Your Health

Halt the salt

Like many people, David Ridd is learning that too much salt can lead to high blood pressure and other health problems, including heart attack and stroke. Now, he is one of a growing number of Canadians who are keeping an eye on their sodium intake.

How salt affects the body Salt by the numbers A strategy to reduce salt Where does salt come from? What can you do to halt the salt? Read the label

BY JUDY OWEN
Winnipeg Health Region
Wave, January / February 2010

There's nothing David Ridd liked to do more than pull into a fast-food restaurant and treat himself and his grandson to some french fries.

The deep-fried, salty potato strips could be hard to resist.

But Ridd and his fries parted ways after he suffered a mild heart attack last spring. His concern was he had too much salt in his diet.

"If we go in, I don't get the fries anymore," Ridd says of his now-rare trips with his grandson, Austin, to fast-food joints. "I try to avoid (those restaurants). I know I can't do it anymore. It's a risk to my health."

That risk is one that many Canadians are taking each day by consuming food with too much sodium, the chemical element found in common salt.

Research has shown that Canadian adults consume an estimated average of 3,400 milligrams of sodium each day. That's more than double the amount most experts recommend to maintain good health.

Health Canada says the recommended adequate intake for anyone over the age of one year is 1,500 mg a day. The upper limit (the highest average daily intake level that likely poses no health risks) is 2,300 mg a day.

While salt is needed to balance the fluid in our bodies and maintain good health, too much sodium can trigger a wide range of health problems.

"In terms of public health, high sodium levels are the most harmful factor in our diet," says Kevin Willis of the Canadian Stroke Network, a coalition of health-care professionals and scientists that raises awareness about sodium consumption.

Blood Pressure Canada, another group concerned about the effects of salt, reports that dietary sodium is a leading contributor to hypertension (high blood pressure), which affects an estimated 25 per cent of Canadians. Hypertension increases the risk for a number of chronic conditions, including stroke, heart attack, kidney disease and congestive heart failure. Indeed, one recent study estimated that high dietary sodium was the seventh leading cause of preventable death in the United States. In Canada, it is estimated that 23,000 heart attacks and strokes could be prevented each year if people consumed less sodium, according to Willis. The Canadian Stroke Network also estimates that high sodium consumption is responsible for as many 30 preventable deaths in Canada each day. And, Blood Pressure Canada estimates a reduction in sodium intake could decrease hypertension by 30 per cent, and save Canada's health-care system about $1.7 billion a year.

The mounting evidence linking high sodium consumption to increased health risks has resulted in a push by government and health organizations to halt the salt. Blood Pressure Canada and the Canadian Stroke Network, for example, have joined federal government officials and grocery product manufacturers in discussing ways to reduce the amount of salt in foods we buy. In addition, Canadians are being encouraged to be mindful of the amount of salt consumed when eating out at restaurants or cooking at home.

But reducing salt levels isn't always easy, especially for grocery manufacturers. In addition to being important to good health, salt affects the taste and texture of food. It's also needed for preserving some food so it's safe to eat. In the end, it's all about finding a balance that's healthy and tasty.

Ridd, 65, has been reducing the amount of salt in his diet ever since his wife, a retired lab technologist, began analyzing what they ate about five years ago.

He wasn't a big user of salt, but he was overweight so they started reading nutrition labels on products to see how much fat and salt they contained. "My biggest deal was looking at the labels and being really surprised at the sodium count in different products," says Ridd, who worked 35 years for Revenue Canada's Customs and Excise. "It's unbelievable."

While the couple always included a variety of fresh fruit and vegetables in their diet, they are now adding new ones to the list, including bok choi, more green and red peppers, squash, and sweet potatoes. David and Dorothy are also using more herbs in their food preparations today. When they do go out to eat, David avoids soup, which is usually high in salt. He'll also order more vegetables and salads, with dressing on the side.

Not wanting to give up his french fries totally, he tried asking for them without salt, but that didn't work. "You can't get away from it," Ridd says. "It's in a bin and they're always putting the seasoning on it. You ask for it (without salt), sure they try, but it's in that bin and it's always got salt on it. I just don't bother (eating them) anymore."

Ridd's dietary changes weren't enough to stave off a heart attack last year, but he does believe his efforts to eat healthier kept the damage to a minimum. As part of his recovery effort, he enrolled in a four-month program at the Reh-Fit Centre on Taylor Avenue.

That's where Ridd met with a cardiologist, a fitness trainer and Martina Gornik- Marion, a registered dietitian who supported his dietary changes. "I was sort of confirming what we were doing," says Ridd. "She (Gornik-Marion) said we were pretty well on the right track of reading labels and avoiding foods with high salt content."

It hasn't always been easy, but Ridd says the changes, along with his exercise regime, have helped put him on the road to better health. "I'm not a saint, and I can't say I don't have something that has sodium in it - I'm not that pure - but I just look at it and say I don't really need that and go from there. It's a lifestyle change. It's like a smoker giving up. You can start tasting the food better. And really, I don't miss the salt."

Gornik-Marion, a registered dietitian for about 17 years, is well aware of the problems that can come from consuming too much salt. She says most of her clients at the Reh-Fit Centre are people who have experienced health issues, including heart disease, high cholesterol and obesity. And most of them are consuming more salt than they should be.

The reasons are fairly straightforward. Many people are challenged by a lack of time or by having to cook for one. Some are relying more on quick, pre-packaged foods or eating out at restaurants. "A lot of my clients are talking about busy lifestyle," she says. "They're busy with work, some have families and they're trying to get their kids out the door really quickly. Even some of the elderly population, they're tired of cooking for themselves, too."

Much of the salt we consume comes from pre-packaged and processed foods. Salt enhances flavour, blocks bitterness and is a tenderizer, Gornik-Marion says. It's also used to preserve some foods, reducing the water available for bacterial growth. "In order to have these processed foods, you want them to taste good, but you also want them to have proper texture and you want them to be safe in terms of food safety," she says.

One way to monitor your salt intake is to check out the nutrition facts label on food products. All grocery products are required to carry a label outlining information such as serving sizes, calories, fat levels and sodium. In addition, the label includes a daily value number, which is a percentage of the total daily nutrient requirements contained in each serving.

It is important to remember, however, that in the case of sodium, the daily value is calculated using the upper limit of 2,300 mg a day, as opposed to the recommended adequate intake of 1,500 mg per day. For example, a can of soup can have as much as 860 mg of sodium in a half-cup serving (125 ml). That works out to about 36 per cent of the daily upper limit of sodium for adults, and about 57 per cent of the recommended daily intake.

That's quite a bit of sodium in one serving of soup, but consider this: If a person eats a whole cup, not just a half cup, they will end up consuming 1,720 mg of sodium, or 114 per cent of the recommended intake for adults.

Grocery makers, meanwhile, are introducing more lower-sodium products. Campbell Soup, for example, has introduced the Healthy Request line of soups, which is now featured in television commercials (the one with the guy standing in a pile of salt). A one-cup serving of its herbed chicken and brown rice Healthy Request soup has 470 mg of sodium. That's 31 per cent of the recommended intake and 20 per cent of the upper limit.

Gornik-Marion, for one, applauds the efforts by some companies to make changes, but she also knows there is a long way to go. "Some manufacturers are making efforts to reduce sodium, but there are challenges. They do need to be cautious as they want to maintain appealing flavour and texture so people will continue to enjoy the product, but also ensure food safety."

In her practice at the Reh-Fit Centre, Gornik-Marion spends a lot of time educating people on ways they can improve their eating habits. One of the best sources of information, she says, is Eating Well with Canada's Food Guide. It contains all sorts of information on healthy eating and can help you get started on a lower-sodium diet that includes more vegetables and fruit, lower-fat dairy products and whole grains.

In addition, Gornik-Marion also stresses the importance of meal planning. She encourages clients to eat at home more often, making meals from scratch and incorporating herbs and spices instead of salt to add flavour to food. If a client eats a lot of smoked or cured meats, she suggests they cook a larger roast or chicken and save the leftover meat for sandwiches. "I think it's important to encourage every small step that one makes," she says. "You want whatever change one makes to be lifelong and not just a flash in the pan."

Willis says consumers should pay attention to the labels when shopping. "Choose products containing 200 mg of sodium or less and avoid those that have 400 mg or more per serving," he says."

One area where consumers don't have a lot of control over what they eat is at restaurants.

Everyone has watched cooking shows on TV and seen a chef add a dash of salt to enhance flavour, but that reliance on salt is changing, as chefs become more conscious of customers' health needs.

Michael Dacquisto began his career in the kitchen of the Sheraton Hotel after graduating from Red River College's culinary course in the mid-1980s. He became chef of the former Between Friends restaurant in 1993, and has been an executive chef for WOW! Hospitality Concepts for 14 years.

In the fall of 2008, he became chef/partner of Dacquisto, an Italian restaurant under the WOW! umbrella. The restaurant received the maximum five-star rating last year by Marion Warhaft, the Winnipeg Free Press's food critic. Dacquisto says he became concerned about the amount of salt in restaurant food when he started at Between Friends. "Most of us consume way too much salt," says Dacquisto. Sodium levels can be high in some restaurants "mainly because we're inundated in our business with the potential to use processed foods," he says. "You have to be able to resist that as a chef."

Those processed foods, he explains, are most often bases such as stocks from powders that have "incredible" amounts of sodium. "They're easy and quick and cheap for chefs to use, but I've never, ever used products like that in my kitchens, and I refuse to - from both a quality standpoint and from just the sheer amount of salt that's contained in these items."

His practise from the get-go has been to reduce salt and use fresh herbs, spices or chilis. "These kinds of things can do the same thing to your taste buds, to your senses, and can balance the flavours without actually using very much salt at all," Dacquisto says. "But that just takes practice and tasting a lot of food and trying different ingredients. The trick is using the bare minimum (of salt) that you can get away with and still have people enjoy what you're cooking."

He has seen some movement in the restaurant industry to reduce salt, but mostly in better-quality restaurants, where chefs write recipes, rather than in corporate restaurants. "That's where the problem comes," he says. "In these corporate chains, it's being dictated by somebody somewhere else, typically, to make something taste the same in every one of those restaurants that you go to. By pre-making sauces, by pre-making different dishes and packaging them to simplify it for consistency in their chain operations, they tend to use a high amount of sodium - way more than any chef creating his own recipes would use. That's where North Americans are getting clobbered by sodium intake."

He has customers ask for lower-sodium options about once a month and can accommodate them because about half the dishes on his menu don't have any salt added in during preparation, except maybe in the last minute, he says. "We can serve a lot of products here without any salt at all, if somebody wishes so." In fact, he says wryly, the most salt used in his restaurant is by customers who pick up the salt shaker at the table.

Reducing salt is just one trend he's seeing among some chefs.

Many are conscious of the source of their ingredients, such as where the meat comes from, how the animals are treated, what they're fed and whether fish such as salmon is farmed or not.

"My peers that I work with, they're becoming a lot more health-conscious in general," Dacquisto says.

"With our aging population, we definitely are more aware of some dietary issues out there. We're way more aware of it now than we would have been 10 years ago."

That's caused chefs to adapt their menus and move away from "dictating" what their guests eat, he says.

"You have to be flexible enough and be aware that there are people who want to eat in your restaurants that have lots of different restrictions," he says. "And you have to be able to cater to their dietary needs, or a lot of those people aren't going to come back to your restaurant."

Judy Owen is a Winnipeg writer.

	About Wave Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books. Read the January / February 2010 issue of Wave