
Burger King Whopper 1020mg
Kentucky Fried Chicken Breast 900mg
Taco
One teaspoon of salt
2325mg
Following a low salt diet while eating out is quite difficult. It is relatively easy to avoid unhealthy fats eating out, but avoiding high salt foods remains difficult.
Suggestions:
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There are some web links listed providing other sources
of information for a low sodium diet.
This includes:
- 26 page download from the USDA listing sodium content of foods
- 64 page download from the NIH about DASH dietary recommendation
- eating out tips from the Mayo Clinic’s website
- salt content of selected items at fast food restaurant
- links to several books that give information on sodium content in foods as well as items in fast food restaurants.
There are many good books detailing the sodium content of foods.
Links are provided to 2 books that I like that include some information on the salt content of specific fast food restaurants.
There are likely to be many similar books at your local bookstore.
Web Resources for low sodium diet and DASH diet
1. USDA list of foods & salt content (26 pages):
http://www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/sr17a307.pdf
2. DASH diet information (64 pages) excellent-from NIH (National Institutes of Health):
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
3. Eating out and following a low sodium diet; Good information on a difficult topic:
http://www.mayoclinic.com/health/dash-diet/HI00021
4. The Complete Food Counter by Annette Natow and Jo-Ann Heslin. $7.50 plus shipping. This paperback is very complete in its information on salt content of specific fast foods as well food from the grocery store. Also gives information on calories, fat, carbs, and fiber.
5. Pocket Guide to Low Sodium Foods by Bobbie Mostyn. $8.95 plus shipping.
(Includes some info on fast food chains.) Less complete than the first book listed, but smaller and perhaps a little easier to use.
(There are no commercial links between this site and these books, nor does money go to this site as a result of using these links. There are many good similar books to the one listed on this page which you may find at your local bookstore.)
6. Water softeners and sodium:
http://www.mayoclinic.com/health/sodium/AN00317
7. How to follow Low-Sodium Diet by Heart Failure Society of America:
http://www.hfsa.org/pdf/module2.pdf
8. Sodium content of selected items at fast food restaurants: http://www.fatcalories.com/
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Summary
In summary, a low sodium diet lowers blood pressure and makes your body more responsive to blood pressure medications when these are needed.
A low sodium diet in combination with the DASH dietary guidelines is equal to a single mild blood pressure medication and that is quite valuable.
If you haven't yet looked at the DASH dietary guidelines video on this web site, I would consider doing so. And it is a considerably shorter video than the sodium restriction video.
In addition, if you have the option of seeing a dietician, for further information, this is highly recommended.
Finally, I wish you the best of luck in all your efforts for good health.