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etables more palatable. Removing salt from dressings or accompaniments MYTH 9:
will make these important diet items less acceptable and will discourage Reducing salt intake can do no harm.
people from eating them. FACT: Reduced salt intakes have repeatedly
been linked in the medical literature to the fol-
MYTH 7: lowing conditions:
Reduced salt levels are critical to the DASH diet.
FACT: When the results of the DASH Sodium trial are examined (see • Insulin resistance (diabetes)
diagram in Figure 4), it is immediately apparent that merely moving to a • Metabolic syndrome
DASH diet (red line) has a significantly greater impact on blood pressure • Increased cardiovascular mortality and
than simply lowering salt consumption. Dropping from the normal level readmissions
of sodium consumption to the Dietary Guidelines' recommended level • Cognition loss in neonates and older adults
reduced the systolic pressure in the American diet (blue line) by an average • Unsteadiness, falls, fractures
of 2.1 mm Hg. However, simply changing from a standard American diet to • Lifelong avidity for salt
the DASH diet, without any changes to sodium consumption, reduced the • And more
systolic blood pressure by 5.9 mm Hg, almost three times the drop result-
ing from the recommended sodium reduction. More important, reducing MYTH 10:
salt makes the DASH diet far less palatable and thus discourages people The U.S. Dietary Guidelines process is valid.
from adopting it. FACT: The original Dietary Recommended
Intakes (DRI), issued under the imprimatur
MYTH 8: of the Institute of Medicine (IOM) (National
There is a clear relationship between salt intake and blood pressure. Academy of Sciences), were immediately ac-
FACT: The lack of a clear relationship between salt intake and blood cepted internationally and spared the critical
pressure is best exemplified with the standard hospital saline IV drip, scientific review normally given to nutritional
which supplies an average of three liters of 0.9 percent sodium chloride recommendations. Indeed, any conscientious
per day. This is equivalent to twenty-seven grams of salt (4.5 teaspoons) perusal of the document reveals the numerous
per day while in the hospital in addition to the six grams (one teaspoon) of compromises and rationalizations made in lieu
salt taken in food (if the Guidelines are followed). That is a total of thirty- of actual evidence in order to arrive at the final
three grams of salt per day or more than five times the Dietary Guideline recommendations. This was reiterated during a
recommendations! Yet patients' BP is checked every four to six hours and 2007 IOM workshop entitled, “The Development
does not change. Where is the purported relationship of salt intake to blood of DRIs 1994–2004: Lessons Learned and New
pressure? Challenges,” where several participants stressed
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that the DRIs were largely based on the lowest
quality of information—opinion—rather than
on randomized controlled clinical trials which
represent the highest quality of evidence. Yet
the disposition of the DRIs provides an insight
into how far we have strayed from the scientific
principle of adherence objectivity and evidence-
based medicine.
The five-year Dietary Guidelines for
Americans (DGA) review process has always
been publicized as being an “independent and
objective” reevaluation of the previous DGAs.
The 2005 DGA for sodium referred to the DRIs
as a foundation document and assumed all its
recommendations. The consequent 2010 DGAs
reconfirmed the recommendations of the 2005
DGAs with the proviso that the at-risk popula-
FIGURE 4. tions consume 1,500 mg sodium per day for the
The DASH Sodium Trial upper limit. As it happened, the Chair of the
32 Wise Traditions SPRING 2012 SPRING 2012 Wise Traditions

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