Winnipeg Free Press - PRINT EDITION
A salt shocker
A pinch here, a pinch there? No, it's everywhere and creates a dietary minefield for those with hypertension
My doctor measured my blood pressure, then repeated the procedure. The readings were not great.
While in the past my blood pressure readings had been on the "high side of normal," they were now inching beyond that. I was joining millions of Canadians who have hypertension, putting me at greater risk of heart problems.
Without inquiring about my drinking, eating or exercise habits, the young physician, whom I had seen only once before, scrawled three directives onto a sheet of paper: Exercise 30 minutes per day four to five days a week, limit alcohol intake to 13 beverages a week (and no more than two per day), and consume less than 1,300 milligrams of sodium per day.
That last dictate, I assumed at the time, would be easy to follow. In our household the salt shaker doesn't appear at the dinner table. We don't use a lot of salt in food preparation. We even buy unsalted butter.
When I mentioned that to my recently graduated MD, he said: "It's in everything."
As I was to find out, he wasn't exaggerating.
I began to scan labels for a food's sodium content -- not just its calorie levels. It was an eye-opener.
Consuming less than 1,300 mg of sodium per day meant I had to be much more careful about my food choices. And it wasn't simply a matter of making my own lunch and avoiding fast-food joints. I was already -- generally -- doing that.
Canadians, on average, consume about 3,400 mg of sodium per day. But the average adult requires only 1,500 mg or less, and the Canadian and American governments advise that we consume no more than 2,300 mg per day.
It's incredibly easy to exceed that.
At breakfast, most cereals and the milk you splash on them contain a significant amount of salt. At lunch, the two slices of bread that form the basis of your sandwich may contain 400 mg of sodium or more, and what you place between those slices can send sodium levels soaring. If you have soup with that, look out! Soups are often laden with salt.
So by the time dinner arrives -- even if you haven't consumed any salty snacks — you're already well on your way to exceeding your safe daily quota of sodium.
How easy is it to consume too much? Consider this: a ham and cheese sandwich with a small dill pickle and a cup of skim milk can furnish you close to 1,600 mg of sodium. (Assumes 400 mg for the bread, 530 mg for two slices (55 g) of a name brand black forest style ham, 320 mg for one slice of processed cheese, 200 mg for the pickle and 125 mg from the milk. It does not count the sodium contained in any butter, mustard or mayonnaise you may add.)
When the weather warms up, you might want to take in some sun at lunch and indulge in a smokie at a hot dog stand. A bratwurst (135 g) can contain more than 1,000 mg of sodium alone. With a small bun, the total is 1,350 mg. Add a tablespoon of mustard, you're at 1,450. How about a can of Coke Zero with that? The cola may not contain any sugar or calories, but it's got 40 mg of sodium. Your grand total for lunch: 1,490 mg.
According to experts, a relatively small portion of the sodium we consume (11 per cent in the average Canadian diet) comes from the salt we cook with or shake onto our food. More than 75 per cent of it comes from processed foods such as pasta sauces, soups, deli meats and restaurant meals. The remainder occurs naturally in food.
It's estimated about 7.5 million Canadians have hypertension (a blood pressure reading of 140 on 90 and above). And about 30 per cent of these cases are related to consuming too much salt. Hypertension is also the most common reason that Canadians see a doctor, accounting for 21.1 million visits to community physicians in 2007. High blood pressure significantly increases the risk for stroke, heart disease and heart failure.
Dr. Norm Campbell, a professor of medicine at the University of Calgary, has long called for reduced sodium levels in processed foods, something he believes Ottawa should take the lead in regulating.
"When humans evolved we were probably eating around a few hundred milligrams of sodium (daily)," Campbell said. "And then as we industrialized food production the sodium in the diet went up."
Now, he said, the sodium content of many processed foods is at "extreme levels."
It's estimated that 30 per cent of Canada's problems with hypertension would go away if daily intake was reduced cut in half -- 1,700 mg vs. the current 3,400. "If we brought it down to 1,200 milligrams there would be much additional benefit," Campbell said in an interview.
Campbell was part of a federal Sodium Working Group a few years ago that set an interim intake goal of 2,300 mg per day for Canadians by 2016. The expert group, which included members of the food industry and academics, set an ultimate goal of seeing 95 per cent of the Canadian population below 2,300 mg.
The group's report recommended voluntary sodium reduction targets for food manufacturers backed up by stricter labelling that would make it easier for consumers to tell if a product contained excessive amounts of salt.
It also called for more public education and suggested governments restrict advertising of high-sodium products targeted at kids.
Canada's provinces and territorial governments have given the Sodium Working Group report their blessing, but Ottawa has refused to implement it, citing economic concerns.
Federal NDP Health Critic Libby Davies has introduced a private member's bill (C-460) in the House of Commons that would implement much of the Sodium Working Group's recommendations. It is to be debated in the next few weeks and should come to a vote in April.
Davies (Vancouver East) isn't impressed with Ottawa's concern that now is not the time -- when the economy is fragile -- to make progress on an important health issue.
"If not now, then when?" she said. "What is the cost of people's health?"
Davies said that with high amounts of sodium and sugar in processed foods, "we're condemning a whole new generation of kids to really poor health outcomes."
Dietitians say one of the best ways to reduce sodium consumption, apart from avoiding processed foods as much as possible, is to read food labels carefully. I've been doing that obsessively for weeks. And what I've found is they leave a lot to be desired.
For starters, the serving size used by many food manufacturers is often unrealistically small, giving the casual label reader a false sense of security on sodium and caloric intake. Kraft Dinner, for instance, is listed as containing 330 mg of sodium per one-quarter box (56 g), when a teenager can probably demolish the whole thing.
Many breakfast cereals list ingredients per three-quarter cup. A quick scan of a box of, say, General Mills' Cinnamon Toast Crunch (whole grain) will reveal a sodium content of 220 mg per serving. That doesn't look all that high until you measure it. Pour three-quarters of a cup into your cereal bowl. It's not a whole lot. You probably normally pour much more. With milk, it's not a stretch that many people would consume about a third of their recommended daily sodium (500 mg) at breakfast this way.
Ironically, some products touted as containing heart-healthy ingredients such as Omega 3 polyunsaturates or oat bran often contain more salt than similar foods -- even those made by the same manufacturer. For instance, Kashi produces at least two cereals that contain no sodium. But its Blueberry Oat Clusters and Flakes -- the one with the heart logo on the box that says oat fibre helps lower cholesterol, a risk for heart disease -- contains 140 mg of sodium per cup (58 g).
In the five weeks since my doctor's prescription on salt, I believe I've exceeded his sodium guideline only once or twice. For breakfast, I will eat Shredded Wheat, oatmeal or steel cut oats -- all of which contain no sodium -- and a piece of fruit. I have a sandwich for lunch, but watch what I put inside it. Salt-free peanut butter -- happily I like this -- is often my choice.
We've had to make some changes at dinner. An Asian dish we make regularly calls for three tablespoons of soy sauce and a half-cup of chicken broth. Soy sauce, at 920 mg of sodium per tablespoon in the brand we use, is really liquid salt. We switched to a 'less-sodium' soy sauce (580 mg). Campbell's chicken broth contains 570 mg of sodium per two-thirds cup, but the same brand's low-sodium version has only 40 mg per two-thirds cup. In a dish that already contains several strong flavourings the reduced salt is hardly noticeable.
A vegetarian chili we eat calls for canned tomatoes and canned black beans, both laden with sodium. But by draining and rinsing the black beans, I'm told by a dietitian, you can cut the sodium content by half. And by purchasing 'no salt added' canned tomatoes, you can slash the sodium content from 290 mg per half cup to 20 mg per half cup. Again, other spices in this dish easily cover for the lower salt content.
It's easier to manage sodium in simple homemade foods, such as grilled meats. Condiments contain a fair bit of salt, though, and I've cut back on them. A low-sodium diet forces you to eat plainer foods and fill up more on fruit and vegetables rather than salty alternatives.
Eating in restaurants poses a bit of a challenge. And if I know I will eat out at night, I am very careful with what I consume earlier in the day. And I select menu items carefully and order salad dressings on the side.
Coralee Hill, a registered dietitian with the Winnipeg Regional Health Authority, said folks who are on a low-sodium diet should still try to eat a well-balanced diet in line with the dictates of the Canada Food Guide. She admits, though, that it can be a challenge.
"If you're trying to eat 1,500 milligrams of sodium a day (or less), I'm going to say it's going to be a little bit difficult," she said.
But in addition to eating your required fruit and vegetables, there are lots of things you can do to keep sodium levels down, Hill said. Look for low-sodium or salt-free versions of foods, including nuts. Instead of getting all your recommended whole grains from breads, consider whole grain rice and sodium-free cereals.
Hill preaches moderation and eating a wide variety of foods, not eliminating whole food groups, such as dairy, because they may contain some sodium. "You need to nourish your body first and foremost and not develop deficiencies -- or have too low a sodium intake."
Age Adequate daily sodium intake Upper daily sodium limit
1-3 years* 1,000 mg 1,500 mg
4-8 years 1,200 mg 1,900 mg
9-13 years 1,500 mg 2,200 mg
14-50 years 1,500 mg2,300 mg
51-70 years 1,300 mg2,300 mg
Over 70 years 1,200 mg2,300 mg
*Salt should not be added to food for children under the age of one year.
Source: Government of Canada, Healthy Canadians website
Fact: 1 teaspoon of salt contains 2,300 milligrams of sodium
Fact: Canadians eat on average about 3,400 mg of sodium per day -- more than double the amount they need.
Fact: All types of salt are high in sodium. Contrary to what some believe, kosher salt, sea salt, fleur de sel, gourmet salt and smoked salt all have the same amount of sodium as regular table salt.
Sodium content of selected foods
Nature's Path organic blueberry cinnamon flax cereal, 230 mg per three-quarter cup
No Name granola, 5 mg per one-third cup
Post Shredded Wheat (original), zero sodium
Kellogg's Two Scoops raisin bran, 280 mg per cup
Post Shreddies, 150 mg per three-quarter cup (45 g)
General Mills Cheerios (has heart logo), 190 mg per cup (27 g)
Kashi organic cinnamon harvest, no sodium
Quaker Oats oatmeal, no sodium
Safeway Organics flax bread with Omega 3 polyunsaturates, 450 mg per two slices (85 g)
Eating Right low fat, less sodium whole wheat bread, 360 mg per two slices (85 g)
Eating Right 100 per cent whole grain, eight grain bread, 320 mg per two slices (85 g)
Wonder soft white loaf with fibre, 220 mg per two slices (63 g)
City Bread rye bread, 135 mg per 28 g slice
Safeway fruit and fibre muffin, 240 mg per muffin (76 g)
Nature's Blend premium bagels, whole-grain, 430 mg per bagel (113 g)
Greek Style pita bread, 380 per 100 g pita
Bakery Counter white hot dog buns, 340 mg per 48 g bun
Bothwell old cheddar cheese, 190 mg per 2.5 cm cube (30 g)
The Deli Counter feta cheese, 290 per two tablespoons (30 g)
Kraft singles, 320 mg per single
Beatrice milk 2%, 120 mg per cup
Beatrice skim milk, 125 mg per cup
Orville Redenbacher's Gourment Popping Corn, 310 mg per seven cups (popped)
Old Dutch Rip L chips, 230 per 25 chips
Rold Gold pretzels, 860 mg per 16 pretzels
President's Choice mild salsa, 75 mg per two tablespoons
Lindt Madagascar 70 per cent dark chocolate, 15 mg per three squares (30 grams)
McDonald's Big Mac, 1,020 mg per burger
Burger King Texas Triple Whopper, 1,990 mg per
Kraft rancher's choice salad dressing, 120 mg per tablespoon
President's Choice creamy cucumber dressing, 190 mg per tablespoon
President's Choice balsamic vinegar, 5 mg per tablespoon
Unico balsamic vinegar, zero salt
Bertoli extra virgin olive oil, zero salt
Kraft Miracle Whip, 120 mg per tablespoon
Hellmann's mayo, 95 mg per tablespoon
Hellmann's half the fat mayo, 135 mg per tablespoon
Heinz ketchup, 140 mg per tablespoon
HP sauce, 160 mg per tablespoon
Maille Dijon mustard, 115 mg per tablespoon
Bull's Eye sweet and sticky BBQ sauce, 300 mg per two tablespoons
Ocean Spray diet cranberry beverage, 60 mg per cup
No Name grapefruit juice, 30 mg per cup
Coke Zero, 40 mg per 355 ml can
Lipton Brisk lemon iced tea, 60 mg per 250 ml
Mott's Clamato cocktail original, 620 per cup (250 ml)
President's Choice tomato clam cocktail, 800 mg per cup
Campbell's original V8, 480 per cup
Campbell's low sodium V8, 135 mg per cup
Heinz tomato juice, 480 mg per cup
The Deli Counter smoked black forest style ham, 530 mg per two slices (55 g)
Primo Taglio summer salami, 950 mg per 12 slices (60 g)
Safeway Select original bacon, 230 mg per two slices (40 g)
Safeway Select sodium reduced bacon, 160 per two slices (40 g)
Harvest sliced back bacon, 650 mg per two slices (55 g)
Johnsonville Brats, original bratwurst, 1,070 mg per 135 g sausage
Maple Leaf Top Dogs weiners (original), 480 per 56 g wiener
Frozen convenience foods
The Gourmet Meat Shoppe frozen cheddar cheese beef burger, 700 mg per 142 g burger
Michelina's spaghetti Bolognese, 820 mg per 255 g dinner
Hungry Man Backyard Barbecue, 2,040 mg per 455 g package
Stouffer's veal parmigiana, 800 mg per 322 g tray
President's Choice Red Curry Chicken, 950 mg per 350 g tray
Lean Cuisine meat lasagna, 540 per 274 g tray
Blue Menu herbal chicken, 570 mg per 290 g tray
VH Steamers chicken teriyaki, 810 mg per 283 g container
McCain rising crust pepperoni pizza, 750 mg, per one-sixth pizza (138 g)
Delissio rising crust deluxe pizza, 970 mg per one-sixth pizza (155 g)
Blue Menu roasted chicken and red pepper pizza (50% less fat), 400 mg per one-quarter pizza (103 g)
Heinz Deep Fried beans, 390 mg per half cup
Cloverlead yellow fin chunk light tuna in broth and oil, 150 mg, per 60 grams (drained); can is 170 g
Green Giant peaches and cream canned corn, 240 mg per half cup
Aylmer whole tomatoes, 290 mg per half cup
Aylmer whole tomatoes 'no salt added,' 20 mg per half cup
Classico tomato and pesto pasta sauce, 430 mg per half cup
Campbell's Healthy Request vegetable beef with barley soup, 480 mg per cup
Campbell's chunky chicken vegetable, 630 per cup (250 ml); a can is 540 ml
Bick's garlic dill pickles 'zero fat,' 'low calorie,' 480 per 60 g pickle.
Kraft Dinner, 330 mg per one-quarter box (56 g)
Aunt Jemima original pancake mix, 450 mg per one-third cup
Tim Horton's hot chocolate mix, 160 per two tablespoons (directions call for two 'heaping' tablespoons
Nature Valley crunch fruit apple crisp granola bar, 140 per two bars (42 g)
Club House 'fat free' packaged poutine gravy, 700 mg per one-fifth package
Kraft Shake 'n Bake, BBQ chicken flavouring, 530 mg per one-sixth pouch
Republished from the Winnipeg Free Press print edition March 9, 2013 J4