By Laura Ann Horwitz, CSUN DPD* Student

This is the fourth article in the series on Sodium. The first two articles centered on foods that contribute to a high Sodium diet, and how to reduce Sodium when eating on campus (or eating out). The third article concentrated on Sodium as it relates to health. In our last article, we’ll explore how to implement healthy lifestyle changes, which include lowering your sodium intake.

In our younger years, especially when we are on the go as students, or busy paving the way towards a career, we may not think about our overall well-being in regard to the future. High blood pressure (aka hypertension) strikes one in every three adults; it is often referred to as a “silent killer” — countless people are unaware they have high blood pressure since it often has no symptoms or warning signs.¹ Family history plays a part in genetic predisposition to disease risks, though it is not always an exact cause.² Experts have not yet cured hypertension, but once diagnosed, it can be controlled.³  While altering your genetic constitution is not possible, it IS possible to make changes to your environmental and lifestyle factors. What you put in your body today, whether you are 25 years old, 50 years old or 75 years old, will make a difference in your health today, tomorrow or many years from now. It is never too late to implement a healthier lifestyle. And today, the prevalence of hypertension is found across all age levels, genders and ethnicities.³

High sodium in your diet is a known risk factor for developing heart disease, ranked as the number one cause of death among men and women throughout the world.⁴   While several major minerals affect hypertension, sodium was among earliest to be identified as having a direct connection to hypertension.⁵  Studies ranging across numerous age levels in various population groups have consistently shown that there is a correlation between reducing sodium in your diet and lowering blood pressure levels.⁵  You can begin lowering your risk factors today by developing healthy lifestyle habits that include implementing a nutritious eating plan, incorporating physical activity into your daily routine and reducing the amount of sodium you eat on a daily basis.

The suggestions given in the article 10 Tips to Reduce Sodium When Eating on Campus can apply to eating at home as well as in restaurants, on campus or just about anywhere if you make it part of your eating routine. Make wise food choices (choose fresh over pre-packaged). Peruse and compare Nutrition Facts Labels (choose lower sodium options). Become choosy about the foods you eat, aiming toward utilizing the no salt, low, very low, reduced or light sodium guidelines given in the previous blog article. Educate yourself about sodium — you can start by reading some of the references used to compile this series on sodium. The Centers for Disease Control (CDC), the National Heart, Lung and Blood Institute (NHLBI), the American Heart Association/American Stroke Association (AHA/ASA) and the Food and Drug Association (FDA, a part of the U. S. Department of Health and Human Services) all have excellent information on their websites about Sodium. A list of helpful websites can be found at the end of this article.

The Dietary Guidelines for Americans were co-developed by the U.S. Department of Health and Human Services and the Department of Agriculture to help professionals in the health field educate the general public to make healthier food choices in their daily diets.⁶ Currently in its 8^th edition, the guidelines recommend maintaining a healthy eating standard, which should include consuming:

• Vegetables and Fruits: an assortment of numerous colors
• Grains: minimum of fifty percent whole grains
• Dairy: low-fat or fat-free
• **Proteins: mixture of lean meats, seafood, poultry, legumes, nuts, seeds
• Oils

And limit consumption of:

• Sodium
• Added sugars
• Trans fats
• Saturated fats

The American Heart Association, the National Institutes of Health and the Centers for Disease Control and Prevention recommend following the DASH diet (Dietary Approaches to Stop Hypertension), all of which incorporate components of the above guidelines.^7,8,9 Additionally, the American Heart Association (AHA) urges smokers to quit smoking and all people to avoid secondhand smoke.⁷ Participating in regular physical activity also contributes to disease prevention. The AHA suggests 150 minutes per week of moderate movement.⁷ You can lower your blood pressure with activities such as brisk walking for 30 minutes (approximately 2 miles), gardening for 30-45 minutes, bicycling for 30 minutes (approximately 5 miles), playing basketball for 15-20 minutes, swimming for 20 minutes or jumping rope for 15 minutes.⁸

The DASH diet makes a difference as early as 14 days after instituting the changes.¹⁰ In addition to lowering your sodium intake, it is high in calcium, potassium, magnesium, fiber and protein.⁸ Principles of the DASH diet^8,10 include:

Food Group	Recommended Servings	Serving Size
Fruits and Vegetables	4-5/day	1 cup leafy greens, ½ cup cooked, 6 ounces juice (vegetable) 1 medium fruit, ¼ cup dried fruit, ½ cup fresh, canned or frozen, 6 ounces juice (fruit)
**Protein-rich foods	2 or less/day	3 ounces
Dairy (low-fat)	2-3/day	8 ounces milk or milk product, 1 cup yogurt, 1 ½ ounces cheese
Grains	7-8/day	1 slice bread, ½ cup cooked pasta or rice, check packages of cereal as serving sizes differ between brands
**Nuts, Seeds & Dry Beans	4-5/week	1/3 cup or 1 ½ ounces Nuts, 1 Tablespoon or ½ ounce Seeds, ½ cup cooked dry beans
Oils and other Fats	2-3/day	1 teaspoon soft margarine, 1 teaspoon oil, 1 Tablespoon low-fat mayonnaise, 2 Tablespoons light salad dressing

Examples of these foods¹⁰ include:

• Vegetables: carrots, pumpkin, sweet potatoes, winter squash, leafy greens (broccoli, kale, cabbage, spinach), green beans
• Fruits: cantaloupe, apples, melons, bananas, berries, black or red grapes, pink grapefruit, dried fruits (dates, prunes, apricots)
• **Proteins: turkey breast, chicken (lean), fish (especially salmon), meats without fat
• Dairy: yogurt, skim milk, low-fat cheeses
• Grains: oatmeal, whole grain breads, whole grain pastas, wheat germ, shredded wheat cereal, or other cereals low in sugar and high in fiber
• **Nuts, Seeds & Beans: peanuts, almonds, walnuts, pistachios, pumpkin seeds, sesame seeds, sunflower seeds, bean and chickpea (garbanzo bean) dishes or dips
• Oils: Olive oil, canola oil (hint: make homemade salad dressings with yogurt or non-fat sour cream, or a favorite lower sodium salad dressing diluted with olive oil and vinegar)

**Proteins, Nuts, Seeds & Dry Beans: the Dietary Guidelines for Americans lumps together PROTEINS as a variety, which includes lean meats, seafood, poultry, legumes, nuts and seeds; whereas in descriptions of the DASH DIET, there is a separation between PROTEINS (seafood, lean meats & poultry) and NUTS, SEEDS & DRY BEANS.

Understanding how to read the Nutrition Facts Label found on packaged foods and drinks is a useful skill in reducing how much sodium you are eating and following a heart-healthy diet. The label tells you the total number of servings in the container, the size of the serving (for example, the size of the serving might be listed as 1 package, or 1 serving could be listed as equal to ½ cup), plus the number of calories for each serving, and other nutrients such as Sodium, carbohydrates, fiber, sugars and protein.¹¹ By comparing the nutrition facts labels, you can determine which product has the least amount of sodium (listed in milligrams [mg] per serving) allowing you to make healthier choices for the foods you eat.

The U. S. Food and Drug Administration (FDA) can help you learn how to navigate the Nutrition Facts Label.  In addition, the United States Department of Agriculture oversees the website ChooseMyPlate.gov  where a multitude of information on healthy eating, nutrition facts label reading and reducing sodium can be found.

Websites to help you find more information on Sodium

From the Centers for Disease Control and Prevention:

• Salt

From the American Heart Association:

• The American Heart Association’s Diet and Lifestyle Recommendations 
• Smart Substitutions to Eat Healthy
• Sodium

From The U. S. Department of Health and Human Services

•  Your guide to lowering blood pressure
• Lower-Sodium Foods: Shopping List
• Sodium Reduction 

*DPD = Didactic Program in Dietetics

References

1.   Centers for Disease Control and Prevention (CDC). High Blood Pressure. CDC. https://www.cdc.gov/bloodpressure/. Published July 18, 2018. Accessed August 14, 2018.

2.   NIH. U.S. National Library of Medicine. (NIH). What does it mean to have a genetic predisposition to a disease? NIH. https://ghr.nlm.nih.gov/primer/mutationsanddisorders/predisposition. Published July 24, 2018. Accessed July 30, 2018.

3.    Mahan LK, Raymond JL. Krause’s Food & the Nutrition Care Process. 14^th St. Louis, MO: Elsevier; 2017:659.

4.   American Heart Association/American Stroke Association (AHA/ASA). About sodium: sodium and your health. AHA/ASA. https://sodiumbreakup.heart.org/sodium_and_your_health. 2018. Accessed July 10, 2018.

5.   Gropper SS, Smith JL. Advanced Nutrition and Human Metabolism. 6^th ed. Belmont, CA: Wadsworth Cengage Learning; 2013:475, 476.

6.    S. Department of Health and Human Services and U. S. Department of Agriculture. (U.S. DHHS/USDA) 2015-2020 Dietary Guidelines for Americans. 8^th ed. U.S. DHHS/USDA.  https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf. December 2015.  Accessed August 11, 2018.

7.    American Heart Association/American Stroke Association (AHA/ASA). The American Heart Association’s diet and lifestyle recommendations. AHA/ASA http://www.heart.org/HEARTORG/HealthyLiving/Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.W3NaspNKho5. August 2015. Accessed August 11, 2018.

8.   U. S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung and Blood Institute. (NHLBI). Your guide to lowering blood pressure. NHLBI.  https://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf. May 2003. Accessed August 6, 2018.

9.   Centers for Disease Control and Prevention. (CDC). How to reduce sodium. CDC. https://www.cdc.gov/salt/reduce_sodium_tips.htm. Published March 20, 2018. Accessed August 11, 2018.

10.  Escott-Stump, S. Nutrition and Diagnosis-Related Care. 8^th ed. Philadelphia: Wolters Kluwer; 2015:357,384-5.

11.   U. S. Department of Health and Human Services. U. S. Food and Drug Administration (FDA). Learn about the nutrition facts label. FDA. https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/#whats-on-the-label. n.d. Accessed August 12, 2018.