Beth Bolt began her career in the health sciences by graduating from the University of Colorado School of Pharmacy in 1996. Beth has worked as a community and home health pharmacist for more than 20 years and turned her passion for educating people on their health and medications into a medical writing career. She has authored articles for several publications on a variety of health-related topics and has logged thousands of hours writing drug monographs and answering Ask the Pharmacist questions in an online format. Beth is a member of the Rho Chi Society and has been a preceptor for the University of Texas at Austin College of Pharmacy.

Beth Bolt, RPh

Many of us take in too much sodium, which can put us at an increased risk for health problems. Your body needs only a very small amount of sodium—an essential nutrient required to maintain a balance of bodily fluids and proper muscle and nerve function.

Do you know how much sodium you take in or need each day? Sodium is both found in salt and occurs naturally in many foods, even those that don’t taste salty. You don’t have to sprinkle table salt, also called sodium chloride, on your food to get too much sodium. In fact, most of the sodium we eat each day sneaks up on us in prepared and processed foods, which has prompted the FDA to take steps to lower the amount of sodium added to the foods we buy. In July of this year, the FDA released guidance for manufacturers and restaurants on reducing the amount of sodium they add.

Your kidneys filter your blood and remove excess fluid, using osmosis to draw the extra water out and move it into a collecting channel that leads to your bladder, where it becomes urine. This process involves a delicate balance of sodium and potassium. If your sodium intake is too high, this raises the amount of sodium in your bloodstream, which pulls water into your blood vessels and disrupts this delicate balancing act. The increased volume of blood inside your blood vessels causes blood pressure (BP) to rise. High BP (also called hypertension) strains your kidneys and can cause diseased kidneys to worsen. Excess sodium in the body also forces the heart to work harder, which can increase the risk for heart disease and stroke.

High BP affects an estimated 1 in 3 Americans, according to the CDC. In African Americans, high BP affects almost 1 in 2 individuals. The effects of salt and sodium on BP tend to be greater in African Americans, individuals older than 50 years, and individuals with high BP, diabetes, or kidney disease.

Ninety percent of Americans, including children and adolescents, consume more sodium than recommended, according to the CDC. Today, the average American takes in a whopping 3400 mg of sodium per day. That’s almost 50% more than what is generally recommended when you consider that the sodium intake goal for adults and older teens is 2300 mg per day. And those who have been diag- nosed with high BP or who have prehypertension may have even lower sodium intake goals.

The recommended upper limits of sodium per day for children are as follows:

Many prepared and processed foods contain high amounts of sodium. These foods include breads, natural and processed cheeses, deli meats, sand- wiches (including hamburgers and hot dogs), snacks (popcorn, chips, pretzels, and crackers), pizza, pasta dishes, salad dressings, and soups. It is important to remember that just because you don’t taste the salt, that doesn’t mean the food is not high in sodium. Even sweet desserts or sugary cereals can contain lots of sodium. You have to keep your daily totals in mind. Even if a single food doesn’t contain too much sodium, eating that food several times a day can put you at risk of getting too much salt.

• Speak with a dietician or your health care pro- vider about your nutritional goals. A dietician can create an eating plan that will help balance your sodium intake and reduce your risk for high BP.

• Keep a food diary to track the amount of sodium you are consuming. The goal is to reduce your sodium intake, not to keep an exact tally.

• Check the nutrition facts label for sodium content because not all foods high in sodium taste salty. Also, check for nutrient claims on food and beverage packages (Table).

• Prepare your own food when possible, and limit your intake of fast foods and convenience foods. About 75% of dietary sodium comes from eating packaged and restaurant foods.

• Flavor your foods with fresh herbs and spices instead of salt. If you are taking certain medications to treat high BP, salt substitutes are not recommended. If you have any questions about what kind of seasoning you can use, be sure to ask your health care provider or pharmacist.

As you reduce the amount of sodium you consume, it’s likely that your taste for sodium will slowly decrease. Before you know it, you probably won’t even miss it.

Beth Bolt is a freelance health and science writer based in Northern California. She’s on Twitter: @beth_bolt.

Articles

Many of us take in too much sodium, which can put us at an increased risk for health problems. 

You Are Probably Getting Too Much Sodium

Insulin is a naturally occurring hormone produced by the pancreas. Insulin is required to move sugar from the blood into the body’s cells, where it can be used for energy. For the symptoms of high blood sugar and low blood sugar, see Tables 1 and 2.

Type 1 diabetes (T1D) is a chronic condition in which the pancreas produces little or no insulin. Only 5% of patients with diabetes have this form of the disease, according to the American Diabetes Association.

Type 2 diabetes (T2D) is much more common; the risk factors are listed in online table 3. Individuals with T2D make insulin, but their bodies don’t respond well to it, a condition known as insulin resistance. Treatment of T2D usually begins with dietary and lifestyle changes, as well as oral medications. Over time, as the pancreas struggles to make an adequate amount of insulin to overcome insulin resistance, patients may require insulin supplementation.

Insulin therapy must be individualized and balanced with meal planning and exercise. When a patient begins using insulin to manage diabetes, the initial dose is just a starting point. Over time, insulin requirements are affected by factors such as weight gain or loss, changes in eating habits, and the addition of other medications. The need for insulin often increases, and the dose must be readjusted to meet the new requirements.

Insulin is injected subcutaneously, meaning not very deep under the skin. Common injection sites include the stomach, buttocks, thighs, and upper arms. By rotating the site of injection, patients can avoid lipohypertrophy, a slight increase in the growth or size of fat cells under the skin. When lipohypertrophy occurs, a soft pillowy growth may form at the repeated-use injection site. Therefore, for reliable absorption rates and cosmetic purposes, it’s important to rotate insulin injection sites.

Insulin types vary depending on how quickly they work, when they peak, and how long they last. As sliding-scale insulin therapy has fallen out of favor, many experts recommend using basal insulin with mealtime insulin added when needed. Basal insulin is intended to keep blood glucose levels under control during periods of fasting or sleep.

The 2 main types of basal insulin are intermediate- acting insulin and long-acting insulin. To mimic the way the body of a patient without diabetes releases insulin, bolus insulin (short-acting or rapid-acting insulin) must be administered to prevent an increase in the blood glucose level after meals.

 (Humulin R; Novolin R; and, for insulin pump, Velosulin):

Neutral protamine Hagedorn (NPH) insulin must be resuspended (gently mixed by rolling) before use

If injected at bedtime, it will likely peak at predawn hours when needed most

 (detemir [Levemir] and glargine [Lantus]):

Premixed insulins combine specific amounts of intermediate-acting and short-acting insulin in 1 bottle or insulin pen. These products, which include Humulin 70/30, Novolin 70/30, Novolog 70/30, Humulin 50/50, and Humalog Mix 75/25, are generally taken 2 or 3 times a day before mealtime.

Insulin is available in several strengths, although most insulin sold in the United States is U100, meaning there are 100 units of insulin in every milliliter of liquid. A 10-mL bottle of U100 insulin contains 1000 units of insulin. There are 3 sizes of U100 insulin syringes: 1/3 cc, 1/2 cc, and 1 cc. A 1/3-cc syringe holds 30 units of insulin, 1/2 cc holds 50 units, and 1 cc holds 100 units. The type of syringe used depends on how much insulin is required.

Several new insulins with concentrations greater than U100 have recently come to the market. These products were developed for individuals requiring large doses of insulin in order to reduce the volume injected and the number of injections. Toujeo (insulin glargine [rDNA origin]), a once-daily, long-acting basal insulin, contains 300 units/mL (U300). For patients with severe insulin resistance in need of more than 200 units/day, superconcentrated U500 insulin is available.

A variety of insulin delivery systems exist, including syringes, insulin pens (disposable and reusable), needle-free jet injectors using very high pressure to push a fine spray of insulin through the skin, and inhaled insulin. Insulin pumps deliver the insulin the body needs 24 hours a day through a catheter placed under the skin. Although these devices have been used to treat T1D for about 35 years, their use has become widespread in only the past 15 years.

All NPH insulin, as well as lente and ultralente (all cloudy insulins), need to be mixed to ensure uniform suspension of the insulin within the liquid. To ensure its effectiveness and to decrease blood glucose fluctuations, be sure to properly mix your insulin by turning the bottle over from end to end a few times, or by rolling the bottle gently between the palms of the hands.

Insulin therapy must be individualized and balanced with meal planning and exercise.

The ABCs of Insulin

Sleep is one of those things that should come naturally. And for many of us, it does. For some individuals, however, getting a good night’s sleep can be a struggle that leads to drowsiness, an inability to focus, and low energy during the day. Over a long period of time, lack of sleep may lead to an increased risk of depression and heart trouble. You may have trouble falling asleep and/or sleeping through the night, wake up earlier than desired, or feel tired upon awakening. These symptoms may be classified by their duration: transient (less than 1 week), short term (1-3 weeks), or chronic (more than 3 weeks). If you have chronic insomnia with daily symptoms and you are waking several times each night, or if your insomnia is caused by other medical conditions, see your health care provider (HCP) for treatment. See Table 1 for medical conditions that cause insomnia. If your insomnia can be classified as short term, several changes in lifestyle may be helpful.

The first step is to get in sync with your body’s natural sleep-wake cycle by following these practices:

		Set and stick to a bedtime schedule. Go to bed at about the same time every night and wake up at the same time every day to set your body’s internal clock. This includes weekends and holidays.

		Avoid late-day naps. Late afternoon naps can make falling asleep or staying asleep at night more difficult. If you do take naps, avoid napping after 3 pm and limit them to 15 to 20 minutes.

		Don’t sleep in on weekends. If your weekend and weekday sleep schedules differ, you may find your natural sleep-wake cycle is easily disturbed.

Melatonin, the naturally occurring hormone that makes you feel sleepy at night, is controlled by daylight, darkness, and the amount of light your eyes are exposed to. Melatonin levels are lowest during the day because your eyes detect large amounts of light through specialized cells of the retina. During the nighttime hours, melatonin levels peak, inducing physiological changes that promote sleep, such as decreased body temperature and respiration rate. In addition to sunlight, artificial lighting can be bright enough to prevent the release of melatonin, which can interfere with the sleep-wake cycle.

Here are some simple tips for optimizing the sleep-wake cycle:

		Spend more daytime hours outside or in lightfilled rooms. Exposure to sunlight during the day will help you fall asleep later on when it’s time for bed because light inhibition of melatonin production stimulates wakefulness and alertness throughout the day. Get outside early in the morning or have your breakfast near a sunny window. During the day, exercise outside or take your dog for a walk and open curtains and blinds in your house and workplace to expose yourself to plenty of light.

		Make your bedroom dark for better sleep. Block all sources of artificial light, including street lamps or outside house lights with heavy curtains or blinds, and cover up the glow from light-emitting electronics and bright alarm clocks.

Consider these other factors that affect sleep:

		Limit caffeine, tea, and nicotine before bedtime. In addition, avoid drinking large amounts of liquids in the evening because it may cause you to have to get up several times during the night to use the restroom. Although alcohol may make you feel tired at first, it may actually compromise the quality of your sleep and should be avoided, especially if you have been having trouble getting a good night’s sleep.

		Create a comfortable sleeping environment and pay attention to the temperature, noise and light in your room, as the bedroom environment can have a significant influence on sleep quality and quantity. This may mean reducing the temperature, turning off the TV, and avoiding computers, iPads, TVs, or work in the bedroom. The bedroom should be reserved for sleep.

		Get ready for bed with a regular routine. Engage in relaxing activities in the hours just before bed, such as light reading and listening to soothing music.

		Make sure your bed is comfortable and use it only for sleep. Avoid watching TV or working in bed.

		Exercise regularly. If timed right, exercise helps promote restful sleep. Engage in strenuous exercise (jogging, swimming, brisk walking, etc.) during the day, especially the day after a bad night’s sleep. However, you need to pay attention to what time you exercise. If you exercise too late in the day, you may have difficulty falling asleep. Try to finish exercising at least 3 hours before bed; however, a gentle stretching routine before bed can also help you to relax and induce sleep.

		Avoid heavy meals within 2 to 4 hours of bedtime. If your body is working to digest a large meal, your sleep may be disturbed— although a little food in your stomach may help you sleep. If you must eat before bed, try to limit your meal to a light snack and avoid protein-rich, high-fat foods near bedtime. See Table 2 for a list of foods to avoid for a good night’s sleep.

		If possible, avoid medications that disrupt sleep. Certain commonly used prescription and OTC medicines contain ingredients that can make it difficult to fall asleep, cause more awakenings during the night, and affect the quality of your sleep. These ingredients include decongestants, steroids, and caffeine in headache medicines. Antihistamines and prescription medications including betablockers, alpha-blockers, asthma treatments, and antidepressants can also affect sleep. If you have trouble sleeping, talk to your pharmacist to see whether any drugs you’re taking might be disrupting your sleep and whether they can be taken at other times in the day. Don’t stop taking prescription drugs or adjust your dosing schedule without talking to your pharmacist or HCP first.

If you’re still having trouble sleeping, you may be tempted to reach for a supplement or an OTC sleep aid. So when is it time to try a sleep aid? The answer is different for every individual because sleep problems are caused by a variety of different factors. For example, certain medications, night-shift work, and jet lag can throw off the sleep-wake cycle. A sleep medication may be an option when improving your sleep habits hasn’t worked, the cause of your sleep problem is known and is best treated with medication, or sleep troubles are making daily activities difficult to perform and the insomnia is expected to be temporary. Although sleep aids can help you fall asleep on occasional sleepless nights, it is best to talk to your HCP or pharmacist about taking any sleep aids or supplements like melatonin or valerian root extract. Supplements, because they are not recognized as drugs, are not regulated by the FDA, so it can be hard to pinpoint the exact melatonin or valerian root extract dosage that works best.

It is normal to have an occasional sleepless night, but if you find yourself having trouble falling sleep or staying asleep on a regular basis, speak to your HCP and don’t get discouraged. Together you can create a plan to help you get the rest you need.

						Smith M, Robinson L, Segal R. How to sleep better. Helpguide .org website. helpguide.org/articles/sleep/how-to-sleep-better. htm. Accessed July 28, 2016.

						Brain basics: understanding sleep. National Institute of Neurological Disorders and Stroke website. ninds.nih.gov/disorders/ brain_basics/understanding_sleep.htm#Tips. Updated July 25, 2014. Accessed July 28, 2016.

						Insomnia. National Sleep Foundation website. sleepfoundation .org/insomnia/content/what-is-insomnia. Accessed July 28, 2016.

						Sleep and chronic disease. CDC website. cdc.gov/sleep/about_ sleep/chronic_disease.html. Updated July 1, 2013. Accessed July 29, 2016.

						Insomnia fact sheet. Office on Women’s Health website. womenshealth. gov/publications/our-publications/fact-sheet/insomnia. html. Updated July 16, 2012. Accessed July 29, 2016.

Beth is a clinical pharmacist and medical editor residing in northern California.