Katie Ferraro (0s):

All right. Quick pulse check. Are you feeling okay about baby Led Weaning a little nervous about this transition? Are you maybe interested in BLW but not entirely sure if this is the approach for you or maybe you started baby Led Weaning, but you're feeling stuck or you're gonna give up, cuz you're not sure if you're doing this right. Don't give up. I have a brand new one hour comprehensive online video training for you called BABYLED Weaning for BEGINNERS. It's totally free. And I think it it's gonna ease a lot of anxiety for you. I just redid this free training. It's packed with videos and visuals on how to safely prepare BLW Foods and what the first few days looks like and how to reduce choking risk. Plus everyone on this free workshop gets a copy of my 100 FIRST FOODS LIST.

Katie Ferraro (41s):

So you'll never run out of ideas aboout what to feed your baby next. You can get signed up for this weeks video workshop times at BABYLEDweaning.co. If you've got one hour to dedicate to learning about BLW, this is the training for you. BABYLEDWeaning.Co has this weeks workshop times, and don't forget you also get that hundred FIRST FOODS LIST from this free training. And I hope to see you there. I would say that the New Zealand guidance about babies should have no more than 120 milligrams of sodium per a hundred grams. Serving is probably the most helpful, except that's only holds true. If you're actually looking at a hundred grams serving sizes, which we don't have at the United States. Hey there I'm Katie Ferraro, Registered dietician, college nutrition professor and mom of seven specializing in bay led weaning here on the baby Led Weaning Made Easy podcast.

Katie Ferraro (1m 26s):

I help you strip out all of the noise and nonsense about feeding, leaving you with the confidence and knowledge you need to give your baby a safe start to solid foods using BABYLED Weaning. No added sugars and minimize the amount of Sodium in the Foods that you offer your baby. That's kind of always been the party line in my world, the world of an Infant feeding specialist, a Registered dietician. But I know for parents that word Minimize ahead of Sodium can be really, really frustrating added sugars, a no brainer, right? The American academy in pediatrics says zero grams of added sugar, no added sugar for Babies until age two.

Katie Ferraro (2m 8s):

Like it's pretty easy to look on an nutrition fax panel. And if it says added sugar and there's anything except zero grams next to it, don't offer that food to your baby. But what about Sodium? I know Sodium can be such a sticky point for parents because they're like, it says Minimize and it being just like the general consensus in the world of advice given from credentialed feeding professionals. But like I know a lot of the parents in the BABYLED Weaning space, like they wanna know the numbers like exactly how many milligrams of Sodium can my baby have. So the point of today's episode is I wanna take you on a tour of Sodium Limits for Babies around the world. Cuz I know personally it's always frustrated me that at least in the United States of America, United States and Canada share a rather large set of dietary guidelines, that dietary reference intakes, which is these tables that you study in the world of nutrition, about how much of X, Y, or Z nutrient you should have for which age and gender group.

Katie Ferraro (2m 58s):

And then there's upper Limits, meaning okay, for Sodium, you shouldn't go above this level or we know there's negative health impacts. Those tables always have like no data across the 0 to 6 month age category and the 7 to 12 month age category and all of the like "great data", even though it's usually not that great. It starts for age one and beyond, except that for the 7 to 12 month old Babies, they don't just have Infant milk anymore. There's real food in their diet. So we can't really use at least in the US, the dietary reference intakes or the DRI tables to guide our choices for when we're looking at Foods and nutrition facts panels to say, gosh, is this a food that's good or not good for my baby? So today I wanna go. As I mentioned around the world, kind of picking out some of the different regions in different countries that have different Sodium guidelines.

Katie Ferraro (3m 44s):

And I wanna say a special thank you to our intern Tessa. So we have a dietetic intern full-time dietetic internship program. Tessa is our fabulous dietetic intern who did all of the research for this episode because it's easy to say, Hey, in the United States, we don't really have any guidelines, but that doesn't mean like, go let your baby eat as much salt as they want. Of course. So I'm always interested in what our nutrition colleagues around the world are doing as far as establishing guidelines. So Tessa, thanks for finding all this research for us. And before we get started, I just wanna say that in the United States, we do not have any official upper Limits for Sodium and no official recommendations on how much salt your baby should have. Okay. We know that Sodium is important as an electrolyte, right?

Katie Ferraro (4m 25s):

It's important for keeping your heart beating, for example. So you can't go down to like zero milligrams of Sodium and your baby's getting some salt from breast milk or formula. But when you're picking Foods, my general rule of thumb, cuz you you're gonna listen to this whole thing and be like, Ugh, this is even more confusing than I thought it would be. And then my goal is not to confuse you. It's just to show you that there's no general consensus around the world, but based on all of the different countries and the data and what we know about Infant nutrition plus that the Foods that you're feeding are not the only source of nutrition, cuz you baby's still getting breast milk or formula. My general rule of thumb is that when it comes to introducing a food to a baby or feeding a baby of food, when I'm looking at the nutrition facts panel, I like to see less than 100 milligrams of Sodium per serving.

Katie Ferraro (5m 5s):

And I've said this for years and years and years, because the reality is most of the Foods that you feed your baby, when you're doing BABYLED Weaning, don't come out of a package. If there're natural whole Foods that are prepared safely that are not packaged or processed, they will not have added Sodium. However, there are some Foods that we offer. I'm thinking, for example, I'm just feeding this baby Brayden right now. And for red bell pepper day, I don't have the time to roast and peel the red bell peppers, jarred bell peppers that have a little bit of Sodium in them that I rinse off is gonna be fine for that baby to eat, but I wanna Minimize the Sodium. So I look at the label and I'm always looking for less than 100 milligrams of Sodium per serving. That's a good rule of thumb that myself as a mom and a Registered dietician, I feel comfortable with not to mention that the baby's not going to eat that full adult portion size, right?

Katie Ferraro (5m 49s):

Because the amount posted on the nutrition facts panel or the food label, that's for an adult portion size and your baby's having like a few licks of it. They talked a lot on the podcast and my other content about reducing Sodium, another good rule of thumb that any dietician worth their salt will tell you that is If you rinse your packaged or processed or canned products underneath the faucet, especially for canned goods, it's thought to reduce the Sodium by about 30%. Although it's really hard to tell, but that's one way that you can kind of cut the Sodium a little bit more so general rule of thumb. If you're going to the grocery store, I always say a hundred milligrams of Sodium or less for that particular food, acknowledging that most of the Foods you feed don't even have a package cuz they're not processed. And then your baby's not even eating that whole serving size, but a little more semantics before we get started on this global tour, salt and Sodium.

Katie Ferraro (6m 32s):

I know people use the terms interchangeably, but they're not the same thing. So not to get all nerdy dietician on you, but salt table salt, like the thing that's in the shaker. Okay. People call that's salt. All right. That's Sodium chloride. It's only 40% Sodium. Okay. And it's 60% chloride. So you cannot use the term salt and Sodium interchangeably. So for this episode, we're talking about Sodium and Sodium is what is listed on the nutrition facts panel. Can I mention a hundred milligrams of Sodium in a food that I feel comfortable offering to my baby on occasion. And just to give you an idea, a teaspoon of salt, okay. That's about six grams. So it's 6,000 milligrams, a teaspoon of salt, right? There's three teaspoons in a tablespoon if you're out there baking, okay.

Katie Ferraro (7m 13s):

That's 40% Sodium. That's all table salt is so in a teaspoon of salt, there's 2,325 milligrams of Sodium. So 2,325 milligrams, that's 23 times more in that teaspoon than I would recommend in any one portion. Okay. And the reality is that most of the Sodium in the standard American diet, it does not come from the salt shaker. I should remember this from my days as an adult weight loss Dietitian. And I did a lot of cardiovascular nutrition health too. And people would be like, oh, don't talk to me about Sodium Katie. Like I don't even use the salt shaker. I was like, but the salt, Shaker's not the source of most Sodium in the US diet. It's packaged, processed and fast Foods. So we don't want to have our Babies being introduced to high Sodium Foods early and often.

Katie Ferraro (7m 54s):

And it's so cool around the world with the different nutrition guidelines, the reason why they say not to use Sodium. And I'm gonna include that in this Roundup as well. So salt and Sodium, not the same thing we're talking about Sodium because table salt is only 40% Sodium. Okay. So in the United States it said a teaspoon of salt has 2300 milligrams of Sodium. The average American eats about 3,400. So 3,400 milligrams. And we know that's too much cardiovascular disease and stroke in the United States, our FDA, we have some short term targets that they always make. These funny targets that nobody achieves and then they just keep making new targets. But for the next two and a half years, the FDA would like to see Americans reduce Sodium by 12% down to 3000 milligrams per day. Okay. And they estimate that this reduction in Sodium, if we could get Americans to stop eating 3,400, and this is Americans age one and up, okay.

Katie Ferraro (8m 40s):

So I'm talking about everyone. Who's not your baby, basically 3,400, get it down to 3000 expected to result in tens of thousands of fewer cases of heart disease and stroke and billions of dollars saved in healthcare costs. Okay. So we don't wanna like start your baby out on the wrong path by like pumping 'em full of Sodium. When we know from adult chronic nutrition studies that high Sodium diets are linked to higher risk of heart disease stroke, and then huge, huge, huge healthcare costs. Okay. We have a lot of, not a lot, but a number of different competing nutrition guidelines in the United States and they're not competing. They just send out conflicting information, which further confuses Americans. So that target to try to get to 3000, that's the Food and Drug Administration. Then the other branch of the us government, the dietary guidelines, okay. The dietary guidelines are the set of nutrition rules that both the United States and Canadian nutrition experts get together and they publish it every five years.

Katie Ferraro (9m 24s):

So the last dietary guidelines for Americans DGAs, they were published for the 2020 to 2025 period. And they recommend even lower than the FDA. The dietary guidelines say that Americans, each one and up should have less than, or around 2300, 2,300 milligrams of Sodium per day. Okay. Now, If you dig deep into the dietary guidelines, the US national academies who their scientists are, the ones on the panels who help to write the dietary guidelines for one to three year olds, they recommend that they should eat less than 1500 milligrams. So 1,500 milligrams of Sodium. All right. So most adults, that's a lot of numbers. I know most adults are eating like around 3,500 milligrams a day. Okay. The FDA says you should get that down to 3000. The dietary guidelines say adults, you should get that down to 2300, the dietary guidelines people also say, Hey, for one to three year olds, we gotta make sure that doesn't go above 1500.

Katie Ferraro (10m 9s):

And then what do they say for Infant infants? Shocker. There's no data for infants. They just skip over it. Okay. So frustrating. They do in this lightest round of the dietary guidelines, they've made a big deal about how they're making like recommendations for birth to 24 months. But like there's still a huge, huge gap for the six to 11 months, seven to 12 month old ranges. And in one part of the dietary guidelines, they do cite. What's called the adequate intake level saying that seven to 12 month old Babies should have around 370 milligrams of Sodium a day. Okay. However, anyone in nutrition knows that the adequate intake level is really like a scientific shot in the dark. It means we do not have enough scientific evidence to set forth what they call an RDA recommended dietary allowance. So If you don't have the data to set a strong RDA, you pick a like middle of the road, adequate intake level.

Katie Ferraro (10m 54s):

And that's where that 370 milligram number comes from. So If you had to nail down, like what's the us saying, as far as how much Sodium a seven to 12 month old baby should have in one place, they cite the AI, the dietary guidelines 370 milligrams. But again, acknowledging with a huge asterisks that that's inadequate intake level, which is not necessarily based on very strong evidence. Okay. What about the upper limit? Okay. In the United States, we also publish in our dietary reference intake values. Like these huge tables that are in your nutrition textbook. If you're studying nutrition, it says what's the upper limit. Meaning If you eat too much of any of these nutrients, you know, vitamins or minerals or other compounds in Foods, they could be potentially harmful or toxic. There's no upper limit for Sodium. Okay. That dietary guidelines for Sodium and potassium are revised in 2019.

Katie Ferraro (11m 36s):

And again, for infants, there's no data. So there's definitely in the citations. If you go deep into the literature, evidence of infants being harmed and killed from very high levels of Sodium, very, very few incidence of these kind of freak situations. But the point is, you know, you can't pump your baby full of salt and you're unlikely to achieve that from food. We're talking usually about supplements. So like for whatever reason, your Infant got into a bunch of supplements that had a very high Sodium content. It could potentially be toxic. Okay. But from a food based standpoint, there's no upper limit of Sodium for Babies. So that's the United States, a lot of gray area, maybe an adequate intake level of Infant should have around 370 milligrams of Sodium a day. And then you have parents who start calculating like how much Sodium is in the breast milk and the formula like, oh my gosh, that's even more than 370.

Katie Ferraro (12m 18s):

The point is we don't have very good data based in the United States, at least, or what our nutrition professionals are interpreting to say, there's any, at the end of the day, there is no data about Sodium for your Infant. They don't set an upper limit. They don't really have a good idea of how much they need. They don't say this is how much you should aim for it or not go below. There's really not a lot of data. So you're kind of left to your own. So when they say things like Minimize Sodium, there's no real numerical guidance there. So what about in the United Kingdom, in the United Kingdom, the national health service or the NHS guidelines say less than 400 milligrams of Sodium per day for six to 12 month olds. Okay. And then for one to three year olds, less than 800 milligrams a day. So they make it kind of nice and simple. Okay. That's still quite a low amount.

Katie Ferraro (12m 59s):

And If you, Infant is inclined to having any process or packaged snack Foods are certainly going to be surpassing that. So just another reason to kind of encourage more wholesome Foods and not package processed snacks for Babies, because that tends to be the higher source of Sodium. So UK 400 milligrams of Sodium per day for six to 12 month in the European union. Okay. Their food safety organization says that for Infant seven to 11 months, they cite an adequate intake level of 200 milligrams. So 200 for the EU 400 for the UK, 370 for the United States, you can see this is not very much salt. And if we're working on gosh, looking for less than a hundred milligrams of Sodium in a packaged food product, you realize there's not a lot of room in your baby's diet for packaged and processed Foods because you'll easily surpass these Limits.

Katie Ferraro (13m 43s):

How about in Canada? Okay. For six to 24 month olds, the recommendations is prepare Foods with little or no added salt. So that's from nutrition for healthy term infants from the government of Canada. Okay. And there's another citation elsewhere from the Canadian pediatric society. Talking about the adequate intake level for six to 12 months saying 370 milligrams a day. And that's the same as the US you'll note. There's a lot of overlap between us and Canadian guidelines. A lot of the researchers work together and co-publish those guidelines. Now, I like that in the Canadian guidance, they add a little bit more perspective saying that saltiness is a defining human taste at birth human infants are either insensitive or indifferent to salty taste. The development of a preference for salt may begin in infancy.

Katie Ferraro (14m 26s):

Dietary exposure to Sodium in early life may contribute to a preference for a salty taste in the preschool years. And then you can surmise. It goes so on and so forth, right? And so if we're inclined to be eating only salty Foods, think about the quality of those Foods that tend to be packaged and processed and fast Foods. So again, if we're setting our baby's stage for their lifelong relationship with food, it's best to avoid excessive saltiness, because then we're setting them up to like Foods that are generally less helpfuL. In Australia the recommendation is, do not add salt to food for infants. This is an important safety issue. As Infant kidneys are immature and unable to excrete excess salt. So If you know anyone who has kidney disease or has been on kidney dialysis, they have to severely limit a number of different minerals, potassium, phosphorus, and Sodium.

Katie Ferraro (15m 10s):

Okay. Your kidneys are what process, the minerals in the Foods that we eat. Okay. And so we don't wanna overdo it while our Babies kidneys are still developing. And in Australia they have an adequate intake level. Again, just kind of a scientific shot in the dark where they say it's 120 milligrams for seven to 12 month old Babies. Okay. And that's very, very, very challenging, quite a very low level. And Australia also does not have an upper limit, meaning they do not have the research or the evidence to set the higher limit above which you do not want to go for Babies. Okay. We just don't know at what level this could be potentially toxic. And sometimes it might be frustrating when you listen to kind of summaries of nutrition research and be like, dude, they don't know anything. And the reality is it's not ethical to design a study whereby you would randomize one group of Babies to get 120 milligrams of Sodium a day and then another one to get 12,000 and just see what happens.

Katie Ferraro (15m 56s):

Right? Okay. So a lot of this is extrapolation data based on, okay. If we breastfeed a baby from zero to six months of age, and we know that breast milk has 100% of the nutrition that that baby needs, then as we're kind of anticipating how they grow and we're adding in solid Foods, they're kind of guessing at a lot of these numbers in New Zealand, the recommendation is when preparing food for your baby or toddler do not add salt or sugar. So we say Minimize Sodium and do not add sugar. New Zealand comes right out and says, do not add salt. It says if using commercially prepared Foods choose those that are low in salt, parenthesis, Sodium, and with no added sugar. And now I like to say, go into a little bit more numerical detail. Commercially produced, baby Foods contain restricted levels of Sodium to ensure they are appropriate for Babies should be no more than 120 milligrams of Sodium per 100 grams.

Katie Ferraro (16m 44s):

And that's from the healthy eating guidelines for New Zealand, for Babies and toddlers zero to two years old. And I wanna say that part again for the packaged Foods that come right out and say no more than 120 milligrams of Sodium per 100 grams of food. The problem with this, if you're in the United States, is that our portion sizes are not listed in a hundred gram portions, the rest of the world tends to do a hundred gram portions in the United States. We let manufacturers pick the serving size. Oh, well, half of a cup of ice cream is a serving size. You guys know you eat way more than a half of a cup of serving of ice cream, right? So one brand could have a serving size, be a half a cup. Another brand could have it be a cup. You would have to like literally do the math to get it to the a hundred gram portion. But if for whatever reason, the label you're looking at is listed in a hundred grams, New Zealand would say less than 120 milligrams of Sodium per that a hundred gram portion would be appropriate In Singapore The recommendation is, do not add sugar, salt, and seasonings into the food.

Katie Ferraro (17m 34s):

And they give examples, especially for seasoning soy sauce and chicken powder says salt cannot be added to baby's food until after 12 months as the kidneys may not be able to excrete the high salt load. So again, not so much a mention of taste preference in the development of cardiovascular disease, but rather here, we're looking again at the potential for kidney problems, with excessive amounts of Sodium. Okay. And then the Singapore one, I know this is translated into English. It says any more than this and their kidneys may not be able to cope, which I think is a nice way to put it. All right. So looking around the world, summarizing there's no real hard and fast data across the board. I would say that New Zealand with 120 milligrams of Sodium per hundred grams serving size is probably the most useful, but only If you portion sizes are listed in a hundred grams, which in the United States, there are not.

Katie Ferraro (18m 20s):

So even after kind of touring all around the world, putting this all together, I still stand by my recommendation that your best bet is when you're looking at your nutrition facts panel, look for less than a 100 milligrams of Sodium in the portion size that you're going to offer your baby keeping in mind that most of the Foods that we offer our kids should not have labels on them cuz they shouldn't come from packages cuz they shouldn't be processed. But in real life we sometimes feed our Babies. Certain types of convenience Foods keep the Sodium as low as you can go. It helps preserve their kidney health. It also helps set the stage so that they're not overly preferring salty Foods, which as we know, tend to be less nutritious. I've got a lot more content about Sodium on the podcast. I'm gonna just put my previous Sodium episodes in the Shownotes here and then also link them up online at BLW podcast.com/253.

Katie Ferraro (19m 3s):

That's where the online Shownotes for this episode are listed and I'll link to all of that other Sodium content there. Cuz I know we have a lot of healthcare professionals who listen and dietician and If you want the source documents for each of these countries and their Sodium recommendations, I will put them there. And Tessa, thank you again, our lovely intern for finding all of this data for us. I hope you guys enjoyed this episode about Sodium Limits for Babies around the world.