Adequacy
The suggested food plan provides foods in amounts that will provide the Dietary Reference Intakes (DRIs) recommended by the National Academy of Sciences for adults.
Diet Principles
Increased sodium chloride (table salt) intake is a major factor elevating blood pressure and is a risk factor for cardiovascular and renal disease. Blood pressure rises with increased sodium chloride intake and has a greater response to changes in sodium below 2,300 mg. (1) Besides reducing sodium chloride intake, other factors that can decrease blood pressure include weight loss, moderation of alcohol intake, and consuming a diet based on the DASH diet. (2)
The DASH diet provides for two levels of daily sodium consumption: 2,300 mg and 1,500 mg. (3) According to a 2006 scientific statement from the American Heart Association Nutrition Committee, a 1,500-mg sodium diet is not readily achievable until there is an increased availability of low sodium, good tasting commercial foods. (4) Processed foods currently provide 75–80% of salt intake. (5) For this reason, only the 2,300-mg sodium DASH diet is provided.
The 2,300-mg sodium DASH diet should be used with caution in the following circumstances:
1. The DASH diet is high in potassium and increases risk of hyperkalemia for elderly with one or more of these diagnoses: diabetes, chronic renal insufficiency, end-stage renal disease, severe heart failure, and adrenal insufficiency. (2)
2. The DASH diet may increase risk of hyperkalemia if one or more medications are taken that impair potassium excretion. (2) These drugs include oral potassium supplements, β-adrenergic blockers, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme (ACE) inhibitors, and potassium-sparing diuretics. (6)
3. Older adults may limit their caloric intake and increase their risk of nutritional deficiencies. (4,7)
4. The DASH diet is not recommended for people with stage 3 or 4 chronic kidney disease due to the high potassium and phosphorus content of the diet. (4)
The DASH diet reduces blood pressure with an eating plan low in saturated fat, cholesterol, and total fat and high in fruits, vegetables, fat-free or low-fat (1% milk) and low-fat milk products. The DASH diet can be adapted for weight loss if needed, which will also decrease blood pressure.
Table 8.2 DASH Diet
| Food for the Day | |
| Vegetables 4–5 servings | 1 c. raw leafy vegetable ½ c. cut-up raw or cooked vegetables ½ c. vegetable juice |
| Fruits 4–5 servings | 1 medium fruit ¼ c. dried fruit ½ c. fresh, frozen, or canned fruit ½ c. fruit juice |
| Grains 6–8 servings Aim for whole grains for most of grain servings per day | 1 slice bread ½ c. cooked rice or pasta ½ c. cooked cereal 1 oz. dry cereal (or check serving size on box) |
| Milk 2–3 cups | 1 c. skim or 1% milk 1 ½ oz. fat-free, low-fat or reduced fat cheese 1 c. fat-free or low-fat regular yogurt 1 c. fat-free or low-fat frozen yogurt |
| Meats and Beans 6 servings or less | 1 oz. cooked lean meats, poultry or fish (trim visible fats; broil, roast or poach; remove skin from poultry) 1 egg –limit to 4 egg yolks per week 1 oz. low sodium ham |
| Nuts, seeds, and legumes 4–5 servings per week |  c. or 1 ½ oz. unsalted nuts 2 Tbsp. peanut butter 2 Tbsp. or ½ oz. unsalted seeds ½ c. cooked legumes (dry beans and peas) |
| Oils/Fats 2–3 servings Use soft margarine or liquid margarines, vegetable oil such as canola, corn, olive, or safflower | 1 tsp. soft margarine 1 tsp. vegetable oil 1 Tbsp. mayonnaise 1 Tbsp. regular salad dressing 2 Tbsp. low-fat dressing Fat-free gravy |
| Sweets/Desserts 5 or less per week | 1 Tbsp. sugar 1 Tbsp. jelly, jam or regular syrup ½ c. sorbet, gelatin 1 c. lemonade |
| Adapted from NIH Publication No. 06-4082, Revised April 2006, p. 8–9 | |
| ALCOHOL: Limit alcohol to ≤2 alcoholic drinks per day for men and ≤1 alcoholic drink per day for women and lighter-weight persons. 1 drink = 12 oz; regular beer, 5 oz; wine (12% alcohol); 1.5 oz. of 80-proof distilled spirits. Moderate drinking is recommended for those who drink alcohol as alcohol can negatively influence blood pressure. (3) | |
*Based on 2,000 calories daily.
Table 8.3 Tips to Reduce Salt and Sodium
Adapted from NIH Publication No. 06-4082, Revised April 2006, pp. 17,19.
|
NO ADDED SALT DIET
This is also known as the Low Salt Diet and salt consumption is limited to between 3,000 and 4,000 mg [130–174 mEq] sodium daily.
Use
Current average sodium intake is >4,000 mg when salt in cooking and salt at the table is added. (5) The No Added Salt (NAS) diet averages <4,000 mg and is a more palatable moderate sodium restricted diet while still providing benefits controlling edema or hypertension. (13) The NAS diet is an appropriate diet for the elderly who have increased risk of weight loss. (14) For management of fluid restrictions, see Fluid Restrictions in Chapter 9.
Adequacy
The suggested food plan provides foods in amounts that will provide the DRIs recommended by the National Academy of Sciences for adults.
Diet Principles
1. Table salt (which is sodium chloride, containing about 40% sodium) and foods processed with salt are limited because1 teaspoon of table salt is the equivalent of 2,300 mg of sodium. Certain foods that contain liberal amounts of natural sodium and other foods that contain sodium compounds may be limited.
2. The General Diet (including lightly salted foods in cooking) is served without a salt packet. Limit foods with visible salt including chips, salted pretzels, salted nuts, salted crackers, and popcorn.
3. Some higher sodium foods may be served during the week, but they should be limited so that the daily average of sodium over the week is <4,000 mg sodium. Foods high in sodium are listed in the Food for the Day in Table 8.5.
4. Salt substitutes may promote acceptance of sodium-restricted diets but should be used only if permitted by the physician.
