Erickson Tribune

Health Secrets

UPDATED: Thursday, March 08, 2007

DASHing through America's salt fascination

Posted on Thursday, March 08, 2007
 

By Wendy J. Meyeroff
THE ERICKSON TRIBUNE

Hypertension, more commonly called high blood pressure, is rampant in adults age 65-plus. It affects 71.6% overall, with numbers even worse in certain ethnic groups.

High blood pressure is defined as an upper number (the systolic pressure) of 140 or higher, with the lower, diastolic number at 90 or more.

“Even below 140/90, people treated with medicines are at risk of heart disease and stroke. These are people for whom diet would be a better approach,” says Lawrence J. Appel, professor of medicine, Johns Hopkins Medical Center.

The DASH breakthrough
In 1997, a breakthrough diet called DASH (Dietary Approaches to Stop Hypertension) proved it was possible to control blood pressure through diet instead of medication. 

DASH was one of three diet plans tested as part of a National Heart, Lung, and Blood Institute study. It made some major dietary changes in the 2,000 calories provided daily.

Instead of five portions of fruits and veggies daily, DASH “increased the number to eight to 12. It also added two to three servings of low-fat dairy products, and reduced fat and cholesterol,” says Phyllis McCarron, M.S., R.D., director of intervention at Johns Hopkins ProHealth Clinical Center.

DASH focused on the cumulative benefits of whole foods (not a single nutrient), and how foods worked together. It recognized that certain nutrients were important and looked for foods rich in them.

“DASH included about a 1/4 cup of nuts, which are rich in magnesium and good oils. Magnesium is one of the DASH nutrients we believe helps lower blood pressure,” says McCarron.

The results were dramatic. “DASH lowered systolic pressure 11.4 points and diastolic 5.5 points. That is what you would expect from medication— and it happened within days,” says Appel.

The sodium question
“There is evidence that high salt levels cause gastric cancer and high blood  pressure, which can cause heart and kidney disease. There is some evidence that salt increases osteoporosis,” says Appel.


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Drinking more water will not flush excess salt from the body. It remains in the kidneys.

The DASH-Sodium diet modified sodium levels in the base DASH diet. “DASH-1 contained 3,000 mg of sodium daily, which is pretty typical for the average American. In  DASH-Sodium we tested three levels: the original 3,000 mg, 2,400 mg, which is generally recommended, and 1,500 mg,” says  McCarron.

The sodium obstacle
Not surprisingly, the 1,500 mg diet did the best job of lowering blood pres- sure. “I have to be honest, that level is harder to achieve,” says McCarron. Even keeping your sodium level to the generally recommended 2,400 mg daily is tough. “There is about 2,400 mg of table salt in one teaspoon. You can get half your day’s allotment of sodium in one dill pickle,” says Doris Henning, R.D., chief dietitian for Erickson Health.

She recommends aiming for about 1,800 mg daily, but adds that is generic. “It can vary by gender,  activity level, and other factors,”says Henning.

Finding hidden sodium
It can be especially hard for older people to avoid higher levels of salt because many rely on easily prepared foods. “Frozen meals and canned soup are both staples in many older adults’ diets—and they generally contain large amounts of salt,” says McCarron.

It isn’t always easy to spot sodium. Besides fairly obvious sources, like MSG (monosodium glutamate), soy sauce, and most BBQ sauces, there are many other ways salt creeps into our system. “Quick breads have baking soda, which contains sodium bicarbonate. Antacids have sodium. Most canned tomato products contain sodium,” says Henning. Also avoid cured meats, like ham and bacon.

Bringing salt down
“At Erickson, we cook with low-sodium soup bases. We figure you can always put salt in, but you can’t take it out,” says Henning. Over and over, experts  recommend learning to cook with spices besides salt.

“Look for low-sodium breads. They are generally now available in most major  supermarkets, but they are more expensive. Choose shredded wheat and oatmeal—the 5-minute kind, not instant—for cereal. Make salad with oil and vinegar dressing,” says McCarron.

What about when you are going out? “Balance is key. If you are going out for lunch and it will be hard to control the sodium content, choose that shredded wheat for breakfast,” says McCarron.

Once out, try making better food choices. Consider these options at the  Chinese restaurant. “Choose steamed brown rice, instead of white. Ask to have the food prepared with no MSG and very little sauce, then avoid adding soy sauce,” says McCarron.

“Go for veggie dishes, or something steamed. Fried food is not only high in fat, it has salt in the batter,” she adds.

Be accommodating
“Initially it is hard to get used to a lower-sodium diet, because you’ve acquired the taste for salt. We did a taste menu here at Erickson that the DASH experts prepared—and people asked for some salt,” says Henning.

One of the keys is to move away from salt slowly. “We did a study on older people and were able to reduce their sodium intake. The key is a gradual  reduction. If you do it abruptly, you will have problems,” says Appel.

“It takes about six weeks to bring down your salt level to about half of what you were used to. Then if I give you something you used to eat, you are likely to say, ‘My goodness, this is salty,’” he concludes.

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