Dietary Salt, TOO much or TOO little?

Today's Health Tip would have to fall under the "more research is needed" category. Nevertheless, recently published studies regarding salt intake and health are helping to define the optimal amount of salt that we should be eating and are worth considering at this time.

What is salt? Common table salt is a mineral made up primarily of sodium chloride (NaCl).The sodium (Na) component of salt is essential to human life, as it is required for important functions such as muscle contraction, including heartbeat, and nerve conduction. Too much sodium in the body, however, has been linked to health risks, such as high blood pressure, stroke, and heart disease. Each gram (1000 mg) of table salt contains approximately 400 mg of sodium. As a reference, one teaspoon of salt is equal to approximately 6 grams of sodium chloride or 2,360 mg of sodium.

What is the "party line" regarding salt intake? The U.S. Centers for Disease Control and Prevention (CDC) has taken the position that 90% of adults in the U.S. consume more sodium than is recommended. The current average intake of sodium per day in the U.S. is around 3400 mg or 8.5 grams of salt. The CDC recommends that the maximum sodium intake among the general population should be 2300 mg, or approximately one teaspoon of table salt a day. For specific high-risk groups, such as African Americans or individuals with high blood pressure, chronic kidney disease, or diabetes, the CDC recommends eating no more than 1500 mg of sodium per day. The American Heart Association (AHA) is even more restrictive, advising everyone to limit his or her sodium intake to 1500 mg per day.

Where does sodium come from in the diet? In a survey of American households from 2007-2008, it was determined that 44% of the sodium consumed came from 10 food categories: bread and rolls, cold cuts/cured meats, pizza, poultry, soups, sandwiches, cheese, pasta mixed dishes, meat mixed dishes, and savory snacks. Around two-thirds of this sodium came from foods obtained from stores, such as supermarkets or convenience stores with 25% coming from restaurants.

What is the harm of eating too much salt? Many studies have demonstrated a direct relationship between sodium intake and high blood pressure, which is a well-known risk factor for the development of coronary heart disease, stroke, and chronic kidney disease. Several countries that have sponsored campaigns to reduce salt intake have reported marked lowering of disease linked to excess sodium. In Japan, a public campaign resulted in a reduction of sodium intake from 13.5 to 12.1 grams per day. Following this modest reduction, an 80% reduction in stroke mortality occurred. In Finland, a gradual reduction in salt intake by one-third occurred over a 30 year period. This was accompanied by a 75 to 80% reduction in deaths from stroke and coronary heart disease, along with a 5 to 6 year increase in life expectancy. A study in the U.S. found that by reducing dietary salt to 3 grams (1200 mg of sodium) per day that we could reduce the number of heart attacks each year by up to 100,000 per year and strokes by up to 66,000 while saving anywhere from 10 to 24 billion dollars in health care costs.

Recent studies that have "rocked the boat". Unfortunately, not all of the recent research agrees in terms of the optimal amount of sodium that we should be eating. Two recent studies published in the Journal of the American Medical Association suggest that there is a minimal level of salt consumption, higher than the amount suggested by the CDC, that is protective in terms of the development of heart disease. These studies (not surprisingly being heartily endorsed by the Salt Institute), seem to indicate that for "normal" people, without problems such as hypertension or heart failure, more liberal salt consumption is not as great a concern as has previously been thought. One kidney specialist has proposed a compromise between the CDC's position and the recent contradictory studies, suggesting that people who are not in a high-risk group should aim for a salt intake of no less than 3 grams (1200 mg of sodium) per day and no more than 7 grams (2800 mg of sodium) per day.

How can sodium consumption be reduced? In those who need to restrict their sodium intake, paying attention to the 10 "salt offenders" mentioned above is a great place to start. Processed foods such as pre-prepared dinners, cold cuts and bacon, cheese, and soups are particularly high in sodium. Two of the leading sources of sodium in restaurant food come from pizza and poultry items. Other suggestions are to limit sodium-laden condiments such as soy sauce, salad dressings, dips, ketchup, and mustard, and to use herbs or spices instead of salt to season food. The Institute of Medicine has called on the government, public health groups, and consumer agencies to help also with the problem of excess sodium in foods that we consume. They would like to see the U.S. Food and Drug Administration develop a national standard for the sodium content of foods and are asking the food industry to voluntarily reduce the sodium content of food.

Setting standards would be much easier to accomplish, of course, if we knew exactly how much is enough and how much is too much. Hopefully, ongoing research will provide these answers. For the time being, however, the recommendations of the CDC, maintaining a salt intake around 6 grams (2300 mg of sodium) per day, seem to be appropriate. For those in whom excess sodium represents a health risk, such as anyone with high blood pressure, chronic kidney disease, or heart failure, sodium intake should be less than 1500 mg per day. Remember that the sodium that we receive in our diet comes not only from the salt added while cooking or at the table, but also from "hidden" salt in processed foods.

Nine things you should know about type 2 diabetes

According to the CDC, 25.8 million children and adults in the United States - representing 8.3% of the population - have diabetes. This represents an increase of roughly 15 percent in just the past few years. Unfortunately, there is a great deal of misunderstanding about this disease, some of which can lead to a delay in diagnosis and worsening of complications. More importantly, people who can be identified as being at risk for developing diabetes may have an opportunity to prevent the disease from occurring.

1. Type 1 and type 2 diabetes have different causes. Type 1 diabetes is a disease that develops when the body's immune system attacks the pancreas resulting in a deficiency of insulin. Without insulin, the body is unable to convert sugar and other starches into energy and the blood sugar can rise to dangerous levels. A person who has type 1 diabetes must take insulin on a regular basis to live. Only about five percent of all people with diabetes have type 1 diabetes. Type 2 diabetes, affecting about 95% of diabetics, develops over time due to genetics and lifestyle factors. These factors include physical inactivity and poor diet. In type 2 diabetes, the cells don't recognize and properly use the insulin that the body produces, a problem known as insulin resistance.
   
   
2. Certain people are at higher risk of developing type 2 diabetes than others. This includes those people with: 1) a family history of the disease, 2) excess body weight, 3) low physical activity, 4) high blood pressure, 5) abnormal blood lipids (HDL under 35 mg/dL or triglycerides higher than 250 mg/dL), and 6) diabetes during a previous pregnancy. People over the age of 45 and certain ethnic groups, including African Americans, Hispanic Americans, Asian Americans, and Native Americans, are also at increased risk of developing type 2 diabetes.
   


3. Many people with type 2 diabetes do not realize that they have it. Symptoms most commonly associated with type 2 diabetes include feeling thirsty, having to urinate more than usual, staying hungry, tiredness, and losing weight without trying. Many people with type 2 diabetes, however, have no symptoms at all. According to the American Diabetes Association, about 16 million people in the United States, or approximately one-third of all people with diabetes, are unaware that they have it.
   
   
4. Before developing type 2 diabetes, most people have a condition known as "prediabetes". In prediabetes, blood glucose levels are higher than normal but not high enough to be diagnosed as having diabetes. Approximately 79 million people in the United States have prediabetes. Although prediabetes is usually not associated with symptoms, long-term damage to the body, especially the heart and circulatory system, may already be occurring.
   
   
5. Complications of diabetes can affect many areas of the body. Sugar or glucose that is not converted into energy by the cells can damage the blood vessels, heart, nerve endings, kidneys and eyes. This results in an increased risk of stroke, high blood pressure, blindness, kidney disease and amputations of the limbs. Fortunately, good control of diabetes can significantly reduce the risk of developing or worsening of complications. Consider these statistics related to diabetes-related complications:
   
   
   • Diabetes is the leading cause of blindness in adults.
     
     
   • Diabetes is the leading cause of kidney failure.
     
     
   • About 60% to 70% of people with diabetes have mild to severe forms of nerve damage.
     
     
   • The risk for stroke is 2 to 4 times higher among people with diabetes.
     
     
   • Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults who do not have diabetes.
     
     
6. Type 2 diabetes is not just an adult disease. In In the past, children with diabetes almost always had type 1, the variety that occurs when the immune system attacks the pancreas, resulting in insulin deficiency. Over the past decade, however, there has been a marked increase in the number of children and adolescents diagnosed with type 2 diabetes. Most of these cases appear to be related to a combination of obesity and physical inactivity. The actual number of children with type 2 diabetes may even be underestimated since it can remain asymptomatic and undiagnosed for a long time.
   
   
7. Diagnosing type 2 diabetes is easy. On One of the best and easiest ways to check for diabetes is by drawing blood from the arm after not eating for 8 hours and measuring the amount of glucose in the plasma. The American Diabetes Association recommends testing for diabetes every 3 years in everyone over the age of 45. The United States Preventive Services Task Force (USPSTF) recommends that people with blood pressure higher than 136/80 also be tested. Testing for diabetes should begin at a younger age in someone who is overweight and has risk factors, such as a parent with type 2 diabetes, or is a member of certain ethnic groups, including African and Native Americans.
   
   
8. A 3rd type of diabetes affects pregnant women. Known as gestational diabetes, this type of diabetes usually starts in the middle part of the pregnancy. Like type 2 diabetes, it is associated with insulin resistance and elevated blood sugar. The excess sugar in the bloodstream commonly causes the baby to grow too large (macrosomia). Potential complications of gestational diabetes include an increased risk of newborn death and stillbirth, delivery-related complications due the infant's large size, and an increased risk of the child developing diabetes later in life. All pregnant women should receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for the condition.
   
   
9. Type 2 Diabetes is often a preventable disease. The good news is that in many people with risk factors or who have prediabetes, type 2 diabetes can be prevented. In these people, moderate weight loss (10-15 pounds) along with 30 minutes of moderate physical activity (such as brisk walking) each day is often enough to prevent its development.
   

To learn more about type 2 diabetes, refer to the CDC's Diabetes and Me or see
Diabetes Basics sponsored by the American Diabetes Association.

Alcohol Abuse vs. Alcoholism

Moderate alcohol use—up to two drinks per day for men and one drink per day for women and older people—is not considered harmful for most adults (a standard drink is 12-ounces of beer, a 5-ounce glass of wine, or 1.5 ounces of distilled spirits). Many people, however, exceed this level of consumption and get into serious trouble because of their drinking. Currently, nearly 17.6 million adult Americans abuse alcohol or are alcoholics. Several million more adults engage in risky alcohol-related practices, such as binge drinking.

Alcoholism, also known as "alcohol dependence," is a disease that includes four symptoms:

• Craving - a strong need, or compulsion, to drink.


• Loss of control - the inability to limit one's drinking on any given occasion.


• Physical dependence - withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking.


• Tolerance - the need to drink greater amounts of alcohol in order to become intoxicated.

The craving that alcoholics experience may cause them to continue to drink despite serious family, health, or legal problems. Alcoholism has been shown to run in families, although having a family history of alcoholism does not mean that someone is destined to become an alcoholic also. As with other chronic illnesses, alcoholism cannot be cured, but is instead "managed". This typically involves abstinence from drinking alcohol.

Alcohol abuse constitutes many of the same traits as alcoholism, but unlike alcoholics, alcohol abusers may feel less of a compulsion to drink and may not experience withdrawal symptoms when they don't drink. Common characteristics of alcohol abuse include: (1) failing to fulfill major work, school, or home responsibilities because of drinking; (2) drinking in situations that are physically dangerous, such as while driving a car or operating machinery; (3) recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk; and (4) having social or relationship problems that are caused by or worsened by the effects of alcohol.

If you've ever wondered whether your drinking crosses the line into alcohol abuse or alcoholism, ask yourself these questions:

1. If you are a man, have you ever had five or more drinks in a day (four if you're a woman)?


2. Have you ever felt you should cut down on your drinking?


3. Have you been annoyed by people criticizing your drinking?


4. Do you ever feel bad or guilty about your drinking?


5. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Answering yes to the first question alone, or two positive responses to questions 2 through 5, indicates that you may have a problem with alcohol that needs to be addressed.

The consequences of alcoholism and alcohol abuse are serious, and in some cases, life threatening. Heavy drinking increases the risk for certain cancers, especially those of the liver, esophagus, throat, and larynx (voice box). It can lead to health problems, such as liver cirrhosis, brain damage, and harm to the fetus during pregnancy. In addition, drinking increases the risk of death from automobile crashes as well as recreational and on-the-job injuries. In purely economic terms, alcohol-related problems cost society approximately $185 billion per year. In human terms, the costs cannot be calculated.

Colorectal Cancer - Screening works!

For some time it has been known that the earlier that colon cancer is detected, the better the survival rate. For example, when colon cancer is diagnosed at an early, localized stage, the five-year survival rate is 90 percent, as compared to a five-year survival rate of only 10 percent when diagnosis is delayed until the later stages. Additionally, the earlier the diagnosis, the less invasive and dangerous the treatment becomes. If the cancer is found at a very early stage, it may be able to be removed without having to enter the abdomen surgically. More advanced stages of colon cancer usually require removal of a portion of the colon and chemotherapy.

What has been suspected, but not proven until recently, is that detection and removal of colon polyps can significantly reduce the number of deaths from colon cancer. The explanation for this is that colon cancer usually begins as a non-cancerous polyp on the inner lining of the colon or rectum. From the time the first abnormal cells start to grow into polyps, it can take up to 10 to 15 years for them to develop into colon cancer. Removal of these polyps before they have the chance to change into cancer can, in many cases, prevent colon cancer altogether. This is particularly true with a type of polyp known as an "adenomatous" polyp.

The study that demonstrated this improvement in survival was published last month in the New England Journal of Medicine. Over 2600 patients who had undergone adenomatous polyp removal by colonoscopy were followed for an average of 16 years. Over this time, there was a 53% reduction in death from colon cancer compared to expected deaths in the general population of similar age and gender. Obviously, polyp removal in this study group did not result in a complete avoidance of the development of colon cancer, but the results are significant enough to encourage widespread colorectal cancer screening.

There are a number of ways to screen for colon cancer. Colonoscopy is considered the "gold standard" for screening, but there are other methods that can also be used. A major advantage of colonoscopy is that if polyps are found during the screening, they can be removed and analyzed at that time. In addition, other methods may require more frequent screening intervals. For example, if no abnormalities are found, a colonoscopy does not need to be repeated for another 10 years. Sigmoidoscopy, which takes a less extensive look at the colon, should be repeated every five years and coupled with annual stool tests for blood.

Most medical authorities, including the United States Preventive Medicine Task Force, the American College of Physicians, and the American Cancer Society recommend that screening for colon cancer begin at age 50. Those people in high-risk groups, including African Americans, individuals with a family history of colon cancer, and someone with a personal history of inflammatory bowel disease (e.g. ulcerative colitis), may require that their screening begin at an earlier age.

Colorectal cancer, the second leading cause of cancer-related deaths for men and women in the United States, is expected to take more than 51,000 American lives this year. March is National Colorectal Cancer Awareness Month. If you are of an appropriate age, are in a high risk group, or are due for a repeat screening, take the time this month to talk to your doctor about colon cancer screening. With the knowledge that, to a large degree, colon cancer is a preventable disease, it only makes sense.

The Decision to Decline Immunizations

The decision to postpone or decline childhood immunizations is one that has important implications for the child, his or her family, and others in the community. Recently, the Centers for Disease Control, along with the American Academy of Family Physicians and American Academy of Pediatrics, released a statement outlining the responsibilities of parents who decline to have their child vaccinated. Today's Health Tip summarizes some of the most important points from that statement.

Special considerations when an unimmunized child gets sick: When seeking medical attention for a sick child, it is essential that the health care profession learn of the child's vaccination status. This applies whether the child is seen in the doctor's office, an emergency department, or if the child is traveling in an ambulance. This is because vaccine-preventable diseases will need to be considered as a possible cause for the child's illness. Also, the child may need to be isolated to avoid spreading the disease to others. For example, an infant who is not yet old enough to be vaccinated or someone with a weakened immune system could be at risk of contracting the child's illness.

With an outbreak of a vaccine-preventable disease in the community: At the time of enrollment, a child's school or child care facility should be informed about the child's immunization status. Should a vaccine-preventable disease strike in the community, it may be necessary to remove an unvaccinated child from school or daycare. With some vaccine-preventable diseases, it may not be too late to receive protection by being vaccinated

When an unimmunized child is exposed to a vaccine-preventable disease: In this situation, the caregivers of the unimmunized child need to know the signs and symptoms of that disease. Medical attention should be sought at the first sign that the child has contracted the disease. In some cases, a medication may be available to treat the illness, such as the use of an anti-viral medication following exposure to influenza.

When traveling with an unimmunized child: Even though many vaccine-preventable diseases have become rare in the United States, they may still occur in foreign countries. For example, India, Nigeria and Pakistan continue to have polio outbreaks. Should an unimmunized child become ill with a vaccine-preventable disease, his or her parents should take measures to avoid spreading the disease to others. This could mean cancelling further travel until a doctor determines that the child is no longer contagious. Also, be aware that prior to admission into some countries, immunization against certain disease, such as Yellow Fever, may be required.

A few of the vaccine-preventable diseases that continue to cause infections in the U.S. include pertussis (whooping cough), hepatitis B, mumps, measles, and Haemophilis influenzae type B (Hib) meningitis. Before deciding to forgo immunizing their children, parents should consider the following facts regarding these vaccine-preventable diseases:

• Cases of whooping cough have been on the rise in the U.S. due to reduced immunization rates, due in part to parental concern regarding the safety of the vaccine. Prior to pertussis immunization, however, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths.
  


• Approximately 20% of people who contract measles require hospitalization due to complications such as pneumonia. Before measles immunization, an average of 450 measles-associated deaths occurred each year.
  


• Before the mumps vaccine was introduced, mumps was a major cause of deafness in children, occurring in approximately 1 in 20,000 reported cases.
  


• Before Hib vaccine became available, Hib meningitis killed 600 children each year and left many survivors with deafness, seizures, or mental retardation.
  


• Of the 2 billion persons worldwide who have been infected with hepatitis B, around 350 million become life-long carriers of the disease and can transmit the virus to others. One million of these people die each year from liver disease and liver cancer.
  

In the U.S., vaccines have reduced or eliminated many infectious diseases that once routinely killed or harmed many infants and children. Parents or caregivers should make the decision to postpone or decline immunizations for their children only after being fully informed of the risks and responsibilities. For more information on childhood vaccines visit the immunization section of the CDC website at www.cdc.gov/vaccines.