Expert Q & A: What can be done to reduce sodium intake?

Dr. Kevin Willis, Director of Partnerships at the Canadian Stroke Network, speaks about how Canadians can kick the salt habit based on his work on the federal sodium working group.

Can you tell us about the benefits of sodium and salt reduction for chronic disease prevention?
It’s all about blood pressure. High blood pressure is a major risk factor for stroke and heart disease. One-quarter of all adults have hypertension, one in every two among seniors. If we can limit sodium intake, we can reduce the average blood pressure, which will significantly reduce chronic diseases like stroke and heart disease.
Currently, the average Canadian consumes 3,400 mg [milligrams] of sodium per day – this is more than double the recommended intake of 1,500 mg or less. Children also have excessively high intake levels. And these levels may be underestimates because the data are from 2004.

Can you tell us about the federal sodium working group?
The multi-stakeholder sodium working group was formed in 2007. Just this July, the group released its recommendations (to view, see link at the end of this article). It had representation from government, health organizations, NGOs [non-governmental organizations], and the food industry – so it covered all the bases. I was a member of the group, and it produced some good recommendations for government and industry, and set an interim intake goal of 2,300 mg by 2016. That’s just a working target for the sodium reduction strategy; the recommended daily intake for adults is still 1,500 mg or less. The strategy outlines voluntary food industry sodium reductions across all categories of food and establishes targets for the government to monitor – bringing about a gradual drop in sodium in the food supply.

In 2016, the group will assess the progress. I have a personal concern that it will be very difficult to achieve healthy sodium intake levels through a voluntary process.

With reduced levels of salt in one’s diet, should there be any concern about reduced iodine levels?
Iodine is not really a concern. Most of the sodium consumed (70-80 percent) is from the salt in processed food, which is not iodized. If people cut back on table salt, this will reduce iodine. But we get enough from other sources. There’s a study addressing this issue coming out in the literature. Iodine levels are something that should be monitored, but there are a lot of ways that iodine could be added back in the food supply, so it’s not an issue for sodium reduction.

Are there examples of industry taking a lead on these voluntary reductions in sodium?
The best example of progress is Campbell’s soups and the company’s efforts to reduce sodium across their products. They still have a way to go to reach healthy levels but they have been leaders in the sector. A lot of major brands are starting to announce changes. Part of the challenge is that we get sodium from a large number of different food product categories and no one category provides more than around 10 percent of our consumption. So we need movement in all categories and across all brands and products before we will see reductions in the average consumption of sodium.

Can you give examples of actions people can take on a personal level to reduce sodium?
With the current food supply, it’s hard to get to healthy levels even if you try not to add salt. The first thing you need to do, if you are buying processed/packaged foods, is to read the labels and try to find the sodium content. We have a simple tool that can help you understand labels: you are looking for 200 mg or less per serving; anything more than 400 mg per serving is too much.

If you are eating out, and it’s a chain restaurant, then you can get information on sodium content from the company website. Many dishes are loaded with sodium and these should be avoided. Restaurant soups, sauces and dressings are typically high in sodium.

If people reduce their sodium consumption, their taste buds will adapt and they will prefer foods with lower levels of sodium.

Do you have any examples of foods that are surprisingly high in sodium?

Foods that advertise health claims – for example, whole grains or zero trans fats – are not always so healthy. Quite often, or at least in the past, if manufacturers reduced one “unhealthy” component, something else increased. So foods with health claims, such as cereals, could contain high levels of sodium. Items like store-bought muffins can surprise – the sweet taste may be predominant, but they may still contain high levels of sodium (400 mg of sodium per serving).

It would be better, if you are able, to prepare your own food from whole ingredients, and reduce your exposure to sugars, trans-fats, and sodium.

What role can an individual play to advocate for reduced sodium in the food supply?
I think everybody should be aware of the importance of diet in the development of non-communicable diseases. Major diseases, like heart disease, stroke, obesity, diabetes, are largely caused by malnutrition. Usually we think of this as an issue for developing countries, but actually malnutrition can mean too little, too much, or in the wrong proportions. This malnutrition is especially concerning when combined with other risk factors, such as a lack of physical activity. We should be concerned about our food supply as the consumption of highly processed foods is causing a major health burden; this will become more of a problem as demographics change and the population ages.

One of the ways to be an advocate for change is to start to change your habits, vote with your dollars by buying unprocessed whole foods that are healthier. Don’t believe the marketing of health claims. As food journalist and author Michael Pollan writes, “Don’t eat food that has a big marketing budget or health claims.” Make the switch to preparing food from unprocessed ingredients…it will change the market and the food and agricultural industry will respond.

For more information about sodium reduction, visit the Canadian Stroke Network’s Sodium 101 website at www.sodium101.ca.

To read the Sodium Working Group’s recommendations in the report, Sodium Reduction Strategy for Canada, visit www.hc-sc.gc.ca.

For more information and suggestions, or to order free Sodium 101 magnets for your program, e-mail info [at] canadianstrokenetwork [dot] ca.