Reducing Sodium

Reducing Sodium

Author: Mark Parkinson BsPharm:  President  AFC-CE

Credit Hours 1 - Approximate time required: 60 min.

 

Educational Goal

Teach caregiving management of salt consumption and sodium metabolism. 

Educational Objectives

• Teach about the physiology of sodium. 
• Provide a basic understanding about the pathophysiology of sodium.  
• Teach caregiving techniques on how to manage sodium consumption.
• Tell how to reduce sodium consumption.

Procedure:

Read the course materials.  2. Click on exam portal [Take Exam].  3. If you have not done so yet fill in Register form (username must be the name you want on your CE certificate).  4. Log in  5. Take exam.  6. Click on [Show Results] when done and follow the instructions that appear.  7. A score of 70% or better is considered passing and a Certificate of Completion will be generated for your records.

Disclaimer

   The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.

 

 Reducing Sodium

 

Salt, we love our salt. We flavor our dishes with it. We brine our meats in it, and we preserve our foods with it. We have a genuine appetite for salt. Look in any pantry and I bet you will find containers of table salt, popcorn salt, garlic salt, onion salt, pickling salt, seasoned salt, sea salt, and kosher salt. It should be no surprise to anyone that we consume a lot of salt but at what cost to our health? 

 

The Chemistry of Sodium

Common table salt is a crystalline compound of sodium and chloride atoms. When chlorine and sodium atoms get together, chlorine takes an electron from the sodium, giving each a charge. Chlorine has a negative charge and sodium gets a positive charge. Like magnets, the opposite charges attract each other, and a uniform crystalline lattice forms. 

Water is also a compound of different atoms. It has two hydrogens atoms and one oxygen atom. Oxygen does not take the electrons from the two hydrogens but shares them instead. Sharing electrons creates a stronger bond between the atoms. But doing so bends the shape of the molecule into a v shape. This v shape gives the water molecule a partial negative pole and a partial positive pole. 

When you place a salt crystal in water the partial charge of the water molecule is strong enough to break up the crystal lattice but not strong enough to take any of the chlorine or sodium’s electrons. The result is you have Na+ and Cl- atoms called ions floating in the water. 

So why all the chemistry mumbo jumbo. Our bodies are set up to take advantage of free-floating sodium molecules to perform many metabolic functions. The positive sodium ions attract free negatively charged electrons. As the electrons move around, an electric current is created. That is how a nerve signal is created. Also, the sodium ion charge attracts water. Wherever the sodium ion goes, water follows it around. If the body wants water to go someplace, it pumps the sodium ion there and the water naturally follows. Our muscles contract, we think and feel, pee, salivate, sweat, and a host of other functions all because of sodium. 

 

Pathophysiology of Sodium

If there is too little sodium in the bloodstream the condition is called Hyponatremia. Too much sodium results in Hypernatremia. Cases can be mild, moderate, or severe, based on the concentration of sodium in the blood. The firing of nerves signals and the contraction of muscles both depend on the ionic charge of the sodium ion, Na+. In the most severe cases when the concentration of the ion is too much or too little, seizures, heart arrhythmias and death may occur.

Because water follows sodium, disorders of sodium are also disorders of water. If too little sodium is in the bloodstream, water will be drawn away into the cells where the salt concentrations are higher. The result is the cell swells and possibly bursts and dies. If there is too much sodium in the blood, then water flows into blood vessels increasing the body’s blood pressure. Chronically high blood pressure has its own set of problems and illnesses throughout the body, organs, and brain. 

Fortunately, our bodies have ways to avoid severe cases of hypo and hypernatremia. Our bodies can control sodium’s impact through several homeostatic mechanisms that regulate sodium’s concentrations in the cells and bloodstream. Unless the change in sodium’s concentration is very quick, the body can adjust and avoid most of the severe cases of Hypo and Hypernatremia. 

 

Caregiving and Severe Cases 

For in-home caregivers’ severe cases of hypo and hypernatremia will be very rare. Acute severe cases would most likely occur in older adults who are 

• mentally and physically impaired, 
• do not eat or drink enough,
• are sick with a high fever,
• has vomiting, 
• has an infection that causes severe dehydration.

In-home caregivers should be on the lookout for symptoms in cases of severe vomiting, diarrhea, kidney or adrenal gland problems, and certain elderly populations. If the following signs occur call the doctor. 

 

Hyponatremia	Hypernatremia
·         Nausea and vomiting ·         Headache ·         Confusion ·         Loss of energy, drowsiness and fatigue ·         Restlessness and irritability ·         Muscle weakness, spasms or cramps ·         Seizures	·        Excessive thirst ·        Nausea and vomiting ·        Loss of appetite ·        Confusion ·        Lethargy ·        Muscle twitches ·        Spasms ·        Seizures

 

In-Home Caregiving and Salt

Hypo and hypernatremia are words that almost never come up in the In-home caregiving industry. What does come up all the time is reducing dietary salt as part of hypertension therapy. Harvard university summed it up in the following. 

“In most people, the kidneys have trouble keeping up with excess sodium in the blood. As sodium accumulates, the body holds onto water to dilute the sodium. This increases both the amount of fluid surrounding cells and the volume of blood in the bloodstream. Increased blood volume means more work for the heart and more pressure on blood vessels. Over time, the extra work and pressure can stiffen blood vessels, leading to high blood pressure, heart attack, and stroke. It can also lead to heart failure. There is some evidence that too much salt can damage the heart, aorta, and kidneys without increasing blood pressure, and that it may be bad for bones, too.”

Source https://www.hsph.harvard.edu/nutritionsource/salt-and-sodium/

 

The Stats of Sodium

• American adults eat an average of about 3,600 mg of sodium per day.
• It has been recommended that we only need 2300 mg (1 teaspoon)
• People with high blood pressure should have 1500 mg from all sources. 
• Reducing salt intake by 3 grams per day (1,200 mg of sodium) could cut the number of new cases of heart disease each year by as many as 120,000, stroke by 66,000, and heart attack by nearly 100,000. It could also prevent up to 92,000 deaths each year.”

It’s pretty clear Americans eat too much salt. Those who are infirm and or have high blood pressure need to consume less salt. So who is going to make that happen? The doctor, nurse, pharmacist- no it’s you. The responsibility to reduce salt intake rests on your shoulders, the In-home caregiver. 

 

How to reduce sodium intake

Now we get to the real good stuff of the article. What In-Home caregivers can do about reducing salt consumption. Stats are good for scientific studies but are not that helpful for home use. Who has the time or the ability to measure how much salt is consumed in a home? We have to work with broad concepts that work on general outcomes for patients. It is the only practical way to proceed. 

 

Start with lifestyle changes, not the saltshaker 

We are used to viewing dietary salt through the lens of a saltshaker. That is not where you need to start. For an average person, 70% of the salt they consume comes from restaurants and prepackaged foods. That comes from the sandwich and fries from the burger joint, the convenience meal frozen pizza, the potato chip snack while watching TV, and the late-night burrito second supper. All of which are lifestyle choices the resident has made that you are now in control of. Salt reduction started to happen the minute you arrived on the scene. By controlling the menu and what is eaten for snacks you are accomplishing a significant salt reduction without even trying. Great Job In-Home caregiver. Keep up the good work of making regular scheduled homecooked meals and making wise snack choices (sodium reduction lifestyle choices). 

Know where the Salt is hiding

Reducing the salt from a restaurant, convenience, and snack food is a good start. Now let’s work on the salt that is hiding in the foods you are cooking. 

I went to my cupboard and found the salt content per serving in 

• Cream of Mushroom Soup 870mg
• Hamburger Helper 530mg
• Ramen noodles 780mg

The sodium amount was easy to find because it was written right in the Nutrition Facts panel on the package. To find which foods have the hidden salt all you have to do is read the label. The DV percentage column on the nutrition facts panel is a quick way to judge the salt content. Consider 5% DV or less of sodium per serving low, and 20% DV or more of sodium per serving high.

In general, you will find the most sodium in Prepared mixes, Packaged rice dishes, Soups, Canned foods, Frozen meals, and Packaged baked goods. 

 

What can be done to reduce the hidden salt?

The answer can be had in one sentence, cook from scratch. “Ow”, I just felt all the mental daggers shot straight through my heart. I know it sounds like cooking from scratch is a lot of work, and you might think you don’t have the cooking skills for that kind of cooking. Let me tell you this, you are a better cook than you might think are. Also, it’s not that much extra work to cook from scratch. It’s just a matter of recipe modification, planning, and practice. 

 

Take a slow cooker beef roast cooked in mushroom soup for instance. How much extra effort is it to replace the can of condensed soup with milk, mushrooms, and a little cream? Just that alone reduced the sodium per serving by 870mg. Skip the garlic salt, onion salt, and or seasoned salt. Instead, put in plain onion and garlic powder. Add a bit of lemon juice, pepper, paprika, chives, and a splash of reduced-sodium soy salt. Bingo, a delicious sodium-reduced beef roast. Work on the spice selection to match your tastes and it will taste better than the original high sodium recipe. All it took extra was just a few steps to the frig and less than 5 minutes of extra prep time. No big deal. You get the general principle, cooking from scratch allows you to cut out all the extra hidden salt even before reaching for a saltshaker. 

 

Try these flavors to liven up your meals without salt.

Herbs and spices on vegetables:

Carrots -- Cinnamon, cloves, dill, ginger, marjoram, nutmeg, rosemary, sage

Corn -- Cumin, curry powder, paprika, parsley

Green beans -- Dill, lemon juice, marjoram, oregano, tarragon, thyme

Tomatoes -- Basil, bay leaf, dill, marjoram, onion, oregano, parsley, pepper

Herbs and spices on meat:

Fish -- Curry powder, dill, dry mustard, lemon juice, paprika, pepper

Chicken -- Poultry seasoning, rosemary, sage, tarragon, thyme

Pork -- Garlic, onion, sage, pepper, oregano

Beef -- Marjoram, nutmeg, sage, thyme

Source: Flavor That Food, National Heart, Lung, and Blood Institute

 

A few extra reduced salt cooking tips 

• Substitute fresh or frozen products for canned products like fish or vegetables. 
• If you have to use canned, rinse the product in water before using
• Make up your own sodium-reduced sauces and dishes in bulk. Then home can them or freeze them in easy-to-use meal size portions. 
• Buying products labeled "low-salt," or "no salt added
• Avoid “cured” meats like ham or bacon, brined foods like pickles or sauerkraut, and sliced luncheon meats. 
• Cook rice, pasta, potatoes, and hot cereals without salt. 
• Premade grain products all contain at least some salt. Each slice of bread, biscuit or bagel, and or bowl of cereal when added all together is quite a lot of salt. 
• For the full meal deal (pun intended) check out the DASH eating plan diet at  https://www.nhlbi.nih.gov/health-topics/dash-eating-plan or other reputable sources. 
• There are plenty of other sodium-reduced recipes and plans on the internet. The trick in using them is to stock up on the ingredients before you start cooking. Salt-free cooking starts in the grocery store.

 

 

A word on “reduced sodium” products

You might be tempted to take a cooking from scratch shortcut by using “reduced sodium” products. It’s an okay option but you need to know what they mean when you reduced sodium on a package label. According to the FDA on reduced-sodium food labels at the grocery store. 

What It Says	What It Means
Salt/Sodium-Free	Less than 5 mg of sodium per serving
Very Low Sodium	35 mg of sodium or less per serving
Low Sodium	140 mg of sodium or less per serving
Reduced Sodium	At least 25% less sodium than the regular product
Light in Sodium or Lightly Salted	At least 50% less sodium than the regular product
No-Salt-Added or Unsalted	No salt is added during processing – but these products may not be salt/sodium-free unless stated

Source https://www.fda.gov/food/nutrition-education-resources-materials/sodium-your-diet

 

Controlling the Saltshaker

Salt from a saltshaker may not be as big a deal as you might have thought but it is an area that still needs to be worked on. The 10% of our salt consumption that comes from a shaker is used to fine-tune the flavor of the foods we eat. At least that is what we tell ourselves. In my years of cooking for a care home, I noticed that the saltshaker was used even before the food was tasted. Often saltshaker use was a habit more than a flavor selection. 

I also noticed that the elderly used a lot of salt to compensate for not being able to taste foods like they use to. Instead of changing the recipe, they got into the habit of using the saltshaker instead. 

As you know, patient habits are not set in stone. Over time habits and tastes can be changed. It’s all a matter of controlling inputs and being consistent in actions over time. Eventually, the sodium-reduced diet patient won’t even miss the salt. To help speed up the process I suggest that you make the table saltshaker disappear. Replace it with Salt substitute shakers. Mrs. Dash, NU-salt No-salt, Morton’s Salt substitute can all be found in the spice aisle. All but MRS Dash (which is a collection of dried herbs and spices) are made from potassium chloride instead of sodium chloride. Adding extra potassium to a diet is actually beneficial in many ways. It tastes different but you can get used to it quickly. They can go crazy with the shaker, and you won’t have to worry about it. Before using a lot of potassium chloride either in cooking or at the tablet you must know that extra potassium triggers extra stomach acid. Monitor for upset stomachs. The remedy is plain over-the-counter antacids. There are some medical considerations when using a lot of potassium. See my CE about potassium. 

 

Conclusion

 

You can make this low-sodium thing work. After all, you are the lifestyle modifier expert. No one else in medical practice can accomplish the things that you can in your home. Your efforts will start at the grocery store as your look at labels and make food choices that steer you away from a high sodium diet and end at the shaker you use at the tablet. Making even a small reduction in sodium consumption can make difference for patients with high blood pressure. Studies have found that the DASH eating plan can lower blood pressure in as fast as 2 weeks. Is all the effort worth it- of course it is. Remember as you work towards a low sodium diet. Healthy patients are easy to take care of patients. 

 

As always good luck in your caregiving efforts. 

Mark Parkinson BsPharm

 

References:

1. Sodium. Wikipedia, the free encyclopedia. 4 November 202. https://en.wikipedia.org/wiki/Sodium
2. Sodium in Your Diet. US Food and Drug Administration. Jun 8, 2021 https://www.fda.gov/food/nutrition-education-resources-materials/sodium-your-diet
3. Salt and Sodium. The Nutrition Source. Harvard T H Chan public school of health. https://www.hsph.harvard.edu/nutritionsource/salt-and-sodium/
4. Sodium: How to tame your salt habit. Nutrition and healthy eating Mayo Clinic .org Sept. 15, 2021. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/sodium/art-20045479?p=1
5. The Salty Stuff, Salt, Blood Pressure, and Your Health. National Institutes of Health NIH News in Health. https://newsinhealth.nih.gov/special-issues/eating/salty-stuff
6. Dustin Williams MD. Residency, Sodium, OnlineMedEd Aug 14, 2014 https://www.youtube.com/watch?v=kac3Uf288k8
7. Most People Consume Too Much Salt. National Center for Chronic Disease Prevention and Health Promotiol, Division for Heart Disease and Stroke Prevention Sep 14, 2021 https://www.cdc.gov/salt/index.htm

 

 

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