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Sodium and Diabetes

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					                                  Sodium and Diabetes
                                  Mamta Bhasin RD BSc IDPP




                                  S
                                          odium is an essential mineral required for        of diabetes, rather than the saturated fat content,
                                          the proper functioning of the body. It is vital   protein or glycation end products. This study sug-
                                          for regulating body fluids and blood pres-        gests reduced consumption of processed meat, and
                                  sure and to help the functioning of muscles and           concurrently sodium, can aid in the prevention of
   you may be                     nerves. Excess sodium intake can have serious             type 2 diabetes (4).
                                  consequences, especially in people with diabetes.             For people with diabetes, hypertension is a major
   living with                    The relationship between excess dietary sodium            risk factor for both the development and progression
  undiagnosed                     and hypertension is well established and docu-            of retinopathy (5). A study conducted in African
 type 2 diabetes                  mented. Dietary sodium has also been associated           American patients with type 1 diabetes indicates that
                                  with a number of other health conditions, includ-         high calorie and high sodium intake are significant
and have no idea.                 ing asthma, osteoporosis, gastric cancer, kidney          and independent risk factors for development of,
                                  stones and obesity (1).                                   and progression to, severe forms of diabetic retin-
                                      Hypertension is the most common chronic               opathy, especially in that population. A reduction in
      Visit
                                  disease among adults (2) but is generally not well        these nutrients is recommended for preventing the
getcheckednow.ca                  managed. In Ontario approximately two-thirds of           development of diabetic retinopathy (6).
                                  people with diabetes had uncontrolled hyperten-




                                                                                            ‘‘
                                  sion. It is estimated that more than 75% of deaths

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                                  in people with diabetes occur due to coronary or
                                  cerebrovascular events (3), and up to 75% of car-
                                  diovascular disease is caused by hypertension (2).
                                     The effect of high blood pressure on the kid-
                                  ney has also been well studied. Hypertension can
                                                                                              It is estimated that more than
                                                                                              75% of deaths in people with
                                                                                              diabetes occur due to cornary
                                                                                                                                ‘‘
                                  cause the development of kidney damage and                  or cerebrovascular events.
                                  deterioration of kidney function. The progression
                                  of chronic kidney disease can be slowed through
                                  intensive glycemic control and optimization of                A sodium working group (SWG) comprising
                                  blood pressure (3).                                       representatives from food manufacturing and food-
                                     It is clear that hypertension needs to be man-         service groups, health-focused nongovernmental
                                  aged to prevent serious health consequences. For          organizations (NGOs), the scientific community,
                                  the prevention and management of hypertension,            consumer advocacy groups, health professional
                                  the Canadian Hypertension Education Program               organizations and government representatives pro-
                                  (CHEP) recommends reducing sodium intake to               duced the Sodium Reduction Strategy for Canada.
                                  the recommended levels of 1200 to 1500 mg/d,              In the recently released report, recommendations
                                  based on age (2).                                         of the SWG indicate that an average Canadian con-
                                     A study conducted on about 25 000 men over a           sumes about 3400 mg of sodium a day, which is
                                  period of 12 years revealed that the risk of type 2       well above the recommended adequate intake (AI)
                                  diabetes increased by 35% in men with high                level of 1500 mg (7).
                                  consumption of processed meat, compared to                    This excessively high sodium intake predispos-
                                  those consuming low amounts of processed meat.            es Canadians to a high risk of hypertension. The
                                  Interestingly, the researchers found no association       coexistence of diabetes and hypertension increases
                                  between consumption of red meat and poultry and           the risk of both macro- and microvascular compli-
                                  the risk of type 2 diabetes (4). The study specifi-       cations of diabetes. Research indicates that 100%
                                  cally suggests that it is the high sodium content         of people with diabetes who progress to end stage
                                  of processed meats that leads to the increased risk       renal disease have hypertension (8).


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    It has been estimated that if the sodium intake      ity research is conducted to ensure that microbial
is brought down to the recommended AI level of           food safety is not compromised due to sodium
1500 mg/d, the benefits would be remarkable.             reduction in foods. The positive aspect of this is
The result would be a reduction in the number of         that it creates opportunities for the industry to
patients with hypertension by 1 million; 23 500          innovate when it comes to ingredients and food
fewer cases of cardiovascular events would result        processing techniques (7).
in a direct cost savings of at least $1.38 billion per       Another important recommendation of the
year in Canada (7).                                      SWG is to change the basis of the calculation of
    Canadians are aware of the health consequenc-        Percent Daily Value on the Nutrition Facts table
es of high sodium intake but are not aware of the        from 2400 mg/d to 1500 mg/d to reflect the ade-
recommended levels. The SWG report indicates             quate intake level, as opposed to the upper toler-
that 89% of Canadian respondents believed others         able intake limit. Educating the public on nutrition
consume too much sodium, whereas their own               labelling remains essential to help people make
sodium intake is all right (7). Most of the sodium       well informed choices. There is strong evidence
in the Canadian diet comes from processed foods,         that suggests reduction in dietary sodium intake
including restaurant foods (about 80%). Another          significantly decreases blood pressure, not only in
important factor for the increased sodium intake         adults but in children (1).
may be the increase in portion sizes, resulting              Reduction in the rates of hypertension, espe-
in higher sodium consumption (1). Several food           cially in people with diabetes can significantly
manufacturing companies have shown leadership            decrease the risk of developing diabetes and
in taking action to reduce the sodium content of         progression of its complications. Thus, reducing
processed foods, but others have done nothing.           sodium intake is a highly cost-effective strategy to
Some health NGOs have taken the initiative of            reduce the global burden of cardiovascular disease
educating consumers about the risks of a high            through a reduction in blood pressure.
sodium diet and the ways of reducing dietary
intake of sodium (7). Considering that the amount        references
of sodium Canadians consume is much higher               1.   Dietary sodium, hypertension and health. Hypertension
than their requirements and that this excess                  Canada website. http://www.lowersodium.ca/uploads/
sodium consumption is costly, it becomes essential            ShorBackground_July2010.pdf. Accessed October 14, 2010.
for the government to take immediate action. As          2.   Hypertension/Diabetes. Hypertension Canada website. http://
part of the sodium reduction strategy, the SWG                hypertension.ca/chep/educational-resources/hypertension-
established an interim goal of reducing the aver-             diabetes/. Accessed October 14, 2010.

age Canadian’s sodium intake to 2300 mg/d by             3.   Canadian Diabetes Association Clinical Practice Guidelines
                                                              Expert Committee. Canadian Diabetes Association 2008 clini-
the year 2016, with a long-term goal of achieving
                                                              cal practice guidelines for the prevention and management of
a daily sodium intake below the tolerable upper
                                                              diabetes in Canada. Can J Diabetes. 2008;32(suppl 1):S1-S201.
intake level (UL) of 2300 mg/d for 95% of the
                                                         4.   Mannisto S, Kontto J, Kataja-Tuomola M, et al. High processed
Canadian population (7). The accomplishment
                                                              meat consumption is a risk factor of type 2 diabetes in the
of this goal requires specific targets for sodium
                                                              alpha-tocopherol, beta-carotene cancer prevention study. Br J
reduction in foods. Collaboration between various
                                                              Nutr.2010;103:1817-1822.
levels of government, the food industry, health
                                                         5.   Wong T, Mitchell P. The eye in hypertension. Lancet. 2007;369
organizations and the media is imperative for the             (9559):425-435.
implementation of these recommendations. Also            6.   Roy M, Janal M. High caloric and sodium intakes as risk factors
essential is research to help support the indus-              for progression of retinopathy in type 1 diabetes mellitus. Arch
try in devising ways to reduce sodium content                 Ophthalmol. 2010;128:33-39.
in foods without compromising safety, taste and          7.   Sodium reduction strategy for Canada. Health Canada web-
acceptability. Sodium and sodium-containing                   site. http://www.hc-sc.gc.ca/fn-an/alt_formats/pdf/nutrition/
additives have important functions in foods, such             sodium/strateg/index-eng.pdf. Accessed October 14, 2010.
as microbial safety, shelf life, protein binding,        8.   Why is high blood pressure dangerous? High blood pressure
mouth feel, tenderness and texture, among many                & diabetes. Canadian Diabetes Association website. http://
others. Given the role of salt in preventing the              www.diabetes.ca/documents/about-diabetes/Diabetes_
growth of pathogenic bacteria, it is vital that qual-         Hypertension.pdf Accessed October 14, 2010.


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