1. PART1: Sodium and Hypertension Jeff Whittle, MD, MPH Staff Physician, Clement J. Zablocki VA Medical Center Professor of Medicine, Medical College of Wisconsin

2. Lifestyle and Blood Pressure LIFESTYLE CHANGE Effect on Systolic BP Modest Doses of most BP Meds Weight loss (10% reduction) 5-20 mmHg8-12 mmHg Adopt DASH diet8-14 mmHg8-12 mmHg Restrict sodium2-8 mmHg8-12 mmHg Increase physical activity 4-9 mmHg8-12 mmHg

3. 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

4. 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

5. How can I eat that much salt? 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

6. 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!

7. 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

8. PART 2: The DASH Diet Jeff Whittle, MD, MPH Staff Physician, Clement J. Zablocki VA Medical Center Professor of Medicine, Medical College of Wisconsin

9. Lifestyle and Blood Pressure LIFESTYLE CHANGE Effect on Systolic BP Modest Doses of most BP Meds Weight loss (10% reduction) 5-20 mmHg8-12 mmHg Adopt DASH diet8-14 mmHg8-12 mmHg Restrict sodium2-8 mmHg8-12 mmHg Increase physical activity 4-9 mmHg8-12 mmHg

10. 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

11. 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

12. 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

13. Servings per Day Type of Food # of Servings: 1600-3100 calorie diets # of Servings: 2000 calorie diet Grains and grain products (include at least 3 whole grain foods per day) 6- 127- 8 Fruits4- 64- 5 Vegetables4- 64- 5 Low fat or non fat dairy foods2- 42- 3 Lean meats, fish, poultry1.5 - 2.52 or less Nuts, seeds, and legumes3- 6 per week4- 5 per week Fats and sweets2- 4limited

14. What is a serving of fruit? 1medium apple ½ cup of orange juice ½ cup of cut-up strawberries ¼ cup of raisins

15. 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

16. 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

17. 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

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