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Hypertension Library: Care of Hypertension

Scouting for Sodium

By Paula Kurtzweil

Label changesThe role of sodiumAlternatives to high-sodium foodsOther informationFood label claimsNutrient claim guide

For years, consumers watching their sodium intake have had to plod through ingredient lists on many food labels like high school students through a Shakespearean play. They had to read a lot of unknown words and then do plenty of guessing.

Aiming to get some idea of a food's sodium content, consumers knowledgeable about sodium-restricted diets looked for names like sodium caseinate, monosodium glutamate, trisodium phosphate, sodium ascorbate, sodium bicarbonate, sodium stearoyl lactylate, and other sodium-containing ingredients, including salt (sodium chloride).

It wasn't easy, and it wasn't always accurate. Elizabeth Adams of Highland, Md., can vouch for that. She started to limit her sodium intake 23 years ago. She recalled spending "a long time" in grocery stores reading ingredient lists and looking for nutrition information, which then was voluntary and, until recently, appeared on only about 60 percent of food labels.

"I got to the point where I didn't buy a food unless it had only one ingredient or carried nutrition information," she said. "I had no idea otherwise how much sodium the food had in it."

Resorting to such measures will no longer be necessary for the nearly 50 million Americans like Adams who suffer from hypertension (high blood pressure) and the many others who want to reduce their risk for it. The food label they depend on to help monitor their sodium intake — and thus control their blood pressure — now must state how much sodium a food contains per serving and how the food fits in with their daily diet.

Label changes

These requirements are the result of the Nutrition Labeling and Education Act of 1990 and regulations from the Food and Drug Administration and the U.S. Department of Agriculture. Under these regulations, consumers are seeing:

  • Nutrition information in bigger, more readable type on almost all packaged foods. It appears in the table headed "Nutrition Facts," which is usually on the side or back of the package. Nutrition information also will be available in stores near many fresh foods, like fruits and vegetables.

  • "% (percent) Daily Values," which tell consumers at a glance the levels of important nutrients in a food and how those amounts fit into a daily diet.

  • Serving sizes that closely reflect the amount people actually eat.

  • Strictly defined nutrient-content claims, like "low-sodium," "salt-free," and "rich in potassium." This means that when consumers see such claims, they can believe them.

  • Strict rules for using health claims, such as one that links low-sodium diets to a reduced risk of high blood pressure.

The role of sodium

Some of the information — particularly that pertaining to sodium content — will be of special interest to people with high blood pressure.

Sodium has long been a major dietary factor in reducing the risk of, and controlling, high blood pressure. This role was reiterated in January 1993 in the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The committee noted that numerous studies have shown that reducing sodium intake can reduce blood pressure.

What is a reduced sodium intake? According to Camille Brewer, a registered dietitian and nutritionist in FDA's Office of Food Labeling, therapeutic sodium-restricted diets can range from below 1,000 milligrams (mg) to 3,000 mg a day.

"American adults, on average, eat too much sodium — between 4 to 6 grams (4,000 mg to 6,000 mg) daily," she said. "Most people would benefit from moderately reducing their sodium intakes."

Brewer advises people who are considering a sodium-restricted diet to consult a physician, dietitian or nutritionist first.

Under FDA's food labeling rules, the Daily Value for sodium is 2,400 mg. FDA established this value because it is consistent with recommendations and government reports that encourage reduced sodium intake.

Salt and other sodium compounds used in food processing are the biggest contributors of sodium to most people's diets, Brewer pointed out. (One teaspoon of salt has about 2,000 mg of sodium.)

These substances are used in food processing for preserving, flavoring and stabilizing other ingredients, she said.

"That's why the ingredient lists of canned, frozen, and other processed foods often contain the names of so many sodium compounds," she said.

Also, kosher beef, lamb and chicken have salt added.

Sodium also is present naturally in some foods, such as milk, cheese, meat, fish, and some vegetables.

Alternatives to high-sodium foods

Weight Reduction
Label information about fat, calories and fiber also will be important for people with high blood pressure who are overweight. These are the nutrients of most concern to those trying to lose weight or control it.

Body weight, like sodium intake, often closely correlates with blood pressure: As weight goes up, blood pressure frequently does, too. If weight is reduced, blood pressure often goes down.

Other Nutrients
Hypertensives also may be interested in label information about potassium, calcium and magnesium. According to the Joint National Committee's report, evidence suggests that these nutrients may play a role in reducing the risk of high blood pressure. For this reason, nutrition experts often encourage people with hypertension to increase their intakes of these nutrients.

Information about a food's potassium and magnesium content is required on the Nutrition Facts panel only if the food contains added potassium or magnesium as a nutrient or if claims about those nutrients appear on the label. In all other cases, it is voluntary. When listed, potassium must appear below sodium on the Nutrition Facts panel, and magnesium must be shown in the list of vitamins and minerals.

The Daily Value for potassium is 3,500 mg. For magnesium, it's 400 mg.

Information about calcium is mandatory. It, too, appears in the list of vitamins and minerals. The Daily Value for calcium is 1 gram (g), or 1,000 mg.

%Daily Values
The place to begin is the "%Daily Value" column under Nutrition Facts. This column contains numbers that show whether a food is high or low in the nutrients listed. For people with high blood pressure, the %Daily Value for sodium is especially important.

If the %Daily Value for sodium is 5 or less, the food is considered low in that nutrient. So, the goal should be to select, as much as possible, foods that have a %Daily Value for sodium of 5 or less. The goal for the full day's diet should be to select foods that together add up to no more than 100 percent of the Daily Value for sodium.

People with high blood pressure also may want to check the %Daily Values for fat, fiber, calcium, and, if listed, potassium and magnesium. The goal for the full day's diet should be to select foods that together add up to no more than 100 percent of the Daily Value for fat and at least 100 percent for fiber and calcium.

Serving Size
Serving size information is important, too. It tells the amount of the food, stated in both common household and metric measures, to which all other numbers apply.

Under the new regulations, serving sizes are designed to reflect the actu

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