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Ask dietitian Leslie Beck

Leslie Beck

Leslie Beck The Globe and Mail

The average Canadian eats double the daily recommended salt intake. Leslie Beck takes your questions on limiting sodium

One thing's clear: Most of us consume way too much salt. "And it’s not just in junk food," writes Carly Weeks in Saturday's Globe and Mail. "Even foods promoted as low in fat, sugar and calories and so part of a healthy diet (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."

So, just how can you eat food that tastes good - and is convenient - without exceeding the daily limit?

Globe dietiatian Leslie Beck took your questions on how to control sodium in your diet.

For the past 20 years, she has helped thousands of individuals achieve their nutrition goals at her private practice in Toronto.

Ms. Beck writes Globe Life's weekly Food for Thought column and appears on CTV as Canada AM’s nutrition expert. Ms. Beck is the best-selling author of nine books on health and nutrition, most recently Heart Healthy Foods for Life (Penguin Canada 2009). Her web site is www.lesliebeck.com.

Editor's Note: globeandmail.com editors will read and allow or reject each question/comment. Comments/questions may be edited for length or clarity. We will not publish questions/comments that include personal attacks on participants in these discussions, that make false or unsubstantiated allegations, that purport to quote people or reports where the purported quote or fact cannot be easily verified, or questions/comments that include vulgar language or libellous statements. Preference will be given to readers who submit questions/comments using their full name and home town, rather than a pseudonym.

Mike writes: I was wondering if there is any other agent that can be substituted for baking powder and baking soda. Whenever I make homemade pancakes or waffles, an awful lot of baking powder goes into the batter. It would be great to have a substitute that would allow the batter to rise without the sodium. Thanks for your help.

Leselie Beck: Baking powder and baking soda both are leavening agents, which means they help baked goods to rise. One teaspoon of baking sodium contains 1259 milligrams of sodium and one teaspoon of baking powder contains 488 milligrams of sodium. Keep in mind that the amount of sodium you consume must be divided by the number of servings your recipe yields. If you want to substitute baking powder for baking soda, you need three teaspoons for every teaspoon of baking powder. In other words, you are not reducing the sodium content.

Because these ingredients are necessary for the quality and texture of baked goods and quick breads, I would use twice the amount of baking powder as baking soda (add 2 teaspoons of baking powder if the recipe calls for 1 teaspoon of baking soda) and I would omit the salt the recipe calls for.

If your recipe calls for 1 teaspoon of baking powder, you can use 1/4 teaspoon of baking soda plus one-half of a teaspoon of cream of tartar.

Rosalind writes: When checking labels at the store I have a difficult time trying to decide if I should buy something with less fat and more sodium or vice versa. Example: 2% cottage cheese has a lower amount of sodium vs. 1% cottage cheese. Which would be the better choice?

Leslie Beck: That’s a good question since it is important to reduce both saturated and trans fat as well as sodium when eating for a healthy heart. Ideally, you want to choose foods that are low in both of saturated plus trans fat and sodium. If you have high blood pressure, choosing lower sodium foods will be a priority, especially when comparing tow foods that have only small differences in saturated fat. Foods with a percent daily value (%DV) of 5 percent or less are considered low in these nutrients.

One-half cup (125 ml) of 1% cottage cheese has 459 milligrams of sodium and 0.7 grams of saturated fat. The same amount of 2% cottage cheese has 373 milligrams of sodium and 1.1 grams of saturated fat. If sodium is your top priority, I would opt for 2% cottage cheese and limit your serving size to one-half cup. The difference in saturated fat isn’t enough to be concerned about.

At the end of the day, so to speak, what matters most is your overall intake of saturated fat and sodium – not necessarily the amount consumed in one food. When choosing foods, keep in mind your daily requirements: 1200 to 1500 milligrams of sodium (depending on age) and at most 20 grams of saturated plus trans fats, the two fats that raise LDL (bad) cholesterol.

Helen writes: I have genetically low blood pressure (on average 100/60 ... sometimes as low as 85/50), and I thought I ate fairly healthily and I exercise. Over the past 4 years my weight has increased 15-20% and I'm having a lot of difficulty taking it off. Until recently I have not paid a lot of attention to salt intake and before the Globe & Mail feature was not really aware of how much sodium there is in what I thought were healthy alternatives ...e.g., plain old All-Bran bran flakes. So my question is, if a person has blood pressure within or "lower than" acceptable levels, does salt intake above recommended levels pose a health risk in terms of coronary artery disease (which in my case is genetic)?

Leslie Beck: Your doctor should advise you on how much sodium you should consume each day. Based on the fact you have low blood pressure, you should not restrict your sodium intake to less than the recommended intake of 1200 to 1500 milligrams per day. I do think, however, it is important that you not exceed the daily upper sodium limit of 2300 milligrams. Beyond high blood pressure, a high sodium intake increases the risk of osteoporosis, kidney stones and water retention.

Susin writes: I'm wondering why, on cereal boxes, it will say "dry cereal" -- 7% (of your recommended daily intake of sodium - I'm using LIFE cereal as an example), then "10%" with 125 ml of partly skimmed milk. Milk has sodium? Is it naturally occurring?

Leslie Beck: Yes, some foods do have naturally occurring sodium in low amounts. Roughly 12 percent of the sodium we consume each day comes from milk, meat, poultry and some vegetables. For example, one cup (250 ml) of 1% milk has 107 milligrams of sodium, 3 ounces (90 grams) of cooked chicken breast has 66 milligrams and ½ cup (125 ml) of cooked spinach has 63 milligrams. The sodium you need to be concerned about is what is added to processed and prepared foods – 77 percent of our daily sodium comes from these foods. Read nutrition labels to compare brands of similar foods. Keep in mind that foods with a percent Daily Value (% DV) of 5% or less are low in sodium.

If you are looking for a lower sodium breakfast cereal, choose one with no more than 200 milligrams of sodium per serving. Some brands such as Post Shredded Wheat and Kashi Puffs have no salt added and, as such, contain no sodium.

Barb writes: After reading the article in the Saturday Globe on the high levels of salt in Cheerios, I checked the salt content in the other morning cereals on my shelf. I was surprised to find that all of them are using a daily allowance of 2500 mg of sodium rather than the 1500 that is quoted in the article. While I recognize that there are variations in the allowance, 1500 versus 2500 are substantially different. It basically means that when I read a package and just scan for the percent daily allowance I am getting the wrong impression, although admittedly I can compare similar products. Why is there such a discrepancy in the daily allowance for salt? How are the daily allowances for the nutrient information on packages determined? Are the daily allowances for other constituents as variable as that for salt?

Leslie Beck: I agree with you – most people do get the wrong impression when reading the daily value for sodium on nutrition labels. Currently, the daily value is 2400 milligrams – an amount that exceeds the needs of all Canadians. The reference standard for sodium was set in 2002 using the U.S. Daily Reference Value for labelling as Canada did not have a specific recommended intake level for sodium at that time.

In 2004, Recommended Dietary Allowances (RDAs) or Adequate Intakes (AIs) and safe upper intake levels for sodium (2300 milligrams) were published. For the first time, these established recommended intake levels for sodium in Canada.

These new recommendations have not yet been translated into labelling regulations in either Canada or the US. However, Health Canada recently established a multi-stakeholder Sodium Working Group to develop and oversee strategy for the reduction of the sodium content in the diets of Canadians. The Working Group is examining a number of issues related to helping Canadians reduce their sodium intakes, including labelling guidelines.

In the meantime, use the % DV for sodium as benchmark to determine if a food (one serving) has a little or a lot of sodium. Choose foods with a lower % DV for sodium (a % DV or 5% or less means that one serving of the food is low in sodium.)

Daily values for other nutrients are based generally on recommendations for a healthy diet; they are not based on a person’s individual requirements. The Daily Values for vitamins and minerals are based on the 1983 Recommended Nutrient Intakes for Canadians, and represent the highest recommended intake for each age/sex group, not including supplemental needs for pregnancy and breastfeeding. For example, the daily value for iron is 14 milligrams despite the fact that menstruating women require 18 milligrams per day and postmenopausal women and men need 8 milligrams. Confusing, yes. And outdated, yes.

Charles writes: I'm familiar with the reason iodine is added to salt (thyroid and brain development), but does the need for iodine persist in a 50-something guy like me? Secondly, I never use common table salt either when I cook or when I'm eating, because I assume I'm already getting more than enough salt from the packaged goods I buy (rice mixes, pasta, cereal, sauces & condiments, etc, etc). So, my bottom line question is that if iodine is still important in the diet of someone like me, can I assume that all of the salt in those packaged goods is iodized salt? If that is an unknown, then are there other sources of dietary iodine?

Leslie Beck: Yes, you assume correctly, iodized salt is used in Canada so you are getting plenty of iodine (and sodium) if you eat packaged, processed foods. (And there is no need to add salt to your foods.) Adults of all ages need 150 micrograms of iodine each day. The mineral is essential to make thyroid hormones, which regulate growth, development, reproduction, body temperature and metabolism.

Iodized table salt, seafood and plants grown in iodine-rich soil are good sources of iodine. (Sea salt does not contain iodine.) Most foods provide from 3 to 75 micrograms of iodine per serving. Fish and shellfish tend to be better sources of the mineral since they concentrate iodine from the ocean.

Jo writes: What IS the daily "limit" for salt, and why is there a limit for healthy, i.e. non-hypertensive, people? I wrote a piece perhaps 15 years ago for a national Canadian magazine, in which the dieticians I interviewed seemed to be telling me that unless you had a problem with hypertension, the salt you ingested simply got excreted one way or another. Is this no longer the received wisdom?

Leslie Beck: There are other health risks associated with consuming excessive amounts of sodium. A high sodium intake causes the kidneys to excrete calcium and may increase the risk of osteoporosis. Because a high-salt diet causes more calcium to be excreted in the urine and makes the urine more acidic, these two factors increase the likelihood of calcium salts crystallizing in the kidneys to form kidney stones. Consuming too much sodium can also worsen symptoms of premenstrual syndrome.

While hypertension is the greatest health risk, a high sodium intake can adversely affect your health in other ways too.

Shy Fly writes: Does 100% natural sea salt (Redmond's) create identical blood plasma results as NaCl (table salt)?

Leslie Beck: Sea salt is obtained by the evaporation of ocean water. Sea salt is about 98% sodium chloride, compared to table salt's 99.9% sodium chloride content. The remaining 2 percent can be minerals such as iron, magnesium, sulphur or iodine. Unlike table salt, which is mined from land-based sources, natural sea salt does not contain added sugar, anti-caking ingredients or iodine. However, its high sodium chloride content makes it comparable to table salt when it comes to affecting blood volume and blood pressure.

Peggy writes: If I rinse canned beans, e.g. kidney beans, before eating them, would I be removing a significant amount of the sodium content?

Leslie Beck: Yes, I always advise my clients to rinse canned beans in a colander before using them to remove excess sodium. You will save considerable sodium. You might also try cooking dried beans to avoid any added salt. All dried beans are prepared in the same way: first they are cleaned and soaked and then they’re cooked to make them ready for to add to soups, salads, pastas and casseroles.

Here’s a quick method: First place beans in a colander and rinse thoroughly under lukewarm running water (cold water can cause beans to become tough). Then you need to soak beans to rehydrate them before cooking, which reduces cooking time. Place cleaned beans in a large pot with three times the volume of cool water. (Beans double in size after soaking.) Bring beans and water to a boil for two minutes and then remove from the heat. Cover and let stand for one hour. After they have soaked for one hour, drain and rinse in a colander. They’re ready to eat!

Steve writes: How do you make soups without soup cubes? There is 1,600 mg in a cube and almost every recipe for 4-6 cups of soup calls for a cube. I heard that you can make preserves with a pressure cooker, so am interested in whatever you have to say about that too.

Leslie Beck: I have to agree that homemade soup needs some salt to taste good. For your stock, consider using one part low sodium broth and one part water. Another trick that many of my clients practice: save the leftover water from steaming vegetables to use for soup stock. (It freezes well.) It adds flavour to soup without adding any sodium.

You might also try using half a cube for the called for water or liquid. Or look for brands of liquid bouillon or bouillon sachets that are sodium reduced (usually 25% less sodium).

Dianne Smith writes: Three months ago I was told by my Dr. to reduce my sodium intake to 1000-1500mg per day. The reason is I am prone to kidney stones. I have not cooked with salt for 33 years but I was shocked at the sodium content on food items.

1. I cannot find online a chart of the amount of sodium in fresh foods. Could you provide some resources to help with keeping track of daily sodium totals.

2. It is very difficult to eat out, do you have any suggestions?

Leslie Beck: Here is a link to Health Canada’s online nutrient data base that allows you to search the nutrient content of foods.

http://webprod.hc-sc.gc.ca/cnf-fce/index-eng.jsp

Yes, we have no idea what’s in a meal ordered in a restaurant since nutrition information is not printed in menus. Some chain restaurants have nutrition information online and I encourage you to check this out before you go. The amount of sodium in many menu items is pretty shocking. I learned this first hand in 2007 In the fall of 2007 when I teamed up with the Globe and Mail and CTV Canada AM to commission an independent lab to analyze popular restaurant meals at four national chains – Kelsey’s, Jack Astor’s, Milestones and the Keg. Just about every menu entrée came in over 1000 calories. Sodium ranged from a low of 245 milligrams (for a lightly dressed salad) to a high of 4550 (chicken fajitas). The meals we analyzed were piled high with calories – and most also provided more than an entire day’s worth of fat, saturated fat and sodium.

Here are a few tips to help you navigate restaurant menus:

• Stay clear of menu items described as pickled, marinated, smoked, barbequed, smothered(in sauce), teriyaki, soy sauce, broth, miso, gravy, bacon, and salted or salty. These words indicate higher sodium meals.

• Avoid using the salt shaker. Taste a few bites before you automatically salt your meal. Chances you’re your meal doesn’t need an extra dash of sodium.

• Order dressings, gravies and condiments on the side. Salad dressings, barbecue sauce, ketchup, mustard and pickles can add considerably to the sodium content of a meal. Request them separate from your meal and use them sparingly.

• If ordering pizza or a burger, skip the cheese or bacon which not only add saturated fat but pile on the sodium too.

• Request that your meal be prepared without added salt, MSG or sodium containing ingredients such as soy sauce and broths.

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A family's struggles with sodium

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A video documentary from Globe photographer Deborah Baic takes you inside the home and hearts of the Quebec family as they deal with consequences of Canada's high-sodium diet

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How salt affects your body

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A family's struggles with sodium

A video documentary from Globe photographer Deborah Baic takes you inside the home and hearts of the Quebec family as they deal with consequences of Canada's high-sodium diet

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