Use this form to record the sodium content of the foods you eat or drink each day. This record will help you see whether you are getting too much sodium in your diet. Use the Nutrition Facts on food labels to help find how much sodium you eat.
You can tell when your body retains fluid by weighing yourself often. Sodium "attracts" fluid, so the more sodium you consume, the more fluid you will retain. When your body retains fluid, your weight may increase.
If you weigh yourself every day, you can tell when your body is retaining fluids because you will weigh more. Record the date and your weight on this form daily.
Take this record with you when you see your doctor or registered dietitian.
My doctor recommends that I have ___________milligrams (or ______ grams) of sodium in my diet each day.
Week of __________________.
|
Date and weight. |
Foods and drinks consumed during the day. |
Milligrams (or grams) of sodium in each meal or snack. |
|---|---|---|
|
Date:_______ Weight:_______ |
Breakfast ______________________ ______________________________ Lunch _________________________ ______________________________ Dinner _________________________ ______________________________ Snacks ________________________ ______________________________ |
Breakfast ________ Lunch ___________ Dinner ___________ Snacks ___________ Total sodium for the day: _______ |
|
Date:_______ Weight:_______ |
Breakfast ______________________ ______________________________ Lunch _________________________ ______________________________ Dinner _________________________ ______________________________ Snacks ________________________ ______________________________ |
Breakfast ________ Lunch ___________ Dinner ___________ Snacks ___________ Total sodium for the day: _______ |
|
Date:_______ Weight:_______ |
Breakfast ______________________ ______________________________ Lunch _________________________ ______________________________ Dinner _________________________ ______________________________ Snacks ________________________ ______________________________ |
Breakfast ________ Lunch ___________ Dinner ___________ Snacks ___________ Total sodium for the day: _______ |
|
Date:_______ Weight:_______ |
Breakfast ______________________ ______________________________ Lunch _________________________ ______________________________ Dinner _________________________ ______________________________ Snacks ________________________ ______________________________ |
Breakfast ________ Lunch ___________ Dinner ___________ Snacks ___________ Total sodium for the day: _______ |
|
Date:_______ Weight:_______ |
Breakfast ______________________ ______________________________ Lunch _________________________ ______________________________ Dinner _________________________ ______________________________ Snacks ________________________ ______________________________ |
Breakfast ________ Lunch ___________ Dinner ___________ Snacks ___________ Total sodium for the day: _______ |
|
Date:_______ Weight:_______ |
Breakfast ______________________ ______________________________ Lunch _________________________ ______________________________ Dinner _________________________ ______________________________ Snacks ________________________ ______________________________ |
Breakfast ________ Lunch ___________ Dinner ___________ Snacks ___________ Total sodium for the day: _______ |
|
Date:_______ Weight:_______ |
Breakfast ______________________ ______________________________ Lunch _________________________ ______________________________ Dinner _________________________ ______________________________ Snacks ________________________ ______________________________ |
Breakfast ________ Lunch ___________ Dinner ___________ Snacks ___________ Total sodium for the day: _______ |
Current as of: August 31, 2020
Author: Healthwise Staff
Medical Review:Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology & Martin J. Gabica MD - Family Medicine & Adam Husney MD - Family Medicine & George Philippides MD - Cardiology
This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.
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