Sunday, August 13, 2017

Sodium by Example

Cooking for your Kidneys

Sodium by Example
Homemade Hot Sauce and Salt in the diet

Hot sauce you can buy is generally loaded with sodium. This acts both as a flavor enhancer and preservative in foods. That is one reason hot sauce and other bottled items can stay on a shelf in the store without refrigeration. It is also vacuum sealed so that limited or no air gets in the bottle, and hence airborne bacteria can grow inside. 
The problem for most people, especially patients with kidney failure, is the salt. Salt is sodium chloride (NaCl), one part sodium to one part chloride.  Even though Salt is equal parts of each, the chloride ion is heavier and that makes salt approximately 40% sodium and 60% chloride. To be specific, it is 39.3% sodium, 60.7% chloride, by weight.
The human body needs both of these positive charged ions in order to survive, and this is why salt used to be a very high valued commodity.  For a period of time salt was a form of currency. The word “Salary” can be traced back to the word “Sal”, the ancient romans soldiers allowance to buy salt.  
Our bodes need balance in our electrolytes (sodium +, chloride -, potassium +, and phosphorus -, as a component of other negatives).  The electrolytes sodium and chloride reside in the plasma of our blood, and potassium and the phosphorus elements reside the the cells of the body. Our bodies are constantly moving fluid around between blood and cells to regulate the all these electrolyte activities through osmosis - the movement through cell walls to keep the concentration of these elements in balance (I know this is all very “scienecy” but it will make sense in the end.)
O.K., back to the hot sauce for a minute. There are many studies that suggest the active ingredient in hot peppers (capsaicin) is beneficial for the body, and that includes CKD patients. 

It has been shown to have positive effects for pain and swelling reduction. It can increase blood flow which will assist with cardio vascular disease and blood pressure.  It even helps with muscle and joint pain along with increasing the rate of healing. These are all key risk factors in CKD patients. 

Most care providers will tell patients to limit sodium intake in their diet, and to offset the flavor issues, to increase the use of spices and herbs. This includes hot sauce. provided it low in sodium.

If you read the label on most bottles of hot sauce you will find a sodium level of anywhere from about 3% to 12% per serving. The problem is what constitutes a serving size.
The Department of Agriculture used two surveys conducted between 1978 and 1988 to determine serving size. The surveys asked citizens about their eating habits to determine the serving size of products that required labeling.  It was important for manufactures to have some kind of standard to use and put nutrition information on the labels. So a serving size is what you (or people of the U.S.) told the researchers they ate in late 70’s and 80’s. 
This really isn’t a problem if we as consumers would read labels and apply the information to our own intake. But I have a suspicion we don’t really do that. 
Hot sauce has a serving size of 1 teaspoon. Go ahead, measure that out the next time you pull that bottle out to spice up your food.  For the very Hot sauces, that might be all you can handle. But as a former restaurant owner and chef,  I can tell you that even an order of six chicken wings is going to have much more hot sauce than 1 teaspoon. A half dozen wings will probably have closer to three tablespoons. That would make your 3% - 12 % RDI jump to 27% to 108% of sodium.  

And keep in mind that this is allowing for a 2300 mg intake of sodium in your diet. 
 1 tsp salt = 2300 mg sodium    

 That’s all you should eat in one day. That’s it. Unless you are in the at risk group. Then less.
(Most chicken wing sauces are made from hot sauces that use jalapeƱo or fresno chili peppers. JalapeƱos turn out a "Mild" chicken wing sauce, about 2500 on the Scoville scale. Fresno peppers will bring you up to at least a medium, as they range from about 2500-10,000 on the same scale. 

To make the hotter varieties, producers  add a hotter sauce to these bases.  The base sauces use the higher sodium content sauces, so keep this in mind when ordering out.)
Today’s nutrition professionals are calling for much less sodium in your diet, and if you are over 50, have hypertension (high blood pressure), kidney disease or a host of other issues, the RDI is 1500mg. If you want to do some math, you will find out that you are consuming a salt lick worth of sodium with those wings. It’s no wonder pubs love to serve them, as they increase fluid purchases (they hope in the form of beer). 

What about all that? The drinking of more fluids when you eat salty food? The thirst? The dry mouth all night long and waking up to gulp down more water? 
Remember all that “sciencey” stuff above? Well, as you increase the sodium and chloride levels in the blood plasma, the body tries to balance out the sudden increase. The body’s cells start pushing water from the cells into the blood stream to balance out the concentration of sodium and chloride to the potassium and phosphorus parts. The concentration of positives and negatives. 
When your cells are depleted of the fluid it tells your body to get more please. So you drink. In a normal body, the excess fluid will travel through your blood stream and into the kidneys. They will filter out the excess electrolytes along with the water and expel them. You pee. It can't clear them all at one pass, so your body carries the excess fluid in the blood plasma through your veins and arteries. This causes your blood pressure to rise, stressing your heart as it pumps harder to get all that water filled blood through your body. In addition, the excess fluid in the arteries and veins causes problems as it accumulates around your bodies other organs, where a high concentration of veins and arteries reside (think congestive heart failure). 
All of this is bad enough for a healthy person, but for someone with limited kidney function, it is very dangerous. The kidneys aren’t  filtering as they should and in some cases not at all.  The excess fluid is either removed  very slowly, increasing the strain on the body, or not until dialysis, if the person has End Stage Renal Disease (ESRD).

For the CKD patient that extra fluid gathers around your major organs and that fluid stresses the body. In addition, dialysis - the removal of those fluids and excess minerals -  also stresses the body. The more fluid you have to remove, the more strain on the body and the worse you feel for the rest of the day All this extra stress on your organs doesn't bode well for the body. 

With the diet for CKD patients being so generalized and restrictive I have noticed that many people get overwhelmed and end up opting out of many of the suggestions. You will see people eating fast food, bags of chips, and other high salt content foods in the dialysis centers, just while they are trying to remove the effects of those very items.
I have found ways to decrease the salt content I consume by altering the recipes of the base ingredients in many foods. A deconstruct and then reconstruct method. 

This is a long way to go to learn about making your own Hot Sauce, but this is how we as patients will learn to eat better and stay healthy. All so that we can live a longer and more enjoyable lives. 

More sodium facts. 
When cooking with salt you should try to use sea salt or large kosher salt. By doing this you will use less salt in your food if you measure the same amounts. It’s not because these products have less sodium or chloride. Remember each piece of salt is one part sodium and one part chloride. Table salt, sea salt, kosher salt: All sodium chloride is the same. There are substitutes out there that claim that have a lower sodium content, but I will get to that. 
The reason there is less sodium in a teaspoon of sea salt or large kosher salt vs your everyday table salt has to do with weight. Yup, weight. If you care to take the time, weigh a teaspoon of each in a kitchen scale and see what you come up with. 

With the larger pieces of salt there is more empty space in the teaspoon between the each piece of salt. Empty space weighs very little when compared to the salt. The smaller the pieces the less empty space, the more the weight. The more weight, the more sodium. Simple stuff. 

Ok, back to those salt substitutes and low sodium products.
We refer to sodium chloride as salt. So does the FDA. If it's not sodium chloride, the label doesn't have to call it salt. 

The problem is that there are other items that are under the salt family but have a different chemical make up. Potassium chloride has a similar to taste to salt, and is often labeled as salt free, meaning there is barely any sodium. That's true. But the replacement of sodium with Potassium can have devastating effects on people with CKD. 

Potassium is a mineral that CKD patients don't process out, and the dangers for high levels in the body are quick and servere. Heart attack. Yup, that's a real problem, especially for those with high blood pressure, or those with lots of excess fluid. I would avoid potassium chloride, even if you generally have low potassium levels. The risks don't seem to outweigh the rewards. 

Other lower salt products are either a combination of sodium chloride and potassium chloride, giving you both risks at once. A few other products attempt to confuse you with statements like "33% less sodium per teaspoon" and still be real salt. This is usually by altering the size and shape creating more empty space per teaspoon. This works to your benefit is you are a measuring type of person, just like the above reference to sea salt and kosher salt. If you still use the "to taste" method, you will probably just add more of whatever you are using. 

I hope all of this helped, and didn't send you into fuzzy wonderland. It is my belief that the more we learn about the food we eat, the better we can participate in our own health with this difficult disease. 

**Please remember to check with your Doctor about how this information may effect your personal health issues. **



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