Scouting for sodium and other nutrients important to blood pressure

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This is the second in a series of articles telling how to use the new food label to meet specific dietary needs.

For years, consumers watching their sodium intake have had to plod through ingredient lists on many food labels like high school students through a Shakespearean play. They had to read a lot of unknown words and then do plenty of guessing. Aiming to get some idea of a food's sodium content, consumers knowledgeable about sodium-restricted diets looked for names like sodium caseinate, monosodium glutamate, trisodium phosphate, sodium ascorbate, sodium bicarbonate, sodium stearoyl lactylate, and other sodium-containing ingredients, including salt(sodium chloride).

It wasn't easy, and it wasn't always accurate. Elizabeth Adams of Churchton, Md., can vouch for that. She started to limit her sodium intake 23 years ago. She recalled spending "a long time" in grocery stores reading ingredient lists and looking for nutrition information, which then was voluntary and, until recently, appeared on only about 60 percent of food labels.

"I got to the point where I didn't buy a food unless it had only one ingredient or carried nutrition information," she said. "I had no idea otherwise how much sodium the food had in it."

Resorting to such measures will no longer be necessary for the nearly 50 million Americans like Adams who suffer from hypertension (high blood pressure) and the many others who want to reduce their risk for it. The food label they depend on to help monitor their sodium intake--and thus control their blood pres-sure--now must state how much sodium a food contains per serving and how the food fits in with their daily diet.
Label Changes

These requirements are the result of the Nutrition Labeling and Education Act of 1990 and regulations from the Food and Drag Administration and the U.S. Department of Agriculture. Under these regulations, consumers are seeing:

Nutrition information in bigger, more readable type on almost all packaged foods. It appears in the table headed "Nutrition Facts," which is usually on the side or back of the package. Nutrition information also will be available in stores near many fresh foods, like fruits and vegetables. (See "Nutrition Info Available for Raw Fruits, Vegetables, and Fish" in the January-February 1993 FDA Consumer.)

"% (percent) Daily Values," which tell consumers at a glance the levels of important nutrients in a food and how those amounts fit into a daily diet.

Serving sizes that closely reflect the amount people actually eat.

Strictly defined nutrient-content claims, like "low-sodium," "salt-free," and "rich in potassium." This means that when consumers see such claims, they can believe them. (See "A Little 'Lite' Reading" in the June 1993 FDA Consumer.)

Strict rules for using health claims, such as one that links low-sodium diets to a reduced risk of high blood pressure. (See "Starting This Month, Look for 'Legit' Health Claims on Foods" in the May 1993 FDA Consumer.)
Sodium's Role

Some of the information--particularly that pertaining to sodium content--will be of special interest to people with high blood pressure.

Sodium has long been a major dietary factor in reducing the risk of, and controlling, high blood pressure. (For more on hypertension, see "High Blood Pressure: Controlling the Silent Killer," in the December 1991 FDA Consumer.) This role was reiterated as recently as January 1993 in the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The committee noted that numerous studies have shown that reducing sodium intake can reduce blood pressure.

What is a reduced sodium intake? According to Camille Brewer, a registered dietitian and nutritionist in FDA's Office of Food Labeling, therapeutic sodium-restricted diets can range from below 1,000 milligrams (mg) to 3,000 mga day.

"American adults, on average, eat too much sodium between 4 to 6 grams (4,000 mg to 6,000 mg) dally," she said. "Most people would benefit from moderately reducing their sodium intakes."

Brewer advises people who are considering a sodium-restricted diet to consult a physician, dietitian or nutritionist first.

Under FDA's food labeling rules, the Daily Value for sodium is 2,400 mg. (Daily Values are a new label reference tool. See "'Daily Values' Encourage Healthy Diet" in the May 1993 FDA Consumer.) FDA established this value because it is consistent with recommendations and government reports that encourage reduced sodium intakes.

Salt and other sodium compounds used in food processing are the biggest contributors of sodium to most people's diets, Brewer pointed out. (One teaspoon of salt has about 2,000 mg of sodium.) These substances are used in food processing for preserving, flavoring and stabilizing other ingredients, she said.

"That's why the ingredient lists of canned, frozen, and other processed foods often contain the names of so many sodium compounds," she said.

Also, kosher beef, lamb and chicken have salt added.

Sodium also is present naturally in some foods, such as milk, cheese, meat, fish, and some vegetables.
Weight Reduction

Label information about fat, calories and fiber also will be important for people with high blood pressure who are overweight. These are the nutrients of most concern to those trying to lose weight or control it. (See "Making It Easier to Shed Pounds" in the July-August 1994 FDA Consumer.)

Body weight, like sodium intake, often closely correlates with blood pressure: As weight goes up, blood pressure frequently does, too. If weight is reduced, blood pressure often goes down.
Other Nutrients

Hypertensives also may be interested in label information about potassium, calcium and magnesium. According to the Joint National Committee's report, evidence suggests that these nutrients may play a role in reducing the risk of high blood pressure. For this reason, nutrition experts often encourage people with hypertension to increase their intakes of these nutrients.

Information about a food's potassium and magnesium content is required on the Nutrition Facts panel only if the food contains added potassium or magnesium as a nutrient or if claims about those nutrients appear on the label. In all other cases, it is voluntary. When listed, potassium must appear below sodium on the NutritionFacts panel, and magnesium must be shown in the list of vitamins and minerals.

The Daily Value for potassium is 3,500 mg. For magnesium, it's 400 mg.

Information about calcium is mandatory. It, too, appears in the list of vitamins and minerals. The Daily Value for calcium is 1 gram (g), or 1,000 mg.
% Daily Values

The place to begin is the "%Daily Value" column under Nutrition Facts. This column contains numbers that show whether a food is high or low in the nutrients listed. For people with high blood pressure, the %Daily Value for sodium is especially important.

If the %Daily Value for sodium is 5 or less, the food is considered low in that nutrient. So, the goal should be to select, as much as possible, foods that have a %Daily Value for sodium of 5 or less. The goal for the full day's diet should be to select foods that together add up to no more than 100 percent of the Daily Value for sodium.

People with high blood pressure also may want to check the %Daily Values for fat, fiber, calcium, and, if listed, potassium and magnesium. The goal for the full day's diet should be to select foods that together add up to no more than 100 percent of the Dally Value for fat and at least 100 percent for fiber and calcium.
Serving Size

Serving size information is important, too. It tells the amount of the food, stated in both common household and metric measures, to which all other numbers apply.

Under the new regulations, serving sizes are designed to reflect the actual amounts that most people eat, although they are not necessarily the amounts recommended by various health groups.

Also, the serving size must be about the same for like products for example, different brands of potato chips--and for similar products within a category of foods--for example, potato chips, pretzels, and popcorn within the category "snacks." This makes it easier to compare the nutritional qualities of related foods.
Other Information

The Nutrition Facts panel also gives the amount in milligrams of a food's sodiumcontent. This information can help consumers who monitor the milligrams of sodium they consume.

The %Daily Values for other nutrients are helpful, too, because they can help consumers determine how nutritious a food is overall. Whether the %Dally Values are for nutrients most people should limit for example, saturated fat and cholesterol--or eat more of--for example, total carbohydrate, fiber, vitamin A, and calcium the %Daily Values tell at a glance how the food compares nutritionally to others.
Food Label Claims

On some food packages, claims describing the food's nutritional benefits may appear. Often, they will show up on the front of the package where shoppers can readily see them.

Nutrient claims--like "sodium-free," "salt-free," and "very low sodium"--describe desirable levels of nutrients in the food. (See "Nutrient Claim Guide.")

Relative nutrient claims compare a product to the "regular" version of the food or to a similar food. For example, a "reduced-sodium" claim on the label of canned spaghetti sauce means the food has at least 25 percent less sodium than regular canned spaghetti sauce. A claim of "light in sodium" on canned spaghetti sauce means the sodium has been reduced by at least 50 percent.

Other claims simply show that a food is high or low in a nutrient, without any particular comparisons to other products. For example, "low-sodium" means the food has 140 mg or less per serving. "Very low sodium" means it has 35 mg or less per serving.

Also, health claims may be made about the relationship between a nutrient or food and a disease or health-related condition. Only those health claims authorized by FDA may appear because they're the only ones supported by substantial scientific evidence.

The claim that diets low in sodium may reduce the risk of high blood pressure is an authorized claim. This claim can appear only on products that meet the definition of "low-sodium" and that provide 20 percent or less of the Daily Value for fat, saturated fat and cholesterol per serving. FDA incorporated this requirement so that low-sodium foods would not be counterproductive by being high in other components that contribute to heart disease.

Whatever the source--health claims, nutrient claims, or the Nutrition Facts panel--consumers, especially those restricting their sodium intake, will find that the new food label puts an end to the guessing games they may have played before. Instead, they'll see that the label gives them more complete, accurate information to help them make more healthful food choices.

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by Paula Kurtzweil

Paula Kurtzweil is a member of FDA 's public affairs staff.

NUTRIENT CLAIM GUIDE
Sodium

Sodium-free: less than 5 milligrams (mg) per serving

Very low sodium: 35 mg or less per serving or, if the serving is 30 grams (g) or less or 2 tablespoons or less, 35 mg or less per 50 g of the food

Low-sodium: 140 mg or less per serving or, if the serving is 30 g or less or 2 tablespoons or less, 140 mg or less per 50 g of the food

Light in sodium: at least 50 percent less sodium per serving than average reference amount for same food with no sodium reduction

Lightly salted: at least 50 percent less sodium per serving than reference amount (If the food is not "low in sodium," the statement "not a low-sodium food" must appear on the same panel as the "Nutrition Facts" panel.)

Reduced or less sodium: at least 25 percent less per serving than reference food

Salt (Sodium Chloride)

Salt-free: sodium-free (see above definition)

Unsalted, without added salt, no salt added:

no salt added during processing, and

the food it resembles and for which it substitutes is normally processed with salt

(If the food is not "sodium free," the statement "not a sodium-free food" or "not for control of sodium in the diet" must appear on the same panel as the Nutrition Facts panel.)

Potassium

High-potassium: 700 mg or more per serving

Good source of potassium: 350 mg to 665 mg per serving

More or added potassium: at least 350 mg more per serving than reference food

Calcium

High-calcium: 200 mg or more per serving

Good source of calcium: 100 mg to 190 mg per serving

More or added calcium: at least 100 mg more per serving than reference food

(For weight-reduction claims, see "Making It Easier to Shed Pounds" in the July-August 1994 FDA Consumer.)

HIGH BLOOD PRESSURE
FOOD LABEL INFO

Check the "Nutrition Facts," usually on the side or back of the package.

Look at the serving size. It is about the same for similar items. So it's easy to compare the nutritional qualities of similar foods.

Look at the column called "%Daily Value." It tells you at a glance whether a food is high or low in sodium, fat, fiber, and calcium.

Look for nutrient content claims, usually on the front of the package. They can help you quickly spot foods that contain desirable levels of pertinent nutrients.

Nutrition Facts

Serving Size 1/2cup (125g)
Servings Per Container about 3 1/2

Amount Per Serving

Calories 50 Calories from Fat 10

% Daily Value(*)

Total Fat 1 g 2%
Saturated Fat 0g 0%
Cholesterol 0mg 0%
Sodium 250mg 10%
Potassium 530mg 15%
Total Carbohydrate 9g 3%
Dietary Fiber 1g 4%
Sugars 7g
Protein 2g

Vitamin A 10% Vitamin C 25%
Calcium 2% Iron 10%

* Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs:

Calories: 2,000 2,500

Total Fat Less than 65g 80g
Sat Fat Less than 20g 25g
Cholesterol Less than 300mg 300mg
Sodium Less than 2,400mg 2,400mg
Potassium 3,500mg 3,500mg
Total Carbohydrate 300g 375g
Dietary Fiber 25g 30g

Light Spaghetti Sauce, 250 milligrams (mg) per serving

Regular Spaghetti Sauce, 500mg per serving

SPECIAL REPORT

In-depth but easy-to-understand information about the new food label is provided in an FDA Consumer special report, Focus on Food Labeling. Copies cost $5 each. To order, write to: Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Ask for stock number S/N 017-012-00360-5.

ALTERNATIVES TO HIGH-SODIUM FOODS

If you find yourself continually eating more than 100 percent of the Daily Value for sodium each day, consider these lower sodium alternatives. For labeled items, check the %Daily Value for sodium; try to select foods that provide 5 percent or less per serving.

Information is presented in the following order: instead of; eat

smoked, cured, salted, and canned meat, fish and poultry; unsalted fresh or frozen beef, lamb, pork, fish, and poultry

regular hard and processed cheese, regular peanut butter; low-sodium cheese, low-sodium peanut butter

crackers with salted tops; unsalted crackers

regular canned and dehydrated soups, broths and bouillons; low-sodium canned soups, broths and bouillons

regular canned vegetables; fresh and frozen vegetables and low-sodium canned vegetables

salted snack foods; unsalted tortilla chips, pretzels, potato chips, and popcorn

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