Halt the Salt: Understanding the Risks of Excessive Dietary Sodium Intake

Facts

• 30 Canadians die every day due to excessive dietary sodium intake.
• Hypertension has a direct link to high sodium intake.
• Hypertension is estimated to be the leading risk factor for death in the world
• Reducing dietary sodium is a key measure in reducing the risk for and management of hypertension.
• The average Canadian diet contains about 3500 mg of sodium per day – 1200 mg greater than the upper recommended daily limit of 2300 mg.
• Approximately 75% of dietary sodium comes from processed food.
• Reducing sodium intake could result in an annual cost savings of $1.4 billion in Canada.

Historical Overview

“The human tongue is hooked on salt, to the extent that it seems to savour the very word” (Creswell, 2010, para. 1).

Historically, salt has been a valued commodity used for preserving food as it eliminated the dependence on the seasonal availability of food. Because it was difficult to obtain, it was a highly valued trade item. Roman soldiers were said to be paid in salt.

But the pendulum has swung. Today, salt is universally accessible and relatively cheap. Prior to the salt trade our ancestors obtained salt primarily from natural sources like meat and vegetables. Although still found naturally in meats, fruits and vegetables, today most people obtain their dietary sodium from eating processed, packaged and fast foods, from eating out in restaurants, and by adding extra salt in cooking and at the table.

The simple truth about salt is that we love its taste and so we consume excessive amounts – sometimes deliberately, but often not. Salt has now been identified as the “silent additive” (Hypertension Canada, 2010, p. 1). It’s easy to identify foods that taste salty, but not so easy when salt is hidden in products such as bread, bakery products, cereals and other foods that don’t usually taste salty.

The taste for salt is purely a habit: the more you eat the more you want. It is a learned behaviour and can be unlearned.

Importance of dietary sodium in today’s world

Hypertension, linked to high sodium intake, is a major cause of cardiovascular disease, and a risk for stroke, kidney disease, osteoporosis, stomach cancer and asthma. It is also the leading preventable risk factor for death.

Hypertension can lead to heart disease which is the leading cause of death for person’s over 60, and the second leading cause of death for persons aged 15 to 59 (World Health Organization [WHO], 2002). “Approximately one in five adult Canadians have hypertension and 90% of adults will develop high blood pressure if they live an average lifespan” (Hypertension Canada, p. 1).

Hypertension is the most common diagnosis for physician visits in Canada, and the pharmaceutical treatment is one of the most costly and not always the most effective. Rates of high blood pressure will continue to grow as the population ages unless steps are taken to change some of the underlying causes. It is estimated that a reduced need to treat hypertension due to lower sodium intake – in conjunction with the associated decrease in cardiovascular disease – could result in a potential cost savings of 1.4 billion dollars per year (Hypertension Canada, 2010).

According to the World Health Report Less Salt, Less Risk of Heart Disease and Stroke, it is known that “80% of heart disease, stroke, and type 2 diabetes, and 40% of cancer can be prevented through inexpensive and cost effective interventions” (WHO, p. 3). “In all settings, population-wide salt reduction strategies were the most cost-effective” (WHO, p. 3). It is estimated that if the average sodium intake is decreased by 1,840 mg per day, hypertension prevalence would be decreased by 30%, resulting in approximately one million fewer hypertension patients, as well as a 13% decrease in cardiovascular disease events.

Canadians’ love affair with salt

Although there is much information available on the risks associated with high sodium intake, as well as information on recommended daily allowances, “there is a large discrepancy between recommended levels of sodium intake and the actual level of sodium consumption by Canadians.” (Hypertension Canada, 2010, p. 6).

According to a public opinion survey, Canadians are aware of sodium as a health issue but perceive it to be everybody else’s problem. Few understand what a healthy amount of sodium is, and most continue to have high dietary intakes. Of those surveyed, 42% used no added salt in cooking, 39% used no added salt at the table, and only 24% avoided processed food, which contains 77% of dietary sodium (Health Canada, 2010).

Health Canada’s national strategy to reduce dietary sodium

The Sodium Working Group, founded in 2007 by Health Canada, collaborated to create a national strategy to reduce sodium consumption through education and consumer awareness, reduction of sodium in the food supply and ongoing research/

The resulting report includes recommendations that adhere to the multi-stage strategy of “voluntary reduction in sodium levels in processed food products and foods sold in food services establishments; education and awareness of consumers, industry, health professionals and other key stakeholders; research…[and] monitoring and evaluation” (Health Canada, 2010, p. v).

The nurses’ role

Nurses are expected to utilize best practice guidelines and current research, and are well-positioned to make a difference in implementing salt reduction strategies within their practice domains.

Health Canada recommends that health-care professionals and scientific organizations be “proactive in integrating sodium knowledge into their practices” (Health Canada, 2010, p. 30). How can nurses help? Nurses can educate patients about the need to select and consume a lower sodium diet, use or develop teaching tools to help patients manage their sodium intake and blood pressure, and advocate for public policies to reduce the addition of sodium to our food. Nurses can encourage:

• reducing sodium content in processed foods;
• providing of nutritional information in fast food and eat-in restaurants;
• reading of nutrition labels on food products prior to purchase;
• choosing of lower sodium products;
• progressively decreasing salt in cooking and at the table;
• eating less processed “convenience” foods;
• avoiding salty foods such as soups, bacon, pepperoni and cheese; and
• eating fresh fruits and vegetables, which are naturally low in sodium.

Nurses are also spouses, mothers, fathers, sisters, brothers, daughters and sons. It is important that nurses bring information about the dangers of dietary sodium to all they come in contact with. Nurses are also consumers and should take personal steps to reduce sodium consumption as part of an overall healthy diet. “Reducing dietary sodium intake within the context of a healthy diet can substantially reduce the incidence of hypertension among Canadians who have normal blood pressure” (Blood Pressure Canada, 2010, p. 1).