Salt intake dietary restrictions

All patients with ascites require counseling on dietary sodium restriction. Salt intake should be limited to less than 800 mg sodium (2 g sodium chloride) per day. More stringent restriction may cause faster mobilization of ascitic fluid, but adherence to such strict limits is very difficult. Patients usually respond well to sodium restriction accompanied by diuretic therapy.14,22,31,32 The goal of therapy is to achieve urinary sodium excretion of at least 78 mEq (78 mmol) per day.22 While a 24-hour urine collection provides this information, a spot urine sodium/ potassium ratio greater than 1.0 provides the same information and is much less cumbersome to perform. 

Hypokalemia. Used in patients with low serum K+ resulting from diuretic therapy with other agents. Its use should be restricted to patients who are unable to supplement their dietary intake or adequately restrict their salt intake or who cannot tolerate orally available KCl preparations. 

In 2002, the British Medical Journal published a review of eleven trials of interventions aimed at reducing dietary salt intake. Tens of thousands of subjects were involved, with and without hypertension. Follow-up ranged from six months to seven years, comparing the blood pressure reductions of people following the advice of salt restriction with those in the control groups, people not given that advice. The average difference was a mere 1.1 mm Hg systolic blood pressure and 0.6 mm Hg diastolic. 

High blood pressure—Sometimes, this condition results from a failure of the kidneys to excrete excess sodium, which promotes the accumulation of water in the body. Certain people appear to be overly susceptible to the effects of only moderate excesses of dietary sodium, so they should restrict their salt intake in order to avoid high blood pressure. 

CHD can be prevented to some extent by controlling risk factors. Hypertension and plasma cholesterol are both affected by the diet. Advice to patients with a family history of coronary heart disease would include suggesting a cholesterol check, and, depending on the results, reducing saturated fat intake to around 8—10 per cent of the diet. Omega-3 poljomsaturated FAs (found in seafoods and rapeseed oils) should be increased in the diet since they lower LDL-cholesterol. Monounsaturated fats (in olive oil) should also be increased, but total fat should not exceed 30 per cent of the dietary intake. Hjrpertension can be reduced by restricting salt intake (19). 

Sodium and Hypertension. Salt-free or low salt diets often are prescribed for hypertensive patients (57). However, sodium chloride increases the blood pressure in some individuals but not in others. Conversely, restriction of dietary NaCl lowers the blood pressure of some hypertensives, but not of others. Genetic factors and other nutrients, eg, Ca " and K", may be involved. The optimal intakes of Na" and K" remain to be estabUshed... 

Restriction of dietary sodium salt to less than 6 g per day by reducing intake or substitution with low-sodium salt alternatives... 

Epidemiologic and clinical data have associated excess sodium intake with hypertension. Population-based studies indicate that high-salt diets are associated with a high prevalence of stroke and hypertension. Conversely, low-salt diets are associated with a low prevalence of hypertension. Clinical studies have shown consistently that dietary sodium restriction lowers BP in many (but not all) patients with elevated BP. The exact mechanisms by which excess sodium leads to hypertension are not known. However, they may be linked to increased circulating natriuretic hormone, which would inhibit intracellular sodium transport, causing increased vascular reactivity and increased BP. 

The Food and Nutrition Board has removed the three electrolytes from its table of estimated safe and adequate daily dietary intake because sufficient information is not available to establish a recommended amount. The major dietary source of sodium and chloride is table salt (40% sodium and 60% chloride). Physicians still recommend that the intake of sodium be restricted to 1-2 g daily. The recommended intake of chloride is approximately 1.7-5.1 g daily. However, getting enough sodium and chloride is not a problem. In fact, sodium intake in the United States is about 5-7 g/day, far in excess of the 1-2 g/day required by a normal adult. 

Nutritional studies suggest that the iodine content of vegetarian diets may be inadequate, but adherence to a vegetarian diet need not lead to iodine deficiency. As diets become increasingly restrictive, assurance of adequate iodine intake increasingly depends on the appropriate use of iodized salt and other dietary supplements. Fortunately, the actual number of individuals who follow strictly vegan diets is small, and therefore so are public health risks of resulting iodine deficiency. 

People who have elevated levels of LDL in their serum can be treated in a number of ways. These include restriction of dietary intake of cholesterol, ingestion of positively charged resin polymers that inhibit intestinal reabsorption of bile salts, and administration of lovastatin, a competitive inhibitor of 3-hydroxy-3-methylglutaryl CoA reductase. 

Saccharin sodium is the oldest artificial sweetener. It is a sulfanilamide derivative and is stable within a wide range of temperatures but, in the presence of acids, does react chemically, and therefore is not compatible with preservatives that require low pH. In its acidic form, saccharin is not particularly water soluble. Therefore, the form used is usually the sodium salt. The calcium salt is also sometimes used, especially for restricting dietary sodium intake. Many studies have been carried out on saccharin, with some showing a correlation between saccharin consumption and increased cancer (especially bladder cancer) and others showing no such correlation. Nevertheless, no study has ever shown health risks in humans when saccharin is taken at normal doses. It has been approved for use in the USA but not in Canada, and was approved for use in Europe for children over 3 years of age. 

For persons on sodium restricted diets, a 1 1 mixture of table salt (NaCI) and potassium chloride (KCI) for salting foods will lessen the sodium intake without a change in taste. However, excessive use of dietary potassium should be avoided due to toxic effects at high levels. 

Deficiencies of vitamin K and indeed all the other fat soluble vitamins are more likely to occur as a result of impairment in fat absorption than from dietary insufficiency. This could occur when the secretion of bile salts is restricted (as in biliary obstruction), when sections of the gut have been removed or damaged by surgery or in diseases, such as tropical sprue and cystic fibrosis, that are associated with poor intestinal absorption. Even when normal absorptive mechanisms are functioning well, some fat is necessary in the diet to improve the absorption and utilization of fat soluble vitamins. There is little evidence, however, that, within the normal range of fat intakes, the amount of dietary fat significantly affects the utilization of fat soluble vitamins. 

---