Sodium is found in most of the foods and salt is the major source of sodium. Although it is an essential mineral, it is often consumed in excess especially by those who eat out frequently. Blood sodium levels affect body water and are regulated by kidneys. Healthy kidneys remove excess sodium from the body. In contrast, excessive sodium intake will lead to sodium build-up in your body especially when your kidneys have lost its regulatory capability. Sodium build-up can result in increased thirst and fluid retention, thereby increasing blood pressure. High blood pressure can further stress your kidneys and worsen your condition as well as cause other disease complications such as stroke.
Here are some ways to control your sodium intake:-
1. Know your limit. Once you are diagnosed with chronic kidney disease, guidelines suggest that you should consume sodium less than 2400mg daily.
2. Familiarise common foods with different levels of sodium content. Fresh, natural food is generally low in sodium. Indeed the main source of sodium in human diet comes from salt and one teaspoon or 5g salt contains 2000mg sodium. Processed and preserved foods and food seasoning are also high in sodium. The table below shows sources and content of sodium in selected foods. You are advised to choose foods with low-to-moderate levels of sodium content.
| Low(< 120mg sodium) | Moderate(120-480 mg sodium) | High(>480 mg sodium) | |
|---|---|---|---|
| Cereal & cereal products | Rice, plain, cooked | Rice porridge, instant (1 packet)Bihun, kuey teow, laksa, mi (<2 cups) | Noodle, instant (>1/4 packet)Noodle snack, flavoured (>1 medium packet) |
| Bread, white (1 slice)Bread, wholemeal (1 slice) | Bread white (2-4 slices)Bread, wholemeal (2-3 slices) | - | |
| Biscuit, soda/plain (<3 pieces)Biscuit, cream crackers (<7 pieces)Crackers, low-salt (<12 pieces) | Biscuit, soda/plain (3-12 pieces) | - | |
| Starchy roots, tubers & products | Potato (<2 whole) | Potato chips (1 small packet) | Potato chip (>1/2 big packet) |
| Legumes & legumes products | Soya bean, white (<1 ½ cup)Soya bean cake, fermented (tempe) | Soya bean paste, fermented (taucu) (1 tablespoon) | Soya sauce ‘thick’ (>1 tablespoon)Soya sauce ‘thin’ (> ¼ tablespoon)Baked bean canned (> ¾ cup) |
| Nut, seeds & products | Mixed nuts, without salt added (<7 cups) | Peanut butter (3 tablespoon)Watermelon seeds, dried, black (3 cups) | Mixed nuts, salt added (> ⅓ cup) |
| Vegetable & vegetable products | Fresh vegetables | Seaweed, dried (hai-tai) ( ½ cup) | Canned vegetables (> ½ cup)Cabbage, Chinese, salted (humchoy) (> 1 tablespoon)Tomato soup, canned (> ½ cup)
Peas, salted, fried (>1 cup) |
| Fruits & fruits products | Fresh fruits | Durian, fermented (tempoyak) (2 tablespoons) | Fruit, mixed, spicy pickled (>1 tablespoon) |
| Meat & poultry products | Chicken, breast meat (<1 cup)Chicken, thigh (<2 medium) | Chicken, fried (1 piece)Chicken frankfurter (2 pieces) | Chicken, fried, fast food franchise (>1 piece, 140g)Chicken curry, canned (>1 can)Chicken, broth cubes, flavouring/seasoning (pati ayam) (>⅓ cube) |
| Beef, lean (< ½ cup) | Beef burger, regular (1 whole)Beef frankfurter (12.0 x 2.0cm) (2 pieces) | Beef burger with cheese (1 whole)Beef rending, canned (> ½ cup) | |
| Mutton, lean, raw (<1 cup) | Mutton, lean, raw (1 cup) | Mutton curry, canned (> ½ cup) | |
| - | Pork, raw (1 cup) | - | |
| Eggs | Hen egg, whole (< 2 eggs) | Duck egg, salted, whole (1 egg) | - |
| Fish, shellfish & products | Fresh fish (except stated in the moderate column) | Fish ball (5 whole small, 2 cm)Bream, threadfin, Japanese (kerisi) (1 whole)Carp, big, head (1 slice)
Carp, common (lee koh) (1 piece medium) Mackerel, Spanish (1 slice) Snapper, red (1 slice) Fish crackers, fried (5 pieces) |
Fish ball (2 ½ large)Fish, dried, salted (1 piece, 25g)Fish sauce (budu) (> ¼ tablespoon)
Anchovy, dried, without head and entrails (> ¼ cup) Sardine, canned (>1 small can) |
| Fresh prawn | Prawn, salted, dried (1 tablespoon)Prawn cracker (1 small packet)Prawn paste (hay-ko) (1 tablespoon) | Shrimp, fermented (cencaluk) (> ½ tablespoon)Shrimp paste (belacan) (> ½ piece) | |
| Cuttlefish, fresh (<2 whole, medium) | Cuttlefish, dried (1 whole, small) | Cuttlefish cracker (1 large packet) | |
| Milk & milk products | Low sodium cheese , cheddar (>5 slices) | Cheese, processed, cheddar (1 slice) | Cheese burger (1 whole) |
| Oil & fats | Margarine, reduced salt (<2 tablespoons) | Margarine (3 table spoons)Butter (2 tablespoons) | - |
| Beverages | Carbonated beverages, cream soda (<2 bottles of 500ml)Carbonated beverage, isotonic sports drink (1 ½ bottles of 500ml) | Carbonated beverage, isotonic sports drink (1 bottle of 1500ml) | - |
| Condiments & spices | All natural condiments (such as cloves, cinnamon, anise seeds, cumin seeds, asam gelugor, cardamom, dried chilli) | Chilli sauce (1 tablespoon)Tomato ketchup (sauce) (1 tablespoon) | All types of instant flavouring or seasoning (1 ½ teaspoons or > ¼ cube)Oyster, sauce (> ½ tablespoon)Tamarind, paste (> ½ tablespoon) |
Adopted from Malaysia Dietary Guidelines (2010)
3. Mind your portion size and consumption frequency. Besides the types of food, daily sodium intake can be influenced by portion size and consumption frequency. Sodium content of a large portion of a low-sodium food can be as high as a portion of a high-sodium food. Same goes to consumption frequency. You can unconsciously exceed your sodium allowance by consuming a low-sodium food intermittently.
4. Eat out smartly. Eating out while controlling your sodium intake is a true challenge because the sodium content of a food served is always unknown and often is higher than expectation. Hence it is advisable to try not eating out too often. Meanwhile there are some eating-out tips for reducing sodium intake:-
5. Shop wisely. While you are doing grocery shopping, you should always read food label. You should note the sodium content of a food in the nutrition label, compare with other available brands of the same products and choose the ones with the lower sodium content. You can also choose brands with ‘sodium free’ or ‘very low/low/lower/reduced sodium’ claims on the label if available. On the other hand, you can also check the ingredient list. If salt is listed in the first five ingredients, the items may be too high in sodium and you should look for alternatives. Besides salt, you should also take noted of all sources of sodium such as monosodium glutamate, sodium nitrate, and sodium benzoate.
6. Be a creative chef. Preparing own foods is the best way to control sodium intake. Fresh, natural food should be put in your main ingredient list instead of canned, processed and preserved foods. You are encouraged to use whole herbs and spices in place of salt and other high-sodium food seasonings (e.g. MSG, soya sauce, oyster sauce, tomato sauce, etc.) as a flavour enhancer. You should also pay attention on salt substitutes because some of them are high in potassium.
7. Consult dietitian. Restricting food unnecessarily and adopting fad diet can be life-threatening. If you have questions and/or face difficulties in managing your diet, do not hesitate to talk to a dietitian (a well-trained and qualified professional in food and nutrition).