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Salt, Part 1

Heath dangers in Canadian children start with high levels of salt Add to ...

When David Beeching was taken to the hospital three years ago after breaking his leg skiing, he was anticipating X-rays, a cast and a painful recovery. He didn't expect the news that he was suffering from a life-threatening condition.

Doctors told David's family that he had seriously high blood pressure, a condition normally associated with the overweight and middle-aged. But David was neither of those things. He seemed fit and healthy - and he was only 13.

By the time he started receiving treatment, though, his heart was enlarged, indicating an elevated risk of cardiac attack or failure. Doctors prescribed medications, but most of all they ordered him to cut down drastically on salt - the prime suspect in causing hypertension.

David Beeching's predicament is increasingly common among Canadian children and teens, and experts say it is due to the dangerously large amount of salt most of them consume - which for some can be sheer poison.

Hypertension may not sound so grim in itself, but it is a leading cause of heart disease and stroke, which kill more Canadians a year than anything but cancer.

Canadians overall take in about 3,100 milligrams of sodium a day - more than double the recommended intake for any age group and significantly higher than the upper limit most people can consume without compromising their health (2,300 mg, or roughly one teaspoon of table salt).

But a survey conducted by Statistics Canada in 2004 found that even toddlers were consuming more than 1,900 mg of sodium a day, nearly double what is recommended for them.

What's more, 90 per cent of children 4 to 8 years old were not only consuming more than the upper tolerable amount of sodium for their age group every day - they were exceeding the maximum safe levels for adults. (For comprehensive figures, see sidebar, "A pinch to a binge.")

High blood pressure and heart disease aren't the only consequences. Excessive sodium has also been associated with an increased risk for stomach cancer, kidney disease, osteoporosis and asthma.

Doctors in Canada and the U.S., such as pediatric urologist Walid Farhat at Toronto's Hospital for Sick Children, also have noted a rise in the number of young patients suffering from kidney stones - a disturbing trend they link to the way high sodium increases the body's excretion of calcium.

"We see patients from the age of 1 all the way up to the age of 15," Dr. Farhat says. "It's all across North America."

Reducing Canada's salt intake is no simple matter, though. After David's family got the news, says his mother France Savoie, she determinedly "scared him off" the habit of adding extra salt to his food. But since then, she has learned that putting away the salt shaker isn't nearly enough.

Even though she's a full-time nurse in Mont-Saint-Hilaire, Que., Ms. Savoie had never realized just how much of the sodium consumed by modern Canadians is already in the food we buy. Seventy to 80 per cent of it comes from packaged, processed foods in which sodium is relied on as a preservative and to enhance flavour.





That, of course, includes salty snacks such as potato chips and pizza. But some of the worst offenders are much less obvious, such as store-bought tomato sauce and breakfast cereal.

The Statistics Canada researchers didn't even include salt added by the consumer. It was hardly necessary, given that a cup of Cheerios with a cup of skim milk, a cup of Campbell's tomato soup and one large flax tortilla add up to more than the adult daily recommended intake - and that's without having any dinner.

Now, Canada's leading health experts are finally sounding the alarm that excess sodium is creating an entirely preventable public-health crisis. But so far Ottawa has done little to address the issue.

Five million Canadians have high blood pressure. Norm Campbell, a medical professor at the University of Calgary, says that simply reducing dietary sodium to nearer recommended amounts would eliminate one case in five.

"It's almost negligent we haven't done something about this before," says Dr. Campbell, who was named the first Canadian Chair in Hypertension Prevention and Control by a group including the Canadian Institutes of Health Research in 2006.

Hypertension already costs the health-care system $430-million a year, and experts say that number will grow exponentially if something isn't done about the extraordinary amounts of sodium consumed by children across Canada.

ROCK OF AGES

Salt has been a cornerstone of human civilization for thousands of years, helping empires expand, cities prosper and leaders crush their rivals. Before the dawn of refrigeration, salting was the best way to preserve meat, making it one of the world's most valuable commodities.

Salt isn't necessary to preserve meat these days. But the modern reality of two-income families and hectic schedules means that few parents now use fresh ingredients exclusively or make all meals from scratch. Packaged snacks, canned food and pre-made or frozen meals loaded with salt are now a normal part of family life. And so is the appetite for candy and junk food loaded with salt, sugar and fat.

Unknown to many Canadians, that has allowed sodium to creep into our diets at astonishing levels.

Research suggests that salt is addictive, making it very difficult to reduce consumption. It seems no coincidence, then, that many food companies use it as an inexpensive way to enhance flavour. Not all high-sodium products taste like it, usually because salt is masked by other ingredients such as sugar, herbs or spices.

Kids demand French fries, pizza, chips, hot dogs and candy, and their exhausted, time-pressed or indulgent parents hand it over. They may try to limit it, but the reality is that many kids eat too much junk. That fact is largely responsible for the childhood-obesity epidemic that has sparked widespread demand for junk-food advertising bans and physical-education reform.

Yet the average Canadian is less aware of the beating that high amounts of salt can inflict on the body, making it harder for the heart to pump blood and demanding extra work from the kidneys.

And it's not just in junk food. Many foods promoted as healthy because they are low in fat, sugar and calories (such as canned vegetables and beans, lean cold cuts, whole-grain breads, fat-free salad dressings and ready-made soups) contain far more sodium than most people suspect.

Indeed, as the market for low-fat, calorie-wise and sugarless food products has exploded over the past few decades, the salt levels in many of these items have crept up, perhaps partly in compensation.

Studies have also found links between childhood obesity and high-sodium diets - children who eat more salt also drink more liquids, often turning to sugary pop and juice.

It's not yet clear how rampant hypertension is becoming among children. Family physicians often don't test for it, meaning that many children may have high blood pressure and not know it. In fact, it's estimated that almost half of adults with the condition are unaware of it.

As health problems common to adults begin to emerge more frequently in children, the medical community has also grappled to understand what constitutes a dangerous blood-pressure reading in a child, whose body is much different from an adult's.

Few people know why sodium should be a top priority on the public-health agenda better than Sheldon Tobe, a researcher in hypertension and kidney disease at Toronto's Sunnybrook Health Sciences Centre who has spent the past few years as a spokesman on the subject for the Heart and Stroke Foundation of Canada. "Now is the time to really work on cutting back on salt in society," he insists.!

GETTING THE WORD OUT

But is anybody listening? For years, Canadians have heard that fat, sugar and high calories are the culprits in rising obesity and spikes in childhood diabetes. Unfortunately, the message was so well received that many parents consider only fat and sugar, not salt, before tossing a product in their shopping carts.

Now, as health advocates try to focus the same attention on sodium, parents are feeling unsure what is left to feed their kids that will not harm their health down the road.

It's a problem Kim Horricks of Calgary lives with every day. Her 14-year-old daughter, Amanda, is seriously overweight, is at risk for developing diabetes and recently found out she is suffering from high blood pressure.





"She doesn't tend to lean towards healthier foods, fruits and vegetables," Ms. Horricks says. Amanda's habits don't include a lot of physical activity either. "She's a teenager who loves her screen time."

Ms. Horricks is trying to give more fruits and vegetables to her daughter as well her 12- and seven-year-old sons. But it's far from easy. Her kids are picky eaters, and between work and errands, Ms. Horricks and her husband, Warren, seldom have the energy to cook from scratch. They tend to rely on packaged snacks for school lunches as well as oven-ready food that can be whipped into a quick dinner and the occasional pizza on the weekend.

When she reads nutrition labels, Ms. Horricks admits that she's still in the habit of looking at fat, sugar and calories, not sodium - even though she has a child with high blood pressure.

Jennifer McIntosh, on the other hand, knows exactly how much sodium her 18-month-old son, Tyler, gets. Ms. McIntosh has a family history of high blood pressure and heart disease, so when her son was born, she became a dedicated label reader.

What she found startled her: Tomato juice, sauces and even baby food were "astronomically high" in sodium. She wondered, "How can they sell this?"

Instead of compromising on Tyler's sodium consumption, Ms. McIntosh, who lives with her family just outside Montreal, made major adjustments to her shopping. She buys low-sodium products and has invested in a pressure cooker, which allows her to can her own stews and sauces.





She knows what a high-salt diet could do to her son's health, and she is not about to let that happen.

Not everyone who eats a high-sodium diet will develop hypertension. Certain people - including those with family histories of hypertension, black people and those who suffer from kidney problems or diabetes - tend to be more sensitive to the effects of sodium and at greater risk for high blood pressure.

Some food companies and industry organizations such as the U.S.-based Salt Institute have used the sensitivity argument to criticize population-wide efforts to reduce sodium consumption, saying it's unnecessary for most people. They have recruited doctors and scientists as experts to back their claims.

But even those who are not salt-sensitive today become more vulnerable as they reach their 40s and 50s. According to non-profit health organization Blood Pressure Canada, more than 90 per cent of Canadians who live to be about 80 will develop high blood pressure unless they take steps such as exercise and sodium control.

Catherine Yarema was only 28 when she found out during a routine physical that her blood pressure was high. Thinking that it may just have been nervousness, she continued to monitor it over the following months. Her readings kept worsening, and she decided to go to the hospital after experiencing intense headaches and heart palpitations.





A specialist prescribed two medications and told her that she would need to take them for the rest of her life. The doctor also instructed her to cut down on salt.

Two years later, last summer, Ms. Yarema found out that one of the medications had triggered an allergic reaction to gluten. She consulted with a dietitian and started to realize that even though she had long ago stopped adding salt to her food, her sodium intake was still high because of packaged, processed food.

"I was quite shocked," she says. She had no idea that ditching the salt shaker wasn't enough to control her intake.

Since then, Ms. Yarema, now 31, has completely changed her eating habits. In addition to avoiding gluten, she and her husband make all their soups, sauces and salad dressings from scratch, never adding salt. She brings a lunch to work religiously and no longer gives into the temptation of convenience foods.

Ms. Yarema saw her family doctor several times after she adopted her new diet. Each time, her doctor noticed an improvement in her blood pressure and lowered the dosage of her medication.

At a checkup in December, the doctor told Ms. Yarema that her blood pressure was completely normal and that she no longer needed medication - something she had been told could never happen.!

AGAINST THE GRAIN

Catherine Yarema healed herself by changing her diet - now the nation of Britain is trying to do the same.

Five years ago, it became one of the few countries to act decisively on sodium by launching what is widely considered the world's most aggressive reduction campaign. Many experts say it provides an excellent model for Canada.

Ottawa, however, appears to be in no hurry. The federal government created a working group to address the issue two years ago. Including representatives from federal agencies, the medical community, health-advocacy organizations and the food and restaurant industries, the group has met several times but has yet to develop a strategy.

"I think we would like to have seen greater progress," says Kevin Willis, director of partnerships with the Canadian Stroke Network and member of the task force. Like hypertension researcher Dr. Campbell, Dr. Willis wants to develop strong measures to compel food producers to reduce sodium levels over time.

Food manufacturers and restaurants say they agree on targeting sodium but resist the idea of strict government regulation.

"I think there's lots of evidence out there that a voluntary approach can work," says Ron Reaman, vice-president of federal government affairs at the Canadian Restaurant and Foodservices Association, pointing to the measures taken in recent years to reduce trans fats. "I think that there's incredible commitment on the part of the food industry to actually address sodium levels."

With the consumer backlash over trans fats still fresh in the food industry's memory, some companies already have moved to create low- or reduced-sodium alternatives. Nielsen market research reports that dozens of such products have begun to appear in the Canadian marketplace.

But many health experts say the current pace of sodium reduction is so sluggish that it's putting lives at risk. They fear that leaving food companies and fast-food chains to their own devices won't be enough.

"We're taking in this substance, which is artificially added to our diet, at such high levels that it's really acting as a chronic poison," says Dr. Willis of the Canadian Stroke Network. "The only way in which we can really make an impact on sodium reduction in our diet is get manufacturers to reduce the amount."

Meanwhile in Mont-Saint-Hilaire, three years after his diagnosis, David Beeching is about to graduate from high school. He dreams of becoming a musician, though for a living he expects to make and repair guitars.

As for his plans to manage his hypertension? "I don't really think about it."

But if he doesn't start thinking about it, his mother worries that he could become a heart-disease statistic before he even turns 30. Despite her best efforts, Ms. Savoie can't always force him to eat fresh fruits and vegetables. She knows the sodium in the bread, lasagna and French fries that David loves to eat outside the house is damaging his health. But she feels helpless.

"When you want to change yourself, it's easy, but to try to change somebody's habit, it's not the same," she says. "It's really difficult."

When salt has you licked

Reducing sodium consumption is not as simple as asking everyone to cut back. Not only do people love the taste of salt, but a significant amount of research suggests that sodium chloride (its chemical name) actually can be addictive.

According to David Kessler, former commissioner of the U.S. Food and Drug Administration, salty foods rewire the brain, making people prone to overindulgence and strong cravings. His new book, The End of Overeating, argues that consuming foods high in salt (as well as fat and sugar) change the way a person sees food.

A study published by the Elsevier journal Medical Hypotheses in 2006 found that a person who goes without salt experiences similar withdrawal symptoms as a drug addict. And the higher a person's sodium consumption is, the greater will be his or her tolerance for more.

A person who switches from a high- to low-salt diet probably will consider the food bland and flavourless at first. But after a few weeks, the taste buds adjust, making the reduction less noticeable. A person who follows a low-sodium diet is likely to find the taste of high-sodium food excessively salty.

***

Salt in your system

Sodium The body needs a certain amount of sodium every day to function; it is an electrolyte that helps regulate fluids and blood pressure and helps nerves transmit signals. Salt is also iodized in Canada to help prevent iodine deficiency, which can lead to mental impairment. (In many developing countries, this is a major cause of mental retardation.)



High blood pressure or hypertension Blood exerts pressure on the walls of the arteries as the heart pumps it around the body. But if excess water in the blood vessels or increased rigidity in the artery walls force the organ to work harder, it can cause it to become enlarged, with the risk of heart attack, failure and other cardiac events.

Damage to blood vessels can cause them to burst or become blocked by a clot - if this occurs in the brain, it can cause a stroke.

Obesity, inactivity and excessive alcohol intake have been linked to high blood pressure, also known as hypertension. But high sodium intake has been shown to be the most significant factor.



Fatalities In 2005, the latest year for which figures are available, heart disease and stroke accounted for 22.4 per cent and 6.1 per cent of deaths in this country respectively, according to Statistics Canada - more than any other cause of death except cancer.



The link The correlation between increased sodium consumption and rising blood pressure is still not completely understood. It is known that excess sodium can cause the body to retain water. Extra water and sodium in the blood vessels means that the heart has to work harder to pump blood around the body.

Emerging research also suggests that a high-salt diet can stiffen the aorta and other central arteries, which could put increased pressure on blood flow.

Kidneys are vital to controlling blood-pressure levels because they remove extra sodium from the body and work to maintain a proper balance of sodium. Consuming excess sodium makes the kidneys work harder, and, in simple terms, can make them function less efficiently.



A safe solution Most medical experts agree that government- and industry-led efforts to reduce sodium in packaged and processed foods won't cause Canadians to become sodium- or iodine-deficient, because the mineral is ubiquitous in the food supply.

***

Our sodium levels

The average Canadian consumes twice the recommended amount of sodium per day - men more than women, with teenaged boys by far the worst offenders.



Recommended daily intake (amount of sodium adequate to good health), by age group:

  • Ages 1-3: 1,000 milligrams (less than half a teaspoon of salt)
  • Ages 4-8: 1,200 mg
  • Ages 9-50: 1,500 mg
  • Ages 51-70: 1,300 mg
  • Over age 70: 1,200 mg


Daily tolerable-consumption limit (highest amount of sodium before significant risk of compromising health), by age group:

  • Ages 1-3: 1,500 mg
  • Ages 4-8: 1,900 mg
  • Ages 9-13: 2,200 mg
  • Ages 14 and older: 2,300 mg (roughly one teaspoon)

Actual average daily sodium intake in Canada, excluding salt added while cooking or at table:

  • 3,092 mg


Actual average daily sodium intake in Canada by age group and gender, excluding added salt:

  • Ages 1-3: males, 1,918 mg; females, 1,918 mg
  • Ages 4-8: males, 2,677 mg; females, 2,677 mg
  • Ages 9-13: males, 3,513 mg; females, 2,959 mg
  • Ages 14-18: males, 4,130 mg; females, 2,938 mg
  • Ages 19-30: males, 4,066 mg; females, 2,793 mg
  • Ages 31-50: males, 3,607 mg; females, 2,806 mg
  • Ages 51-70: males, 3,334 mg; females, 2,573 mg
  • Seniors over age 70: males, 2,882 mg; females, 2,300 mg

Source: Statistics Canada's Canadian Community Health Survey



Carly Weeks is a reporter for Globe Life.

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