Sodium and the Healthy Plate Connie Diekman,  M.Ed, RD, LD, FADA Past President, American Dietetic Association Director of...
Who Is ADA? <ul><li>Largest professional association of food   and nutrition professionals in the world </li></ul><ul><li>...
Who Are ADA’s 68,000 Members? <ul><li>Majority are registered dietitians (RD) </li></ul><ul><li>>50% have graduate degrees...
Most ADA Members Are Clinicians Membership Practice Area Percent of Membership 0% 10% 20% 30% 40% 50% 60% Clinical Nutriti...
ADA Supports 2005 Dietary Guidelines for Americans <ul><li>In favor of educational efforts for consumers </li></ul><ul><ul...
Sodium Essential to Health <ul><li>Major mineral in the body </li></ul><ul><li>Maintains fluid balance </li></ul><ul><li>R...
Sodium Essential to Health <ul><li>Kidneys regulate sodium levels </li></ul><ul><li>Increased salt intake leads to   incre...
Sodium Essential to Health <ul><li>Minimum needed 500 milligrams/day </li></ul><ul><li>Dietary Reference Intakes for adult...
ADA Comments to FDA on Sodium <ul><li>Quantitative amounts of sodium be required on front-of-package when sodium claims ar...
<ul><li>FDA encourage innovation and approval of new salt substitutes additives </li></ul><ul><li>FDA reduce the amount of...
How Much Sodium? <ul><li>Current estimates indicate average   intake is 3,000 – 4,000 mg/day </li></ul><ul><li>Scientific ...
ADA Evidence Analysis Guideline <ul><li>Evidence process to review science   and grade significance </li></ul><ul><li>Curr...
Evidence Analysis Guidelines <ul><li>Group has developed questions to ask   in reviewing the science </li></ul><ul><li>Com...
Help Americans make informed decisions  to build a better diet Labeling Policy Should… …  always be based on the best scie...
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Sodium and the Healthy Plate

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  • Although the ADA wants evidence-based recommendations, the meeting in Chicago did not provide time enough to discuss the ongoing controversy among medical experts over the scientific questions. The science was reviewed by Dr. Larry Appel, a member of the anti-salt activist group WASH (#273 at http://www.worldactiononsalt.com/home/docs/wash_members.xls). For balance, I've downloaded a recent PPT by Dr. Hillel Cohen, author of several health outcomes studies of the NHANES database. You can find it at

    http://www.slideshare.net/rhanneman/salt-and-cardiovascular-mortality
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  • Your presentation hit a number of important points that we should all keep in mind. These include:

    1. ADA’s advocacy of “a total diet approach to communicating food and nutrition information”

    2. “Sodium Essential to Health” – unassailable fact; needed for balanced communication

    3. Under “How much sodium” the statement “Scientific evidence does not show a ‘clear’ appropriate intake.”

    4. ADA suggests more research on benefit of lower levels” – the Salt Institute has called for a controlled trial of the health outcomes of low-sodium diets. Please join our petition.

    5. Perhaps the most exciting and positive discussion in your presentation was your introduction of ADA’s process to develop an “evidence analysis guideline.” I understand the rigorous scientific review you’ve undertaken to approximate the approach of the Cochrane Collaboration, the inventor of “evidence-based medicine.” Many groups have called their recommendations evidence-based (e.g. the Dietary Guidelines Advisory Committee), but their “analysis” was a majority vote of the “experts” whose collective opinion is passed off as “evidence-based” just because it cites peer-reviewed publications. “Evidence-based medicine” is far, far more than that. The Cochrane Review on salt, by the way, “Advice to reduce dietary salt for prevention of cardiovascular disease” was just re-released a month ago; the abstract is online at http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003656/frame.html.

    We trust that ADA’s evidence analysis guideline will also include reconsideration of ADA’s non-evidence-based endorsement of a 2,300 mg/day limit.



    Dick Hanneman

    Salt Institute
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  • Sodium and the Healthy Plate

    1. 1. Sodium and the Healthy Plate Connie Diekman, M.Ed, RD, LD, FADA Past President, American Dietetic Association Director of University Nutrition, Washington University in St. Louis
    2. 2. Who Is ADA? <ul><li>Largest professional association of food and nutrition professionals in the world </li></ul><ul><li>Founded in 1917 </li></ul><ul><li>Total membership of more than 68,000 </li></ul><ul><ul><li>50 states, D.C., Puerto Rico and international affiliates </li></ul></ul><ul><li>Headquarters in Chicago </li></ul><ul><ul><li>D.C. office: ADA’s policy work </li></ul></ul>
    3. 3. Who Are ADA’s 68,000 Members? <ul><li>Majority are registered dietitians (RD) </li></ul><ul><li>>50% have graduate degrees </li></ul><ul><ul><li>More than 1,500 have earned doctoral or professional degrees </li></ul></ul><ul><li>Members also include: </li></ul><ul><ul><li>Nutritionists who are not RDs </li></ul></ul><ul><ul><li>Dietetic technicians, registered (DTR) </li></ul></ul><ul><ul><li>Students </li></ul></ul><ul><ul><li>Honorary members </li></ul></ul>
    4. 4. Most ADA Members Are Clinicians Membership Practice Area Percent of Membership 0% 10% 20% 30% 40% 50% 60% Clinical Nutrition Community Nutrition Consultation & Business Practice Food & Nutrition Management Education Research
    5. 5. ADA Supports 2005 Dietary Guidelines for Americans <ul><li>In favor of educational efforts for consumers </li></ul><ul><ul><li>Public (governmental) </li></ul></ul><ul><ul><li>Private (proprietary, industrial) </li></ul></ul><ul><li>A total diet approach to communicating food and nutrition information best serves the public </li></ul>
    6. 6. Sodium Essential to Health <ul><li>Major mineral in the body </li></ul><ul><li>Maintains fluid balance </li></ul><ul><li>Regulates blood pressure with potassium and magnesium </li></ul><ul><li>Transmits nerve impulses </li></ul><ul><li>Aids muscle relaxation </li></ul>
    7. 7. Sodium Essential to Health <ul><li>Kidneys regulate sodium levels </li></ul><ul><li>Increased salt intake leads to increased sodium loss </li></ul><ul><li>Kidney failure to remove excess leads to retention </li></ul>
    8. 8. Sodium Essential to Health <ul><li>Minimum needed 500 milligrams/day </li></ul><ul><li>Dietary Reference Intakes for adults: </li></ul><ul><ul><li>Tolerable Upper Limit - </li></ul></ul><ul><ul><li>2300 milligrams/day </li></ul></ul><ul><ul><li>Adequate Intake - 1500 milligrams/day </li></ul></ul>
    9. 9. ADA Comments to FDA on Sodium <ul><li>Quantitative amounts of sodium be required on front-of-package when sodium claims are made </li></ul><ul><ul><li>Facilitate consumer understanding of sodium claims </li></ul></ul><ul><li>Manufacturers also be allowed to truthfully claim reformulation of products to yield lower sodium on front-of-package </li></ul><ul><ul><li>Even if not qualify for sodium content claim </li></ul></ul><ul><ul><li>Required to provide quantitative amounts on FOP </li></ul></ul>
    10. 10. <ul><li>FDA encourage innovation and approval of new salt substitutes additives </li></ul><ul><li>FDA reduce the amount of sodium allowed in a food when a health claim is made </li></ul><ul><ul><li>Disqualifying sodium levels for health claims be consistent with sodium levels to claim a food is “healthy” </li></ul></ul><ul><ul><li>Across-the-board reduction of 15%-25% for disqualifying levels of sodium </li></ul></ul>ADA Comments to FDA on Sodium
    11. 11. How Much Sodium? <ul><li>Current estimates indicate average intake is 3,000 – 4,000 mg/day </li></ul><ul><li>Scientific evidence does not show a “clear” appropriate intake </li></ul><ul><li>ADA currently suggests 2,300 mg/day </li></ul><ul><li>ADA suggests more research on benefit of lower levels </li></ul>
    12. 12. ADA Evidence Analysis Guideline <ul><li>Evidence process to review science and grade significance </li></ul><ul><li>Currently a group is appointed to review science of sodium and health </li></ul>
    13. 13. Evidence Analysis Guidelines <ul><li>Group has developed questions to ask in reviewing the science </li></ul><ul><li>Completion will provide overview of current science and recommendation for intake based on science </li></ul>
    14. 14. Help Americans make informed decisions to build a better diet Labeling Policy Should… … always be based on the best scientific evidence with the goal to …
    15. 15. Thank you!
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