Thursday, November 24, 2005

DASH for Thanksgiving

As we gather our family today for Thanksgiving (ten of us together this year, spanning four generations), we have much to be thankful for. TV network sports have been touting “Feast Week” football and basketball and today’s Thanksgiving meal will probably have most of us leaving the table the same way the turkey arrives – stuffed. Certainly on Thanksgiving, few will be following the DASH eating plan advocated by both the Salt Institute and the Dietary Guidelines for Americans. The DASH Diet is high in fruits, vegetables and dairy products (and, by implication, low on turkey, stuffing, mashed potatoes and gravy). While the American Council for Science and Health has used the “traditional” Thanksgiving meal to illustrate the dose-determines-toxicity arguments about carcinogens in our foods, so far I haven’t seen a Thanksgiving DASH Diet. That’s something to be thankful for, anyway. The DASH Diet gained immediate national prominence in 1997 when it demonstrated that, holding salt constant, enormous blood pressure lowering could be achieved – fully as much as taking any single medication. The most responsive group were people who already had hypertension (>140 mmHg systolic blood pressure, the “top number” thought to be the most accurate predictor of the risk of cardiovascular events). This group averaged an 11.4 mmHg SBP reduction. Some complained that the common-sense DASH Diet, consistent with diets advocated for years to reduce the risk of cancer and other maladies, didn’t also include evidence showing the “politically correct” results for low-salt diets, or the Mediterranean diet or other favored interventions. With all the favorable publicity around the DASH Diet, others wanted to get on board. So new studies were launched to “improve” the DASH Diet. First came the anti-salt folks. They produced a version of the DASH Diet that also cut salt by 60% and found, voila!, that the hypertensives in their study reduced their average SBP by 11.5 mmHg. They proclaimed that “everyone” would benefit by reducing dietary salt even though this unachievable salt reduction contributed, at best, marginally to the blood pressure benefit (after all, the DASH Diet produced 11.4 mmHg lowering so we’re going to attempt a massive salt reduction to get that additional 0.1 mmHg instead of putting our energies into boosting consumption of fruits, vegetables and dairy products?). Earlier this month came a second round: “DASH Diets” that were also “improved” by making them Atkins/South Beach-like “low carb DASH Diets” and “DASH Diets” with added amounts of monosaturated fats like the Mediterranean diet or high in protein. If this keeps up, the dilution factor will soon destroy the strong effort of the 2005 Dietary Guidelines for Americans to encourage eating the original DASH Diet. That would be nothing to be thankful for. Let's make sure our Thanksgiving plates have some green and yellow veggies and include a glass of milk with our fruit pie for dessert.

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