Carolyn Klempay
KNH 413
Diet Instruction
1 gram Sodium Diet
Patient History:
Darla is a 42-yr old wife and mother of three. She loves to cook and enjoys trying new foods and recipes in the
kitchen as she cooks meals for her entire family. Darla works full-time, volunteers with her local church, and attends
many games and recitals for her children who play soccer and instruments in the school band. With such a full
household and hectic schedule, Darla spends all of her time caring for others and has sacrificed her own well-being in
the process. With little time to exercise or focus on her own health, she is 5’2” and weighs 160 lbs (72.7kg). Recently
Darla went to her doctor’s office and was told she was pre-hypertensive. The doctor said she should meet with a
dietitian and ask specifically how to decrease her salt intake.
BMI = wt (kg) / ht2 (m2)
BMI = 72.7 kg / (1.57m)2
BMI = 72.7/2.46
BMI = 29.5 kg/m2
24-hour Dietary Recall:
Breakfast
Lunch
Dinner
Snack
2 eggs over-medium with salt and pepper, 2 slices bacon, one medium plain bagel
with butter
Deli sliced ham sandwich on white bread, Provolone cheese, lettuce, and mustard.
1 medium pickle slice
Spaghetti with pork sausage, Parmesan cheese, Italian bread, creamed corn, salad
with Italian dressing
Pretzels with 2 Tbsp peanut butter
24-hour Dietary Recall Analysis:
Food Item
2 eggs
1/16 tsp table salt
2 slices bacon
1 medium plain bagel
1 Tbsp salted butter
2 slices white bread
1 oz deli ham
1 oz low-fat provolone cheese
Lettuce
1 tsp mustard
1 medium pickle slice
3 oz Spaghetti pasta with ¼ cup sauce
2 oz pork sausage
1 Tbsp Parmesan cheese
1 slice Italian bread
½ cup creamed corn
Salad with 1 Tbsp Italian dressing
1 oz pretzels
2 Tbsp peanut butter
Total
Sodium Content (mg)
140
145
300
400
80
340
750
250
0
55
370
300
400
75
120
365
242
400
150
4,882 mg sodium
Diet Instruction:
1g (1,000 mg) Sodium Diet
Basic Information on Pre-Hypertension:
-Blood pressure is the force of blood against the walls of arteries
-When BP is elevated for an extended period of time, this is hypertension
-Hypertension makes the heart work too hard and contributes to atherosclerosis (hardening of the arteries)
-Hypertension increases risk of heart attack, stroke, heart failure, kidney disease, and blindness
-Blood pressure between 120/80 and 139/89is pre-hypertension (don’t have high BP now, but likely in the future)
-Above 140/90 is hypertension
-Systolic/Diastolic (BP when heart beats/BP when heart is at rest)
(National Institute of Health)
Basic Information on Sodium:
-Salt is commonly referred to as “Sodium”
-We need salt in our diets for proper functioning of nerves and muscles and correct balances of fluids in our bodies
-Kidneys are responsible for helping regulate our sodium levels
-When we take in too much sodium, our kidneys can’t get rid of it all and it builds up in the blood
 This results in high blood pressure, or hypertension
-Typically, it is recommended to consume less than 2,400 mg sodium (2.4 g) per day (MedlinePlus)
24-hour Dietary Recall Modifications Analysis:
Food Item
Sodium Content (mg)
2 eggs
140
1/16 tsp table salt
145
2 slices bacon
300
1 medium plain bagel
400
1 Tbsp salted butter
80
2 slices white bread
340
2 oz deli ham
750
1 oz low-fat provolone cheese
250
Lettuce
0
1 tsp mustard
55
1 medium pickle slice
370
3 oz Spaghetti pasta with ¼ cup
300
sauce
2 oz pork sausage
400
1 Tbsp Parmesan cheese
75
1 slice Italian bread
120
½ cup creamed corn
365
Salad with 1 Tbsp Italian dressing 242
1 oz pretzels
400
2 Tbsp peanut butter
150
Total
4,882 mg sodium
Food Modifications
2 eggs
½ cup honeydew
8 oz yogurt
1 cup oatmeal
unsalted pecans & raisins
2 slices wheat bread
3 oz turkey
1 oz Swiss cheese
Lettuce
1 tsp mustard
1 cup canned peaches
1 cup brown rice, cooked
tomatoes & avocado
3 oz ground beef meatballs
½ cup cauliflower
sweet potato baked in skin
½ cup cooked broccoli
spinach with oil & spices
3 cups air popped popcorn
1 oz unsalted almonds
Sodium Content (mg)
140
30
100
10
0
260
60
55
0
55
10
10
Total
935 mg sodium
60
10
40
30
65
0
0
Foods to Avoid:
-Salt
-Processed foods
-Canned, frozen foods
-Snack foods
-Packaged starchy foods (stuffing mix)
-Instant cooking foods (potatoes)
-Mixes (biscuits, cake)
-Certain meats and cheeses
Low Sodium Foods:
Fruit
Vegetables
Protein
Starch
Dairy
Other
-Deli/ lunch meats (ham, bologna)
-Cured/ smoked meats (sausage, bacon)
-Canned meats (Spam, Vienna sausage)
-Cheeses - avoid over 140mg sodium per
serving (American cheese, Velveeta)
-Condiments and Sauces
- Ketchup and salad dressings
-Worcestershire, pizza, barbeque, steak, soy
-Pickles and Olives
-unsalted fresh, frozen, or canned
-fruit juices
-unsalted fresh, frozen, or canned
-vegetable juices, without salt added
-tomatoes
-plain meats
-fish
-poultry
-eggs
-shredded wheat
-plain pasta or rice
-homemade yeast breads, made without salt
-milk
-yogurt
-low sodium cheese
-hard cheeses (cheddar, Swiss)
-ice cream
-unsalted nuts
-unsalted butter or margarine
Tips to lower Sodium in foods:
-Make foods homemade, you can control the amount of salt that is added
-Choose fresh, frozen, or canned items without added salt
-Snack on fresh fruits, vegetables, or unsalted nuts which are low in sodium
-Read the nutrition facts label!
-Use fresh or salt-free spices to add flavor to foods
-When eating out, ask for gravies and sauces on the side for better portion control
SUMMARY:
Goals:
-Begin 1 gram (1,000 mg) sodium dietary regimen
-Become educated on foods high and low in sodium
-Decrease BP to below 120/80, rid pre-hypertension
Closing Questions:
-Can you name 2 foods high in sodium?
-Can you name 2 foods low in sodium?
-Can you explain 2 changes you are going to implement this week to help reduce your sodium intake?
**Here is my card and I think it would be good to have a follow-up appointment in 2 weeks to see how things are
coming along!!
Resources:
Academy of Nutrition and Dietetics. (2013, January). The Basics of the Nutrition Facts Panel. A Guide on How to Read a
Nutrition Facts Panel from the Academy. Retrieved February 19, 2014, from
http://www.eatright.org/Public/content.aspx?id=10935
American Heart Association. (2013). Eat Less Salt. - book review by the Academy of Nutrition and Dietetics. Retrieved
February 19, 2014, from http://www.eatright.org/Media/content.aspx?id=6442475958#.UwTliIWurK
ClevelandClinic. (2013). Eat Right. Cleveland Clinic. Retrieved February 19, 2014, from
http://my.clevelandclinic.org/healthy_living/nutrition/hic_low-sodium_diet_guidelines.aspx
Columbia Edu. (2012). Sample Menus for the DASH Eating Plan. Mayo Clinic Source. Retrieved February 19, 2014, from
http://www.cumc.columbia.edu/student/health/pdf/Sample%20menus%20for%20the%20D
Department of Health and Human Services. (2014, February 18). Low Sodium Foods: Shopping list. Low Sodium Foods:
Shopping list. Retrieved February 19, 2014, from http://healthfinder.gov/HealthTopics/Category/healthconditions-and-diseases/heart-health/low-sodium-foods-shopping-list
Dugdale, D. C. (2012, September 6). Low-salt diet : MedlinePlus Medical Encyclopedia. U.S National Library of Medicine.
Retrieved February 19, 2014, from http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000109.htm
FDA. (2013, April 18). Food. Sodium in Your Diet: Using the Nutrition Facts Label to Reduce Your Intake. Retrieved
February 19, 2014, from http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm315393.htm
MayoClinic Staff. (2013). Low-sodium recipes. - Healthy Recipes. Retrieved February 19, 2014, from
http://www.mayoclinic.org/healthy-living/recipes/low-sodium-recipes/rcs-20077197
Nutrition Care Manual. (2014). NCM Nutrition Care Manual eat right. Public Home Page. Retrieved February 19, 2014,
from.http://www.nutritioncaremanual.org/category.cfm?ncm_category_id=1&ncm_heading=Meal%20Plans&cli
ent_ed=1
Zernel, M. B. (1997). McKinley Health Center - DASH Diet/1500, 1800, and 2000 calories per day - University of Illinois.
McKinley Health Center - DASH Diet/1500, 1800, and 2000 calories per day - University of Illinois. Retrieved
February 19, 2014, from http://www.mckinley.illinois.edu/handouts