Managing diet and PAH6 High-sodium foods to be aware of 2 • Prepared meat products: hot dogs, bacon, sausage, canned meats • Salty snacks: potato and corn chips, salted nuts, pretzels

KNOWLEDGE I N A C T I O N

Managing diet and PAHYour weekly food and liquid journal

Sodium is one of the main components of common table salt. It’s an essential mineral, helping control the balance of fluids in your body. Everyone needs sodium, but most people only need a small amount in their diets.1,2

Too much sodium can make your body hold onto fluid, which can cause swelling in the feet, ankles and legs. This is known as edema.2,3

Fluid retention, or edema, is problematic for patients with pulmonary arterial hypertension (PAH) because it can strain the heart and worsen symptoms such as shortness of breath and fatigue. As fluid retention may already be an issue if you have been diagnosed with PAH, you should consider talking to your doctor about whether you need to change the amount of sodium in your diet.3

If your doctor recommends reducing your sodium intake, you can refer to this brochure for tips—use it to help figure out the sodium content in foods and to keep track of what you eat and how you feel. This may help you better manage your diet, sodium intake, and PAH symptoms.

At Actelion, we believe that knowledge is power. When you understand your condition, you can ask the right questions, make informed decisions, and get the most from your healthcare team and your therapeutic options. That’s our goal in PAH education and that’s KNOWLEDGE IN ACTION.

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Managing your sodium intake

No more than 1,500 mg/day of sodium

What the experts recommend: For optimal health, the American Heart Association (AHA) recommends no more than 1,500 milligrams (mg) of sodium per day. That’s less than ¾ of a teaspoon of salt. Most Americans eat more than twice the recommended amount.1

A good start toward reducing sodium intake is to stop using the saltshaker when cooking, baking, or eating. Also, try to limit processed, canned, and frozen foods as these contain large amounts of sodium.4

Managing your fluid intake

No more than 8.5 cups/day of fluids

Patients with PAH are often advised to limit their total fluid intake to no more than 2 liters per day, or about 8.5 cups. This can help prevent swelling and fluid retention.3

Managing your weight

Watch out for 2 lbs/day or 5 lbs/week weight gain

It’s a good idea to weigh yourself daily, because weight gain is often one of the first signs of fluid retention. If you notice a gain of 2 pounds in one day or 5 pounds over a week, contact your healthcare team.5

Serving SizeServings per container

Amount Per Serving

Calories 260

20%

25%

10%

28%

10%

0%

1 cup (228g)2

Calories from Fat 120

Saturated Fat 5g

Dietary Fiber 0g

Vitamin A 4% Vitamin C 2%

Sugars 5g

Trans Fat 2g

Total Fat 13g

Cholesterol 30mg

Sodium 660mg

Protein 5g

Total Carbohydrate 31g

% Daily Value*

•

Calcium 15%

*Percent Daily Values are based on a 2,000 calorie diet.

Iron 4%•

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How much sodium is hiding in your food?Because almost all foods contain sodium, check the nutrition labels to see just how much sodium is in each product.

Understanding and tracking how much sodium is in the food you eat can help you control how much you’re consuming—and help you achieve your sodium reduction goals.

Also, when you go shopping, be sure to take into account not only the milligrams of sodium per serving but also the size of the serving. Remember the percent daily value for sodium found in food is based on 2,400 mg per day, which may be higher than your recommended daily amount.4

See page 23 of this brochure for a website that lists the sodium content of common foods.

Serving size

The nutrition values listed are for a single

serving. If you eat 2 servings, all of the values will double.6

Sodium

A single serving has 660 mg of sodium.6

One serving has 28% of the daily value for sodium.

Important note: this value is calculated based on consuming 2,400 mg of sodium per day, rather than the AHA’s recommended 1,500 mg per day.4

K N O W L E D G E I N A C T I O N : M A N A G I N G D I E T A N D P A H

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What does it mean? Here are some relevant terms you might find on your food packaging.1

• Sodium free: Less than 5 milligrams of sodium per serving and containing no sodium chloride

• Very low sodium: 35 milligrams or less per serving

• Low sodium: 140 milligrams or less per serving

• Reduced sodium: At least 25% less per serving than the usual sodium level*

• Light in sodium: Reduced by at least 50% per serving*

• Healthy: 480 mg or less per individual dish serving or 600 mg or less for a full meal product

* This does not mean that the food is low sodium, just that it’s lower than the original product. The “reduced sodium” label can be deceptive if a food item is high in sodium to begin with. For example, reduced-sodium soy sauce contains over 500 mg of sodium per tablespoon!4

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High-sodium foods to be aware of2

• Prepared meat products: hot dogs, bacon, sausage, canned meats

• Salty snacks: potato and corn chips, salted nuts, pretzels

• Breaded and battered foods: fresh or frozen

• Smoked, cured, or pickled foods: olives, sauerkraut

• Packaged or bottled sauces: clam, spaghetti, and curry sauce

• Condiments: soy sauce, mustard, horseradish, ketchup, and even sweet relish

Your taste for salt may decrease over time. If you gradually reduce your sodium intake, you may find that you don’t miss it.2


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Sodium/Salt substitutesDiscuss substitutes with your doctor. Many are high in potassium and may be dangerous for patients with kidney disease or those who are taking certain drugs for high blood pressure or heart failure.4,7

Instead of salt, use herbs and spices to enhance flavor4:

• Basil • Parsley

• Bay leaves • Rosemary

• Chives • Sage

• Dill • Thyme

• Ginger • Turmeric

• Nutmeg

You can also try lemon juice, peppers, garlic, and onion — keep experimenting until you find flavors that you like.2

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The importance of a healthy dietIn addition to limiting sodium, it’s essential to follow a healthy diet and maintain a healthy weight. Try to eat foods that are natural, unprocessed, or home-cooked (from scratch) rather than commercially prepared meals.

The DASH* Plan is a healthy diet that includes8:

• Foods low in saturated and total fat

• Foods low in cholesterol

• Fruits and vegetables

The DASH plan also includes whole grains, poultry, fish, and nuts. DASH is low in red meats, sweets, and sugared beverages, while providing high levels of potassium, calcium, and magnesium, as well as protein and fiber. It’s a good overall eating plan for individuals who want to be healthier.8 Talk to your doctor about whether the DASH plan is right for you.

See page 23 of this brochure for a link to the DASH plan.8


* DASH stands for “Dietary Approaches to Stop Hypertension.” Both the National Heart, Lung, and Blood Institute and the American Heart Association recommend the DASH eating plan.

How to use your weekly journalKeeping track of what you eat and drink and your weight with this journal can help you manage your health.

Write down what you eat every day.

Write down how much liquid you consume every day.

Liquids include3:

• Water • Other drinks like juice and coffee

• Soups • Ice cream and sherbets

• Jell-O • Popsicles

• Yogurt • Ice

Weigh yourself every day and write down your weight in the space provided. Weigh yourself at the same time every day, wearing similar clothing. If you have any sudden weight changes, be sure to contact your healthcare team.

Use the scale to mark the number that best describes how you’re feeling each day. Write down any comments you think are important to share with your healthcare team; for example, if your PAH prevented you from doing an activity, or if your symptoms got better.

Scrambled eggs, toast

Oatmeal, yogurt

Peach rice cakes almonds

PlumsLicorice

Turkey and Swiss sandwich

Bean and cheese burrito

Salmon steak, salad, vegetables

Roast chicken, asparagus baked potatoCold cereal with fresh fruit

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drinks weight PAH today

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Notes

REFERENCES1. American Heart Association. Healthy living: about sodium (salt). American Heart Association Website. http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/About-Sodium-Salt_UCM_463416_Article.jsp#.V6jClZMrLUI. Accessed August 2, 2016. 2. Hayes GB, Wilcox, D. What to eat when you have PH. In: Oudiz R, ed. Pulmonary Hypertension: A Patient’s Survival Guide. 5th ed. 2013:197-214. 3. Pulmonary Hypertension RN. Salt and water restrictions. http://pulmonaryhypertensionrn.com/salt-and-water-restrictions-for-ph-patients/. Accessed August 4, 2016. 4. Pulmonary Hypertension Association. Consensus Statement by Scientific Leadership Council. Sodium restriction for patients with PAH. Pulmonary Hypertension Association website. http://www.phaonlineuniv.org/files/Sodium%20Restriction%20for%20Patients%20with%20PAH.pdf. Accessed August 4, 2016. 5. Cleveland Clinic. Diseases & Conditions. Living with pulmonary hypertension: dietary & lifestyle changes. Cleveland Clinic Website. http://my.clevelandclinic.org/health/diseases_conditions/hic_Pulmonary_Hypertension_Causes_Symptoms_Diagnosis_Treatment/hic_Living_With_Pulmonary_Hypertension_Dietary_and_Lifestyle_Changes. Accessed August 2, 2016. 6. National Institute of Diabetes and Digestive and Kidney Diseases. Food label reading: tips for people with chronic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases website. https://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/a-z/nutrition-food-label/pages/nutrition-food-label.aspx. Accessed August 4, 2016. 7. Doorenbos CJ, Vermeij CG. Danger of salt substitutes that contain potassium in patients with renal failure. BMJ. 2003;326:35-36. 8. US Department of Health and Human Services. National Institutes of Health, National Heart, Lung, and Blood Institute. Your guide to lowering blood pressure. National Institutes of Health, National Heart, Lung, and Blood Institute website. http://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf. Accessed August 4, 2016.

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Resources and supportTo learn more about lifestyle changes and healthy eating for patients with PAH (including the benefits of sodium reduction), visit these organizations online:

American Heart Association

Builds healthier lives, free of heart disease and stroke

www.heart.org

National Heart, Lung, and Blood Institute

Provides information on heart, lung, and blood diseases and conditions

www.nhlbi.nih.gov

DASH Healthy Eating Plan

Go to the site and download the PDF file for healthy, low sodium food options.

www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf

Sodium content of common foods

Visit the National Center for Biotechnology Information website.

www.ncbi.nlm.nih.gov/books/NBK133307/

The following resources are great places to start for PAH information, news, and ideas on how to get involved with the PAH community:

Pulmonary Hypertension Association

Sponsors over 200 support groups and hosts online chat rooms

www.phassociation.org

1-301-565-3004

Scleroderma Foundation

Provides support, education, and research for scleroderma patients

www.scleroderma.org

1-800-722-4673

© 2016 Actelion Pharmaceuticals US, Inc. All rights reserved. ACT-01072 0916

Documents

Managing diet and PAH6 High-sodium foods to be aware of 2 • Prepared meat products: hot dogs, bacon, sausage, canned meats • Salty snacks: potato and corn chips, salted nuts, pretzels