Hypertension: Is Sodium all there is?

by Robin Allen, MSPH, RDN, LDN

Creative Commons Attribution 2.0 Generic (Flikr Army BP, May 26, 2011)
Creative Commons Attribution 2.0 Generic (Flikr Army BP, May 26, 2011)

When I ask the question, “Hypertension: is sodium all there is?”  I, first, refer you to the USDA 2010 Dietary Guidelines for American  which recommends:

  • Reduce daily sodium intake to less than 2,300 milligrams (mg).
  • Further reduce intake to 1,500 mg among persons who are 51 and older.
  • Reduce intake to 1,500 and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.
  • The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.” It is estimated that Americans consume about 3400mg per day of sodium.

Second, I remind you that one in three adults has high blood pressure according to the American Society of Hypertension.

Risk factors include:

  • Older age > 35 years
  • Family history
  • Race- African Americans and Hispanic Americans are at higher risk
  • Overweight/obesity
  • Diet high in sodium, too little fruits and vegetables
  • Lack of exercise- recommend at least 30 minutes per day
  • Drinking too much alcohol regularly-more than 2 servings per day

Since the Dietary Guidelines were released, Public Health efforts have focused on reducing the consumption of sodium in the population while many in the food industry have committed to a gradual reduction of sodium in the food supply.  However do consumers care about sodium in their diet?

The 2011 Consumer Sodium Research Report by the International Food Information Council (IFIC) reported that sodium is not a priority for Americans.    Most Americans do not know how much their sodium intake should be or how much sodium they consume. There is also no clear understanding of what constitutes high and low sodium foods.  

As I get older I am astonished at the number of my friends who have high blood pressure or are taking blood pressure lowering medication.  The first thing they tell me is “I never eat salt”.   I want to say that is great but what does the rest of your lifestyle look like? Is salting your food your biggest source of sodium?  Are you exercising routinely?  What about your fruits and vegetables. What is your alcohol intake?  And have you weighed recently?

How do Dietitians/health care providers help their clients/patients manage their blood pressure?

Experts in the field of chronic disease agree that limiting blood pressure education to sodium restriction does not help the consumer sufficiently to manage their blood pressure. Life style strategies must go beyond limiting sodium intake.  Even the most knowledgeable consumer would have difficulty meeting the 1500 mg/d sodium recommendation without changes in the food supply.  Other strategies for managing high blood pressure include eating more fruits and vegetables, weight management, increasing physical activity and moderating alcohol intake.  While certainly sodium restriction is important; a more holistic approach is needed to help consumers manage their blood pressure. 

What struggles do you face with your patients when trying to apply the scientific recommendations to the real life situations?

References:

[1] Kolasa, Kathryn, M., Sollid, Kris, Edge, Marianne Smith, Bouchoux, Ann,.Blood Pressure Management: Communicating Comprehensive Lifestyle Strategies Beyond Sodium. Nutrition Today. 47(4):183-190, July/August 2012.

[2] US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 6th ed. Washington, DC: US Government Printing Office; 2010. http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf

[3] http://www.ash-us.org/ASH-Patient-Portal/Get-Information/Your-Risk-for-Hypertension.aspx

[4] International Food Information Council Foundation (IFIC),  Consumer Sodium Research Concern, Perception, and Action 2011 Food and Health Survey.

This post was written by Robin Allen, member of the Military Families Learning Network (MFLN) Nutrition and Wellness team which aims to support the development of professionals working with military families.  Find out more about the MFLN Nutrition and Wellness concentration on our website, on Facebook, on Twitter and on LinkedIn.

 

Leave a Reply

Your email address will not be published. Required fields are marked *