Education key to helping Americans break off love affair with salt

Fifty-nine percent are not concerned about their sodium intake. New evidence shows elevated prehypertension increases the risk of stroke.

By Kevin B. O’Reilly — Posted Oct. 31, 2011

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Reports show that the vast majority of Americans are failing to reduce their sodium intake, are unaware of federal dietary guidelines and are largely unconcerned with their daily sodium consumption.

Nearly all Americans who should be limiting their sodium intake to control blood pressure and prevent heart disease and stroke are failing to do so, according to the Centers for Disease Control and Prevention's Oct. 21 Morbidity and Mortality Weekly Report.

Federal dietary guidelines say patients who are older than 50, have hypertension, diabetes or chronic kidney disease, or who are black should consume less than 1,500 mg of sodium daily. That is nearly half the American population, yet 98.5% of these patients exceeded the recommended limit, according to a survey of nearly 10,000 people reported by the CDC.

Guidelines say the other half of the population should limit daily sodium intake to 2,300 mg, but 88.2% of patients in this category fail to meet the target.

Survey results released in September may explain why so many Americans have trouble meeting dietary guidelines. Ninety-one percent of patients said they do not know how much sodium healthy people are supposed to consume on a daily basis, said a survey of 1,000 adults conducted by the International Food Information Council, a Washington-based nonprofit.

Nearly 60% do not know how much sodium they consume in a day. The response was similar for patients with hypertension or heart disease. Fifty-nine percent of Americans are not concerned about their sodium intake.

"That is worrisome," said Bruce Ovbiagele, MD, a professor of neurosciences at the University of California, San Diego, School of Medicine. "That definitely means our work is cut out for us to boost awareness of the dangers of high salt intake."

Dr. Ovbiagele's research, published in the Oct. 4 issue of Neurology, should add to the urgency. He and his colleagues reviewed 12 studies involving nearly 520,000 patients and found that those with prehypertension in the high range -- 130/85 mm Hg to 139/89 mm Hg -- have a 55% greater risk of stroke. However, a subgroup of patients 65 and older with prehypertension did not have greater stroke risk.

It is unclear whether prescribing antihypertensive medications to patients with prehypertension would reduce the risk of stroke, Dr. Ovbiagele said. He plans to study the question in a clinical trial.

"For physicians, this means strongly advocating a healthy lifestyle," he said. "Even before we had all this evidence, we did that. But now it's more imperative to advise these patients to try and maintain a healthy body mass index, exercise most days of the week and eat a healthy diet."

Not just about salt

Limiting sodium is an important part of the counseling physicians should be doing, he added.

"It is extremely important to focus on the salt issue," Dr. Ovbiagele said. "It's clear that it's a very important aspect of overall health and of cardiovascular health."

Yet just as clearly, the message patients receive about sodium is not hitting home, said Kris Sollid, a dietitian with the International Food Information Council. "We have learned that just talking about numbers does not resonate very much with patients," he said. "We see the average sodium intake to be consistently higher than the recommended amounts. Perhaps it's time our message focused on overall behaviors and a message that goes beyond just the numbers to the how-to's of maintaining a healthy lifestyle."

The Salt Institute, which represents salt companies, wrote a letter to the Dept. of Agriculture and the Dept. of Health and Human Services in late September calling on them to retract the sodium provisions in the federal dietary guidelines.

The institute argues that they are not based on sound science.

American Medical Association policy supports a 50% reduction in sodium in processed foods, fast-food products and restaurant meals during the next decade. AMA policy also supports improved nutritional labeling.

An Institute of Medicine panel in October backed a front-of-the-package, three-point scale to rate foods on how much sodium, fat and sugar they contain. The plan is aimed at helping Americans make healthier diet choices.

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External links

"Usual Sodium Intakes Compared with Current Dietary Guidelines -- United States, 2005-2008," Morbidity and Mortality Weekly Report, Oct. 21 (link)

"Consumer Sodium Research: Concern, Perceptions, and Action," International Food Information Council, August (link)

"Presence of baseline prehypertension and risk of incident stroke: A meta-analysis," Neurology, Oct. 4 (link)

"Requests for Withdrawal of Sodium Dietary Guideline Provisions, Transparent Rulemaking and Freedom of Information Act Request," Salt Institute, Sept. 30 (link)

"Front-of-Package Nutrition Rating Systems and Symbols: Promoting Healthier Choices," Institute of Medicine, Oct. 20 (link)

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