- The Washington Times - Monday, May 9, 2005

The National Heart, Lung and Blood Institute wants the American public to forgo that extra dash of salt intended to add flavor to a meal and instead try DASH, an eating plan designed to cut down on sodium in a daily diet.

The acronym DASH stands for Dietary Approaches to Stop Hypertension, which this branch of the National Institutes of Health created four years ago to encourage people to stay within federal guidelines established for the safe consumption of salt. The mineral, found in liberal doses in processed foods, including canned soups, is connected to a growing incidence of heart disease resulting from high blood pressure levels.

DASH menus and recipes — which can be ordered by mail or downloaded from the Web (www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm) — contain no more than the suggested upper limit of 2,400 milligrams for a 2,000-calorie daily diet. That gets translated into percentages on food labels, the so-called Nutrition Facts Daily Value listing. The ideal as determined by the government’s National High Blood Pressure Education Program is closer to 1,500 milligrams per day.

Salt, also known as sodium chloride, is a mineral that occurs naturally in food. Certain body functions depend on sodium, but too much sodium is dangerous because of its tendency to draw fluid out of body cells and throw off the chemistry needed to stay in good health, according to Dee Sandquist of Vancouver, Wash., a spokeswoman for the American Dietetic Association. Different people have different reactions to high levels of sodium based on their genetic makeup, she cautions.

Studies show that lower amounts of sodium contribute to a lessening of hypertension (high blood pressure levels), which is said to affect one in four adult Americans. Black people and anyone 55 or older are especially vulnerable to having high blood pressure. Hypertension is dangerous because it makes the heart work too hard, forcing blood through arteries that get harmed in the process. There are few warning signs for high blood pressure. If left uncontrolled, it can lead to heart and kidney disease and stroke.

The alarms about excess sodium have been sounded for a long time. Physical exercise as well as a balanced diet containing plenty of whole grains, fish, and low amounts of fat and cholesterol are good preventive measures and can help reduce high blood pressure, but the NIH and a number of medical and health professionals are concerned that the messages are not getting through.

“Unless you cook from scratch, you have sodium overload,” says Eva Obarzanek, a research nutritionist who was the project officer for the DASH diet plan. Ten percent of daily salt intake occurs naturally in food staples such as fruit, vegetables and diary, plus a small amount in fish, she says.

“Then we tend to add another 15 percent at the table. And 75 percent [comes] from processed food. Frozen vegetables are OK for the most part, but something as simple as bread has a high amount of sodium — on the order of 140 milligrams a slice.”

She urges consumers to plan carefully what they are going to eat, to look at food labels before buying, and to buy food as minimally processed as possible.

“The issue now is that we as a society have moved from eating foods in their natural state to eating out in restaurants and often purchasing convenience items that tend to be processed,” says Noralyn Mills, a spokeswoman for the American Dietetic Association in Baltimore. “[As a result] we have significantly increased our daily sodium amount without picking up a salt shaker.”

Homemade spaghetti and sauce can contain 140 milligrams of sodium per 1-cup serving, compared to a typical weight-reducing prepared meal “that we consider healthy,” which has 680 milligrams, she says. A low-cost mass market can of spaghetti and sauce can have up to 1,000 milligrams per serving. A measured teaspoon of salt contains 2,000 milligrams of sodium, she points out for comparison purposes.

Some well-known sport drinks have sodium added to accent flavoring, Mrs. Mills notes, and are sold in the belief that a person exercising sweats a lot and needs to replace salts in the system.

“What they don’t realize is that happens only with rigorous exercise of two hours or more and not in your typical gym jaunt,” she says.

Dr. Patricia Davidson, a Washington Hospital Center cardiologist, works aggressively to educate patients. She suggests that the focus has gone off salt in recent years because of attention to many other competing, but related, health issues.

“We have attacked the food industry for everything. When we were concerned about salt, there wasn’t as much worry about refined carbohydrates and we didn’t know or pay attention to [the dangers of] trans fats or the tropical oils.”

The bottom line, she says, is that “sugar, fat and salt are three substances that if you grow up on them and develop a taste for them, it is hard to enjoy foods without them. It is a matter of mind-set, and not introducing them to children.”

Michael Jacobson, executive director of the nonprofit Washington-based Center for Science in the Public Interest, agrees, saying, “it’s hard to get away from [salt], and the government has shown no leadership in encouraging industry to get away from salt. The more we have in food, the more we like it. Everything is loaded.”

His organization filed suit in the D.C. Court of Appeals to try to force the Food and Drug Administration to move beyond mandating voluntary measures.

“We need the government to take the lead and either cajole or regulate industry to reduce sodium [amounts in food] gradually.” He cites a figure he says was quoted last year in the American Journal of Public Health by a former director of the NHLBI stating that cutting sodium levels in packaged and restaurant food would save 150,000 American lives annually.

“A modest reduction is important,” he says. “If you ever eat salt-free bread, it does taste flat. You don’t leave it out entirely. Probably a 25 percent reduction wouldn’t be noticed by the consumer.”

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