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/.

By Carolyn M. Clancy, M.D.

February 7, 2012

With Valentine’s Day around the corner, hearts shapes are everywhere – on cards, candy, and clothing. But every day of the year, your heart plays a big role in your health and well-being. And conditions or habits that harm our hearts, like high blood pressure or smoking, put our hearts at risk.

The risk is serious. Heart disease and strokes kill more than 800,000 Americans each year and cost $445 billion each year, according to the Department of Health and Human Services (HHS) (PDF File, PDF Help). People with heart disease are often unable to work or enjoy normal activities. They are also at higher risk of early death.

To help combat heart disease, especially heart attack and stroke, HHS recently joined several groups that include doctors, nurses, pharmacists, insurance companies, and drug stores in a campaign called Million Hearts.

Over the next 5 years, the partners aim to help millions of Americans improve their heart health by preventing and treating high blood pressure, high cholesterol, and tobacco use.

The goals are ambitious. But the good news is that heart disease can be prevented or reduced with two approaches.

The first is making healthy choices, like quitting smoking (or never starting), and lowering the amount of salt and trans fats we consume. Today, 19 percent of the U.S. population smokes; in 5 years, the partnership aims to cut that to 17 percent.

The second approach is making treatment for heart disease available for people who need it. Simple but effective techniques, known as the “ABCS,” help focus these efforts. The ABCS stand for: Aspirin for people at risk, Blood pressure control, Cholesterol management, and Smoking cessation.

We have good tools to treat heart disease, but they’re not used enough. Today, less than half (47 percent) of people at risk for heart disease take a daily aspirin. The Million Hearts campaign hopes to increase that to 65 percent by 2017. Reducing salt intake, a factor in high blood pressure, by 20 percent, is another goal.

HHS is working with partners to help attain the Million Hearts goals. The partners include:

• The American Heart Association  is offering access to online tools , including one that helps you understand your heart health.

• America’s Health Insurance Plans  and its members are hosting programs to reduce heart disease with programs that promote fitness, lower obesity and manage chronic disease.

• The Y is expanding coverage of its diabetes prevention program  and other national disease prevention programs to better address risks for diabetes, heart attack, and stroke.

My Agency, the Agency for Healthcare Research and Quality (AHRQ), supports the Million Hearts campaign and has tools and knowledge that can support its goals.

For example, one AHRQ-funded resource that highlights innovative practices describes how pharmacists can help people lower their risk for heart disease.

In the HealthyHeartClub.com program, pharmacists educate patients to lower their heart risk by changing their diet, exercising more, and taking the right medicines. Working with primary care doctors, pharmacists meet with patients, email them weekly, and provide access to classes and tools that support their goals. It works! After 3 months, patients’ weight, blood pressure, and daily activity all improved.

AHRQ’s Effective Health Care Program produces free, plain-language booklets that can help you learn about treatment options for high blood pressure and high cholesterol. They describe treatment options, discuss risks and benefits, and identify areas where more research is needed.

All these resources for the Million Hearts initiative have one thing in common—they are an excellent source of information to share with your health care provider. Together, you can discuss steps you need to take to be sure you’re healthy for many more Valentine’s Days in the future.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

U.S. Department of Health and Human Services: Million Hearts

New public-private initiative aims to prevent 1 million heart attacks and strokes in five years
http://millionhearts.hhs.gov/docs/Million_Hearts_Press_Release.pdf [PDF Help]

Million Hearts
http://millionhearts.hhs.gov/

Heart Disease Prevention: Million Hearts
http://millionhearts.hhs.gov/about-hd-prevention.shtml

Agency for Healthcare Research and Quality

AHRQ Innovations Exchange: Innovation Profile
http://innovations.ahrq.gov/content.aspx?id=3182

Effective Health Care Program

Choosing Medications for High Blood Pressure: A Review of the Research on ACEIs, ARBs, and DRIs
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=75

Treating High Cholesterol: A Guide for Adults
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=351

American Heart Association

AHA
http://www.heart.org/HEARTORG/

American Heart Association/American Stroke Association 

My Life Check
http://50.56.33.51/mlc01/main_en_US.html

America’s Health Insurance Plans (AHIP)

AHIP Statement on Million Hearts Initiative
http://www.ahip.org/News/Press-Room/2011/AHIP-Statement-on-Million-Hearts-Initiative.aspx

The Y

The Y Joins CDC, HHS, CMS in Million Hearts Initiative
http://www.ymca.net/news-releases/20110913-cdc.html

Current as of February 2012

Internet Citation:

Million Hearts Campaign Aims to Lower Risk, Improve Care. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, February 7, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc020712.htm

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.

Chef Eric has struggled to manage his weight his entire life, and blogs on the Swedish website about food, his weight loss journey, eating in public, and more.

Dr. Richard Lindquist, a specialist with Swedish’s Weight Loss Services, provides some holiday eating tips to help you avoid those extra calories.

Spiced Hot Toddy

Serves 6 — 5oz drinks

Ingredients:

• 1 quart Light Soy milk
• 1 vanilla bean — split with seed scraped out
• 2 cinnamon sticks
• 1 TBSP honey
• 1 whole Nutmeg

Preparation:

1. Place soy milk w/vanilla bean and cinnamon sticks in sauce pan, bring just to simmer, insuring not to boil. Remove from heat. Add honey.
2. Allow the spices to steep for 10 minutes.
3. Transfer all the ingredients to a French press and press all spices down to the bottom.
4. Froth the toddy by carefully pumping up and down on the press, divide among 6 tea cups
5. Grate fresh Nutmeg over the Toddy, serve immediately.

Nutritional Information:

• 100 calories
• 1.5 grams of fat
• 6 grams of protein
• 12 grams carbs

Green Tea & Rosemary Sparkler

Makes 1 — 12 oz serving

Ingredients:

• 1 bag – Favorite Green Tea
• 2 inch stalk of Lemongrass (can substitute a lemon wedge)
• 1 stem of rosemary — small sprig removed from the top reserved
• 4 oz hot water
• 8 oz favorite sparkling water
• Ice cubes (optional)
• Artificial sweetener (optional)

 Preparation:

1. Steep the tea bag in the 4 oz of hot water with the lemongrass and the rosemary. Remove the teabag after 3 minutes let the herbs remain until the water reaches room temperature.
2. Strain tea into a tall glass over ice and sweetener (optional)
3. Add the 8 oz of bubbly water and a sprig of rosemary for garnish

Nutritional Information:

• 0 calories