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

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Presentation on theme: "PART1: Sodium and Hypertension Jeff Whittle, MD, MPH Staff Physician, Clement J. Zablocki VA Medical Center Professor of Medicine, Medical College of Wisconsin."— Presentation transcript:

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) *

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 *

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: calorie diets # of Servings: 2000 calorie diet Grains and grain products (include at least 3 whole grain foods per day) Fruits Vegetables Low fat or non fat dairy foods Lean meats, fish, poultry 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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