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The Dose Transcript for March 15, 2023

Host: Dr. Brian Goldman

STORIES FROM THIS EPISODE

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. Do you know how much sodium you eat in a day? The World Health Organization recently weighed in on the health risks of too much salt. And it turns out that most Canadians consume something close to twice as much salt as they should. So for the good of our health, we're asking, how can I cut down on salt in my diet? Hi, Samantha. Welcome to The Dose.

SAMANTHA CHABOIR: Hi, Brian. Thanks for having me on the show today.

BRIAN GOLDMAN: Great to have you. I just wanted to ask you, you know, to what extent do you track the salt that you eat in a typical day?

SAMANTHA CHABOIR: You know, I don't actually do any tracking, per se. As a dietitian, I do tend to read food labels before I bring foods into the house. But, you know, just like most people, I might find myself overindulging at times. And I think, you know, I like a good, salty treat every now and then, too. So I'm not immune to getting salt and sodium in my diet in general.

BRIAN GOLDMAN: What are some of your salty pleasures?

SAMANTHA CHABOIR: Oh boy. I like a sweet and salty combination. That's my absolute favorite. So that Chicago mixed popcorn with caramel, which is that That's my kryptonite.

BRIAN GOLDMAN: Kryptonite. I like that. And a little bit of salted caramel. That's what I like. It sounds like you're the perfect person to date to have this conversation. But before we begin, can you give us a. Hi, my name is. Tell us what you do and where you do it. Just ad lib.

SAMANTHA CHABOIR: Sure. So my name is Samantha Chabior. I'm a registered dietitian at a cardiology clinic in a Toronto hospital, and I also run a website called The Heart Healthy Plate. So my work is really focused on helping people make heart healthy food choices.

BRIAN GOLDMAN: And and that's going to come into our conversation. That's very important because of the strong link between salt intake and cardiovascular disease, which we will get into in just a moment. But I want to begin with that World Health Organization report that says Canadians, on average eat just under two teaspoons of salt per day, while the recommends eating only or consuming only one teaspoon. So first of all, in general terms, what are Canadians eating that puts them so out of line with the World Health Organization?

SAMANTHA CHABOIR: Well, you know, majority of the sodium in Canadians diets is actually coming from processed and restaurant foods. So more than 70% of the sodium in our diets is actually coming from those food sources. I think most people assume it's coming from table salt, but that's actually contributing a much smaller amount of sodium to our diets. So those are the types of foods that are really driving up our sodium intake.

BRIAN GOLDMAN: And when you talk to your patients and I'm assuming these are patients who are either at risk of strokes and heart attacks or perhaps had them congestive heart failure, when you when you talk to them, what's their reaction when you explain how little salt they should be consuming?

SAMANTHA CHABOIR: I think for most people they are quite surprised. A common response I get is, wow, why is there so much sodium in the foods that I'm eating, especially restaurant foods, which can be quite shocking if, you know, if our our limit is under one teaspoon of table salt a day. It's easy and common to have that much an entire meal or more in a restaurant meal. So I think that that's often a big surprise for people.

BRIAN GOLDMAN: Do you happen to know why the World Health Organization chose that five grams per day number?

SAMANTHA CHABOIR: Yeah, well, we know that having too much salt is not good for our health. So obviously, especially our cardiovascular health, as you alluded to earlier, and this goal of less than five grams of salt per day or a little less than a teaspoon of table salt can actually help lower our risk of negative health outcomes by lowering blood pressure and reducing risk of heart attack and stroke. So really, that's the main benefit of achieving this target, is that it helps lower blood pressure. And I think, you know, in the report it's quite fascinating. They actually call sodium reduction measures a life saving strategy, which is, you know, kind of shows how important this topic really is.

BRIAN GOLDMAN: Which is why we're talking about it. But before we talk about the dangers of salt and the need to cut back, can you remind us why salt is important? Why do we need sodium chloride?

SAMANTHA CHABOIR: Yeah. So like you just mentioned, so salt is made up of sodium and chloride. So about 40% of salt is actually sodium. And we often use the words salt and sodium interchangeably. But really, it's it's sodium that is an essential nutrient for our bodies to function. So that means we do need to get some sodium in our bodies to work properly. And sodium is involved in muscle and nerve function and in regulating the amount of fluid and minerals in our body. So we really can't live without some sodium in our diet.

BRIAN GOLDMAN: Is there any danger? I mean, I've certainly seen patients in the emergency department who have low sodium hyponatremia. So just briefly, what are what are some of the dangers of consuming too little salt?

SAMANTHA CHABOIR: Yeah. So definitely there is a risk if you eat too little salt because. It is involved in so many important functions of the body. But for the majority of people, it's quite uncommon to get too little salt in the in the diet because we don't need too much sodium for a body to function. So it's actually easy to get the minimum requirements. But there are certain cases, like you mentioned, where people might need to worry about getting too little salt. So certain medical conditions or medications. Older adults, definitely. If you're having a lot of increase losses of sodium, so diarrhea, vomiting, excessive sweating. But in general, the concern for most people is getting too much salt because, as you mention, you know, most Canadians are getting more than double the recommended daily amount of sodium.

BRIAN GOLDMAN: What are some of the biggest hidden sources of sodium in the foods that we tend to love to consume?

SAMANTHA CHABOIR: Yeah. So as I mentioned, I think that most people first associate sodium with table salts. But in reality, more than 70% of the sodium in our diets is coming from those processed, packaged and restaurant foods. So really, the three key big categories of foods that contribute the most sodium to our diets are bakery products, these mixed dishes and processed meats. So bakery products are going to be things like our breads, muffins, crackers and cookies. And I think that's really the one that surprises most people because these foods don't actually taste very salty. So I like to kind of call them sneaky sources of sodium because they're really unexpected, are mixed dishes are going to be like pizza, lasagna, frozen dinners and then processed meats. So sausages, deli meats. And then in addition, we've got your soups and cheese and sauces and condiments that also are big contributors to our diets.

BRIAN GOLDMAN: What about breakfast cereals?

SAMANTHA CHABOIR: Yeah, those are actually they can vary quite a bit, but they can be actually surprisingly sometimes high in sodium, too.

BRIAN GOLDMAN: And what is happening inside our bodies when we eat too much salt.

SAMANTHA CHABOIR: Sodium actually makes our body hold on to water. So when we eat too much sodium, it can cause extra fluid to be pulled into our blood vessels and putting that extra pressure on our blood vessels. So over time, this can lead to damage to the blood vessels, making them harden and stiffen and that can lead to high blood pressure are also known as hypertension over time.

BRIAN GOLDMAN: And so, so high blood pressure. When I think high blood pressure, I think heart attacks and strokes are those the two biggest health conditions that we need to worry about?

SAMANTHA CHABOIR: Absolutely. Those are the biggest risks when it comes to getting too much sodium. You know, in addition to that, there is also research linking too much sodium to stomach cancer and osteoporosis. So there are many benefits to cutting back on our salt intake. And the interesting thing is, I think a lot of people also ask me, you know, what, if I have normal blood pressure? Is this still important to me? And even, you know, the answer is yes. Even generally, healthy people with normal blood pressure benefit from less sodium to lower their risk of these chronic diseases.

BRIAN GOLDMAN: And I would add congestive heart failure, heart failure to to the list of conditions that that could be precipitated by too much salt. I guess I'm now I want to drill down to some of the advice that you're giving people when you're telling them, you know, they've had a stroke or they've they've had a heart attack or they've got severe high blood pressure. What are you telling them about salt consumption and what that can do to to the conditions that they already have?

SAMANTHA CHABOIR: Yeah, absolutely. So it can definitely worsen these conditions. So you mentioned heart failure, hypertension. So these particular conditions are affected and made worse by having too much salt in the diet. So just how I mentioned, you know, sodium causes that fluid retention and increase in blood pressure. So these groups really would need to pay extra careful attention to the sodium in their diet. And of course, if someone's had a heart attack or stroke, these are important considerations for them to to take into account in the future as well for their diet.

BRIAN GOLDMAN: When I was listening to the to the list of of foods, particularly the sneaky foods that you were talking about that contain too much salt, I was also wondering whether they're also high in fats, trans fats, sugars. And, you know, is there a kind of a double whammy to your health to consuming these, that it's not just the salt, but it may be something else in the food that's also putting your health at risk?

SAMANTHA CHABOIR: Absolutely. You know, many of these processed foods are not just high in sodium or salt, but also the fats and the sugars. They tend to be quite devoid of those good beneficial nutrients like fiber and vitamins and minerals. So there's definitely, I think, a complex picture at play here and a combination of of the high sodium with with some of these kind of less desirable nutrients can definitely put people at risk for weight gain and, you know, diabetes. So I think that it's a complex kind of situation for sure. But many of these foods take. To be high in sodium and other nutrients such as sugar and saturated fat. Like you mentioned.

BRIAN GOLDMAN: We're talking about salt in a vacuum or by itself. And people aren't equal. They don't bring the same genetic risks to to the and other risks for that matter, too, to the table. So are there some people who are more at risk than others when it comes to to salt intake, where there are some people who need to be more careful and perhaps some people don't have to be as careful.

SAMANTHA CHABOIR: Yeah. So so definitely, you know, there may be this genetic component to how people are responding to salt. So call them kind of salt sensitive. So these people may experience a greater increase in blood pressure if they if they have a higher amount of sodium. And so they may benefit more from that reduction in sodium. And in general, overall, you know, we all benefit to sticking within the sodium limit, but perhaps certain people may be even at higher risk when it comes to the access sodium intake.

BRIAN GOLDMAN: Okay. So let's talk about your advice. How how do you get people to begin the process of cutting down on salt?

SAMANTHA CHABOIR: Yeah. So the most simple answer, which is unfortunately not that simple to implement in reality, but in theory is as simple as to try and cook more at home and try to use those minimally processed ingredients. So trying to limit how often we eat at restaurants is also very key. Focusing on are whole foods, so whole fruits, veggies or whole grains, legumes, nuts and seeds, and then unprocessed meat, poultry and fish. So those are really going to be key. And then I also think it's really important to get in the habit of tasting our food before we add salt to it. So many people just, you know, add the salt shaker before they actually even taste their food. Usually it's salty enough and then definitely becoming a salt savvy consumer. So get comfortable with reading food labels. That's a key part of the education I provide in my practice food labels and can actually require the sodium content of the food to be listed and the percent daily value on the nutrition facts table is really helpful in understanding the sodium content of foods. So the percent daily value can tell you if there's a little or a lot of a nutrient in the food. And when you see 5% or less for sodium, that means the food is low in sodium. And if it contains more than 15% of the daily value, that means it's high in sodium. So this can be a really great way to cut down on high sodium processed foods.

BRIAN GOLDMAN: So that's what you're doing while you're grocery shopping. What about if you're going out to eat? Can you assume that you're going to be consuming more, more sodium, more salt, or are there menu items that you can pick that might be lower in salt?

SAMANTHA CHABOIR: Yeah, When you're going out to eat at restaurants, it is challenging to stay within that limit for sure. It's you know, they're notoriously high in sodium and oftentimes I'm even shocked at how high in sodium these meals can be even surprising. Things like salads can actually be high in sodium. So, you know, I think rather than kind of generalizing, you know, this food tends to be lower in sodium, you know, being aware of what are those hidden sources of sodium that could be adding extra salt to our diet. So whether it's the breads that are part of our appetizer or dips, if their sources are gravies, trying to ask for those on the side, those are little tips that people can implement if they're going out to eat. If there is nutrition information available online, try and check it out before you go to the restaurant, too. That's a really key piece of advice.

BRIAN GOLDMAN: Is it helpful to look at your total daily salt intake so that if you are indulging in a restaurant meal, you can cut back for the rest of the day and maybe things would even out?

SAMANTHA CHABOIR: You know, I think that all of our foods can really fit. I mean, obviously with certain medical conditions, we might need to tweak things a little bit more, kind of reduce the portions and the frequency. If we're using that percent daily value that I mentioned to guide our food choices. And we're mostly choosing foods that have less than 5% of the daily value for sodium or minimally processed, and we're mostly cooking at home, That will definitely leave some more room in our diet for higher sodium foods or meals, you know, So it's okay to go out sometimes with friends or family and enjoy ourselves or have a salty treat. You know, I mentioned my Chicago mix popcorn that I love. It's definitely a normal part of healthy eating, but just being careful with the amount and how frequent we have it is really the key.

BRIAN GOLDMAN: So how frequent is safe? Because, you know, I know people who have a fast food meal every day.

SAMANTHA CHABOIR: Yeah. I don't think that there's going to be, you know, one rule that's going to work for everyone. I usually say however little you can have while still enjoying your life, you know what is the lowest you can go? That is the number we should aim for. Also, if we do have to eat out more often, I'm thinking about our truck drivers, for example, or people that travel often and they have to rely on some of these meals, you know, trying to make a conscious effort to choose the low sodium options. I think that will definitely have a big impact.

BRIAN GOLDMAN: Home cooking certainly from what you've said is is the safest option or allows the safest potential or the biggest potential for for reducing sodium in your diet. You know, I'm thinking about how tasteless food might seem when you really start to cut back salt. Are there substitutes that you can use that can add flavor to your meal without without the salt?

SAMANTHA CHABOIR: Absolutely. It's definitely possible to add flavor without salt. And, you know, we definitely want to enjoy our foods. That's that's a part of life is just enjoying our food. Some people are foodies. They can't imagine sacrificing flavor. You don't have to sacrifice flavor when you reduce salt. In fact, I think many people find they certain flavors are enhanced when they're kind of cut. Bring back the salt. So some some little tips that you can use when you're actually cooking at home is using some acidic ingredients. So things like vinegar, lemon, lemon zest, aromatics. So things that smell really nice when you cook them up like ginger, garlic and onion, fresh and dried herbs and spices that we mix up ourselves. There are also mixed seasoning blends that are salt free already, so pre-mixed for veggies or meat and for some people potassium salt substitutes. So we talked about sodium chloride being salt. So they're salts made from potassium chloride and those could be an alternative as well. It's also important to be aware of like other sources of sodium that, you know, could be coming in. So things like sauces and condiments or soy sauce. And then if you do cook with salt, because inevitably we're allowed to have some salt in our diet, maybe measuring it out and trying to use less, maybe start by cutting down by just a quarter of a teaspoon in your cooking and and then kind of go from there.

BRIAN GOLDMAN: You know, we had we had another guest on a few months back who said that, you know, one way to cut out, you know, if you like sweet tastes and you're trying to cut artificial sweeteners out of your out of your diet, if you do it gradually, it's a lot easier. Are you saying it's the same thing when it comes to salt?

SAMANTHA CHABOIR: Yes, I think most people would find that gradual reduction tends to be easier. So cutting down a little by a little, the small changes really do add up. We don't have to go all or nothing. Of course, there are certain medical conditions that might warrant us to try and cut it out a little bit faster to get, you know, maybe your blood pressure down or or whatnot. But gradual approaches do tend to be maybe the most well tolerated or enjoyable for people. But, you know, over time, we do adapt to the lower sodium amount.

BRIAN GOLDMAN: What we're talking about here is is voluntarily reducing salt in your diet. And right now there are no government restrictions on how much salt can be put into food. Would that would that help? Some groups are certainly pushing for a reduction in salt contained in in processed foods. Do you think that would help?

SAMANTHA CHABOIR: Yeah, you're right. So currently Health Canada only has these voluntary sodium reduction targets for certain processed foods. And and there's a mandatory declaration to declare how much sodium is in a food on the food label. And we know that with these voluntary policies, they've been in place for some time now. But unfortunately, we haven't seen a big reduction in the sodium content of our processed foods. So the W.H.O. actually encourage government led mandatory sodium reduction policies in their report because they've been shown to be more effective than these voluntary policies in addition to, you know, these other measures, of course. But I think, you know, if we we were to ask food companies to voluntarily reduce the salt in these foods, they may have concerns about how it might affect consumer demand for the product. So if we have these mandatory sodium reduction policies in place, then it could kind of level the playing field for all of the food companies. And then it just makes it that much easier for Canadians to get less sodium in their diets.

BRIAN GOLDMAN: We started early on by me asking you about about the patients that you counsel and how surprised they are when they when they're told how little salt they should be consuming. When you do advise them, do they take your advice?

SAMANTHA CHABOIR: I would say that majority of the people that I see are quite motivated to make changes. You know, if someone suffered a heart attack or a stroke, you're you're kind of in a different mindset. So motivation tends to be pretty high for most people. I think for for everyone, it can be challenging to cut back because sodium is found in in so many different foods. So and it tastes good. You know, we like the taste of it so it can be hard to reduce. And also, you know, our incomes can be playing a role to these processed foods tend to be usually a little bit cheaper, more more affordable. So depending on someone's income or lifestyle, it might not be as feasible to cook more at home. But I would say for most people, they're able to reduce their sodium and they don't find that it's too painful. Eventually, they do get used to to this less salt in their diet.

BRIAN GOLDMAN: It sounds like you don't hit people over. They had just beginning the conversation by thinking about the salt that you consume in your diet puts you on the path to to reducing it. Do you think I'm right?

SAMANTHA CHABOIR: Yes, for sure. You know, I think just getting the ball rolling and I think once people have their eyes open to how much sodium is in their foods, they're they're pretty open to making changes. But I think the voluntary changes, that's that's definitely a big component of what I am obviously focused on in my work. But these mandatory practices are mandatory reduction policies, I should say. They could definitely make it just easier for. For most people because the foods they would be buying are already lowering sodium.

BRIAN GOLDMAN: Well, Samantha, I want to thank you for laying out the case for reducing salt in our diets. And you certainly got me convinced. And I want to thank you for speaking with me.

SAMANTHA CHABOIR: Thank you so much for having me.

BRIAN GOLDMAN: Samantha Shabbir is a registered dietitian in Toronto. Here's your dose of smart advice. Canadians consume just over nine grams of salt per day, nearly twice as much as recommended by the World Health Organization. Only about 12% of our daily intake of sodium comes from the saltshaker. The lion's share roughly three quarters of our salt intake comes from processed and restaurant foods, especially fast food foods. Do not have to taste salty to be high in sodium. Bakery items like breads, muffins, bagels and even breakfast cereals are among the culprits. Salt contributes to high blood pressure by pulling fluid into our blood vessels, causing them to stiffen. High blood pressure can lead to strokes and heart disease. Too much salt can also affect the health of your bones. Although people with a family history of high blood pressure are at greater risk, it's important that everyone reduce their intake of salt. The most effective thing you can do to lower salt intake is to have fewer restaurant meals and to prepare more of your meals from scratch at home. Try cutting down on processed foods and on hidden sources of salt like baked goods and cereals. Read The labels are prepared foods you buy. Any foods that contain 5% or less of your daily sodium intake are low in salt. If you want to add some tastier meals, try adding ground pepper vinegar, lemon fresh or dried herbs and spices, garlic, onion or ginger. Changing your eating habits takes some getting used to. The payoff in terms of better health could be life-saving. If you have topics you'd like discussed or questions answered, our email address is the dose at cbc.ca. If you like this episode, please give us a rating and review wherever you listen. The dose was produced this week by Isabelle Gallant. Our senior producers, Colleen Ross. The dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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How can I cut down on salt in my diet?- Transcript

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