Ostomy News Dietitian

Let’s delve into this common compound and the role it plays in diet and health

Salt in relation to your stoma output

A standard stoma output is in the range of 400-800mls, You may have experienced or be aware of what’s referred to as a ‘high output stoma’ – where outputs reach over 1200mls in 24 hours. In these situations, it’s really important to correct fluid balance and prevent dehydration. Salt forms part of that picture as it creates the right environment to support water being reabsorbed back in the body, helping to reduce the amount of fluid lost.

If you have an end jejunostomy or an ileostomy, where higher outputs are most common, you may have been advised by your stoma team to increase your salt intake to help with this.

Taking isotonic drinks (which include some salt in them) helps to regulate fluid balance in instances when outputs are too high. You would usually pair this advice with other dietary tweaks, such as eating plenty of complex carbohydrates to add bulk and limiting intake of sugar alcohols which are often found in sugar free foods or liquid medications.

If you have any concerns about the volume or consistency of your output, or need individualised advice, do speak to your medical team.

This might be a good opportunity to review your salt intake, as recommendations you were given a long time ago, may need adjustment, particularly if the output or consistency of what you’re producing has changed.

Salt in relation to your health

I wanted to take the opportunity to talk about salt more broadly speaking, as it relates to your health and well-being.

Often in the ‘ostomy world, salt is mentioned in relation to outputs, but it’s important to think about the context of salt in your diet generally. In the UK, we eat on average 8g salt per day. It is recommended that we have no more than 6g/ day. What’s interesting, is when questioned, we think we’re doing better than we actually are. In those surveyed, they estimated they were eating about 3g per day, when in reality it is more than double this. Perhaps this is because, we’re aware of obvious sources like salted crisps or nuts, but less aware of hidden sources of salt in the foods we’re choosing.

Despite being a significant risk factor for health, salt often gets overlooked. A study in The Lancet found excess sodium to be one of the biggest dietary risk factors globally. It is implicated in diseases that affect us most namely cardiovascular disease and Cancer. Whilst this all sounds a bit doom and gloom, the good news is this is a risk factor we can absolutely do something about.  

How does salt affect our health?

Currently, 2.5 million people in the UK have been diagnosed with high blood pressure (hypertension).

As we know salt helps your body hold onto water. This is not a bad thing, and as we reflected above, salt helps to control stoma outputs. However, if you eat too much, it can force our body to hold onto even more water and this extra water in our blood puts extra pressure on our blood vessel walls, and raises blood pressure.

Many people have hypertension but it has not been diagnosed, so take the opportunity to get it checked when you can. We are also seeing cases of high blood pressure emerging in children, so it’s really key for the whole family that we have a sense of where our salt is coming from.

Remember for adults we’re aiming for less than 6g/ day. For the little ones in your family, 4–6-year-olds need half of that (3g/d), under 6’s even less and 7–10-year-olds 5g/d.

Top tips for looking after your salt intake.

Firstly, make sure you’re clear on the advice from your medical team on the role of salt to support you with a manageable output. We tend to add salt easily to our diets during cooking or at the table. It’s important to strike the right balance and not add more to your diet than you really need.

Secondly, build your awareness of where else salt is coming from in your diet. If you take a look at food labels, this is what you’ll see:

GREEN Per 100g – Less that 0.3g = low

AMBER Per 100g – 0.3-1.5g = medium

RED Per 100g – more than 1.5g = high

You can also look per portion and if a portion has more than 1.8g, that’s high.

This is a really helpful resource on labelling.

Top tips for shopping

Salt with fancy names, for example Himalayan rock salt, is still salt – even if it’s pink.

If you buy a lot of readymade meals, this is where salt amounts have the potential to be higher so check labels using the guide above.

Reduced salt sauces are a good option to switch to. A reduced claim doesn’t translate to mean low salt though, so be careful not to fall into the trap of adding more. For everyday basics though like stock cubes and soya sauce, it’s a easy swap to the reduced salt options.

Other high salt foods and what to consider

Processed meats, such as ham, sausages and salami. They don’t add a lot of nutritional value apart from protein, so do look for lower salt versions.

Cheese – high in salt but a valuable source of other nutrients, so include as part of a balanced diet.

Crisps and nuts – unsalted or reduced salt varieties could be a good option.

Olives – a handful counts towards your fruit and veg portions for the day so they’re a healthy way to keep salt in your diet, but be careful with portion size.

Breakfast cereals – some can be higher in salt but do consider the bigger picture – how much fibre they’re giving you, the portion size being eating and the carrier nutrients that come from the milk/ yogurt you’re likely to be serving it with.

Salt substitutes based on potassium chloride are also a good option and can be used in cooking or at the table. Do check though if you’ve been advised to add more salt to your diet because potassium chloride behaves different to sodium chloride (salt).  

 

Cooking tips

Exploring other flavours to substitute in for the salt is a good idea.

Coriander
Really versatile herb. You can also freeze fresh bunches and put straight in frozen, so no wastage either.

Mint
Best served fresh, why not pop a mint plant on your window -sill – works well in both sweet and savoury dishes.

Basil
My fav. Our plant is called unsurprisingly, Basil. Add this into pasta dishes for a little extra something.

Ginger
Fresh is great but ready chopped in jars or frozen is a huge time saver.

Oregano
Great base for sauces or for sprinkling onto meats or fish before cooking.

Paprika
I use this for chicken tray bakes, as it’s mild but gives a lovely flavour.

Parsley
Another staple and goes well with other herbs too.

Cumin
Probably the spice I use the most. For Indian, Moroccan and Mexican dishes when teamed with different options, it works so well.

Chilli
This is down to personal preference and whether you know spicier foods to irritate your gut. A little can add real depth to a dish though.

 

Often when we think of health we’re drawn into debates about fat and sugar. We’ll save that for another time here. The concerns around salt really stem from the kind of diets we eat these days. Our busy lives mean we rely more on convenience foods and we tend to eat out a lot more. In both of these scenarios it can be difficult to clock just where we’re up to.

Hopefully this information gives you the opportunity to take a pause and consider your diet from a bird’s eye view. Do you eat the balance of foods you think you do? Has more processed or convenience food crept in? Are there small changes you can make to readjust the balance?

 

References

http://www.actiononsalt.org.uk/

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61174-4/fulltext

https://www.gov.uk/government/news/new-phe-data-on-salt-consumption-levels