2010 Dietary Guidelines Limit Sodium

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The proposed new US Dietary Guidelines for Americans will lower the amount of sodium to no more than 1500mg per day for adults and even less for small children. This is another 35% reduction from the previous guideline of no more than 2300mg from this new Dietary Guidelines Advisory Panel. In their section on "Major Conclusions" on page E1-23 they state that "The projected health benefits of a reduced sodium intake are substantial and include fewer strokes, cardiovascular disease events and deaths, as well as substantially reduced healthcare costs." Of course, it is appropriate to have the US Dietary Guidelines finally recommending a level of sodium (and salt) intake that if followed would largely eliminate primary hypertension, related cardiovascular events, and numerous other ills increasingly linked to excessive salt intake such as kidney stones, osteoporosis, headaches, edema, acid reflux (which leads to esophageal cancer) and atrophic gastritis (which leads to stomach cancer). In the past pressure from the commercial food industry has been successful at watering down health concerns associated with excess salt. At the same time far too many physicians and the pharmaceutical companies have been successful at marginalizing the application of a low-salt diet for treating hypertension in part by lobbying the public and private health insurers to pay for medical office visits and often prescription anti-hypertensive drugs while systematically denying payments for expert dietary counseling in patients diagnosed with hypertension.

Unfortunately for those who profit from the medical-pharmaceutical approach to dealing with elevated blood pressure evidence continues to mount that this approach is far from optimal. Research shows that the risk of CVD events begins to rise when one's usual blood pressure rises above 110/70. The risk of CVD events roughly doubles for each 20/10 increase in blood pressure above that level. Current guidelines do not call for pharmaceutical treatment until blood pressure rises above 140/90. A recent study at the University of Florida found that people whose blood pressure was reduced below 130 with drugs fared no better than those whose blood pressure was simply reduced below 140. Indeed, in this study those whose blood pressure was more tightly controlled with drugs were significantly more likely to die than those whose blood pressure was simply reduced to below 140. [JAMA. 2010;304:61-8].

Bottom Line: Pharmaceutical treatment of hypertensive never cures the disease and has far too many adverse effects to allow blood pressure to be lowered to the physiologically normal range where the risk of cardiovascular events are minimized. Given the difficulties in adopting a low-salt diet in the USA without expert dietary counseling perhaps it is time Medicare/Medicaid and the private health insurance companies start reimbursing patients with pre-hypertension and hypertension for expert dietary counseling.

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