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Volume 2 Published - 14:00 UTC    08:00 EST    16-February-2001      
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Back To Vidyya Information For Patients:

Follow A Healthy Eating Plan With Focus On Salt Intake

Box #10: Lower Salt to Lower Blood Pressure
Box #11: Tips to Reduce Salt and Sodium
Box #12: Spice It Up
Box #13: Label Language
Box #14: Use the Food Label
Box #15: Compare Labels
Box #16: The DASH Eating Plan
Box #17: Tips on Making the Switch to the DASH Eating Plan
Box #18: DASH Diet Servings for Other Calorie Levels
Research has shown that what you eat affects the development of high blood pressure. A healthy eating plan can both reduce the risk of developing high blood pressure and lower an already-elevated blood pressure.

A key ingredient of healthy eating is choosing foods lower in salt (sodium chloride) and other forms of sodium. A recent study showed just how important lowering sodium is in keeping blood pressure at a healthy level (see Box 10).

Box #10: Lower Salt to Lower Blood Pressure

The DASH study occurred in two parts. DASH, the initial study, found that the eating plan high in fruits and vegetables and low in animal fat reduced blood pressure. DASH-Sodium then examined the relationships between blood pressure, eating patterns, and various sodium intakes.

DASH-Sodium looked at the effect on blood pressure of three sodium levels: a "higher" intake of 3,200 milligrams per day (mg/day), which is similar to how much most Americans now consume, an "intermediate" intake of 2,400 mg/day, which is similar to the upper limit of current recommendations; and a "lower" intake of 1,400 mg/day.

The effect of each sodium level was tested for two diet plans: A "control" diet, typical of what many Americans eat, and the DASH diet.

Here are some key results:

  • The less sodium consumed, the lower the blood pressure.
  • Blood pressure was lower in the DASH diet than in the control diet at all three sodium levels.
  • The lowest blood pressures occurred with the DASH diet at the lower sodium level.
  • Sodium level had a bigger effect in the control diet than in the DASH diet.
  • The effects of sodium reduction were seen in all study participants--those with and without high blood pressure, men and women, and African Americans and others.

DASH-Sodium shows the importance of lowering sodium intake--whatever your eating plan. But for a true winning combination, follow the DASH diet and lower your intake of salt.


Most Americans eat more salt and sodium than they need. Some people, such as African Americans and the elderly, are especially sensitive to salt and sodium and may need to be particularly careful about how much they consume.

Most Americans should consume no more than 2.4 grams (2,400 milligrams) of sodium a day. That equals 6 grams (about 1 teaspoon) of table salt a day. For someone with high blood pressure, the doctor may advise less.

The 6 grams includes ALL salt and sodium consumed, including that used in cooking and at the table. Boxes 11 and 12 offer tips on how to choose and prepare foods lower in salt and sodium.

Box #11:Tips to Reduce Salt and Sodium

  • Buy fresh, plain frozen, or canned "with no salt added" vegetables.
  • Use fresh poultry, fish, and lean meat, rather than canned or processed types.
  • Use herbs, spices, and salt-free seasoning blends in cooking and at the table--see Box 12 on ways to spice up food.
  • Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt.
  • Choose "convenience" foods that are lower in sodium. Cut back on frozen dinners, mixed dishes such as pizza, packaged mixes, canned soups or broths, and salad dressings--these often have a lot of sodium.
  • Rinse canned foods, such as tuna, to remove some sodium.
  • When available, buy low- or reduced-sodium, or no-salt-added versions of foods--see Boxes 13, 14, and 15 on how to use food labels for guidance.
  • Choose ready-to-eat breakfast cereals that are lower in sodium.


Box #12: Spice It Up

Make foods tasty without using salt. Try these flavoring, spices, and herbs:

For Meat, Poultry, and Fish

Beef ................................... Bay leaf, marjoram, nutmeg, onion, pepper, sage, thyme

Lamb ................................. Curry powder, garlic, rosemary, mint

Pork .................................. Garlic, onion, sage, pepper, oregano

Veal ................................... Bay leaf, curry powder, ginger, marjoram, oregano

Chicken .............................. Ginger, marjoram, oregano, paprika, poultry seasoning, rosemary, sage, tarragon, thyme

Fish .................................... Curry powder, dill, dry mustard, lemon juice, marjoram, paprika, pepper


For Vegetables

Carrots .............................. Cinnamon, cloves, marjoram, nutmeg, rosemary, sage

Corn .................................. Cumin, curry powder, onion, paprika, parsley

Green beans ...................... Dill, curry powder, lemon juice, marjoram, oregano, tarragon, thyme

Greens .............................. Onion, pepper

Peas ................................. Ginger, marjoram, onion, parsley, sage

Potatoes ............................ Dill, garlic, onion, paprika, parsley, sage

Summer squash .................. Cloves, curry powder, marjoram, nutmeg, rosemary, sage

Winter squash...................... Cinnamon, ginger, nutmeg, onion

Tomatoes ............................ Basil, bay leaf, dill, marjoram, onion, oregano, parsley, pepper


Sodium is found naturally in many foods. But processed foods account for most of the salt and sodium Americans consume. Processed foods with high amounts of salt include regular canned vegetables and soups, frozen dinners, lunch meats, instant and ready-to-eat cereals, and salty chips and other snacks. You should use food labels to choose products lower in sodium. Boxes 13, 14, and 15 can help you learn how to read and compare food labels.

Box #13: Label Language

Food labels can help you choose items lower in sodium. Look for labels on cans, boxes, bottles, bags, and other products that say:

  • Sodium free
  • Very low sodium
  • Low sodium
  • Light in sodium
  • Reduced or less sodium
  • Unsalted or no salt added


Box #14: Use the Food Label


Frozen Peas:

Nutrition Facts
Serving Size: 1/2 cup
Servings Per Container: about 3

Amount Per Serving
Calories: 60     Calories from Fat: 0
% Daily Value*
Total Fat  0g
      Saturated Fat  0g
0%
0%
Cholesterol  0mg 0%
Sodium  125mg 5%
Total Carbohydrate  11g
      Dietary Fiber 6g
      Sugars 5g
4%
22%
Protein 5g  

Vitamin A 15%         Vitamin C 30%
Calcium 0%               Iron 6%

* Percent Daily Values are based on a 2,000 calorie diet.

 


Food labels can help you choose foods lower in sodium, as well as calories, saturated fat, total fat, and cholesterol. The label tells you:

Amount per Serving: Nutrient amounts are given for one serving. If you eat more or less than a serving, add or subtract amounts. For example, if you eat 1 cup of peas, you need to double the nutrient amounts on the label.

Nutrients: You´ll find the milligrams of sodium in one serving.

Number of Servings: The serving size is 1/2 cup. The package contains about 3 servings.

Percent Daily Value: Percent Daily Value helps you compare products and tells you if the food is high or low in sodium. Choose products with the lowest Percent Daily Value for sodium.



Box #15: Compare Labels

Which of these two items is lower in sodium? To tell, check the Percent Daily Value. The answer is given below.


Frozen Peas:


Nutrition Facts
Serving Size: 1/2 cup
Servings Per Container: about 3

Amount Per Serving
Calories: 60     Calories from Fat: 0
% Daily Value*
Total Fat  0g
      Saturated Fat  0g
0%
0%
Cholesterol  0mg 0%
Sodium  125mg 5%
Total Carbohydrate  11g
      Dietary Fiber 6g
      Sugars 5g
4%
22%
Protein 5g  

Vitamin A 15%         Vitamin C 30%
Calcium 0%               Iron 6%

* Percent Daily Values are based on a 2,000 calorie diet.


Canned Peas:


Nutrition Facts
Serving Size: 1/2 cup
Servings Per Container: about 3

Amount Per Serving
Calories: 60     Calories from Fat: 0
% Daily Value*
Total Fat  0g
      Saturated Fat  0g
0%
0%
Cholesterol  0mg 0%
Sodium  380mg 16%
Total Carbohydrate  12g
      Dietary Fiber 3g
      Sugars 4g
4%
14%
Protein 4g  

Vitamin A 6%           Vitamin C 10%
Calcium 2%               Iron 8%

* Percent Daily Values are based on a 2,000 calorie diet.


ANSWER: The frozen peas. The canned peas have three times more sodium than the frozen peas.


Sodium also is found in many foods that may surprise you, such as baking soda, soy sauce, monosodium glutamate (MSG), seasoned salts, and some antacids--the range is wide.

Before trying salt substitutes, you should check with your doctor, especially if you have high blood pressure. These contain potassium chloride and may be harmful for those with certain medical conditions.

For an overall eating plan, consider the DASH diet. DASH stands for "Dietary Approaches to Stop Hypertension." DASH was a clinical study that tested the effects on blood pressure of nutrients as they occur together in food. It found that blood pressures were reduced by an eating plan low in saturated fat, total fat, and cholesterol, and rich in fruits, vegetables, and lowfat dairy foods. The DASH diet includes whole grains, poultry, fish, and nuts, and has reduced amounts of fats, red meats, sweets, and sugared beverages. It also is rich in potassium, calcium, and magnesium, as well as protein and fiber.

A second study, called DASH-Sodium, found that even when using the DASH diet, lowering salt and sodium is important--blood pressure was lowest when both lifestyles were followed. See Box 10 for more on the findings from DASH-Sodium about the effects of lowering salt.

Box 16 gives the servings and food groups for the DASH diet. The number of servings you require may vary, depending on your caloric need.

Box #16: The DASH Eating Plan

The DASH plan shown below is based on 2,000 calories a day. The number of daily servings in a food group may vary from those listed depending on your caloric needs. (See Box 18 for more.)

Grains & grain products: 7-8 servings daily
Serving sizes:
1 slice bread
1 cup ready-to-eat cereal*
1/2 cup cooked rice, pasta, or cereal

Vegetables: 4-5 servings daily
Serving sizes:
1 cup raw leafy vegetable
1/2 cup cooked vegetable
6 ounces vegetable juice

Fruits: 4-5 servings daily
Serving sizes:
1 medium fruit
1/4 cup dried fruit
1/2 cup fresh, frozen, or canned fruit
6 ounces fruit juice

Lowfat or fat free dairy foods: 2-3 servings daily
Serving sizes:
8 ounces milk
1 cup yogurt
1 1/2 ounces cheese

Lean meats, poultry, and fish: 2 or fewer servings daily
Serving sizes:
3 ounces cooked lean meats, skinless poultry, or fish

Nuts, seeds, and dry beans: 4-5 servings per week
Serving sizes:
1/3 cup or 1 1/2 ounces nuts
1 tablespoon or 1/2 ounce seeds
1/2 cup cooked dry beans

Fats & oils**: 2-3 servings per day
Serving sizes:
1 teaspoon soft margarine
1 tablespoon lowfat mayonnaise
2 tablespoons light salad dressing
1 teaspoon vegetable oil

Sweets: 5 servings per week
Serving sizes:
1 tablespoon sugar
1 tablespoon jelly or jam
1/2 ounce jelly beans
8 ounces lemonade

*Serving sizes vary between 1/2-1 1/4 cups. Check the product´s nutrition label.
**Fat content changes serving counts for fats and oils: For example, 1 tablespoon of regular salad dressing equals 1 serving; 1 tablespoon of a lowfat dressing equals 1/2 serving; 1 tablespoon of a fat free dressing equals 0 servings.


You should be aware that the DASH diet has more daily servings of fruits, vegetables, and grains than you may be used to eating. The servings make it high in fiber, which may temporarily cause bloating and diarrhea. To get used to the DASH diet, gradually increase your servings of fruits, vegetables, and grains. Box 17 offers some tips on how to adopt the DASH diet.

Box #17: Tips on Making the Switch to the DASH Eating Plan

  • Change gradually. Add a vegetable or fruit serving at lunch and dinner.
  • Use only half the butter or margarine you do now.
  • If you have trouble digesting dairy products, try lactase enzyme pills or drops--they´re available at drugstores and groceries. Or buy lactose-free milk or milk with lactase enzyme added to it.
  • Get added nutrients such as the B vitamins by choosing whole grain foods, including whole wheat bread or whole grain cereals.
  • Spread out the servings. Have two servings of fruits and/or vegetables at each meal, or add fruits as snacks.
  • Treat meat as one part of the meal, instead of the focus. Try casseroles, pasta, and stir-fry dishes. Have two or more meatless meals a week.
  • Use fruits or lowfat foods as desserts and snacks.


A good way to change to the DASH diet is to keep a diary of your current eating habits. Write down what you eat, how much, when, and why. Note whether or not you snack on high fat foods while watching television, or if you skip breakfast and eat a big lunch. Do this for several days. You'll be able to see where you can start making changes.

If you are trying to lose weight, you should choose an eating plan lower in calories. You can still use the DASH diet, but follow it at a lower calorie level (see Box 18). Again, a food diary can be helpful. It can tell you if there are certain times you eat but aren´t really hungry, or when you can substitute lower-calorie foods for higher-calorie items.

Box #18: DASH Diet Servings for Other Calorie Levels

Food Group Servings/day
at 1,600 calories/day
Servings/day
at 3,100 calories/day
Grains & grain products 6 12-13
Vegetables 3-4 6
Fruits 4 6
Lowfat or fat free dairy foods 2-3 3-4
Meats, poultry, and fish 1-2 2-3
Nuts, seeds, and dry beans 3/week 1
Fat & oils 2 4
Sweets 0 2


Other dietary information from the NHLBI includes:

Eating Healthy When Dining Out

Eating Healthy With Ethnic Food

Fat Matters, But Calories Count

Eating Healthy Starts With Healthy Food Shopping



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Editor: Susan K. Boyer, RN
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