saltrax.com Blog

A research study published in the Annals of Internal Medicine (http://www.annals.org/content/early/2010/02/25/0003-4819-152-8-201004200-00212.full?aimhp) and recently featured in several news articles showed that even small to moderate reductions in sodium intake for the United States population could prevent almost one million heart attacks and strokes over the lifetime of adults aged 45  - 85. The study, which built on the previous research, created a mathematical model to look at the impact of reducing sodium intake.  Even more, the US stands to save almost 32 billion dollars in medical costs just by reducing dietary sodium. The results are very impressive and provide one more piece of evidence that the time has come for policy changes to address the amount of sodium added to processed, packaged and restaurant foods.

As I have stated in my testimony before the FDA panel looking at the regulation of sodium in 2007 and in my testimony before the committee making recommendations for Healthy People 2020, we must address this problem now, before another person becomes chronically ill or even dies because of a simple modifiable lifestyle change. I’m going to restate part of my testimony to the FDA below because I feel so strongly about this issue:

It is imperative that we address this significant public health problem now with a thoughtful, planned, and strategic approach. Food labels regarding salt must describe things in ways that have meaning and can be understood by most consumers. Policies that guide food labeling are a critical strategy to producing these changes. If food labeling and policy do not clearly show that eating salt is a problem with a consequence, then the problem will continue to be invisible and the significant human and financial costs will continue to grow. As a human cost, it is not only the loss of life that is concerning. As we prevent cardiovascular deaths through improved technology, we also need to focus on what is the quality of life that we are saving. If people cannot access the low-sodium foods necessitated by their chronic conditions, then their quality of life will be decreased; these people are essentially isolated from our society and are at risk for becoming clinically depressed.

In order to truly change salt eating behavior and promote optimal health, it is our responsibility as clinicians, researchers, and policy makers to find ways to make salt eating behavior more visible and thus measurable to the person consuming it. Policy makers hold the critical responsibility to produce meaningful guidelines that shape the environment in which the consumer shops, makes food choices, purchases, and consumes the food products containing sodium. These policies will support our efforts to promote and reinforce healthy dietary behaviors.

For the past month I’ve been part of an interesting eating experience shared with another member of the San Diego Child Obesity Initiative  www.ourcommunityourkids.org

When a member of our volunteer work group came to our meeting last month and asked for volunteers to eat only “Natural” foods for 30 days, I readily accepted the challenge . . . then immediately thought to myself, “Well, how do we define natural?” The food manufacturers have obscured the definition of natural to their own ends, so that by now, I and I think most other consumers in the U.S. are totally confused by the term. So, we set out to try to set some criteria and parameters for our new way of eating and we plan to share our findings with our group soon. My eyes, which I thought to be quite sensitive to food labels and added sodium, were opened by what I have learned. Through this new way of eating, I’ve lost almost 3 pounds and an inch from my waist and it’s not even been a full month! I’ll share what I’ve learned very soon in this blog so that others can hopefully use my learnings and share with others what they learn too.

My main thought is that it’s time to take the term “Natural” back from the marketing industry and define it for ourselves and then use this new operational definition to teach others how they too can eat a healthy diet within their daily routine lives without having to change too much about where they shop, how they cook meals (or not), etc. What I’ve learned is that something I thought as too difficult to change on a daily basis is actually quite easy and doesn’t cost any more money or time than previously!

Several people have shown me a recent article published in the New York Times by author John Tierney called, “When it comes to Salt, No Rights or Wrongs. Yet.” Although I strongly feel that discourse and discussion about controversial issues are very necessary, I have my doubts that Salt is as highly a controversial topic as the Salt Institute and its followers who don’t understand the issue like to define it. Over the past 30 or more years, there have been many studies showing the negative effects of a high salt diet.

I’m not going to get into discussing studies in this blog, however ask any doctor or nurse and their experience with seeing patients who suffer from the dietary effects of too much sodium and you will hear countless stories of suffering. Especially when, at the end of their disease states, patients are told to reduce their dietary sodium intake to improve the quality of their remaining lives (good advice too late received) – it is nearly impossible to eat out in a restaurant or buy processed foods without overdoing the sodium. How do we expect these people to live? Do we want them to try to learn to cook if they’ve never cooked when they are busy coping with a chronic disease that causes weakness and fatigue? The time to learn to cook low sodium and eat a lower sodium (even moderate sodium is better than what we have now) is when people are y0ung and healthy. Even better, would be to teach children when they are young how to eat a healthy diet and learn to like the taste of whole foods without just adding salt unthinkingly because using herbs requires thought and creativity.

Someone sent me an excellent article from, Well and Good NYC about the New York City initiative to lower dietary salt. The article can be found at:

http://wellandgoodnyc.com/2010/02/18/licking-salt-how-to-tell-if-your-organic-natural-vegetarian-food-is-too-salty/

The author talks about how even organic, natural, vegetarian foods can be high in sodium. For example Muir Glen Organic Garden Vegetable Soup has 960 mg of sodium per serving – - that is 10 SalTrax points or almost 1/2 of the daily allowed salt content for someone following the limit of 2,300 mg/day. If you are following a 1,500 mg sodium/day diet (for those over 50, those with high blood pressure, and/or African American) then this is nearly 3/4 of your daily allowed salt intake!

Nothing beats reading food labels and being aware of the places where sodium hides in food; and this example above shows that even foods labeled “healthy”, “organic”, “vegetarian” or “natural”, etc. can still have enormous amounts of sodium. In order to lick sodium, we all must be food detectives and be ever vigilant about the places it hides.

Please send me the results of your efforts to find “hidden sodium”. I’d love to share with others where you find sodium hiding in your diet.

February 1st – 7th is World Salt Awareness Week! I applaud this effort, however I feel it is also very important to keep this issue in the forefront of people’s minds every day of the year.

Check out this link for important information about salt from the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention:

http://www.cdc.gov/DHDSP/library/sodium.htm

I’m honored to report that the local organization for which I have volunteered for the past 4 years chose to feature me and my work on dietary salt in the domain partner highlight section of their current newsletter. The San Diego Childhood Obesity Initiative (COI) is a public/private partnership whose mission is to reduce and prevent childhood obesity in San Diego County by creating healthy environments for all children and families through advocacy, education, policy development, and environmental change. To fulfill its mission, the Initiative creates, supports, and mobilizes partners from multiple domains (i.e., sectors); provides leadership and vision; and coordinates county-wide efforts in the prevention and reduction of childhood obesity.

The article is very well written. I am proud to be a member of this exciting and passionate organization. Please check out the link to the article at:

https://app.e2ma.net/app/view:CampaignPublic/id:28469.6593172295/rid:86a02175d75747166b40c6c05cd31f7c

Just published January 20th in the New England Journal of Medicine (NEJM): Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease  http://content.nejm.org/cgi/content/full/NEJMoa0907355v1

Authors: Kirsten Bibbins-Domingo, Ph.D., M.D., Glenn M. Chertow, M.D., M.P.H., Pamela G. Coxson, Ph.D., Andrew Moran, M.D., James M. Lightwood, Ph.D., Mark J. Pletcher, M.D., M.P.H., and Lee Goldman, M.D., M.P.H.

This excellent research should be read by all who are interested in the details of why it is so important for all people to lower their intake of sodium/salt. The research found significant benefits of lowering the amounts of salt we eat. Reducing dietary salt intake was projected to reduce the yearly number of new cases of coronary heart disease by 60,000 to 120,000 and stroke by 32,000 to 66,000. It was also found that there would be 54,000 – 99,000 less heart attacks and we would see a decrease in the yearly number of deaths from any cause by 44,000 to 92,000.

Everyone would benefit from this very basic modest nutritional change. In addition, this type of change in our diets would be more cost-effective than using medications to lower blood pressure for people with hypertension.

This research supports my passion to continue to teach people how to manage their salt intake in concert with policies that reduce the amount of sodium that is currently is being added in excess amounts to our processed and restaurant foods. For example, when a single restaurant dinner has over 4,000 – 5,000 mg of sodium (as many of them do), this is very much in excess of any usual amount of sodium found in foods naturally; and surely cannot be good for our bodies. The toxicity of this added salt over many years is what contributed to the epidemic of heart disease and stroke that we now see in the United States.

Please read this important research article today and think about what you can do today to start reducing the amount of sodium that you eat on a daily basis.

Great News! New York City is taking on the large amounts of additional and unnecessary salt that is hidden in many processed and restaurant foods. In articles in the New York Daily News and the Wall Street Journal this past week, it was reported that a new voluntary phased reduction sodium in processed foods is just beginning. The health department planned to release draft guidelines of suggested maximum amounts of sodium in packaged and processed foods. This is a great first step since if food manufacturers reduce the sodium for one area of the U.S., it will be much easier to do the same on a large scale across the country. The National Salt Reduction Initiative is a positive move for consumers who will gain more control of their diets and increased choices.

While I’ve seen a few posted comments stating that this is effort will lead to more government control of our food intake, nothing could be further from the truth. We consumers have NOT had the choice to control our salt intake since the food manufacturers decided to add large amounts of sodium to most packaged and processed foods years ago, mainly to cover for poor quality food and to make food more shelf stable for longer periods of time. Unfortunately, our nation’s health has suffered as a result of the huge amounts of unnecessary added sodium.

While many people became accustomed to eating foods high in salt and thus losing the more delicate tastes of fresh, well seasoned food; there were many other people who were told by their doctor or nurse that they must lower their intake of sodium for a variety of health reasons. Oftentimes, these people suffered in silence thinking they were the only ones on this “special low salt diet”. It turns out that in truth they were the “silent” majority – a large and growing population of those with heart disease, high blood pressure, stroke and many other conditions that necessitated a lower more reasonable sodium content in their daily diets in order to enjoy optimal levels of health.

I applaud New York City and Health Commissioner, Dr. Thomas Farley for this first step in what will be a long road to take back control of our diets. Let’s join together and ask other states and our nation to support these efforts that help us achieve levels of excellent health and a better quality of life for many years to come.

To read the referenced articles, please visit:

http://www.nyc.gov/html/doh/html/pr2010/pr002-10.shtml

http://www.nydailynews.com/ny_local/2010/01/11/2010-01-11_new_city_foe_salt_plan_would_urge_whopping_25_reduction_in_nearly_all_food_produ.html

http://news.yahoo.com/s/ap/20100111/ap_on_bi_ge/us_nyc_salt_guidelines

I spent about eight hours last weekend poring over the tiny printed nutrition information for sixteen local and national chain restaurants in preparation for a community speaking engagement about low-sodium eating.

The good news is that this information is available to those of us in California; the bad news is that there are not many low-sodium items from which to choose . . . YET.

I believe that if consumers request this information and demand lower sodium, healthier options that the restaurants will seek to meet this demand, especially in this economy where restaurants need every customer to survive.

The nutritional information for most of the restaurants was well hidden on their websites or even not available online for some of them. Specifically, Buca di Beppo, Chevy’s Mexican, TGI Fridays, Outback Steakhouse, Mimi’s Café were a few that I tried to find online information. The restaurants are required to have the information in the restaurant and I was able to find the information when eating at Mimi’s Café, Red Robin, and Elephant Bar.

However, the information is in such a tiny font that a magnifying glass is necessary. Often, the customer is hungry and doesn’t have time to pore over the information – which I assume is what the restaurants are counting on. Furthermore, some of the restaurants only show saturated fat, not total fat, which makes it very difficult to determine how healthy a given item might be! I wonder how they can get away with this – maybe they are counting on no one looking too closely.

Please take time to view the document, “California Restaurant Nutrition Information” located at:http://www.saltrax.com/saltcontent.html

What the Chain Restaurants Don’t Want You to Know. To see a list of California Restaurant chains, links to their related nutrition information, and lower sodium options pleaseclick here.

The document is an overview of the sixteen restaurants I reviewed, including where to find the information on their websites (website link in the second column) and my best recommendation for keeping the sodium within ‘reasonable’ limits which means that it is not necessarily a low fat item, but for this purpose I’m focusing on sodium. I’ve included milligrams of sodium as well as the conversion to SalTrax ™ Points.

I included French Fries at In ‘n Out because we all cheat and when you’re at a burger joint, it sure is hard to resist ordering a small french fry. Compared with ordering sauce, ketchup and mustard on the hamburger, the fries at 245 mg sodium (2 SalTrax™ Points) are not such a bad deal. But, you wouldn’t want to eat these on a regular basis because of the fat content.

I will continue to pore over the nutrition information as I come across it and update this list periodically. I’m hoping that more and more low-sodium healthy options will become available. You can make a difference – ask for more low-sodium options!

July 1st is a new beginning. The new California menu labeling law goes into effect tomorrow. This means that consumers will have more information available to them about foods beforethey eat them.

As they say, “knowledge is power” and in this case it is true. Knowing the calorie, fat and sodium content of a food before you eat it gives you the power to choose to eat that food or not.

When you do choose to eat healthier foods while eating out, a good tool is the Healthy Dining Finder at www.HealthyDiningFinder.com

This web site offers a way to find lower sodium menu options at many well known restaurants. Check it out today!