Thursday, February 17, 2011

Dietary Guidelines for Americans disappoint

Quick: How many milligrams of sodium did you eat during the Super Bowl?

If your big game buffet was anything like mine (hot dogs, buffalo wings, fries, and cole slaw), you probably blew through your day’s allowance of sodium in a single meal, according to the most recent edition of the federal government's Dietary Guidelines for Americans. These comprehensive guidelines for healthy eating, which are updated every five years to reflect the latest scientific data, advise that healthy adults and children ages 2 and older consume less than 2,300 mg of sodium per day. Adults over 50, or those with high blood pressure, diabetes, or kidney disease, should consume less than 1,500 mg. Unfortunately, only 1 in 7 of us currently meets those targets; the average American consumes 3,400 mg of sodium per day.

Eating too much sodium leads to high blood pressure, which increases risk of a heart attack, stroke, and kidney problems. Two studies published last year in the New England Journal of Medicine and the Annals of Internal Medicine estimated that reducing average sodium intake by 1,200 mg per day could prevent up to 92,000 deaths each year and save more than $30 billion in medical costs by 2050.

As a family doctor, I've observed that more and more of my practice is devoted to preventing and treating nutrition-related disorders such as high blood pressure, obesity, and diabetes. So I had hoped that the new dietary guidelines would provide me with concrete strategies for helping change my patients' eating habits for the better. Instead, the guidelines merely advise that folks "compare sodium in foods like soup, bread, and frozen meals—and choose the foods with lower numbers." That’s reasonable advice, but since up to 75 percent of dietary sodium comes from processed foods and restaurant meals, we should also be cooking more and eating out less—a simple message that I could not find in the guidelines.

"Enjoy your food, but eat less," the guidelines say. This empty statement is analogous to giving the Surgeon General's recent Call to Action to Support Breastfeeding a new title: "Dietary Guidelines for Infants," with the key message being: "Drink breast milk for as long as you can." Just as infants have little control over the milk they drink, your sodium intake is mostly determined by outside factors such as where you live, where the closest grocery stores and restaurants are, and what sorts of foods they offer. Recognizing this reality, the Institute of Medicine concluded last year that “the current focus on instructing consumers to select lower-sodium foods…cannot result in intakes consistent with public health recommendations.” But that’s exactly what the dietary guidelines do.

Although I can advise my patients to ignore the salt shakers in restaurants, to use spices in lieu of salt at home, and, yes, to choose foods with the lower sodium numbers, there is nothing they can do about sodium that is already in their food. It’s reassuring that Wal-Mart has announced plans to reduce the sodium content in its packaged food items by 25 percent and to make healthier choices such as fruits and vegetables more affordable. Hopefully, others in the food industry will follow suit.

The fact is that for most people, relying on willpower and personal choices to lower sodium intake to healthy levels is unrealistic and a recipe for failure. That doesn’t mean we should stop trying, but we need a lot more help to reach recommended nutritional goals—help that the Dietary Guidelines for Americans don’t offer.


The above post was first published on my Healthcare Headaches blog at