Showing posts with label sodium bicarbonate. Show all posts
Showing posts with label sodium bicarbonate. Show all posts

Saturday, September 19, 2009

Cutting Salt Intake in US Could Save $50 Billion a Year

As organ transplant recipients we must be vigilant about our salt intake to keep our blood pressure in check and to prevent renal (kidney) damage. The recommended highest daily allowance for everyone is 2300 mg/day and the 1,500 milligram level can lower blood pressure further and more recently is the amount recommended by the Institute of Medicine as an adequate intake level and one that most people should try to achieve.

Shopping for low-sodium food can be a frustrating experience these days. I always check for sodium content and it's alarming to find so many foods with high salt content. I check everything before I buy it, especially canned soups, packaged and prepared meals, processed foods, luncheon and deli meats. You will find them loaded with salt. I recently read the sodium content in a can of chili and was frightened to see over 1,000 mg in a half-can serving. I put it back on the shelf immediately. Also, check for the serving size listed for the sodium content. Many producers show a very small serving size so as to make the salt content appear to be reasonable. For sodium content of fast food in restaurants such as McDonald's go to this link: food-facts.suite101.com.


By Lisa Nainggolan
Medscape Pulmonary Medicine

September 17, 2009 (Santa Monica, California) — One of the first studies to estimate the economic benefits of lowering sodium consumption among the US public has found that $18 billion in healthcare costs for hypertension could be saved every year if salt intake were reduced to the amount recommended by health officials.

n addition, quality of life would be improved for millions of people, with a further potential saving of $32 billion annually, say Kartika Palar (RAND Pardee Graduate School , Santa Monica, CA) and Dr Roland Sturm (RAND, Santa Monica, CA) in their paper in the September/October 2009 issue of the American Journal of Health Promotion.

"This study provides an important first step toward quantifying the benefits of reducing the intake of sodium by the American public," says Palar in a statement [2]. "These findings make a strong case that there's value in pursuing a population-based approach to reducing sodium intake among Americans."

30% of US Have Hypertension, Much Due to Excessive Sodium Intake

Excessive consumption of salt is a persistent health problem in many parts of the world, and the US is no exception, say Palar and Sturm. Using population-level data on blood pressure, antihypertensive medication use, and sodium intake from the National Health and Nutrition Examination Survey (NHANES 1999–2004), they estimated that American adults consume around 3400 mg of sodium a day, when the recommended amount is 2300 mg/day. Only about 30% of the population eats less than 2300 mg/day, they say.

Their objective was to quantify the potential benefits of reducing salt consumption at the population level by considering both savings in healthcare costs and increases in quality of life. They modeled sodium-reduction scenarios by using a cross-sectional simulation approach and calculated the following outcome measures: hypertension prevalence, direct healthcare costs, and quality-adjusted life-years (QALYs).

Reducing average population sodium intake to the amount recommended (2300 mg/day) could reduce cases of hypertension by 11 million, saving $18 billion in direct healthcare dollars and gaining 312 000 QALYs that are worth $32 billion annually, say Palar and Sturm.

"Our results are driven by the fact that nearly 30% of the nation's population has hypertension," says Palar, adding that one of the reasons that high blood pressure is so pervasive is that sodium consumption is so excessive.

And although she and Sturm note a number of limitations to their study, they say their estimates are likely conservative, because they were unable to calculate the savings for illnesses such as cardiovascular diseases, where sodium consumption plays a less well-defined role.

Strategies Desperately Needed to Lower Sodium Intake in US

They stress that much better strategies for lowering sodium intake need to be developed in the US and that the main drivers must be changes to government regulations and/or voluntary actions by companies.

"Although clinicians can educate their patients about sodium intake, it is very difficult for individuals to reduce sodium intake. Studies estimate that 75% of dietary salt intake in the US population comes from processed foods rather than sources added during cooking or at the table," they explain.

"Without more accessible information, voluntary actions by companies, or government regulation, consumers may have difficulty reducing sodium consumption on their own."

They discuss strategies that have been successfully adopted elsewhere in the world, such as in the UK, where the Food Standards Agency has encouraged companies to use a traffic-light, front-of-package labeling system that identifies food products as low (ie, green), medium (yellow), or high (red) in sodium. This agency has also run an aggressive advertising campaign to lower salt consumption, they note.

In the US, although the FDA has recently opened proceedings to evaluate the regulatory status of salt and sodium, this has remained "unchanged for more than 40 years," they point out.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network. NEW for Ontario: recycleMe.org - Learn The Ins & Outs Of Organ And Tissue Donation. Register Today! For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ transplant.

Saturday, July 18, 2009

Baking Soda May Slow Progression of Chronic Kidney Disease

One of the major side effects of anti-rejection drugs is impairment of kidney function. When my Creatinine blood levels (A fairly reliable indicator of kidney function) started increasing soon after my lung transplant, the nephrologist put me on several medications, including Sodium Bicarbonate tablets. Since then, my kidney function has remained stable.

Medscape Pulmonary Medicine

July 16, 2009 — Daily supplementation with sodium bicarbonate slows the progression rate of renal failure to end-stage renal disease (ESRD) and improves nutritional status among patients with chronic kidney disease (CKD), according to a randomized, open-label study reported online July 16 in the Journal of the American Society of Nephrology.

"Metabolic acidosis..., generally perceived by clinicians as a low plasma bicarbonate, is a common complication in patients with [CKD], particularly when [glomerular filtration rate] falls below 30 ml/min," write Ione de Brito-Ashurst, from the Department of Renal Medicine and Transplantation at the William Harvey Research Institute, and Barts and the London National Health Service Trust, United Kingdom, and colleagues. "This, in turn, may bring about a variety of sequelae, such as stunted growth in children, loss of bone and muscle mass, negative nitrogen balance, and possible acceleration of progression of CKD."

Past studies have shown that bicarbonate supplementation preserves renal function in experimental CKD, but whether the same benefit occurs in humans is unknown, the authors write. "The lack of long-term studies examining the impact of alleviation of metabolic acidosis on renal function in predialysis patients and on nutritional status was the particular stimulus to perform this study."

The primary endpoints were rate of creatinine clearance (CrCl) decline and the proportion of patients with rapid decline of CrCl (>3 mL/minute/1.73 m2/year) and ESRD (CrCl < 10 mL/minute). Secondary endpoints were dietary protein intake, normalized protein nitrogen appearance, serum albumin, and midarm muscle circumference.

The investigators enrolled 134 adult patients with CKD (CrCl 15 – 30 mL/minute/1.73 m2) and serum bicarbonate levels of 16 to 20 μmol/L. All patients were randomly assigned to receive either 600 mg oral sodium bicarbonate tablets at 1.82 ± 0.08 g/day (n = 67; mean age, 54.78 ± 2.56 years; 52% men; 52% white) or standard treatment (n = 67; mean age, 54.77 ± 2.56 years; 51% men; 52% white) during a 2-year period.

All patients performed 24-hour urine collections at the study's start and then every 2 months, which the investigators used to measure serum HCO3 −, potassium, creatinine, urea, albumin, and C-reactive protein. At each follow-up visit, blood pressure, drug compliance by direct questioning, body weight, and midarm circumference were documented. The phosphoenolpyruvate method was used for measuring bicarbonate levels. An estimate of the habitual dietary intake of each patient was made from a 4-day food diary completed before each follow-up appointment.

At the end of the study, the rate of decline in CrCl was significantly slower for those treated with the bicarbonate supplementation compared with the control group (5.93 vs 1.88 mL/minute/1.73 m2; P < .0001).

In addition, rapid progression occurred in just 9% of the patients receiving bicarbonate supplementation vs 45% of those receiving standard care (relative risk [RR], 0.15; 95% confidence interval [CI], 0.06 – 0.40; P < .0001).

Four patients in the bicarbonate group developed ESRD requiring dialysis (6.5%) compared with 22 patients in the control group (33%; RR, 0.13; 95% CI, 0.04 – 0.40; P < .001).

Several nutritional parameters also improved significantly with bicarbonate supplementation. Dietary protein intake showed a significant increment compared with that in the control group (P < .007), whereas normalized protein nitrogen appearance decreased (P < .002). This increase in dietary protein intake and reduction in normalized protein nitrogen appearance led to an increment in the lean body mass as assessed by midarm muscle circumference in the treatment group from 24.8 (23.7 – 25.8) to 26.3 (25.0 – 27.5) compared with no change in the control group (P < .03).

In addition, serum albumin levels rose in the treatment group but remained unchanged in the control group, and serum potassium levels declined (P < .05).

Although sodium intake did increase for the sodium bicarbonate group vs the control group, it did not lead to increased blood pressure.

"This is the first randomized, controlled clinical study in which oral sodium bicarbonate supplementation was associated with positive results in both primary and secondary endpoints in patients with CKD," the study authors write. In addition, "there was no effect on [blood pressure] or evidence of worsening edema as assessed clinically at every clinic consultation."

Limitations of the study include the absence of a double-blind design — the researchers were aware of which patients were receiving the supplement — and the lack of placebo.

"Oral sodium bicarbonate supplementation in patients with low plasma HCO3 − levels slows the rate of decline of renal function and the development of ESRD in patients with advanced stages of CKD," the study authors conclude. "This cheap and simple strategy...improves the nutritional status of patients and has the potential of translating into significant economic, quality-of-life, and clinical outcome benefits."

Barts and the London Charitable Foundation provided support for the study but had no part in the design, conduct, collection, management, analysis, or interpretation of data. The study authors have disclosed no relevant financial relationships.

J Am Soc Nephrol. Published online July 16, 2009.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network. NEW for Ontario: recycleMe.org - Learn The Ins & Outs Of Organ And Tissue Donation. Register Today! For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation