Among the latest no-nos for healthy eating, the federal government said Monday that Americans should consume less salt in an effort to lower their risk of high blood pressure and a host of other chronic diseases.
People should limit their intake to about one teaspoon of sodium daily, according to dietary guidelines released from the U.S. Department of Agriculture and the U.S. Department of Health and Human Services. That figure should be even lower for people 51 and older, African-Americans, or anyone with high blood pressure, diabetes or kidney disease — a group that is about half the U.S. population.
The recommendations, which come out every five years, are the foundation of federal nutrition policies and influence everything from school lunches to food labeling. The guidelines advise Americans to drink water instead of sugary drinks and to eat more fish, whole grains, fruits and vegetables.
They also advise people to switch to fat-free or 1 percent milk, consume less than 300 milligrams of cholesterol per day and consume fewer calories, particularly from fat. With two-thirds of Americans overweight or obese, the guidelines underscore the urgency for adopting healthier eating habits. The overarching message: "Enjoy your food, but eat less."
This year's guidelines aren't a huge departure from previous suggestions, but the advice on salt is notable, said Lawrence J. Appel, a professor of medicine, epidemiology and international health at Johns Hopkins School of Medicine and a member of the expert panel that made the new dietary recommendations.
"There is now a greater focus that this is really an important issue, considering the number of people who have elevated blood pressure," he said. "Nearly 90 percent of adults will develop hypertension. We could wait until we develop hypertension, but my view is that we have to start early."
In Baltimore, where hypertension is an acute problem, the city has made reducing salt a cornerstone of public health efforts. In 2008, the city health department launched the Salt Reduction Task Force, composed of health, industry and public representatives. Since then, city health officials have partnered with barber shops, churches and federally qualified health centers to spread the word about reducing salt consumption.
"We hope the new guidelines remind people about being diligent about labels and paying attention to the amount of salt they use in their homes," said Dr. Oxiris Barbot, city health commissioner. "These new, more detailed guidelines will help create an even clearer road map for individuals to follow."
In a report from 2009, the task force said that even modest reduction in salt consumption could lead to a 20 percent drop in hypertension and a reduction in mortality rates of 9 percent for coronary heart disease, 14 percent for strokes and 7 percent from other causes.
High blood pressure is a key risk factor for cardiovascular disease, the nation and the city's leading cause of death. It's also a leading source of racial disparities in life expectancy. Blacks in Baltimore are 15 percent more likely to die of cardiovascular disease than whites, accord to health department statistics.
The recommended daily sodium intake is 2,300 milligrams, according to the federal guidelines, and just 1,500 milligrams for people 51 and older, African-Americans, or anyone with high blood pressure, diabetes or kidney disease. But Americans consume about a teaspoon and a half, or 3,400 milligrams, according to an Institute of Medicine report from last year.
Reducing salt intake is difficult even if you limit the amount of processed food you eat, said Mindy Athas, a dietician at the University of Maryland Medical Center.
"A can of tuna, which is good for you, is 420 milligrams, that's nearly a third if you are in that 1,500 milligram group. It's really hard," she said.
With cell phone applications and websites that do the counting for you, there is help out there, but most people simply need better access to healthier food, she said.
The city has been working to increase access to fresh fruits and vegetables in city neighborhoods so devoid of healthy options they are called "food deserts."
Last year, the health department launched the Virtual Supermarket Project, which allows residents to order groceries through a free delivery system from their local library. The program offers laptops where residents can order groceries online from Santoni's Super Market in Highlandtown and pick them up the next day at the Orleans Street or Washington Village library branches of the Enoch Pratt Free Library.
On Monday, the program was expanded to the Cherry Hill library branch and George Washington Elementary School, with the help of grants from Walmart Foundation and the United Way of Central Maryland.
The link between the lack of healthy food and disease is striking — the neighborhoods that are home to the project have some of the highest mortality rates in the city, with alarmingly high rates of heart disease, stroke and diabetes.
The health department is also working with the city's department of planning to get small grocers and food distributors to negotiate better prices for healthier food.
"We want to see how we can influence the food distribution network so we can make these healthy options available through the city and at prices that are more affordable," said Barbot.
Dietary Guidelines for Americans highlights
Among the new recommendations, people should:
•Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids.
•Reduce daily sodium intake to less than 2,300 milligrams and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.
•Consume less than 300 mg per day of dietary cholesterol.
•Reduce the intake of calories from solid fats and added sugars.
•Consume at least half of all grains as whole grains. Increase whole-grain intake by replacing refined grains with whole grains.
•Increase intake of fat-free or low-fat milk and milk products, such as milk, yogurt, cheese, or fortified soy beverages.
•Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry.