Since the early 1950s the health promoting qualities of the Mediterranean diet have been universally acknowledged. The Mediterranean diet "is characterized by abundant plant foods (fruit, vegetables, breads, other forms of cereals, beans, nuts and seeds), fresh fruit as the typical daily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt) and fish and poultry consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts, normally with meals. This diet is low in saturated fat (less than or equal to 7-8% of energy) with total fat ranging from less than 25% to greater than 35% of energy throughout the region." In fact, the famous DASH diet was designed using the Mediterranean diet as the model. What is never revealed, however, is that the level of salt in the Mediterraneam diet is considerably higher than that the levels recommended for the US diet.
Drs. Leclercq and Ferro-Luzzi of the WHO Collaborating Centre for Nutrition, at the National Institute of Nutrition in Rome, Italy reported in that males consumed 4400mg sodium per day based upon 24 hr Urinary excretion, equivalent to 11grams of salt per day . It was also observed that the discretionary intake of salt for adults varied from 36% (males) to 39% (females) of the total intake. The discretionary intake alone, of salt in Italy amounts to almost 75% of the total sodium recommended in the US (2300 mg). Since many of the Mediterranean foods are naturally well salted (cheeses, olives, salted fish (cod, anchovies), fish eggs, etc., it is natural to expect that a majority of the discretionary salt is used to improve the palatability of the variety of vegetables that are such a conspicuous and essential part of the diet.
When the DASH-Sodium trial is examined, it is immediately apparent that moving to a DASH-type diet has a far greater impact on blood pressure than lowering salt consumption. Dropping from the current level of sodium consumption to the recommended dietary level dropped the systolic pressure by an average of 2.1 mm Hg. However, simply changing from a regular to the DASH diet, without any changes to sodium consumption, reduced the systolic blood pressure by 5.9 mm Hg, almost three times the drop resulting from the sodium reduction. This clearly explains why Mediterranean people enjoy an excellent cardiovascular status despite their high salt consumption. With a DASH diet, the impact of sodium on the blood pressure of hypertensives is minimal (and of no significance to normotensive people - the majority in the population).
Considering that significantly increased fruit and vegetable consumption is a key element to the DASH/Mediterranean diet models, it is entirely realistic to question whether the current recommended daily intake of sodium (2300mg/day) is realistic, given the Italian example above. Amongst the most important foods are the bitter cruciferous vegetables. While they have so much nutrition to offer, without salt, they are not palatable to adults or children (who are even more sensitive to bitterness). In addition to the benefits of the DASH/Mediterranean diet for cardiovascular disease outcomes, all other health parameters are significantly improved. Based on all the scientific evidence we have available, fruits and vegetables are the cheapest, most readily available, and most beneficial foods we can consume to give a significant degree of protection from the modern health challenges we face. Considering the hierarchy of positive health impacts, maintaining the DASH/Mediterranean diet is far more significant than reducing salt - the one safe condiment that has traditionally made this diet so agreeable.
