End the War on Sodium and Still Lower Your Blood Pressure

Hola amigos! Welcome back!

The recommendations to lower sodium or salt in food is promoted as a personal responsibility. Is that fair? What does the research really say?

Highlights of this episode:

• Sodium Controversy
• Jeff’s Story
• Alexithymia
• Sleep and High Blood Pressure

Episode Description: 

[1:33] November is Men’s Health Awareness Month 

David’s personal connection to this observance is from his father, who suffered from hypertension, high cholesterol, heart attack, stroke, and severe digestive bleed. His father passed away in 2016 due to prostate cancer.

Introducing a Hero, Jeff

David introduces a hero from his book, Jeff, who reminded David of his father. Many of the details about these two people are different, yet somethings were similar. Jeff’s blood pressure was high and he became frustrated from a long history of techniques to try and control his weight. Like many people, Jeff is told over and over to control his blood pressure, he needed to lose weight.

By not focusing on weight in nutrition consulting with David, Jeff was able to focus more energy on his routine and lifestyle. For Jeff, he learned how his loneliness is a form of stress. Jeff had an experience at work that triggered unhelpful coping habits. After a very bad day at the office, he went to his favorite pub for shots and wings. Upon reflection, he was able to realize that food and alcohol was not going to solve any of his problems. He liked the food okay, but the physical feeling afterward was horrible.

Jeff was able to start writing his own story. To quote Brené Brown, “when we deny our stories, They define us. When we own our stories, we get to write the ending.” “ When we deny our stories, They define us. When we own our stories, we get to write the ending. ”

[13:48] The Issue with Sodium Guidelines

Note: Sodium and salt are interchangeable in this context.

We need to end the war of sodium and help our blood pressure. For reference, the Dietary Guidelines for Americans recommends less than 2300 mg for anyone over the age of 13 years old. The American Heart Association recommends less than 1500 mg.

David does not recommend doing the math in your daily eating. Let’s go over it together.

In America, the average consumption is 3500 mg of sodium a day, with females averaging 3100 mg and males averaging 5200 mg a day.  How do we know? The NHANES survey, a nationwide survey system developed in the 1970’s, collects dietary data every five years. This data is often used to build more scientific research studies.

What’s a “mg”? 1500 mg is roughly 1 teaspoon salt or about a thumb’s nail. That’s very small amount. If we were to do the math per meal, with 3 meals a day, and rounding up to 2400 mg, that is about 800 mg per meal.  With 1500 mg divided by 3, that is 500 mg per meal.

So, food for thought. It is so easy to way over consume 1 teaspoon per day. For example, if one sandwich from Subway with turkey, cheese, vegetables, maybe mayo and mustard, can empty your entire sodium bank.  Similarly, a chicken sandwich with fries and soda is usually around 1500-1800 mg of sodium.

The data collected shows that over 75% of dietary sodium from prepared foods outside the home. Makes sense. Now, only 11% of dietary sodium comes from in adding table salt to food.

These recommendations are challenging because we are told to eat less processed foods, restaurants, and packaged foods. Which means, we have to eat more meals that contain fresh foods and prepare them ourselves. Talk about real world barriers.

To have food taste good, that means being savvy with cooking skills. And if you are like Jeff and living alone, it’s likely you are not cooking much for yourself.

You also have to be able to obtain foods with less sodium – this can be more expensive. Some stores do not have low-sodium options at all.

[21:50] Research builds on itself

In a landmark study – the DASH study enrolled 459 adults with systolic blood pressures of less than 160 mm Hg and diastolic blood pressures of 80 to 95 mm Hg, which is diagnosable as hypertension or high blood pressure. Study participants received 3 weeks of DASH diet. Next, participants were divided into 3 groups, followed by 8 weeks. One group had the control diet (average American patterns). Another group had a diet rich in fruits and vegetables. Another group had a “combination” diet rich in fruits, vegetables, and low-fat dairy products and with reduced saturated and total fat.

The results showed that for participants with a blood pressure reading over 140/90, the combination diet reduced blood pressure by 11.4-5.5 mmHg respectfully. That is a huge success. For participants without hypertension, the reduction was minimal.

David notes that 326 subjects did not have hypertension, only 133 participants were statically improved with dietary intervention.

However, the conclusion of this study is that a DASH diet pattern can lower blood pressure. Reduction in sodium was not the indicator. Was sodium reduced? The study says that sodium and body weight were monitored at constant levels. So was it “sodium reduction” or adding in more foods that helped?

Now, 8 weeks is reasonable for adherence, but what does this say about the long-term effects? Longitudinal data stated that 20 years later, “DASH is not a reduced-sodium diet, but its effect is enhanced by also lowering sodium intake.”

[30:11] Changing our Approach and Perspective

The Dietary Guidelines for Americas focuses on a population not adherent. That blames the individual. There are so many calls to action to lower blood pressure from a personal responsibility. This is because stroke and coronary heart disease are number one for the cause of death.

But what about depression, sleep, loneliness? These are all forms of stress. Often, research is built on the same ideas without questioning.

So, heart disease is #1 in the US, but there is a 7% improvement trend. In the last 20 years, has blaming the individual helping this decrease? It’s doubtful. The data collection for intake is usually through food frequency questionnaires, 24-hour food recalls, food records – they are subjective, prone to errors. A urine analysis may be more helpful, but come with disadvantages as well.

[34:25] A New Consideration: Salt Sensitivity

A longitudinal follow-up study explored the effects of sodium in the diet on blood pressure among Chinese adults. The researchers categorized the results as high-sensitivity, medium sensitivity, and sodium resistant. These are good research questions that may explain the differences in individual’s eating patterns and health outcomes.

Other Risk Factors

Smoking, alcohol, and social determinants of health can be overlooked in the hypertension conversation. Are people able to get healthcare? Jeff, our hero, started avoiding going to the doctor because he was tired of providers telling him to lose weight. He had lost weight. The weight loss was not sustainable. The problem is the individualized pressure in healthcare. Yes, pressure, like high blood pressure.

At the pub, Jeff did eat a high sodium food, the chicken wings. But what about the alcohol? Growing out of a coping behavior with alcohol is a tremulous task.

[39:13] Sleep and High Blood Pressure

Short sleep can have a 45% greater risk of fatal and non-fatal heart disease with 7-25 years. With sleep less than 6 hours, it can be a huge indictor for heart disease while excluding other risk factors such as diet, smoking, BMI, and other lifestyle factors.

Why?  Our bodies have a sympathetic and parasympathetic nervous system. Sympathetic is flight and fight. During sleep, our parasympathetic nervous system, a pausing system, helps prepare us to handle the stress hormone, like cortisol, during the waking daytime. Removing a default resting rate. It also restores our heart’s ability to properly preform contractions. If there is no brake, the heart pumps on.

The growth hormone can be a great healer in the body, which works during deep REM sleep, to help build the brain’s structural integrity. Sleep deprivation can cause a hypertensive strain. For further reading about sleep, check out, Why We Sleep by Dr. Matthew Walker.

[42:40] Hello to The Food Industry

Sodium is used in the industry because it is a natural food preservative and flavor enhancer.  We could do more flavor without sodium on an industry level. Not all people have the food security to choose low sodium recommendations.

[44:37] Alexithymia and High Blood Pressure

Alexithymia is the inability to recognize social cues and struggle to identify emotions. Men are taught to suck in their emotions. Not every male, but many men have explosive reactions or retreat into a hole. This stress plays havoc on our bodies.

Jeff focused on self-compassion and how important it was to pay attention of how he talked to himself. For Jeff, his small bite was doing something he enjoyed. This was to dribble a basketball. Basketball helped him flush out some of his thoughts, leading to more positive changes over time.

[47:50] Final Thoughts

David is not against choosing lower sodium foods if that is a change the individual may benefit from.

Some quick tips:

• Pick one meal with extra fruit and vegetables.
• Do one meal at home.
• Track blood pressure consistently.
• Smoking and alcohol reduction
• Sleep hygiene, do you need a routine?

For more information on social determinants, check out Episode 61, with Emory University Hospital dietitian, Michelle Gooden.

Or, find a registered dietitian nutritionist (RDN) who specializes in an anti-diet approach. David’s practice of RDNs focus on the whole person and other factors in their life.

David learned from his experience with his dad, that self-compassion and self-kindness is really important for our health and our society.

References:

• 2009 Review: A comprehensive review on salt and health and current experience of worldwide salt reduction programmes
• 2013 Review: Effect of lower sodium intake on health: systematic review and meta-analyses
• The DASH Diet, 20 Years Later
• Sleep and Cardiovascular Disease

Where do I go from here?

• Listener Feedback Survey is still open!  Click here to give your feedback.  Four lucky participants will be randomly selected to receive a $25 gift card to Amazon.com!
• David’s book releases next year. It focuses on real clients, heroes and sheroes, that took one small bite towards their health that improved energy, mood, or sleep. The website has a sign-up sheet to launch a feedback group prior to publishing!

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Chop the diet mentality; Fuel Your Body; and Nourish Your Soul!