Main sources of sodium include many common foods

From the CDC

Nearly all Americans consume much more sodium than they should, according to a report from the Centers for Disease Control and Prevention.  Most of the sodium comes from common restaurant or grocery store items.

The latest Vital Signs report finds that 10 types of foods are responsible for more than 40 percent of people’s sodium intake.

The most common sources are breads and rolls, luncheon meat such as deli ham or turkey, pizza, poultry, soups, cheeseburgers and other sandwiches, cheese, pasta dishes, meat dishes such as meat loaf, and snack foods such as potato chips, pretzels and popcorn.

Some foods that are consumed several times a day, such as bread, add up to a lot of sodium even though each serving is not high in sodium.

“Too much sodium raises blood pressure, which is a major risk factor for heart disease and stroke,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “These diseases kill more than 800,000 Americans each year and contribute an estimated $273 billion in health care costs.”

The report notes that the average person consumes about 3,300 milligrams of sodium per day, not including any salt added at the table, which is more than twice the recommended limit for about half of Americans and 6 of every 10 adults.

Top Sources of Sodium in Our Diet

• Breads and rolls

• Cold cuts and cured meats

• Pizza

• Poultry

• Soups

• Sandwiches

• Cheese

• Pasta dishes

• Meat dishes

• Snacks

The U.S. Dietary Guidelines recommend limiting sodium intake to less than 2,300 milligrams per day.  The recommendation is 1,500 milligrams per day for people aged 51 and older, and anyone with high blood pressure, diabetes, and chronic kidney disease, and African Americans.

Key points in the Vital Signs Report:

• Ten types of foods account for 44 percent of dietary sodium consumed each day.

• 65 percent of sodium comes from food sold in stores.

• 25 percent of sodium comes from meals purchased in restaurants.

• Reducing the sodium content of the 10 leading sodium sources by 25 percent would lower total dietary sodium by more than 10 percent and could play a role in preventing up to an estimated 28,000 deaths per year.

Reducing daily sodium consumption is difficult since it is in so many of the foods we eat.  People can lower their sodium intake by eating a diet rich in fresh or frozen fruits and vegetables without sauce, while limiting the amount of processed foods with added sodium.

Individuals can also check grocery food labels and choose the products lowest in sodium.  CDC supports recommendations for food manufacturers and restaurants to reduce the amount of sodium added to foods.

“We’re encouraged that some food manufacturers are already taking steps to reduce sodium,” said Dr. Frieden. “Kraft Foods has committed to an average 10 percent reduction of sodium in their products over a two year period, and dozens of companies have joined a national initiative to reduce sodium.

The leading supplier of cheese for pizza, Leprino Foods, is actively working on providing customers and consumers with healthier options.  We are confident that more manufacturers will do the same.”

To learn more:

• To learn more about ways to reduce sodium, visit www.cdc.gov/salt.

• For more information on heart disease and stroke, visit http://www.cdc.gov/heartdisease/.

• Reducing sodium is also a key component of the Million Hearts™ initiative to prevent a million heart attacks and strokes over the next five years.

• To learn how to reduce sodium using the DASH eating plan, visithttp://www.nhlbi.nih.gov/health/health-topics/topics/dash/.

From NIH News in Health 

February is American Heart Month—a time to reflect on the sobering fact that heart disease remains the number one killer of both women and men in the United States.

The good news is you have the power to protect and improve your heart health.

NIH and other government agencies have been working to advance our understanding of heart disease so that people can live longer, healthier lives. Research has found that you can lower your risk for heart disease simply by adopting sensible health habits.

To protect your heart, the first step is to learn your own personal risk factors for heart disease. Risk factors are conditions or habits that make you more likely to develop a disease. Risk factors can also increase the chances that an existing disease will get worse.

Certain risk factors—like getting older or having a family history of heart disease—can’t be changed. But you do have control over some important risk factors such as high blood cholesterol, high blood pressure, smoking, excess weight, diabetes and physical inactivity. Many people have more than one risk factor.

To safeguard your heart, it’s best to lower or eliminate as many as you can because they tend to “gang up” and worsen each other’s effects.

A large NIH-supported study published last month underscores the importance of managing your risk factors. Scientists found that middle-aged adults with one or more elevated risk factors, such as high blood pressure, were much more likely to have a heart attack or other major heart-related event during their remaining lifetime than people with optimal levels of risk factors.

“For example, women with at least 2 major risk factors were 3 times as likely to die from cardiovascular disease as women with none or 1 risk factor,” says Dr. Susan B. Shurin, acting director of NIH’s National Heart, Lung and Blood Institute. “You can and should make a difference in your heart health by understanding and addressing your personal risk.”

Protect Your Heart

• Don’t smoke.

• Maintain healthy cholesterol levels and blood pressure.

• Maintain a healthy weight.

• Choose more heart-healthy foods.

• Get and stay active.

• Know your family history.

• Learn the signs that something’s wrong.

• Set a good example.

To tackle your heart risk factors, it helps to know your numbers. Ask your health care provider to measure your blood cholesterol and blood pressure. Then determine if your weight is in the healthy range.

The higher your cholesterol level, the greater your risk for heart disease or heart attack. High blood cholesterol itself doesn’t cause symptoms, so you can’t know if your cholesterol is too high unless you have it tested. Routine blood tests can show your overall cholesterol level and separate levels of LDL (“bad”) cholesterol, HDL (“good”) cholesterol and triglycerides. All of these blood measurements are linked to your heart health.

High blood pressure (hypertension) is another major risk factor for heart disease, as well as for stroke. High blood pressure is often called the “silent killer” because, like high cholesterol, it usually has no symptoms. Blood pressure is always reported as 2 numbers, and any numbers above 120/80 mmHg raise your risk of heart disease and stroke.

“Scientific evidence is strong that controlling high blood cholesterol and high blood pressure prevents cardiac events such as heart attacks,” says Dr. Michael Lauer, a heart disease specialist at NIH.

Your weight is another important number to know. To find out if you need to lose weight to reduce your risk of heart disease, you’ll need to calculate your body mass index (BMI, a ratio of weight to height). This NIH web page can help: www.nhlbisupport.com/bmi/bmicalc.htm. A BMI between 25 and 29.9 means that you’re overweight, while a BMI of 30 or higher means obesity.

Next, take out a tape measure. A waist measurement of more than 35 inches for women and 40 inches for men raises the risk of heart disease and other serious health conditions. Fortunately, even a small weight loss (between 5% and 10% of your current weight) can help lower your risk.

NIH has many tools available to help you aim for a healthy weight, including physical activity tips and a menu planner. To learn more, visit http://healthyweight.nhlbi.nih.gov/.

A heart-healthy diet includes a variety of fruits, vegetables and whole grains, as well as lean meats, poultry, fish, beans and fat-free or low-fat dairy products. Try to avoid saturated fat, trans fat, cholesterol, sodium (salt) and added sugar.

NIH’s Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH) diets both promote healthy eating. U.S. News & World Report named TLC and DASH the top 2 overall diets for 2012.

Regular physical activity is another powerful way to reduce your risk of heart-related problems and enjoy a host of other health benefits. To make physical activity a pleasure rather than a chore, choose activities you enjoy. Take a brisk walk, play ball, lift light weights, dance or garden. Even taking the stairs instead of an elevator can make a difference.

Resources for further information and tips

“At least 2 and a half hours a week of moderate-intensity physical activity can lower your risk of heart disease, stroke, hypertension and diabetes—a winner on multiple counts,” says Dr. Diane Bild, a cardiovascular epidemiologist at NIH.

If you have diabetes, it’s important to keep your blood sugar, or glucose, under control. About two-thirds of people with diabetes die of heart or blood vessel disease. If you’re at risk for diabetes, modest changes in diet and level of physical activity can often prevent or delay its development.

If you happen to be a smoker, the best thing you can do for your heart is stop. People who smoke are up to 6 times more likely to suffer a heart attack than nonsmokers. The risk of heart attack increases with the number of cigarettes smoked each day.

The good news is that quitting smoking will immediately begin to reduce your risk, and the benefit in reduced risk will continue to increase over time. Just one year after you stop smoking, your risk will have dropped by more than half.

Beyond controlling your risk factors, you should be alert to certain symptoms and get checked by a doctor. Common signals that something‘s wrong with your heart include angina—pain in the chest, shoulders, arms, neck, jaw or back—as well as shortness of breath, irregular heartbeat or palpitations (arrhythmia)
and fatigue.

Be aware that the symptoms of a heart attack can vary from person to person. If you’ve already had a heart attack, your symptoms may not be the same if you have another one.

Finally, don’t forget that you can influence your loved ones’ heart health by setting an example. Do you have children, grandchildren or other young people who look up to you? If you follow a heart-healthy lifestyle, it’s more likely that they will, too.  Because heart disease begins in childhood, one of the best things you can do for those you love is to help children build strong bodies and healthy habits.

The bottom line is, it’s never too late to take steps to protect your heart. It’s also never too early. Start today to keep your heart strong. Talk to your doctor about your risk and to create an action plan. Love your heart.

By Caroline E. Mayer

Determine if you qualify financially

Washington state has prepared a guide to buying long-term care insurance

Don’t buy if the out-of-pocket cost for the coverage would be more than you can afford. Consumer Reports advises people that if their net worth, excluding their home, is below $300,000, long-term care insurance is not a good buy for them.

The National Association of Insurance Commissioners also recommends that consumers spend no more than 5 percent of their income on a long-term care policy.

If you need long-term care but have few financial resources, Medicaid should quickly kick in to pay, although that will probably limit your choices for care.

On the other hand, if you have a lot of resources (some financial advisers put that threshold at $2 million), you may be able to self-insure and pay the costs as they arise, thereby eliminating the need to buy a policy.

Shop around.

Unlike car insurance where you can switch carriers easily, it can be expensive to change long-term care policies because the premiums increase as you age and you lose the investments already made. Comparison shopping is critical.

Some companies and associations (such as alumni groups and AARP) offer group policies with relatively liberal eligibility, making it easier to obtain coverage if the policyholder has any health issues.

However, these policies may have more limited benefits than individually purchased plans.

If you are young or in excellent health, a group plan may also be more expensive; you may end up paying more to subsidize your less healthy peers.

And if you are certain you want LTC insurance, the younger you are, the better. Your annual premiums will be smaller, and you have less chance of being denied for health reasons.

Know what’s covered.

Policies differ greatly so know what you are buying:

• What services are covered?
• How long is the disability period before benefits kick in and what happens if you move from one facility to another?
• How much does the policy pay per day for nursing home care, home-health care and assisted living?
• How long will benefits last?
• Is there an inflation adjustment that anticipates rising medical costs as you age?
• How long are benefits extended (one, three or five years, or indefinitely)?
• Who determines benefit eligibility — your doctor, or the insurance company’s doctor — and on what basis?
• Are preexisting conditions excluded?
• Does the policy cover mental or nervous disorders, alcoholism, drug abuse or self-inflicted injuries?

The National Association of Insurance Commissioners advises consumers to look for policies that include at least one year of nursing home or home health care coverage, including intermediate and custodial care; coverage for Alzheimer’s disease; inflation protection; a guarantee that the policy cannot be terminated because you get older or your health deteriorates; no requirement that the beneficiary has to first be hospitalized to receive benefits and a 30-day cancellation period after purchase.

Check out the insurance company.

Review a carrier’s record with your state insurance commissioner’s office. Find out how long it has been in business its complaint record and history of raising rates. Stick with a company that has an A financial rating.

Also, the National Association of Insurance Commissioners and the American Association for Long-Term Care Insurance have consumer guides on their Web sites.

The Department of Health and Human Services provides extensive information on it’s website, longtermcare.gov.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Jenny Gold
This story was produced in collaboration with 

On a Monday night in December, Lauretta Martin, 47, visited the sleep lab at the National Rehabilitation Hospital in Washington, D.C. for the second time.

On her first visit, Martin, a heavyset woman whose husband reports she is a loud snorer, was diagnosed with sleep apnea. This time, she was being fitted for a CPAP machine, which helps keep a snorer’s airway open throughout the night.

The sleep lab has six testing rooms, each of which looks just like a room at a Holiday Inn, with striped wallpaper, a floral bedspread, framed prints of the seaside and free wifi.

“They have a brochure that says it’s just like being in a hotel room, and it is,” says Martin, sitting on the edge of her bed wearing a pair of soft grey pajamas and watching a football game on her flat-screen TV.

Aside from the two-dozen colorful electrodes taped to her body to monitor her every motion and the scuba-style mask on her face to enhance her breathing, she looked ready for a cozy night of slumber.

In the tech room a few doors down, a professional sleep technician observed her over a video monitor, testing the electrodes and preparing to listen in to the sounds of her sleep.

Snoring was once considered a simple annoyance for bed partners, but there is a growing awareness in the medical community that the grunts and snorts of noisy sleepers can also be a sign of sleep apnea, a condition shown to increase the risk of numerous serious illnesses, including heart disease, stroke and dementia.

Testing can be a lucrative business, and labs have popped up in free-standing clinics and hospitals across the country. Over the past decade, the number of accredited sleep labs that test for the disorder has quadrupled, according to the American Academy of Sleep Medicine (AASM).

Sleep apnea occurs when the muscles in the back of the throat relax, causing an airway obstruction that can stop a person’s breathing for several seconds or even minutes.  It causes restless sleep and sometimes dangerously-low blood oxygen levels.

The disorder can be diagnosed by monitoring a snorer’s sleep patterns, either in an overnight visit to a sleep lab or at home using a portable testing device. It is then often treated with a CPAP machine, which helps keep a snorer’s airway open during sleep.

Sleep apnea has likely gotten more common as the population has grown older and more obese, two major risk factors for apnea, and the National Institutes of Health estimates that more than 12 million Americans suffer from the disorder.  Many are never diagnosed.

“I think the medical community is sort of dropping the ball” on apnea, explains Dr. David Gross, medical director of the sleep lab at the National Rehabilitation Hospital. “It’s just sad when you walk through the hospital and you see these patients with heart failure—the person might be 35 years old, he’s 350 lbs — but no one’s thinking that he has sleep apnea, which he statistically does.”

Dr. David Gross, director of the sleep lab at the National Rehabilitation Hospital in Washington, D.C., analyzes a sleep test (Photo by Jenny Gold/KHN)

He says more than three-quarters of the patients who come to the lab are diagnosed with apnea.

But the testing isn’t cheap: each night at a hospital sleep lab can cost $1,900 and is usually mostly covered by a patient’s health insurance. Some patients, including Martin, end up spending two nights at the lab – one to test for apnea, and the second to try the CPAP machine.

Dr. Fred Holt, an expert on fraud and abuse and the medical director of Blue Cross Blue Shield in North Carolina, says some patients aren’t having basic exams done first and are therefore being prescribed expensive tests they don’t need. Not everyone who snores has a chronic disorder, he notes.

In other cases, Holt says the labs prescribe CPAP machines right away without first suggesting other strategies like losing weight of sleeping on your side, which can also reduce apnea.

“We are spending more and more money on sleep testing and treatment, and like anything else in health care, there are unscrupulous people out there who are more than happy to do testing and treatment that might be of questionable value,” says Holt. “This might be because of naiveté on the part of the physician, or unfortunately, it could be done for the sake of improving the cash flow of one’s business.”

It’s no secret that the sleep business can be lucrative for physicians. A website for Aviisha, a sleep testing company, has a section for physicians showing a picture of a doctor with a stack of money in his lab coat pocket.  And in February, the AASM is offering a seminar on the “business of sleep medicine for physicians” at a golf resort in Arizona.

Dr. Nancy Collop, president of the AASM, says that while many sleep centers offer comprehensive care for sleep disorders, others are largely focused on overnight sleep testing.

“A lot of people have gotten into the sleep business specifically to do that procedure,” she explains. The goal of the AASM’s accreditation process, she says, is to make sure sleep labs are offering more because “many patients may not even need a sleep study.”

Helen Darling, president of the National Business Group on Health, which represents large employers offering health insurance to their workers, says the tests are driving up the cost of premiums.

“This is a good example of something where we have technology, we have financial incentives to use more of it then we have historically done, you have enough problems including a growing obesity epidemic, and you sort of put together the so-called perfect storm for driving up overuse and health care cost,” Darling says.

She says doctors should focus instead on common-sense approaches to sleep apnea, like losing weight, before turning to expensive testing and medical devices.

Another option are home sleep tests, which costs less than a fifth of the cost of a lab test, and are considered effective for most patients. Medicare began paying for home sleep tests in 2008, but the tests have had only modest growth.

“I believe lab tests, as opposed to the home tests, are being wildly overprescribed,” says Mike Backus, senior vice president of American Imaging Management, a subsidiary of Wellpoint.

Right now, he says, 99 percent of the sleep tests given to Wellpoint patients are done in the lab, but “it should be 70 percent at home and 30 percent in the lab.”

Backus adds that the majority of patients who are diagnosed with apnea and then given CPAP machines stop using them within the first year.

Some insurers, including Wellpoint, are changing the way they pay for sleep testing to curb the costs. Many now require a special pre-authorization. They also ask the doctor whether a patient qualifies for a home sleep test instead of one at the lab.

Those changes are now widespread among Massachusetts insurers and are having an effect on the sleep industry in the state.

Dr. Lawrence Epstein, the chief medical officer of Sleep Healthcenters in Massachusetts, says the labs have already experienced a 20 percent drop in the number of patients coming in for testing.

While the past decade was focused on industry growth, he says it’s “now going to be about consolidation and provision of better quality, more efficient care.”

Sleep Healthcenters has shut down three of its 15 sleep labs, and more closures may be on the way. Epstein says the company is focusing more on “sleep wellness,” including treating and managing sleep disorders, and less on testing.

The key, he explains, is to become more efficient without decreasing access to care for patients who need it.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Zocalo Public Square: How Doctors Die

Photo: Hanspeter Klasser

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. … He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible.

Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little (Dr. Ken Murray, 11/30).

Photo courtesy of Hanspeter Klasser

Health Affairs: An MS Patient Loses Trust When She Finds Out Her Doctor Is Paid By Drug Companies’

Last year, four years after showing initial symptoms of multiple sclerosis (MS), I walked out the door of one neurologist’s office and, after several months of searching, switched to a different doctor.

It was the final act in a series of events that had gradually eroded my trust in the first neurologist’s judgment, which I believe was colored by his financial relationships with drug companies who manufacture and market medicines for MS patients. … Given my background in medical ethics, I was familiar with the potential conflicts of interest that exist for physicians participating in clinical pharmaceutical trials.

Assuming that my neurologist was being compensated for running the trial, in addition to his earnings from seeing patients in his neurology practice, I’d asked him if that was the case, and he confirmed that it was (Maran Wolston, December 2011).

The New Republic: More Health Care Heresy From Newt

Newt Gingrich

Newt Gingrich’s past endorsement of an individual mandate has drawn fire from conservatives. But that’s not his only health care heresy.

In 2008, Gingrich made the case for another idea that became part of Obamacare and, in due time, the focus of right-wing attacks.

Worse still, at least from the standpoint of conservatives, he did so by writing an op-ed for The New York Times. Oh, and did I mention he had some help? Gingrich had a co-author: John Kerry, the Democratic senator and former presidential nominee. … they also acknowledged that ultimately the private sector couldn’t solve this problem on its own.

More action was necessary, they said, and that action had to come from government … That’s the problem for Gingrich when it comes to improving the delivery of health care. He isn’t crazy. But plenty of influential conservatives are (Jonathan Cohn, 12/13).

Photo by Gage Skidmore

Newsweek: Could This Be The End Of Cancer?

By all rights, Shari Baker should have said her final goodbyes years ago. In 2005, more than a year after three doctors dismissed a lump under her arm as a harmless cyst, she was diagnosed with stage IV (metastatic) breast cancer … In May 2006, she traveled to the University of Washington.

The (cancer) vaccine was injected into her upper arm; she got five more shots over the next five months. Today, with scans detecting no cancer anywhere, Baker seems to have beaten some extremely stiff odds. …

By “cancer vaccine,” scientists mean something that will stimulate the immune system to attack malignant cells (Sharon Begley, 12/12).

The Atlantic: The Top 10 Health Stories Of 2011

Photo by Jean Scheijen

Coffee is good for you. And coffee is bad for you. Cell phones cause cancer. And cell phones don’t cause cancer.

Like any other year in health, 2011 was one of conflicting studies. In the end, we’re not always sure how to act or what to drink or when to exercise, but we do know more about ourselves and the world we live in thanks to researchers everywhere and the work that they do.

However broad or specific their conclusions, however small or large their sample size, medical studies do contribute to our wellbeing simply by existing and, if nothing else, by making us think twice about the things we eat, say, and do on a daily basis (Nicholas Jackson, 12/14).

Photo courtesy of Jean Scheijen

The Daily Show: Ed Gillespie

Jon Stewart talks health care with Republican political strategist Ed Gillespie (12/8).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.