An assault on salt?

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Controlling Your Blood Pressure
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An alarming one in three American adults has high blood pressure. Known medically as hypertension, many people don't even know they have it, because high blood pressure has no symptoms or warning signs. But when elevated blood pressure is accompanied by abnormal cholesterol and blood sugar levels, the damage to your arteries, kidneys, and heart accelerates exponentially. Fortunately, high blood pressure is easy to detect and treat. Sometimes people can keep blood pressure in a healthy range simply by making lifestyle changes, such as losing weight, increasing activity, and eating more healthfully.

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Help may be on the way for cutting back on salt in a way your taste buds won't notice but your heart and arteries will appreciate. In a long-awaited study and report commissioned by Congress, the Institute of Medicine has recommended that the FDA decrease the amount of salt in commercially prepared food. The proposal aims to rein in the overabundance of sodium (which is one of two components of table salt, along with chloride) in the American diet. Too much sodium helps usher in high blood pressure and damages arteries. By the Institute of Medicine's reckoning, reducing Americans' salt intake could save at least 100,000 lives a year.

The proposal isn't a Big Brother approach to watch how much salt you use at home. For most people, that's small potatoes — under 25% of daily salt intake. Instead, the institute recommends that the FDA take a step-down approach that would gradually lower the amount of salt in prepared foods in the next 10 years (2010 to 2020). Such a move could make a big difference, since most of the salt in the American diet is put there by someone else — a food company, chef, or cook.

How much is too much?

Every day, the average American takes in about 1½ teaspoons, or 8,500 milligrams (mg), of salt — which translates to about 3,400 mg of sodium. That's 50% higher than the 5,700 mg of salt (2,300 mg of sodium) recommended for healthy people by the federal Dietary Guidelines for Americans, and double what the American Heart Association recommends (3,800 mg of salt, or 1,500 mg of sodium) for older people or those with borderline high blood pressure, heart conditions, kidney trouble, or diabetes.

Most of this is "hidden" salt, which is everywhere — breakfast cereals (1 cup of Raisin Bran, 354 mg of sodium), a tuna sandwich (1,300 mg), a cup of cottage cheese (900 mg), prepared cookies (3 Oreos, 190 mg). Salt plays many roles in food, from acting as a preservative or a binder to helping yeast rise. It is also a cheap way to make food tastier.

Some companies have a head start

The Institute of Medicine's proposal would codify a move that some food companies began voluntarily several years ago. Campbell's, for example, has slowly reduced the amount of sodium in its regular V8 drink by one-third since 1992. Sales during that period held steady, suggesting that consumers didn't notice the change.

If efforts like this work, why bring in the FDA? Because most of the food industry has gone in the other direction, gradually increasing the amount of salt in prepared foods. The more salt we eat, the more our taste buds get used to it, making low-sodium foods taste bland.

A little is good, a lot isn't

The assault against salt comes after decades of scientific bickering about whether too much sodium in the diet is harmful and whether cutting back is beneficial. The consensus today is yes and yes.

No one is looking to ban salt. It occurs naturally in many foods, and the human body needs some sodium to make muscles contract, to help nerves conduct impulses, and to maintain a healthy balance of fluids in the body. Instead, the Institute of Medicine and other public health organizations just want to reduce salt consumption to a less harmful level. Targeting prepared foods is one way to do this.

Predictably, the Institute of Medicine's proposal drew immediate support from public health officials and criticism from the Salt Institute, a trade group of salt producers. The Salt Institute has long fought both the idea that excess sodium in the diet contributes to heart disease and restrictions on salt use.

Whether the FDA adopts the Institute of Medicine's proposal remains to be seen. In the meantime, there are many things you can do to reduce your salt intake. The Department of Nutrition at the Harvard School of Public Health teamed up with the Culinary Institute of America, a leader in teaching chefs and other food service workers, to create 25 science-based strategies for cutting back on salt. They include commonsense tips from reading food labels and tasting food before you salt it to discovering and using umami — the so-called fifth taste, along with salty, sweet, bitter, and sour.

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Alcohol Use and Abuse
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Nationwide, nearly one in 13 people over the age of 12 has a drinking problem. Millions more engage in risky drinking behaviors that jeopardize their health, relationships, productivity, and general well-being. This report explores the many factors to consider when deciding how much (if any) alcohol is safe for you. It also details the dangers of alcohol misuse, from drunk driving to chronic, life-threatening health conditions.

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Will drinking help my heart or harm my health?

Q. I am a 57-year-old man with a dilemma. I understand from your articles that moderate drinking may help me avoid a heart attack like the one that killed my brother. But I've just been diagnosed with hypertension, and I was told that alcohol can raise my blood pressure and stress my heart. So I need to know if drinking is likely to help my heart or harm my health.

A. Your question itself holds the solution to your quandary; it's the word moderate. In moderate amounts, alcohol does appear to reduce the risk of heart attacks, particularly in men who are middle-aged and older. And while heavy drinking will raise blood pressure and cause many other health problems, moderate drinking does not lead to hypertension. In both cases, a moderate "dose" amounts to one to two drinks a day, counting 5 ounces of wine, 12 ounces of beer, or 1½ ounces of liquor as one drink.

A Harvard study makes the point. The subjects were 5,164 male physicians who had hypertension but no other cardiovascular diseases when the study began in 1982. The scientists tracked the men over the next 26 years. During that time, moderate drinking was associated with a reduced risk of heart attacks, even in these hypertensive men. As compared with their non-drinking peers, men who averaged five to seven drinks a week experienced a 22% lower risk of heart attacks, while men who averaged over eight drinks a week enjoyed a 43% lower risk. Because so few of the men averaged two or more drinks a day, the researchers were unable to evaluate the impact of heavier drinking.

In the bad old days, some tobacco companies used doctors (or actors posing as medics) to tout their terrible wares. Now, Harvard scientists report that drinking appears to protect hypertensive doctors from heart attacks. It may sound odd, but it represents enormous progress — as long as you include the word "moderate."

— Harvey B. Simon, M.D.
Editor, Harvard Men's Health Watch