New French Guidelines Emphasize lower Salt Intake for Blood Pressure Control
Table of Contents
PARIS — Recent updates from the French Society of Arterial Hypertension (SFHTA) on nutrition and high blood pressure, presented during high Blood Pressure days (JHTA), recommend a notable reduction in dietary salt intake to manage hypertension and lower cardiovascular risks. These guidelines, developed through a collaborative effort between dieticians and hypertension specialists, offer practical tools for healthcare professionals advising patients.
the multidisciplinary team, led by dieticians Emma Tordjmann and helene Bely, created a comprehensive document addressing various dietary aspects. “The aim was to produce a summary document for use by health professionals who follow hypertensive patients and who must give dietary advice. It is indeed both theoretical and includes lots of small practical tools,” explained Professor Emmanuelle Vidal-Petiot, from the department of physiology and functional explorations at Bichat hospital.
The guidelines cover key areas including sodium and salt, potassium, fiber, calcium, magnesium, vitamin D, alcohol, licorice, coffee, tea, other beverages, and weight management.
The Salt Focus: Less is More
While the minimum physiological sodium requirement is very low—less than 0.5 grams (1.25 grams of salt) per day—the Esteban study by Public Health france revealed that only 22% of adults and 40% of children consumed less than 6 grams of salt daily in 2015. This highlights a significant challenge in achieving optimal salt reduction.
The SFHTA’s new advice is for less than 5 grams of salt per day, translating to approximately 90 mmol of sodium in the urine. While any reduction is beneficial, this stricter threshold contrasts with the 6-8 gram range recommended by the SFHTA and the HAS in 2016. The updated guidelines emphasize the strong link between excess salt and increased blood pressure, raising cardiovascular disease risk.
“Reducing your salt consumption requires therapeutic education because the salt we add to the table accounts for a small minority of intake (20%). In reality, salt is already present in foods,” Professor Vidal-Petiot noted. This underscores the need for education on hidden salt in processed foods.
The guidelines advise limiting processed foods high in salt,such as bread,cheese,and cold cuts,and avoiding ultra-processed foods like frozen meals,canned goods,sauces,and pizza,which often contain high levels of “hidden” salt and unhealthy additives.
While acknowledging ongoing debates about the precise relationship between salt intake and health outcomes, professor Vidal-Petiot emphasized, “We know that ther is a very strong link between salt and blood pressure and salt and cardiovascular diseases. But, we don’t know if the link is linear, if each additional gram of salt is bad, or if it starts from a certain threshold.”
These new guidelines offer valuable insights for U.S. healthcare professionals and consumers alike, highlighting the importance of mindful dietary choices in managing blood pressure and promoting overall cardiovascular health. The emphasis on therapeutic education and awareness of hidden salt in processed foods is particularly relevant to the American diet.
Licorice Consumption Warning: Experts Urge Caution
New health recommendations are urging Americans to carefully consider their licorice intake, highlighting potential health risks associated with excessive consumption. Experts are stressing the importance of open interaction between patients and healthcare providers regarding licorice consumption in all its forms.
The advisory comes as part of a broader set of guidelines focusing on dietary changes to manage hypertension. These guidelines emphasize the crucial role of a balanced diet in maintaining healthy blood pressure levels. Key recommendations include increasing potassium intake,reducing sodium,and incorporating more fiber into the daily diet.
sodium, Potassium, and a Balanced Diet
the guidelines recommend limiting sodium intake to less than 2,300 milligrams per day, which is equivalent to about one teaspoon of salt. Conversely, they encourage increasing potassium intake to more than 3.5 grams (90 mmol) daily, primarily through foods like fruits, vegetables, legumes, and adherence to the DASH and Mediterranean diets. However, a note of caution is added: “replacing table salt (sodium salt) with potassium-enriched salts without other precautions may prove risky in certain populations such as those with kidney failure and patients receiving hyperkalemic medications.”
Consume at least 5 servings of fruits and vegetables daily (ideally 3 servings of vegetables and 2 of fruit). A serving of vegetables is about half a medium plate of cooked vegetables or a small plate of raw vegetables or 1 bowl of soup; a serving of fruit is 1 large fruit, or 2 medium fruits, or a handful of small fruits (approximately 500g of plants per day). Prioritize whole fruits over juices.
Eat dried vegetables at least twice a week.
Include whole-grain products at least once a day.
Enjoy a small handful of plain nuts daily.
The guidelines also stress the importance of adequate fiber intake (at least 25 grams, ideally over 30 grams daily) through legumes, nuts, whole grains, fruits, and vegetables. Optimal intake of calcium (900-1200 mg depending on age), magnesium, and vitamin D is also recommended, achievable through a balanced diet including dairy products, certain mineral waters, and foods like nuts, whole grains, and dark chocolate.
Alcohol and Licorice: Key Considerations
Regarding alcohol, the guidelines state: “there is no threshold effect. Ideally, we shoudl not consume alcohol at all. If consumed, this should not exceed two drinks per day (i.e. 20 grams of alcohol) or one drink for women and men of small build (i.e. 10 grams of alcohol), and not every day.”
The most significant new warning centers on licorice consumption. “any consumption of food or drink containing liquorice […] must be careful and limited in time. […] We must make caregivers and doctors aware of the need to systematically ask their patients about the consumption of licorice in its various forms,” recommend the experts.
These comprehensive guidelines underscore the vital role of diet in managing blood pressure and overall health. The emphasis on open communication between patients and healthcare providers highlights the collaborative approach needed for effective health management.
Combating Hypertension: Lifestyle Changes and New Treatments
High blood pressure, or hypertension, affects millions of Americans. While medication plays a crucial role in management, lifestyle changes are equally vital. Experts emphasize the importance of a holistic approach, combining dietary adjustments with physical activity and, in some cases, new therapeutic options.
the Role of Diet and Hydration
Moderate consumption of coffee and tea—less than three to four cups daily—generally isn’t problematic. However, beware of energy drinks, which are “packed with sugar and contain extremely large doses of caffeine,” cautions a leading expert.
weight Management: A Cornerstone of Hypertension Control
Obesity is a significant risk factor for hypertension and cardiovascular disease. In the U.S., a substantial portion of the adult population grapples with excess weight.The link between excess weight, particularly obesity, and hypertension is well-established. Weight loss is a key recommendation for managing hypertension, even modest reductions can significantly lower blood pressure and other cardiovascular risk factors.Studies show a blood pressure drop of approximately 1 mmHg per kilogram of weight lost.
“Gradual and moderate weight loss,with the support of dietitians,is most likely to be maintained over the long term; this is the recommended approach. The combination of physical activity adapted to dietary measures is essential. Multidisciplinary care (with a dietitian-nutritionist, doctor, psychologist, practitioner trained in motivational interview techniques, physiotherapist, etc.) and coordinated between the city and the hospital, may prove necessary, especially since the situation is complex (high level of obesity and numerous obstacles to change). the arrival of new therapeutic classes, notably GLP-1 analogues (glucagon-like peptide 1) must now be integrated into the therapeutic strategy. Bariatric surgery has demonstrated its effectiveness, but must be part of an appropriate care pathway and nutritional support pre- and post-operatively,” according to a recent expert consensus statement.
This statement was developed by a panel of leading experts including: Hélène Bely, Emma Tordjmann, Julia Rivière, Jacques Blacher, Jean-Pierre Fauvel, and emmanuelle Vidal-Petiot. It was reviewed by dieticians from leading hypertension centers across the country.
For more information on managing hypertension and staying up-to-date on the latest research, consider subscribing to relevant medical newsletters.
Subscribe to Medscape Newsletters
This article provides a thorough overview of new dietary guidelines for managing hypertension, focusing specifically on salt intake, licorice consumption, and the importance of a balanced diet. Here are the key takeaways:
Salt Reduction:
The new guidelines recommend limiting salt intake to less than 5 grams per day (around 90 mmol of sodium in urine).
This is stricter than the previous recommendation of 6-8 grams.
The emphasis is on reducing hidden salt in processed foods.
Licorice Warning:
The guidelines urge caution with licorice consumption, advising limited and careful intake.
Balanced Diet:
Increased potassium intake through fruits,vegetables,legumes,and adherence to the DASH and Mediterranean diets is recommended. However,caution is advised for individuals with kidney failure or those taking hyperkalemic medications.
Adequate fiber intake (at least 25 grams, ideally over 30 grams daily).
Other Key Points:
Limited alcohol intake (no more than two drinks per day for men, one for women).
Importance of calcium, magnesium, and vitamin D intake, achievable through a balanced diet.
Relevance to U.S. Consumers:
These guidelines offer valuable insights for American healthcare providers and consumers, highlighting the importance of mindful dietary choices for managing blood pressure and overall cardiovascular health. The emphasis on:
Reducing hidden salt in processed foods is particularly relevant to the American diet, which is often high in processed foods.
Open communication between patients and healthcare providers regarding licorice consumption is crucial.
this article provides a comprehensive and actionable guide to dietary changes for managing hypertension, with a clear focus on the science behind the recommendations.
