Hypertension (high blood pressure) has become a near-epidemic in the U.S. The numbers themselves tell the story. According to the Centers for Disease Control and Prevention (CDC), it affects 67 million American adults today. And slightly fewer than half of them (47%) currently have their hypertension under control. Seven out of 10 people having their first heart attack, 8 out of 10 people having their first stroke, and 7 out of 10 people suffering from chronic heart failure have high blood pressure. Hypertension costs the nation $47.5 billion per year, counting the cost of health care services, medications to treat high blood pressure, and missed days of work.
One of the primary causes of high blood pressure is the consumption of too much sodium in our diet. Most of the sodium comes from salt already present in processed foods that we eat, with only about 10% added during cooking or from the salt shaker on the dinner table. The CDC’s Dietary Guidelines for Americans recommend a maximum sodium intake of 2,300 milligrams per day (mg/day), and less (1,500 mg/day) if you are over 51 years of age, of African American descent, or already have high blood pressure, diabetes, or kidney disease.
And herein lies the problem – most Americans’ daily consumption of salt is two to three times higher than the recommended amounts. We are literally “salting” ourselves to death. So a legitimate public health concern becomes “How can we teach people to consume less salt?”
That question formed the basis of new research funded by the McCormick Science Institute and presented in March at the American Heart Association’s Epidemiology & Prevention and Nutrition, Physical Activity & Metabolism Scientific Sessions in San Diego, CA. To answer the question, a research team led by Cheryl Anderson, PhD and MPH, undertook a two-phase study. Fifty-five people – most of whom had high blood pressure and many of whom were diabetic – took part in the first phase of the study, during which they ate a controlled low-sodium (low-salt) diet for four weeks. During this phase of the study, the participants’ sodium intake dropped from an average of 3,490 mg/day to an average of 1,656 mg/day.
But these reductions in sodium intake were in controlled conditions, often difficult to maintain in daily life, so in the second phase of the study, 20 of the original study group participated in a 20-week behavioral intervention designed to teach them how to reduce their average sodium intake to 1,500 mg/day by substituting herbs and spices for salt. The other 20 from the original group tried to reduce their sodium intake on their own, without the training.
During this second phase, overall sodium intake increased in both groups (which was expected because they were not on the controlled diet any more), but the group that received the training in how to use herbs and spices to replace salt consumed an average of 960 mg/day less sodium than the non-intervention group. As Dr. Anderson puts it, “People in the intervention group learned problem-solving strategies, use of herbs and spices in recipes, how culture influences spice choices, how to monitor diet, overcoming the barriers to making dietary changes, how to choose and order foods when eating out and how to make low-sodium intake permanent.” Study subjects in the intervention group also attended cooking demonstrations and were able to share with each other how they changed traditional recipes to remove salt and substitute herbs and spices.
The researchers do not recommend any particular herbs and spices, but urge health-conscious Americans to find out more from their doctors, chiropractors, and nutritionists, and to undertake similar sodium-intake reductions themselves. The success of the intervention led researchers to suggest that this should be made a public health priority: “Given the challenges of lowering salt in the American diet, we need a public health approach aimed at making it possible for consumers to adhere to an eating pattern with less salt. This intervention using education and tasty alternatives to sodium could be one solution.”