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The doctor tells you to “cut back on salt” due to high blood pressure. What do you do? Stop using the saltshaker? Scan the food labels for sodium content? Read on to find out the best way to follow your doctor’s advice.

Salt vs. sodium

Table salt is the common name for sodium chloride, a mixture that is 40% sodium and 60% chloride. The American Heart Association recommends limiting sodium intake to no more than 2400 mg per day, about the amount of sodium present in 1 ¼ teaspoons of table salt.

Sodium’s connection to high blood pressure

High blood pressure affects one in four adults and is a major risk factor for stroke, heart disease, and kidney failure. About 30% of the American population is believed to be sodium-sensitive; meaning too much sodium in their diet contributes to high blood pressure by upsetting the body’s fluid balance. Since there’s no way of knowing if you’re one of the sodium-sensitive people, standard medical advice often begins with lowering dietary intake of sodium. Other minerals may be just as important in regulating blood pressure. Adequate intake of potassium from fruits and vegetables, calcium from dairy products and some vegetables, and magnesium from whole grains is crucial in determining blood pressure levels.

So where’s the sodium?

Seventy five percent of the sodium in the American diet comes from processed foods, not from the salt shaker sitting on your dining room table. A preference for salty foods is acquired through frequent exposure and not an inborn taste preference. Just taste any brand of commercial baby food and you’ll immediately notice the lack of salt. Infants haven’t yet developed a liking for salt, and too much can damage their still fragile kidneys so it is intentionally left out of commercial baby food products.

Sodium helps preserve food by slowing the work of harmful bacteria, yeast and molds to prevent food spoilage and illness. Think back to the days of salt-cured meats and pickled vegetables. Salt was used in preserving these foods for later use, with flavor being only a secondary issue.

Other uses of sodium in food processing include:

- Slowing the fermentation process in cheese, bread dough and sauerkraut

- Holding processed meats such as sausage together

- Improving the texture of breads and crackers

- Enhancing flavors

Label reading for sodium content

The Food and Drug Administration (FDA) closely regulates statements about sodium content on food labels. The following terms found on food labels meet these guidelines:

· Sodium-free – less than 5 milligrams of sodium per serving

· Very low-sodium – 35 milligrams or less per serving

· Low-sodium – 140 milligrams or less per serving

· Unsalted, no salt added or without added salt – made without the salt that is normally used, but still contains the sodium that is a natural part of the food itself.

Sodium content of foods

Processed foods, including canned foods, cured meats, frozen dinners and commercially baked goods such as cookies and pastries contain the most sodium. Take a trip through the grocery store with us to identify foods low and high in sodium:

- Produce section:

· Fruit and vegetables are naturally low in sodium. Some people believe celery is high in sodium, yet one stalk contains only 35 mg of sodium. Fruits and vegetables are also high in potassium, which helps lower blood pressure levels.

- Baked goods:

· Breads, bagels and English muffins typically contain 140-345 mg of sodium per serving (1 slice bread, 1 bagel or English muffin).

· Cookies and crackers may appear low in sodium, but that’s because the serving sizes are small – typically two cookies or crackers. Sodium content per serving ranges from 25-270 mg.

· Muffins contain 150-350 mg sodium per serving. Remember that larger muffins contain more sodium.

· Pancakes and waffles contain 150-300 mg sodium each.

· A slice of pie or cake or a piece of pastry will give you 150-300 mg of sodium.

- Chips and Snack Foods

· One cup of pork skins has 850 mg sodium; one cup of cheese-flavored snacks 700 mg, one cup chips 165 mg, and one cup popcorn has 90 mg sodium. One cup is approximately the amount you can hold in both hands cupped together.

· Pretzels are typically high in salt: one soft pretzel has 770 mg sodium, while 10 small pretzel sticks contains 85 mg.

- Dairy Products

· One ounce of cheese typically contains 160-200 mg sodium. Feta, gorgonzola, and processed cheese contain even more sodium, up to 500 mg per ounce.

· One cup milk contains 120 mg sodium, but remember the calcium in milk helps lower blood pressure.

· One-half cup of most ice cream, frozen yogurt or yogurt contains 50-75 mg of sodium.

- Breakfast cereals

· Read breakfast cereal labels carefully for sodium content. Some types such as puffed rice contain almost no sodium while others pack a whopping 475 mg per cup.

- Cured meats

· Smoked meats such as lox contain 220 mg sodium per ounce. Canned tuna ranges from 75 mg sodium per can when unsalted to 500 mg per can when salted. Two pieces of cured bacon contain 500 to 800 mg sodium (about one-third of your daily total), while cured ham contains 345 mg sodium per ounce.

· Sausage and lunchmeat are high in sodium unless you search for unsalted varieties. One slice of lunchmeat contains 250 mg sodium, while one typical sausage can contain 700 mg of sodium.

- Frozen dinners

· The size of frozen dinners varies considerably, yet the sodium content remains consistently high. 550-1300 mg sodium per serving are not uncommon.

- Canned foods

· Canned soups contain 800-1100 mg sodium per cup. Remember that most cans of soups are meant to serve two people; if you eat the entire can yourself you’ll double the sodium content.

· Canned vegetables are processed with salt unless you seek out unsalted varieties. One-half cup of most canned vegetables contains 150-300 mg sodium.

Our recommendations

General recommendations for healthy people without high blood pressure are 2400 mg sodium per day. That’s the amount used on food labels to calculate the percent Daily Value. The American Heart Association recommends no more than 3000 mg sodium per day for healthy individuals. If you have high blood pressure, limiting sodium to the 2400-3000 mg range is a good start, since the typical American diet contains 4000-6000 mg of sodium per day! Physicians may recommend lower amounts of sodium, but it is difficult to follow a plan that contains less than 2000 mg of sodium without purchasing special low-sodium foods. To keep within the 2400-3000 mg sodium range, following the suggestions here:

- choose fresh fruits and vegetables as often as possible
- look for sodium-free frozen and canned vegetables
- use salt-free seasonings such as herbs, spices and vinegar in cooking and at the table
- avoid adding salt when cooking pasta, rice, or vegetables
- choose fewer salty snacks such as salted nuts, popcorn, chips, pretzels and crackers
- read food labels for sodium content.

It has become almost common knowledge that the group of antidepressants called SSRIs (selective serotonin reuptake inhibitors) can cause sexual problems, including lack of interest and difficulty in becoming aroused or reaching orgasm. But research findings presented at the annual meeting of the American Psychiatric Association in Chicago last week suggest that for most depressed patients, sexual interest and function get better, not worse, when depressive symptoms are treated effectively.

"You have a considerably larger number who are reporting improvement during treatment. That’s not generally appreciated," stated Dr. David Michelson, a neuroscientist from Eli Lilly and Company, the manufacturers of Prozac. "The degree to which treating the depressive symptoms seems to actually improve sexual functioning is pretty impressive". Dr. Michelson was part of a team of researchers that studied sexual function in more than 500 adult men and women being treated with fluoxetine (Prozac).

The researchers asked study participants to complete questionnaires rating four aspects of sexual function: interest, arousal, orgasm and overall sexual function. The questionnaires were filled out before beginning to take the drug, after the initial 13-week treatment period and then monthly, during a 25-week continuation study.

Almost half of the women reported a high baseline rate of sexual dysfunction. By the end of the first 13-week treatment, fewer women reported moderate to severe dysfunction, and 70 percent reported minimal or no sexual dysfunction. Overall, men reported lower levels of sexual dysfunction at baseline than women did, and their ratings changed less during the treatment period.

Dr. Michelson reported that about 13 percent of women and 18 percent of men found that their sexual function got worse during treatment, and that these percentages were somewhat higher when patients were asked specifically about orgasm.

A second study, presented by Dr. Christina Dording of Massachusetts General Hospital in Boston, reported similar proportions of patients who develop sexual dysfunction during treatment for major depression. In this study, 127 adult men and women who had responded well to eight weeks of treatment with 20 mg/day of fluoxetine had their doses increased to 40 mg/day.

Overall, 19 percent of the patients who completed the second, 28-week phase of the study reported sexual dysfunction, including inability to reach orgasm, loss of interest, erectile dysfunction and delayed ejaculation. About half of these reported sexual dysfunction during the first eight-week part of the study, and half reported difficulties during the second phase. In six of these 24 patients, sexual difficulties cleared up without treatment, Dr. Dording reported.

"We found that the overall incidence of sexual dysfunction was comparable to that of other studies," said Dr. Dording. She pointed out that the study design did not allow the researchers to tell whether sexual dysfunction was the result of the change in medication dose, or of the passage of time.

"We also found that a significant proportion of patients experienced spontaneous remission of the symptoms of sexual dysfunction. Also, we were surprised that none of the patients who dropped out did so because of sexual dysfunction," Dr. Dording added.

These two sets of findings suggest that about one in five patients who take fluoxetine for depression may experience symptoms of sexual dysfunction. On the other hand, the majority of patients don’t, and in fact many find that with effective treatment of their depressive symptoms, their sexual function improves too.

Editorial Commentary: Sexual dysfunction, primarily decreased sex drive and difficulty with orgasm, has been an important issue since the launch of SSRIs. Some studies have reported such side -effects in over 50 percent of users. Generally, the side effects improve with time, but do not disappear. The studies cited in the accompanying article report moderate rates of sexual side effects, and confirms a generally recognized finding of moderate baseline sexual dysfunction prior to treatment for depression. For patients with SSRI-induced sexual dysfunction, lowering the dose, waiting, and adding an additional medication, such as buproprion, a stimulant, or Viagra, have all been reported to be helpful.

If you’ve ever had a stomachache before an exam or important meeting, or developed a headache during an argument, you have some idea of what somatization is. Although it’s common to experience these types of medically unexplained symptoms, such as pain and digestive upset under stress, somatization is often a part of serious disorders such as depression, anxiety, and schizophrenia.

“Somatization is a normal, daily experience. It’s highly situational, [with] marked individual differences and marked cultural differences, and associated clearly with psychosocial stress,” stated Normal Jensen, M.D., a professor at the University of Wisconsin in Madison. Jensen addressed an audience of physicians at the annual meeting of the American College of Physicians/American Society of Internal Medicine in Philadelphia last week.

Although “full blown” somatization disorder is fairly rare — less than two percent of Americans are diagnosed with it — Jensen explained that features of the disorder are common. “In primary care, anywhere up to three quarters of our patients have medically unexplained symptoms,” he reported. “The impact on health care services is HUGE.”

Physicians who see patients with complaints that can’t be explained are often distressed and frustrated, noted Jensen. And that frustration is shared by patients, who often consult a long series of physicians and specialists who fail to identify what’s wrong. Some doctors, Jensen said, may turn their frustration on the patient, telling them “it’s all in their head.”

But somatization, he emphasized, is real. Our understanding of pain and other somatic complaints has evolved in recent decades to reveal that sensations are affected by thoughts, emotions, and prior experience. In addition, new discoveries about the role of opioid receptors in the nervous system have provided increasing evidence for a physical basis for somatic complaints.

“Patients appreciate knowing that there are possible molecular and neurophysiological reasons for why their sensations vary from [those of] others, and within themselves from day to day,” Jensen explained.

Patients with these kinds of symptoms shouldn’t be told that there’s no physical reason for their complaints, said Jensen. “I tell them that in fact there is a good physiological reason for their symptoms. I tell them that ‘you’ve either acquired, or were born with, an abnormal nervous system.’ I tell them that ‘your nervous system is allowing you to feel sensations that normal people, or you when you are normal, don’t feel.’

“The nervous system quite naturally filters out unnecessary, confusing, distracting information,” Jensen continued. “Think how it would be if I was constantly aware of my clothes, and my watch, and my jewelry. If I had to process all that information all the time, what else would I be able to do? I wouldn’t even be able to read a book!”

One of the difficulties in treating patients with somatic symptoms is that many patients have an additional illness. “It’s not just somatization. It’s somatization with an anxiety disorder, or with a bad mood disorder, or a thought disorder, or a personality disorder,” said Jensen. He noted that he refers patients to psychiatrists when he wants “to be sure that there isn’t a comorbid condition… or when I want help with treating one of these disorders.”

Another concern, according to Jensen, is that one patient may consult a number of doctors, and specialists may diagnose serious medical conditions based on a patient’s complaints. “These people can get in trouble, because if you look closely enough at any of us, you’re going to find something wrong that could be treated,” he explained.

“What that means is that [generalists] and [their] sub-specialty colleagues have to learn to work together with our patients,” stated Jensen.

Right now, there are no medications that modify sensory perception by targeting opioid receptors, and none specifically for somatization symptoms, noted Jensen. In his own practice, he reported, he looks for symptoms of depression and/or anxiety, and tries antidepressant or anti-anxiety medications if the patient has such symptoms, even if they don’t meet the diagnostic criteria for one of these disorders.

Cognitive behavior therapy has proven helpful for patients with somatic symptoms, too. This therapy, which can be delivered by a trained general practitioner or by a mental health professional, focuses on the relationship between variability of a patient’s symptoms and changes in mood and life events.

As for the future, Jensen reports that there has been some recent evidence that gabapentin (neurontin), an anti-epileptic medication used to prevent seizures, may affect the body’s opioid receptors and thus alter sensory perceptions.

It’s important to remember that somatic symptoms can also mask emotional distress, said Jensen. Patients who have been taught or conditioned not to express emotions, particularly negative ones, may not even realize they’re depressed, anxious, fearful, or grief-stricken. “I do believe that there is a sort of transformation of psychological distress into physical symptoms,” he stated.

Blood cholesterol levels are measured in mmol/L.

Shown below are the recommended levels for cholesterol and lipoproteins for people:

• With no risk factors
• With risk factors
• With heart disease

These are recommended values only. Your cholesterol values may be different depending on your own individual history and conditions.

Any decisions related to lifestyle and therapy should be discussed with your doctor.

Eat Wisely To Protect Your Heart!

What is Cholesterol?

Cholesterol is a type of fat that our body needs to help us absorb nutrients from the foods we eat, make hormones, build cells, and make vitamin D. Cholesterol becomes a concern when there is too much of it in our blood. This may lead to problems such as heart disease and stroke.

Types of Cholesterol

There are two main types of cholesterol in our body, carried through our blood in chemical packages called lipoproteins:

1. The “bad” type of cholesterol is carried by LDL (low-density lipoprotein) which brings cholesterol to the blood and clogs arteries.
2. The “good” type of cholesterol is carried by HDL (high density lipoprotein) which removes cholesterol from the blood stream.

Saturated and Unsaturated Fats

Saturated fats come from animal sources and are usually solid at room temperature. Foods such as butter, poultry, animal meat, and dairy products are high in saturated fats.

Unsaturated fats come from plant sources, and are usually liquid at room temperature. These fats, like vegetable oils, tend to lower cholesterol levels in the body. It’s wise to replace some of the saturated fats in your diet with the unsaturated fats.

What are Hydrogenated Fats?

Hydrogenated fats are formed when liquid, unsaturated fats are chemically changed so that they become more solid. These fats will increase your cholesterol level and can be found in hydrogenated margarine and shortenings.

The Four Food Groups

1. Dairy Products

   Dairy products are labeled with percentage butter fat (%B.F.) or milk fat (%M.F.). By eating low fat cheese (less than 20% M.F.) or part-skim cheese, low fat yogurt, and skim or 1% milk, you will reduce the saturated fat in your diet.

2. Meat, Poultry and Fish

   Fish is lower in saturated fat and cholesterol than meat and poultry. When buying meat, it is always wise to choose lean cuts and trim all fat from meat before cooking. It also helps to remove the skin from chicken and turkey, since most of the fat is found just under the skin. Egg yolks, organ meats (such as liver and kidney) and shellfish are high in cholesterol.

3. Fruits and Vegetables

   Fruits and vegetables will not raise your cholesterol. They are rich in many important vitamins and minerals.

4. Breads and Cereals

   A high fibre diet can help to lower your cholesterol. It is important, however, to limit croissants, biscuits, and other commercially prepared baked goods, since such products are often high in cholesterol and fat.

Tips to Lower Your Fat Intake:

• When selecting foods at the grocery store, choose foods that contain low total and saturated fat.
• Avoid gravies from fat drippings.
• Skim fat from soups or stews by placing in the refrigerator, chilling, and skimming off the fat which will rise to the top.
• No more than 30% of your total daily calories should come from fat (60-105g of fat).
• Saturated fat should account for no more than 7% of your total daily calories.
• “Cholesterol free” claims made on food labels don’t mean that a product is low in fat.
• “Light or lite” claims may refer to texture or taste and not calories or fat.

Food Labels

Example of a food label:

Nutrition Information Per 50G Serving
Energy		100 cal
Protein		3.0 g
Fat		0.7 g
Carbohydrate		24.0 g
	Sugars	4.2 g
	Starch	16.8 g
	Fibre	3.0 g
Sodium		210 mg
Potassium		168 mg

Percentage of Recommended Daily Intake
Thiamin	38%
Niacin	7%
Vitamin B6	10%
Folacin	6%
Iron	21%

Per 50G Serving – This is the amount of food the label information is based on.

Fat – Includes saturated and unsaturated fats.

Carbohydate - This is the total amount of sugar, starch, and fibre per serving.

Sodium - This is the amount of salt per serving.

Percentage of Recommended
Daily Intake – All vitamins and minerals are listed under this heading.

Preparing Your Food

You should try to use low fat methods of cooking such as baking, broiling, roasting, or microwaving and avoid frying.

Ask your pharmacist for more information on how
to lower fat and cholesterol in your diet and reduce the risk of heart disease.