Posts Tagged ‘Sodium’

Hypertension for Beginners

July 18th, 2015 at 1:54 pm by timigustafson

More than half of people who have hypertension, a.k.a. high blood pressure, don’t know enough about the condition and are unable to control it properly, according to a new survey.

Oftentimes patients don’t even correctly understand the meaning of the word “hypertension,” and think of it more in terms of stress, anxiety, or other psychological disturbance rather than what it actually is, namely a physiological dysfunction that can turn into a chronic disease if untreated, the researchers found.

Many healthcare professionals use the words “hypertension” and “high blood pressure” interchangeably when talking to their patients, which can be confusing for some, said Dr. Barbara Bokhour, a professor of health policy and management at Boston University School of Public Health and co-author of the study report, to Reuters.

Explained in a nutshell, blood pressure is the force exerted by the blood against the walls of blood vessels. It is measured in millimeters of mercury (mmHg). Measuring involves two readings: systolic, indicating the pressure as the heart pumps blood out, and diastolic, the remaining pressure as the heart relaxes and refills with blood.

Normal blood pressure ranges below 120 systolic and 80 diastolic. Readings of 120 to139 systolic or 80 to 89 diastolic are considered “pre-hypertension,” meaning there is a risk of developing hypertension without intervention. Everything above 140 over 90 is categorized as hypertension of various stages, with 180+ over 110+ seen as a medical emergency.

Hypertension can build up for years without ever showing discernable symptoms. But left uncontrolled, it can lead to life-threatening complications like kidney disease and heart disease as well as heart attack and stroke.

Hypertension is a growing worldwide epidemic. The number of people living with the disease has crossed the 1 billion mark in 2008 and is predicted to reach well over 1.5 billion within the next ten years, according to the World Health Organization (WHO). The causes are seen to a large degree as diet and lifestyle-related, including excessive consumption of salt and alcohol as well as excess weight and lack of physical activity.

Against widely shared assumption, hypertension is not a disease that predominantly occurs with age. Recent studies found that young adults in their 20s and 30s are now increasingly at risk as well, facing complications much sooner than generations before them.

For this reason it is extremely important to keep blood pressure as low as possible, especially in the first half of adult life, said Dr. Joao Lima, a professor of medicine at Johns Hopkins University and lead author of one such study, ideally even below the recommended limits.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (


Trying to Cut Back on Salt Is Hard to Do

February 4th, 2015 at 6:17 pm by timigustafson

The warnings have been loud and clear for a long time: High levels of sodium (salt) intake are hazardous to our health. Especially the so-called “Western diet,” which is dominated by processed foods, is notorious for its sodium content that is often obscured in hard to decipher nutrition facts labels and ingredient lists. That makes it difficult even for health-conscious consumers to keep their daily sodium doses down.

The Institute of Medicine (IOM) recommends 1,500 mg of daily sodium intake for people age 51 and older, those who suffer from hypertension, diabetes, or chronic kidney disease, and African Americans in general; for everyone else, 2,300 mg is considered the tolerable upper limit. The average daily intake for most Northern Americans is about 3,400 mg – way above what is believed to be safe.

The potential consequences are multiple. While a small amount of sodium – approximately 180 mg to 500 mg per day – is necessary for the body to function properly, excessively high amounts can cause a wide range of health problems, including heart disease, kidney disease, and certain forms of cancer. At an advanced age, it can also contribute to osteoporosis. And, as a recent study found, even the brain can get affected by an elevated sodium presence, leading to adverse biochemical changes in its neurons.

Still, experts remain divided over the actual effects of dietary sodium on overall mortality. A study just published in the Journal of the American Medical Association (JAMA) concluded that higher sodium intake was not correlated with greater mortality risk from all causes, at least not in healthy older adults, regardless of gender or race.

As it is too often the case, contradictory findings of various studies such as these leave consumers ever more confused. Of course, only by continuously questioning and testing its work science can progress, but first ringing the alarm bells and then backtracking on issues of public interest is not always the most helpful approach. There should be a minimum of what we can agree upon before releasing guidelines and recommendations that are meant to influence people’s behavior.

This, it seems to me, is one these occasions. None of the studies I’m aware of calls for more consumption of salt in any form. None advise against keeping levels low. There is only disagreement over its impact on people’s health and well-being. For this, empirical evidence is hard to come by because it requires large-scale, long-term investigations, which are laborious and expensive. But that doesn’t mean we are completely in the dark without them.

One of the main reasons why people consume so much salt is that they are unaware of its many sources. It’s not the saltshaker that puts us at risk but sodium used by food manufacturers in countless food items, many of which don’t taste salty at all. High amounts can be found in most canned and packaged foods, including breads, breakfast cereals, soups, lunch meats, pasta sauces, pancake mixes, cheese, condiments, salad dressings, pizza, frozen dinners, even medications and nutritional supplements. In other words, sodium is nearly omnipresent in much of our commercial food supply, which makes it next to impossible to avoid.

So, if you are absolutely determined to escape the sodium trap, the best you can do is to stick with whole fruits and vegetables, lean, unprocessed meats, fresh seafood, beans and legumes, and unrefined whole grains.

On a personal note, I decided a long time ago not to even own a can opener. I like my meals made from scratch with minimally invasive cooking techniques like steaming and sautéing. To me, this is preferable to anything that can be purchased in ready-to-eat form. Soups, salads, or pasta sauces of almost endless varieties can easily be created on a whim without using any ingredients other than what Mother Nature provides. Yes, that sometimes comes with a little more work and a little less convenience, but to me, that’s part of my investment in my health and certainly worth the effort.

If you liked this article, you may also enjoy reading “Too Much Salt and Too Little Potassium Makes for a Deadly Combo” and “Reducing Salt Intake by Small Amounts Could Save Thousands of Lives Every Year.”

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (


Less salt in our food supply could save at least half a million Americans from dying prematurely over the next ten years, according to separate studies conducted at three universities, two American and one Canadian. If the average daily salt intake were to drop to 1,500 milligrams, as recommended by the Dietary Guidelines for Americans, the number of lives saved could more than double. All study results were published in the medical journal Hypertension, a publication of the American Heart Association (AHA).

Americans currently consume on average 3,600 milligrams of salt daily, mostly in form of sodium, widely used as an ingredient in processed foods. Sodium is considered a significant contributor to high blood pressure, which can lead to heart disease, heart attack and stroke, all leading causes of death in the U.S. today.

About a third of American adults, or 68 million, suffer from high blood pressure, a.k.a. hypertension, according to the Centers for Disease Control and Prevention (CDC). The condition was identified as a primary or contributing cause of nearly 350,000 deaths in the U.S. in 2008, the last time the CDC has updated its research on the subject.

Despite of these alarming statistics, there are currently no signs of improvement. Even better treatment has only shown mixed results. Less than half (46 percent) of high blood pressure patients have their condition under control, according to the CDC.

Because the salt content in processed food is already added before it reaches the consumer, there is little opportunity to make changes on an individual basis other than limiting one’s choices to fresh items like produce. This would also exclude many options in restaurants.

“Individuals can’t make this choice easily,” said Dr. Kirstin Bibbins-Domingo, professor of medicine and epidemiology at the University of California, San Francisco (UCSF), to ABC News. “So maybe we should find ways to work with the food industry,” she suggested.

The National Salt Reduction Initiative, a partnership started by the New York City Health Department that has expanded to nearly 100 city and state health organizations across the country, has been trying to get food manufacturers and restaurant operators to cut salt by 25 percent or more since 2008, the year of the organization’s inception. The current goal is to achieve a reduction of 20 percent by 2014.

Critics say that such measures are impractical and would make little difference. Public health advocates have been focusing on hypertension as if no other health threats existed, said Morton Satin, Vice President of science and research at the Salt Institute, a trade association for the salt industry, in response to the recent studies to ABC News. The association warns that low salt intake could produce its own set of health problems, especially for the elderly.

While most experts would agree that multiple factors can be responsible for the development of high blood pressure, including genetic predisposition, gender, age and other non-modifiable components, poor diet and lifestyle choices, which are modifiable and therefore preventable risk factors, usually play a much greater role. In a milestone conference on the connections between sodium intake and blood pressure, sponsored by the National Heart, Lung and Blood Institute (NHLBI), the participating scientists concluded that “an abundance of scientific evidence indicates that higher sodium consumption is associated with higher levels of blood pressure, [as demonstrated in] animal studies, observational epidemiologic studies, and clinical studies and trials.” They were also hopeful that more effective strategies could be developed to improve diet and lifestyles patterns that benefit the larger population.

If you liked this article, you may also enjoy reading: “Too Much Salt in Our Food Creates Serious Health Hazards.”

Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” ( You can follow Timi on Twitter and on Facebook.


So It Is Possible to Reduce Salt in Our Food

April 17th, 2012 at 5:46 pm by timigustafson

The salt content of popular fast food items like chicken nuggets can vary considerably, depending where you buy them, according to a study report by an international group of scientists that tested products of leading multinational restaurant chains. What they found were dramatic differences in the amounts of added salt in the same kinds of food, made by the same companies, only in different parts of the world.

For the study, researchers from Australia, Canada, France, New Zealand, the United Kingdom and the United States analyzed fast food items from McDonald’s, Burger King, KFC, Domino’s Pizza, Pizza Hut and Subway in each of their respective countries and compared notes.

Although fast food is known for being notoriously high in salt wherever you go, the study results are nevertheless startling. The U.S. and Canada were reported to have the highest levels of salt compared to other countries – in some cases nearly twice as high.

One reason for the differences could be government guidelines for salt reduction like in the U.K., said Dr. Norman Campbell of the University of Calgary, Canada, one of the authors of the study report. The British government has set voluntary targets for the food industry, although not yet for fast food restaurants. Still, a growing number of food manufacturers and restaurant operators have committed themselves to meeting the proposed levels as soon as possible and are already using their pledges for advertising purposes.

What this study shows is that reducing salt in our food is indeed feasible and that the technology to do so exists despite of the food industry’s long-standing assertions to the contrary. If it can be done in one country by the same manufacturers and with virtually identical items, it can be repeated elsewhere and certainly here in the U.S.

“Consumers should not have to bear all the responsibility for their diet choices,” said Dr. Campbell. 80 percent of most people’s daily salt intake doesn’t come from the saltshaker on the dining room table but is already added to many processed foods, including items that don’t even taste salty.

The best strategy for reducing salt consumption is for governments to intervene and regulate the use of salt in food processing, he said. All other attempts have been proven unsuccessful. Education campaigns like the National Salt Reduction Initiative here in the U.S. may be well-intended, but they can only work if supported by binding regulations for the food industry.

Dr. Campbell doesn’t believe that trying to further educate the public will produce better outcomes. “We have a highly educated population that is aware of the issues. They are trying to eat healthy and a lot of them perceive they are eating healthy.” What persists is widespread confusion because people don’t know how ubiquitous salt is in their food supply. They eat their food as it’s presented to them, trusting that – although it may not always be perfectly healthy – it will do them no harm.

Another frequently made argument by food manufacturers is that Americans love salty foods and would not buy them if they had a bland taste. “That is because they are used to higher salt levels,” said Dr. David Katz, director of the Prevention Research Center at Yale University. In other words, it’s an acquired, not a natural taste.

According to a study in the New England Journal of Medicine, it is estimated that cutting back just 3 grams of salt (1,200 mg sodium) a day could save the lives of almost 100,000 Americans annually. If the industry substantially reduced the levels of salt it currently uses for food processing, it could translate to large gains for the health of the population, wrote the researchers in their concluding summary. How much longer do we have to wait?

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (, and at You can follow Timi on Twitter and on Facebook.


Too Much Salt in Our Bread, U.S. Government Study Finds

February 12th, 2012 at 3:35 pm by timigustafson

The highest amount of salt Americans eat comes from bread, according to a study by the Centers for Disease Control and Prevention (CDC). Nearly 50 percent of the salt consumed in the U.S. is linked to popular foods such as baked goods, cold cuts, cured meats, pizza, poultry, soups, sandwiches, cheese, pasta and snacks like pretzels and potato chips. Many items loaded with salt don’t even taste salty.

The study, which involved over 7,000 participants, found that bread accounted for an average of seven percent of daily sodium intake, more than any other individual food item. Bread may not contain the highest amount of salt per serving, but the fact that people eat it more often and in larger quantities than most other foods makes it a leading contributor to high blood pressure, heart disease and stroke.

The average American consumes about 3,250 milligrams of salt per day, far more than what’s recommended by the government’s Dietary Guidelines, which is 2,300 milligrams for healthy adults and 1,500 milligrams for high blood pressure and heart disease patients. Over 30 percent of the adult population suffer from high blood pressure, according to the CDC.

Most consumers are not aware that they are getting too much salt. What makes matters worse is that they could not easily change that even if they wanted to. “Most sodium comes from common grocery store and restaurant items and only a very small portion from the shaker at the table,” Dr. Thomas R. Frieden, the Director of the CDC, told reporters. “People can choose how much salt they add to their food at the table,” he said, “but they can’t take it out once it’s there.”

In fact, over 60 percent of the salt consumed by Americans is found in processed foods, about 25 percent in restaurant meals and the remainder from other sources such as vending machines and extra salt added at home, according to CDC statistics.

Dr. Frieden called for food manufacturers and restaurant owners to reduce the amount of salt they apply to their products. It is estimated that a 25 percent reduction in salt content in the most popular food items could save tens of thousands of lives every year.

Food industry representatives have responded by saying that reducing sodium would adversely affect taste and may also violate food safety standards because salt is commonly used as a preservative.

The CDC study report was released in the February edition of the journal “Vital Signs,” just in time to coincide with “Heart Health Month.” Sodium is well known to raise blood pressure, which is a major risk factor for heart disease and stroke. More than 800,000 Americans die each year from these diseases.

Health experts have long advised that people with heart problems should avoid processed and packaged foods as much as possible and eat more fresh produce instead. With regards to bread, it is important to read the Nutrition Facts labels. Sodium content in different breads can considerably vary between 80 and well over 200 milligrams. Other items like canned soups can have a wide sodium range from 100 to well over 900 milligrams, depending on the brand. Many fast food choices and TV dinners contain astronomical amounts of salt, often more than the recommended daily values in just one serving.

Asking food manufacturers and restaurants to voluntarily change the ways they use salt has not been very effective, although there are exceptions. Other than through legislation, the only promising approach would be consumer demand. If grocery store owners found that customers prefer low-sodium products and restaurant patrons asked to have salt reduced or eliminated in their dishes, we could see some positive changes over time.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (, and at You can follow Timi on Twitter and on Facebook.

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About timigustafson

Timi Gustafson, RD, LDN, FAND is a registered dietitian, health counselor, book author, syndicated newspaper columnist and blogger. She lectures on nutrition and healthy living to audiences worldwide. She is the founder and president of Solstice Publications LLC, a publishing company specializing in health and lifestyle education. Timi completed her Clinical Dietetic Internship at the University of California Medical Center, San Francisco. She is a Fellow of the Academy of Nutrition and Dietetics, an active member of the Washington State Dietetic Association, a member of the Diabetes Care and Education, Healthy Aging, Vegetarian Nutrition and the Sports, Cardiovascular and Wellness Nutrition practice groups. For more information, please visit

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