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Hypertension/High Blood Pressure Health Center

Here's What's Shakin' With Salt

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"The issue about salt has become unnecessarily polarized, and I am not sure why," Theodore Kotchen, MD, tells WebMD. "I think the more balanced overview is that salt is one component of a diet that affects blood pressure -- but it is an important component." Kotchen, a professor and chairman of the department of medicine at the Medical College of Wisconsin in Milwaukee, is also a member of the Nutrition Committee of the AHA, which makes up the recommendations.

"Kaplan's position reflects the thinking of a relatively large number of professional organizations including the AHA, the National Heart, Lung, and Blood Institute [part of the National Institutes of Health], and others," says Kotchen. "I think it is a balanced and accurate assessment of the salt issue.

"I think McCarron does make some important points, and I think it's true that we don't have the definitive evidence that perhaps some people would like before making population-based recommendations, but I do think his conclusions are somewhat distorted," he says.

But McCarron stands firm. "We have made too much of the issue of low sodium diets helping reduce blood pressure, and in that process we have not been talking to people about the issues that really matter," McCarron tells WebMD. Those issues are weight, too much alcohol, and getting a balanced diet. "We're not promoting the DASH diet, which has shown an effect that is probably 10 times as powerful as reducing salt." The DASH diet includes eating a lot of fruits and vegetables and low-fat dairy products.

"The problem is we started setting policy before we did the science," says McCarron. "What happens is that you get policy and education, and basically the bias is built-in. And then you get the data, and then what do you do?"

"Sometimes science get brushed aside in the interest of politics," he says, noting that it is hard to turn the tide of public policy.

Despite their differences, both men can agree on one thing: the need for Americans to adopt a healthier diet.

"I think the positive message, in terms of both blood pressure and overall [heart] health, is people should pay attention to their overall diet," says Kotchen, adding that it is "probably a mistake" to focus exclusively on salt. He says we should avoid obesity, avoid eating too much salt, and make sure we eat plenty of fruits and vegetables.

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