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Hold the salt ... please!


Busy and hectic schedules have prompted Canadians to seek out quick and convenient meal options. As a result, most Canadians consume more sodium than may be good for their health. Sodium is needed to control blood volume and maintain water and mineral balances. Research has shown that excessive salt intake can lead to hypertension, which increases the risk of heart disease, stroke and kidney disease (Canadian Stroke Network, 2008).

Recommendations for the general population ages four and older are 1,200 mg of sodium daily with a Tolerable Upper Intake Level (UL) of 2,300 mg/day (Lawes, 2006). Sodium guidelines for chronic kidney disease (CKD) and dialysis patients are similar to the general population, with the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI[TM]) and the Canadian Hypertension Education Program (CHEP) recommending 2,300 mg/day while the American Dietetic Association (ADA) best practice guidelines suggest 2,000mg/day to 3,000 mg/day (Vennegoor, 2009). Current sodium consumption in industrialized countries averages between 3,100 milligrams/day and 3,500 milligrams/day, with processed foods contributing 75% of total intake (Garriguet, 2007; Mattes & Donnelly, 1991). Unfortunately, a diet high in sodium affects Canadians of all ages, which may lead one to believe sodium is deeply embedded in the Canadian diet. According to the 2004 Canadian Community Health Survey (CCHS 2.2), approximately 90% of men and 66% of women over the age of 19 had intakes above the UL for sodium (Health Canada, 2009). Also, 97% of adolescent boys and ~80% of adolescent girls exceed the UL of sodium (Health Canada, 2009).

The World Health Organization (WHO) estimates hypertension as the leading risk factor for death in the world. A number of organizations (Canadian Hypertension Society, Canadian Cardiovascular Society, Canadian Stroke Network, Canadian Council of Cardiovascular Nurses, Canadian Society of Nephrology, Dietitians of Canada, Heart and Stroke Foundation of Canada, Blood Pressure Canada) have formed a Coalition on Sodium to develop strategies to reduce the sodium intake of Canadians. Health Canada has also formed a working group to develop strategies to lower the sodium content in Canadian diets. Stakeholders represented in the working group include the scientific and health professional community, health-focused and consumer non-governmental organizations, food manufacturing, and food service industries, as well as government agencies.

The U.S. National Institute of Health developed the DASH diet, which recommends a sodium intake of 2,300 mg/day to help lower blood pressure (Vennegoor, 2009). It's important to note that the DASH diet was developed for the general population. This diet provides more than just a low-sodium plan to help lower blood pressure--it is based on a meal plan rich in high-potassium fruits, vegetables, whole grains and low-fat dairy. As such, this diet is not suitable for clients with CKD or those on dialysis. Although adhering to a low-sodium diet can be challenging, it can be incorporated into a balanced diet with some guidance and planning.

Practical ways to limit sodium intake

* Choose unprocessed, fresh foods that are naturally low in sodium

* Use spices and herbs to enhance the flavour of food

* Use less salt in cooking and avoid salt substitutes such as Nu-Salt[TM], Half Salt[TM], No Salt[TM]

* Limit processed foods, deli meats, cheese, canned soups

* Limit baking powder and self-raising flour, as they are sources of sodium

* Cut the salty snacks such as potato chips, pretzels, nachos, popcorn, nuts and crackers

* Choose unsalted popcorn, crackers and plain cookies

* When dining out, limit sauces, gravies, soups, salad dressing and condiments

* Some restaurants have nutritional information on their websites--check the menu and plan your meal ahead of time

Reading labels:Sodium food claims explained

* Sodium-free, no sodium or zero salt means less than 5 mg of sodium per serving

* Low sodium or low salt means 140 mg or less per serving

* Reduced sodium, lower sodium or lower in salt means 25% less sodium than the original product and may still be high in sodium

* No added sodium, unsalted or no salt added means that no salt was added during processing, but items may still contain sodium

* Lightly salted means product contains at least 50% less sodium than comparable products and may still be high in sodium

* When choosing packaged foods, look for items that are sodium-free (<5 mg per serving) and low in sodium (140 mg per serving).

* Avoid products with more than 400 mg of sodium per serving.


Canadian Stroke Network. (2008, June). News release: Dietary sodium contributes to 17,000 cases a year of stroke and heart disease in Canada, study says. Retrieved April 14, 2009, from

Garriguet, D. (2007, May). Sodium consumption at all ages. Health Reports/Statistics Canada, 18, 47-52.

Health Canada. (2009). It's your health: Healthy living--Sodium. Retrieved April 14, 2009, from

Lawes, C.M.M., Vander Hoorn, S., Law, M.R., Elliott, P., MacMahon, S., & Rodgers, A. (2006). Blood pressure and the global burden of disease 2000. Part II: Estimates of attributable burden. Journal of Hypertension, 24, 423-430.

Mattes, R.D., & Donnelly, D. (1991). Relative contributions of dietary sodium sources. Journal of the American College of Nutrition, 10(4), 383-393.

Vennegoor, M.A. (2009). Salt restriction and practical aspects to improve compliance. Journal of Renal Nutrition, 19(1), 63-68.

By Dorothy Allen, RD, Gulnar Damji, RD, and Diane Zianis, RD, Dietitians for the Nephrology Program, Sunnybrook Health Sciences Centre,Toronto, ON
COPYRIGHT 2009 Canadian Association of Nephrology Nurses & Technologists
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Author:Allen, Dorothy; Damji, Gulnar; Zianis, Diane
Publication:CANNT Journal
Date:Apr 1, 2009
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