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PART1: Sodium and Hypertension. Jeff Whittle, MD, MPH Staff Physician, Clement J. Zablocki VA Medical Center Professor of Medicine, Medical College of Wisconsin. Lifestyle and Blood Pressure. Sodium vs. Salt. When I say salt, I mean table salt Sodium chloride
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PART1: Sodium and Hypertension Jeff Whittle, MD, MPH Staff Physician, Clement J. Zablocki VA Medical Center Professor of Medicine, Medical College of Wisconsin
Sodium vs. Salt • When I say salt, I mean table salt • Sodium chloride • One teaspoon has 2350 milligrams of sodium • Sodium comes in a lot of forms • Baking soda/powder – sodium bicarbonate • Monosodium glutamate (MSG) • Garlic salt/garlic powder/creole seasoning
How much sodium should I eat? • Most people eat about 3500 mg • 1 1/2 teaspoonful of salt • Lots of variability • It used to be more • Maximum intake should be 2300 mg • 1 teaspoonful of salt • AHA says if “high risk,” aim for1500 mg • High risk includes anyone with hypertension • High risk includes anyone over 50 years old
How can I eat that muchsalt? • 80% of dietary sodium is added in cooking or processing • Your salt shaker is probably not the problem • It is very easy: • Kraft macaroni and cheese, 1 cup = 580 mg • Culver’s 3-piece cod dinner = 3000 mg • You are used to it – people generally take 2-4 weeks to regain their salt taste
How can I cut sodium intake? • Whole foods • Almost no salt in any fresh fruit or vegetable • Relatively little in meat, dry beans, etc. • Read the label!! • Salt alternatives: • Mrs. Dash and others – non-salt spices • Morton’s Lite salt and others – potassium chloride, not sodium chloride • Sea salt is not a low-sodium alternative!
What do I get out of this? • In short term studies BP drops quickly and modestly, but stays down • 3500 2300 mg sodium: BP 5/3 mm Hg • 2300 mg 1500 mg: BP 2/1 mmHg • In societies where dietary sodium is typically less than 1200 mg/day, essential hypertension is rare • Long term low sodium may help Americans • How “long term” has really not been studied
PART 2:The DASH Diet Jeff Whittle, MD, MPH Staff Physician, Clement J. Zablocki VA Medical Center Professor of Medicine, Medical College of Wisconsin
What is DASH? • Dietary Approaches to Stop Hypertension • More fiber/potassium/calcium/magnesium in your diet • Less saturated fats/simple carbohydrates • Drops blood pressure (5-6 points) • More in hypertensive people (11-12 points) • Takes less than 2 weeks to see effect • Better than just fruits & veggies (3-4 points) * http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
What is DASH not? • Not a weight reduction diet • But the dietary components are bulky, so if you eat your DASH foods, you are likely to eat fewer high-calorie foods, and many people do lose weight on DASH • Not a reduced salt diet • Combining DASH with sodium restriction will lower BP more than either alone * http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
What is in the DASH Diet? • More: • Fruits and vegetables • Low fat dairy (mostly skim milk) • Whole grains/nuts • Less: • Saturated fats • Concentrated sweets • Red meat
What is a serving of fruit? • 1medium apple • ½ cup of orange juice • ½ cup of cut-up strawberries • ¼ cup of raisins
What is a serving of vegetables? • 1 cup of lettuce • 1 cup of raw kale or collards (can be cooked, but the measure is when raw) • ½ cup of cut-up green beans • 1 cup of broccoli florets • ½ cup of canned carrots • ½ cup of frozen lima beans
Other Serving Sizes • Meat – 3 ounces (fish/poultry/beef/pork) • Milk or yogurt – 1 cup • Nuts or seeds – 1/3 cup or 1.5 ounces • Peanut butter – 2 Tablespoons • Cooked dry beans – 1/2 cup • Butter or margarine – 1 teaspoon • Mayonnaise – 1 Tablespoon • Sugar – 1 Tablespoon
Why does DASH work? • Potassium (2-4 mmHg) and calcium (1-2 mmHg) • Lots of potassium in fruits and vegetables • Calcium in dairy products • Fiber (3-4 mmHg) • Fiber is found in fruits and vegetables • Maybe magnesium, unsaturated fats, fish? • Magnesium is also in meat, nuts, and milk • Unsaturated fats in fish, nuts, oils