Research presented this week at the American Society of Hypertension 2007 Scientific Sessions in Chicago, has shown that fewer and fewer people are following the DASH diet. Even though more people are aware of hypertension, investigator Dr Phillip Mellen said the dietary quality of hypertensive adults has deteriorated.

Speculating as to why fewer patients are following the recommendations, Mellen noted that many physicians do not feel adequately trained to implement the DASH diet. More likely, however, is the fact that dietary counseling takes time, and clinicians are still not reimbursed for their counseling labors. "It might be easier to give a prescription than to address root causes," said Mellen.

Dr. Mellen is correct, but he neglects to expand on the role of the American Medical Association on the issue. Instead of prescribing medication as physicians do, the AMA has prescribed the magic bullet of salt reduction as the answer to hypertension.

Of course, the AMA will agree that the DASH diet is useful, but their high priority target is salt reduction. As a consequence, recommendations from the AMA to consume the DASH diet takes a back seat - a distant back seat to salt reduction .

While salt reduction may reduce the single cardiovascular risk factor of hypertension in some sensitive individuals, consumption of the DASH diet reduces all 10 major cardiovascular disease risk factors in all individuals. If a prestigious organization such as the AMA would spend more time and money on promoting the DASH diet, a number of things would occur. Physicians, whose knowledge of dietetics and nutrition is generally wanting, may choose to learn more about balanced diets and may be influenced to spend more time telling their patients about the overall benefits of the DASH diet.

Positive open support for the DASH diet from the AMA may also influence the food industry to develop new products that will allow consumers to consume the 5 - 10 servings of fruits and vegetables recommended each day. The new fusion juices (fruit and vegetable combined) are a perfect example. One glass is the tasty equivalent to two servings and a lot easier to take at breakfast than a bowl full of chopped kale!

With the proper emphasis on balanced diet, the medical community can help millions achieve better health.

As highlighted in one of our previous blogs , the anti-salt campaign being waged in the U.K. by the Food Standards Agency (FSA), has resulted in the removal of saltshakers from school lunchrooms. Telegraph correspondent Paul Eastham reported that this has resulted in students totally avoiding their vegetables while in school. By blindly following the "avoid salt at all costs" mantra, the FSA has effectively prevented young students from enjoying the benefits of vegetable consumption during the school day.

A far more rational approach was advocated by the Alliance for a Healthier Generation, the coalition between Bill Clinton and the American Heart Association. They made it clear that increased salt consumption was warranted whenever consuming foods that delivered essential nutrients, if the salt made these foods more palatable. They based their recommendation on the overall benefit/risk balance.

In order to reduce the level of rhetoric and to begin bringing scientifically-derived data to the issue, the Salt Institute, together with the Center for Innovative Technologies and the Department of Food Science and Technology of Ohio State University organized a series of formal taste panels to determine the impact of different levels of salt on the palatability and acceptability of cruciferous vegetables.

Sample preparation

Broccoli was chosen as the first test vegetable. Two levels of salt, high and medium/low, as well as zero salt were added to cooked broccoli and the participants were asked to rate their preferences. Computerized sensory evaluation software by Compusense was used to evaluate all responses and compile the resulting analysis. Naturally, participants were not informed which samples contained which levels of salt and all sample numbers were randomly generated

This is serious work

The first trial involved 88 students, ranging in age from 9 - 13 years. The students were fully briefed on the procedures and enthusiastically took part in the trials.

A good rinse between samples

The result was a virtual tie in preference between the high and medium/low levels of salt addition, with the zero salt a very distant third. Cruciferous vegetables are very nutritious, but are known to contain bitter components which youngsters are sensitive to. However, a small amount of salt makes these vegetables (together with their nutrients) highly acceptable.

Which one tastes best?

This study, together with future trial will be published in detail in the near future