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Dietary Sodium and Blood Pressure Control

Dietary Sodium and Blood Pressure Control. Presented by Kim Felker, RD April 21, 2010. Outline. Mortality and Expense of Hypertension 2010 Canadian Hypertension Education Guidelines (CHEP) Statistics on Canadians and Self-management of Hypertension Sodium: Where do we get it?

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Dietary Sodium and Blood Pressure Control

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  1. Dietary Sodium and Blood Pressure Control Presented by Kim Felker, RD April 21, 2010

  2. Outline • Mortality and Expense of Hypertension • 2010 Canadian Hypertension Education Guidelines (CHEP) • Statistics on Canadians and Self-management of Hypertension • Sodium: • Where do we get it? • What does it do? • How is it a health risk? • Sodium and Hypertension Relationship • Recommended Daily Sodium Intake • How to Reduce Your Sodium Intake • Label Reading and Nutrient Claims • Salt Replacers

  3. Deaths attributed to 19 leading factors, by country income level, 2004

  4. Hypertension is prevalent and costly 25 * 20 15 Routine medical exams Depression Acute respiratory tract infection Millionvisits/year Diabetes Hypertension 10 5 0 Reasons for visits to physicians in Canada * Antihypertensivesare one of the most expensive drug categories Source: IMS HEALTH Canada 2002. http://www.imshealthcanada.com/

  5. The Expense of Treating HTN • In 2005, 5.7 million adults diagnosed with HTN • Over 5 million were treated with anti-hypertensive drugs • Since 2005 that number has doubled! • Estimation: lowering sodium intake could decrease HTN by 30% in Canada = $1.7 Billion/yr savings • Can J Cardio 2007; 23(6):437-43

  6. The Canadian Hypertension Education Program (CHEP) recommends that people with hypertension: • Lower BP below 140/90 mmHg; diabetics or chronic kidney disease below 130/80 mmHg. • Regular BP monitoring by a health professional. • Self BP monitoring at home using a monitor endorsed by CHEP. • Reduce dietary sodium (salt).

  7. Continued • Consume a diet rich in fruits, and vegetables; choose lower fat dairy foods and lean meats. • Physical activity of 30 – 60 minutes duration at moderate intensity 4-7 days a week. • Maintain a healthy body weight. • Limit alcohol consumption. • Quit smoking.

  8. Statistics • 1 in 5 Canadians over the age of 20 years are aware of having hypertension. • 1 in 4 Canadians reported that their HTN was not well controlled. • 71% were overweight or obese. • 58% ate less than 5 servings of fruits and vegetables everyday. • 58% were physically inactive. • 17% smoked daily. • 1 in 20 had no family physician. 2009 Survey on Living with chronic disease in Canada

  9. Where do we get sodium? Salt • Table salt, sea salt, seasoning salts • Sodium additives – ie: MSG • Processed foods

  10. Sources Of Sodium 2008 blood Pressure Canada.

  11. What does sodium do? In food: • Prevents food from spoiling • Performs many different functions in processed foods • Adds flavor

  12. What does sodium do? (con’t) In the body: • Helps to 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.

  13. IN CANADA “What’s Sodium Got to do with it?” • Dietary sodium can cause up to 17,000 cases of stroke or heart disease per year • One third can eliminate HTN by eating 1200-1500 mg/day of sodium • Limiting sodium can decrease: • Stroke 13% • Congestive heart failure 17% • Heart attack 5% WORLDWIDE • Decreasing sodium by 2g/day can prevent 1.25 million deaths from strokes & 3 million deaths from CVD Penz, M.R et al. Can J Cardiol. 2008 June; 24(6): 497–501 Strazzullo, P. et al. BMJ. 2009; 339:b4567

  14. Sodium: Meta-analyses Hypertensives Reduction of BP 5.1 / 2.7 mmHg with a average reduction of 1800 mg sodium/day 7.2/3.8 mmHg with a average reduction of 2300 mg sodium/day Normotensives Reduction of BP 2.0 / 1.0 mmHg with a average reduction of sodium 1700 mg/day 3.6/1.7 mmHg with a average reduction of 2300 mg/day sodium The Cochrane Library 2006;3:1-41

  15. Meta analysis on different reductions in dietary sodium intake on blood pressure Hypertension 2003;42:1093-1099

  16. DASH: Dietary Approaches to Stop HTN • Emphasize whole grains, vegetables, low fat dairy • Can delay/prevent need for meds • If followed by general pop. can reduce incidence of CHD by 15% and stroke by 27% • If restrict Na & follow DASH will decrease HTN even more • Comparable results when compared to a standard low Na diet • But DASH is more palatable & less restrictive resulting in greater compliance Manual of Clinical Dietetics,6th ed. P.296 Fleet. (2001). Nutr Reviews. 59(9);291-7

  17. Effects of sodium reduction on BP over time DASH Data: Obarzanek, E et al. Hypertension 2003; 42:459-467

  18. DASH: Dietary Approaches to Stop HTN Approx. 2000 kcal/day • 7-8 grain products • 4-5 vegetables • 4-5 fruits • 2-3 low-fat or non-dairy foods • <2 meats, poultry, fish • 4-5x/week nuts, seeds, and legumes • 2-3 servings of additional fat • <1/day or <5/week additional sweets

  19. Sample Menu 2086 calories, 1786 mg sodium www.mayoclinic.com/health/dash-diet/HI00046

  20. What is the recommended daily sodium intake? Canada and USA: 1300- 1500 mg/day (age dependant) is estimated to be adequate (Adequate Intake AI) For health: • Current Upper Limit (UL) – 2300 mg/d • Equals 1 tsp of table salt Hypertensive/prevention: • <1500 mg/d (aged 50 years or less) • Equals 2/3’s tsp of table salt

  21. How to reduce your dietary sodium intake

  22. Label Reading • Conveinence Foods • Canned, pre-packaged, frozen dinners • Watch out for words • Pickled, Cured, Smoked, MSG, Processed • Watch out for ingredients • Gravies, soya sauce, ketchup, mustard, relish, olives, anchovies, brine, baking powder, baking soda • Aim for ≤5%DV sodium, try to avoid if >20% • BUT %DV based on 2400mg/day when we should aim for 1500 mg/day • Pay attention to serving size

  23. How many mg of Sodium? Helpful Guideline Label Reading (con’t) • 2 ½ pickles • 1550 mg • 1 slice pizza • 1770 mg • 10 pretzels • 966 mg • Spaghetti with sauce • 1030 mg • Classic breakfast • 1141 mg • Canned vegetable soup • 921 mg

  24. Label Reading (con’t) • The average 250 ml of canned soup has 700 mg sodium • Do you stick to a 250 ml portion? • President’s Choice Blue Menu & Campbell’s Healthy Request are aiming at 480 mg/serving • How? • Sea salt (31% sodium versus 39% in regular salt ) • Potassium Chloride • Refrigerated soups don’t need as much sodium • 100-150 mg/portion • Heart & Stroke Foundation gives a health check to soups with ≤ 650 mg per serving • Plans to lower cut off to 480 mg www.sodium101.ca Nutrition Action Healthletter Jan/Feb 2010

  25. Match the Claim to the Sodium Content • sodium/salt free • low sodium/salt • Reduced/less sodium • lower in salt/sodium • No added sodium/salt, unsalted • Lightly salted 25% less than comparable product • ≤140 mg/serving • 25% less than original • < 5mg sodium per serving No salt added during processing • 50% less added than comparable item

  26. Sneaky Sodium Sources Acceptable Replacements Herbs Spices Mrs.Dash Lemon juice Onion Pureed Fruit • Half Salt® • 50% less sodium • Laxatives • Docusate sodium, sodium phosphate • Antacids • Sodium bicarbonate, alka-seltzer • Any other examples?

  27. Conclusions and Afterthoughts…

  28. Potential Benefits of a Wide Spread Reduction in Dietary Sodium in Canada REDUCTION IN AVERAGE DIETARY SODIUM FROM ABOUT 3500 MG TO 1700 MG • 1 million fewer hypertensives • 5 million fewer physicians visits a year for hypertension • Health care cost savings of $430 to 540 million per year related to fewer office visits, drugs and laboratory costs for hypertension • Prevention of 11,550 CVD events/year • 13% reduction in CVD with total health care cost savings of over $1.3 billion/year

  29. Sodium a Risk Factor for Obesity? • High dietary sodium increases thirst and fluid consumption • Fluids can contain simple sugars or alcohol • 20-30% of the excess calories consumed by children and adolescents are from increased beverage intake associated with high sodium intake. He et al Salt Intake, Soft Drinks, and Obesity in Children, Hypertension. 2008;51:629-634

  30. Questions?

  31. Resources for patients? • www.htnupdate.ca • www.hypertension.ca/tools • www.sodium101.ca • www.mybpsite.ca

  32. References • Feldman, R.D. et al. (1999). CMAJ (supp 9); 161 (12);s35-s45 • E.D., Penz, M.R., Joffres, & N.R.C., Campbell. Reducing dietary sodium and decreases in cardiovascular disease in Canada. Can J Cardiol. 2008 June; 24(6): 497–501. • Strazzullo, P., D’Elia, L., Kandala, N., Cappuccio, F.P. Salt intake, stroke, and cardiovascular disease: metaanalysis of prospective studies. BMJ. 2009;339:b4567. • www.eatrightontario.ca/en/viewdocument.aspx?id=265 • www.hc-sc.gc.ca/hl-vs/iyh-vsv/food-aliment/sodium-eng.php • www.heartandstroke.on.ca/site/c.pvI3IeNWJwE/b.4119695/k.9ECB/The_DASH_Diet_to_lower_blood_pressure.htm • www.health.gov/dietaryguidelines/dga2005/toolkit/olderadults/oasodium.htm • www.sodium101.ca/en/less/adults.html • www.mayoclinic.com/health/dash-diet/HI00046

  33. References • www.hypertension.ca/chep/recommendations-overview/ • www.mybpsite.ca • www.medscape.com/viewarticle/715584

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