Today was a good day.

Today, the Institute of Medicine (IOM) released the report on the review of evidence concerning the consequences of sodium reduction. Their conclusion was that the current recommendations for drastic salt reductions, down to 1,500 mg sodium per day, were inappropriate and could increase the risks to health for some.

Whereas the specific recommendations were important, the true impact of this report was the IOM committee’s acceptance that health outcomes were considerably more significant than the single surrogate measure that was used in the past. While logical for any thinking individual, the straightforward notion that a person’s overall health matters far more than a simple blood pressure test, eluded the public health establishment for decades. This finding permits us to explain why people placed on low salt diets experience greater rates of illness and death.

This report also signifies, for the first time in more than a decade, that the dialogue on salt will not be controlled by the same group of outspoken anti-salt advocates that has fully controlled it in the past – a dialogue described by Bayer and colleagues as “…the concealment of scientific uncertainty … that has served neither the ends of science nor good policy.”

Of course, those heavily vested in the distorted approach of the past will rise up in full-throated protest, because for the first time, the sodium podium, is being offered to a more inclusive view of salt and health. The Center for Science in the Public Interest and the American Heart Association, the two most vociferous and well-financed anti-salt activists have already started howling. Tomorrow, we will see MacGregor, Cappuccio and Strazzulo of WASH in the UK stand up and repeat the old, “Do you know who I am?” refrain and claim the IOM to be all wrong. The George Institute and AWASH of Australia will assert the IOM to be out of line and simplistic in their approach. These people cannot help themselves. They are so committed to salt reduction that no evidence of harm to the public will ever convince them. That is what it is to be a zealot.

But, the issue of health is not about old dogma or saving the face of a few radicals – it is about the health of consumers. And for that reason, I give credit to the IOM for taking what they knew would be the hard road. Consumers will ultimately benefit.

Like I said, today was a good day.

The latest research coming out of the University of Virginia may result in a paradigm shift in our approach to salt consumption. A team led by Dr. Robin Felder has demonstrated a quick and simple test to determine an individual’s sensitivity to salt . The initial studies indicate that about 25% of people experience increased blood pressure on very high salt diets and 11% develop the same high blood pressure when placed on low salt diets. The team went on to isolate the gene responsible for salt sensitivity.

Just as our unique genes predetermine our physical features such as iris patterns or fingerprints, they govern the characteristics of metabolism and our risk to all health challenges. That is why doctors always check for family history and why the most effective medical and nutrition approaches target individual requirements. If we can have shoe sizes that fit properly, isn't it equally important to have nutrition and health measures that fit our individual needs?

Yet, for more than 3 decades the government’s line on dietary salt has reflected an indifferent, ‘one size fits all’ approach that will not benefit the majority of people and place a significant portion of the population at a risk of higher blood pressure. In fact, most of the research during the last five years suggests that the majority of the population will face increased negative health outcomes if the government recommendations for salt are realized.

The ability to quickly and easily determine individual salt sensitivity removes any rationalization for a population-wide approach. People are not stamped out by cookie cutters. We have individual, unique needs. If the shoe doesn’t fit, no one should be forced to wear it.

The recent paper in the Journal Nature on sodium chloride and autoimmune disease has highlighted some important contradictions. The authors claim that the marked increase in the incidence of autoimmune diseases in the last 50 years may be due to the increased consumption of salt, the actual evidence indicates that no such increase in salt intake has occurred. On the contrary, prior to World War II, because most of our food was preserved with salt, we consumed almost double the amount we do today. After World War II, when refrigeration replaced salt as the main means of food preservation, salt consumption in the U.S. (and elsewhere) dropped dramatically to about 9 g (1.5 teaspoons) per day and, based on twenty-four hour urinary sodium data, has remained flat for the last fifty years .[1] So while increases in autoimmune diseases and the obesity epidemic have occurred in the last 50 years, an increase in the consumption of salt has not occurred.

As the authors in this paper have stated, this data does not demonstrate any causality between salt intakes and autoimmune disease. However, I highly welcome the authors’ call for a large-scale clinical trial that would show the impact of salt reduction on total health outcomes – not merely autoimmune diseases. The Salt Institute has long been on the record demanding such a trial and has repeatedly written to successive Secretaries of health and Human Services asking for such a trial this.

[1] Bernstein AM, Willett WC. Trends in 24-h Urinary Sodium Excretion in the United States, 1957–2003: A Systematic Review, 92 Am. J. Clin. Nutr. 1172-80 (2011).

Dr. Frieden’s perspective on the Government’s Role in Protecting Health and Safety (NEJM, April 17, 2013 ) requires some examination. Amongst the long standing interventions that are considered great successes in protecting and promoting public health are milk pasteurization (1890s) (1), iodization of salt (1924) (2), addition of niacin to bread (1938) (3), UV irradiation of milk to increase vitamin D levels (1930s) (4), fluoride supplementation of toothpaste (1956) (5), addition of natural fiber to bread and other products (1975) (6) and the supplementation of baked goods with folic acid (1977) (7). But, contrary to Dr. Frieden’s assertions, these were not the actions of a responsive government – they were the actions of a responsive private sector - based on objective scientific evidence. It was the open market and the common sense of consumers that allowed these interventions to result in the success that is now history.

Trans-fats, first used in margarines and frying fats in the early 20th century established a limited market up until the 1980s. At that time concerns were made by some medical researchers that saturated animal fats were related to heart disease. Immediately, the consumer activist groups CSPI and the National Heart Savers Association (NHSA), attacked the use of saturated animal fats and forcefully endorsed and lobbied in favor of trans-fats as a healthier, alternative (8). In response to this attack, the food industry began replacing animal fats with trans-fats. The government simply sat back and allowed this market shift to take place. It was neither the industry nor the market that demanded the much wider use of trans-fats; it was the consumer activist movement and a government unwilling to evaluate the possible health consequences which created the market. Years later, when additional evidence indicated possible negative consequences, it was the same CSPI that campaigned against trans-fats. Under Mayor Bloomberg and Dr. Frieden’s role as NYC Health Commissioner, with much publicity, trans-fats were banned in New York City in 2006. Despite great claims of success, the only metric used to qualify this was sales of trans-fats – not the quantifiable health outcomes of New York’s residents. If the citizens of New York were intended to be the beneficiary of this intervention, why was a post mortem analysis of the effect of the trans-fat ban on quantifiable health metrics of consumers never done? Could it be that the impact of the trans-fat ban was impossible to measure, or worse, was the trans-fat ban a total failure, and those heavily vested in it are trying to hide this sham? Where are the figures that show the trans-fat ban has improved the cardiovascular health outcomes of New Yorkers? Can Dr. Frieden answer that please?

Dr. Frieden has been a committed activist on salt reduction since he was the New York City Health Commissioner and initiated the National Salt Reduction Initiative (9). Here again, market forces reveal an interesting story. The only written records we have regarding historical salt consumption are military archives of rations for soldiers and prisoners of war. They indicate that from as far back as the War of 1812 up until the end of WWII, the amount of salt consumed was remarkably consistent, from 18-20g/day (10, 11). Yet, in the dozen years from the end of WWII until 1957, our consumption of salt dropped in half, down to 9g/day. The reason was simple and it was market driven. Up until the end of WWII, salt was the primary means of food preservation. All traditional foods, including cheeses, meats, fish and certain vegetable were all preserved with salt. After WWII refrigeration and the cold chain quickly overtook salt as the main means of food preservation and consumers immediately gravitated towards a fresher food supply. There were no government campaigns to reduce salt, no Dietary Guidelines, no CDC, no CSPI and no American Heart Institute. It was simply the market at work that resulted in the reduction in salt intake. But this dramatic drop stopped at 9g/salt per day and stayed there until today (12). Why? Sodium is an essential nutrient and when insufficient quantities are available from our diet, the renin-angiotensin-aldosterone system (RAS) is activated so that we become efficient sodium conservers. The available evidence indicates that when salt consumption drops below 9g/day, the renin-angiotensin-aldosterone system is stimulated, with negative consequences to our overall health. This stable consumption of salt for five decades despite great changes in food products and eating habits lends support to the notion of the “wisdom of the body” related to sodium appetite. Yet, the CDC, with the active collaboration of CSPI and the AHA is now spending millions of dollars of public funds to drive our consumption way down to 6g/day – a level unprecedented in recent history. How do they have the nerve to experiment with this untested dietary regime on the entire population? Will they end up doing the same thing as was done with the trans fat experiment - put in the policy, reap the immediate publicity and then walk away patting each other on the back - regardless of all unintended consequences.

Will the cocktail of synthetic chemicals used to replace salt come back to haunt is just like the trans-fats did?

The Salt Institute has claimed for several years that the government, by exaggerating the benefits and concealing the negative consequences, has engaged in scientific misconduct (13) in pursuit of their salt reduction agenda. This claim has been echoed more recently by health policy researchers totally uninvolved with the salt and health debate (14). While there will always be some debate on how far the government should intrude on an individual’s freedom, few would argue that the basis of any intervention should be honestly represented scientific evidence. This has not been the experience with the salt reduction agenda. There have been several recent publications in the last five years which have cautioned against population-wide salt reduction. These publications were to be reviewed by the 2015 Dietary Guidelines Advisory Group in preparation of the next issue off the Dietary Guidelines. This process was commandeered by the CDC who, with a limitless supply of public funds, contracted the IOM to establish a committee to carry out this evaluation before the DGAC could do it (15). The IOM selected a committee with 80% of its members on the public record supporting population-wide salt reduction. Did the CDC not trust the joint IOM/USDA Dietary Guidelines process and decided to obstruct it by manipulating a process involving the IOM alone?

Because government interventions and policies affects more than 300 million people in the US, manipulating the presentation and utilization of evidence can result in disasters of biblical proportions. This is not the behavior of a socially responsible government.

(Note: This was originally submitted to the NEJM on 4/19/2013, but as it appears that no action will be taken on this until mid-June, which would no longer make this commentary pertinent to Dr. Frieden's article, it has been placed in today's blog.)

References

1. Hall CW and Trout GM. Milk Pasteurization. 1968. The AVI Publication Company, Westport, CT.
2. International Council for the Control of Iodine Deficiency Disorders. History of salt iodization. 2013. Accessed at http://iccidd.server295.com/pages/protecting-children/fortifying-salt/history-of-salt-iodization.php on 4/19/2013 .
3. Park YK, Sempos CT, Barton CN, Vanderveen JE, Yetley EA (2000). "Effectiveness of food fortification in the United States: the case of [[pellagra]]". American journal of public health 90 (5): 727–38.
4. Weckel KG and Jackson HC. The Irradiation of Milk. Wisconsin Agricultural Experiment Station (Madison) Bulletin. 1939;136:1-55.
5. History of Toothpaste. Accessed at http://toothpaste.com/toothpaste-history/history-of-tooth-paste on 4/19/2013.
6. Satin M, McKeown B and Findlay C. Design of a Commercial Natural Fiber White Bread. Cereal Foods World, 1978;23(11):676-680.
7. Gorman T. Now, “white bread” has as much as 100% whole wheat. Bakery. 1981:4;50.
8. Schleifer D. The perfect solution. How trans-fats became the healthy replacement for saturated fats. Technol Cult. 2012 Jan;53(1):94-119.
9. Severson K. Throwing the Book at Salt. New York Times. January 27, 2009. Accessed at http://www.nytimes.com/2009/01/28/dining/28salt.html?pagewanted=all&_r=0 on 4/19/2013.
10. Rations: The History of Rations, Conference Notes, Prepared by The Quartermaster School for the Quartermaster General, January 1949, accessed at http://www.qmfound.com/history_of_rations.htm on 12/20/2011.
11. American Prisoners Of War In Germany, Prepared by Military Intelligence Service War Department, November 1945, Restricted Classification Removed-STALAG 17B (Air Force Non-Commissioned Officers) accessed at http://www.valerosos.com/AMERICANPRISONERSOFWAR.pdf on 12/20/2011.
12. Bernstein AM, Willett WC. Trends in 24-h urinary sodium excretion in the United States, 1957-2003: a systematic review. Am J Clin Nutr. 2010 Nov;92(5):1172-80. Epub 2010 Sep 8.
13. Fanelli D. Redefine misconduct as distorted reporting. Nature, 2014; 494: 149.
14. Bayer R, Johns DM, Galea S. Salt and Public Health: Contested Science and the Challenge of Evidence-Based Decision Making. Health Affairs, 31, no.12 (2012):2738-2746.
15. IOM. Committee on the Consequences of Sodium Reduction in Populations. Accessed at http://www.iom.edu/Activities/Nutrition/ConsequencesSodiumReduction.aspx on 4/19/2013.

The media comments we have seen regarding recent research on the relationship of very high salt concentrations to the development of autoimmune diseases are a classic example of exaggeration and myth-information. Dr. David Hafler, the author of one of the studies stated that the salt concentrations employed were at the very high end of salt ingestion limits, higher than what is consumed in current high salt diets, such as the classic Mediterranean diet, and way above the levels in the American diet. Because these extremely high salt concentrations seems to activate the immune system, Hafler went on to theorize that some people may actually benefit from them.

In reality, based upon the current World Health Organization figures, those populations that consume higher levels of salt in their diets have longer life expectancies, which is the only practical measure of lifelong health. Of course, total life expectancy is the result of many factors such as genetics, social development, etc., but these data conclusively demonstrate that current levels of salt consumption are fully compatible with increasing life expectancies.

The most recent research, just published in the peer-reviewed scientific journal, Cell Metabolism, has shown that the Government’s dogmatic salt reduction agenda is not based on sound science (1). An international team of researchers, working on the long-term space simulation projects, Mars105 and Mars520 at the Institute for Biomedical Problems in Moscow, have determined that all the studies relating hypertension to salt consumption are critically flawed .

Up until now, it has been assumed that the gold standard for calculating salt consumption is the amount of sodium found in a 24 hour urinary analysis. However, in what was the largest and most highly controlled, long-term study of salt metabolism ever carried out in a fully enclosed system, these researchers found that that the body does not eliminate the sodium from consumed salt on a regular basis, but stores and releases it in a fixed biological cycle. So measuring the amount of sodium excreted in any 24 hour period is meaningless. Sodium excretion has to be measured over a much longer time period to accurately estimate salt intake. This explains why so many previous studies have been so inconsistent.

(1) Rakova, N. et al. Long-Term Space Flight Simulation Reveals Infradian Rhythmicity in Human Na+ Balance.Cell Metabolism. 2013; 17: 125–131. (January 8, 2013)

Health advocates, who do not have a firm scientific basis upon which to promote their cause, often elect to characterize available data completely out of context in order to further their case. Followers of this column have often read how members of the global anti-salt groups CASH (Consensus Action on Salt and Health) and WASH (World Action on Salt and Health) are willing to say anything and attack anyone in order to further their population-wide salt-reduction agenda. They approach the issue of salt and health as if they were members of a religious cult and consider all scientists who question the public-health value of salt reduction as infidels.

Today brings us another picture-perfect example of this. BMJ Open has just published an article entitled, “Spatial variation of salt intake in Britain and association with socioeconomic status ,” by Chen Ji, Ngianga-Bakwin Kandala, and Francesco P Cappuccio. The senior author and correspondent is Professor Cappuccio, a longtime member of WASH. The key conclusion of this study was that low socioeconomic status was associated with higher levels of sodium (or salt) intake. The authors went on to state, “…measures of low socioeconomic status are associated with higher salt intake, indicating a higher risk of hypertension and CVD.” In other words, the authors contend that if you reduce the amount of salt that poor people eat, you will reduce their risk of hypertension and cardiovascular disease. It’s that simple, is it?

But wait. We have long known that low socioeconomic status was associated with a great many risk factors for health and mortality. Epidemiological studies have repeatedly shown that increasing wealth is associated with less heart disease and better overall health.

Dr. George Davey Smith and colleagues have made it clear that socioeconomic hardships are grouped or clustered together [i] . Low economic status is characterized by a multitude of adversity. The poor work harder and are less educated than the well-off; they smoke more; they eat cheaper foods that are higher in calories and lower in essential nutrients; they eat more processed foods that last longer; they can’t afford to eat the same ratio of healthy fresh green vegetables and fruits than better-off individuals do, so they weigh more; they worry more about paying bills, their children’s education, medical costs and simply surviving than richer people do. They live in nastier conditions with far more noise, crime and environmental pollution. Is it any wonder that they’re more prone to hypertension and other cardiovascular disease?

Anyone who believes that the answer to improving the health of people at low socioeconomic status is salt reduction can’t be serious. The answer is as complex as the problem. If anyone were to insist on a single solution, it can only be to improve their overall economic status. But nothing is that simple. If one were to look to changes in the diet that could significantly reduce the risk of hypertension and CVD, then the very first action to take would be to give the poor greater access to fresh vegetables and fruits – the single most important dietary factor to lowering the overall burden of disease.

Effective public health policy development will never result from a myopic view of risks, particularly if it is not supported by the preponderance of science. The authors of the BMJ Open article would be far more effective if they placed people ahead of their parochial salt-reduction agenda.

__________

[i] Bruna Galobardes, John W. Lynch, and George Davey Smith. Childhood Socioeconomic Circumstances and Cause-specific Mortality in Adulthood: Systematic Review and Interpretation. Epidemiol Rev 2004;26:7–21.

An American Heart Association Presidential Advisory on salt and health is in the process of being published. The stated purpose of this AHA Presidential Advisory is to review all the recent studies that contradict the ongoing population-wide salt reduction agenda. It is fitting that the Advisory is being published at the height of the Presidential election campaign, which has been characterized by negative propaganda, innuendo and half-truths. This AHA Presidential Advisory follows that paradigm closely. If the fact-checkers went to work on this paper, they would surely award it all four Pinocchios !

The authors of this paper, almost half of whom are listed as members of the anti-salt activist group WASH ( World Action on Salt and Health (vnd.ms-excel 529.00 kB) ) seem to share certain particular characteristics: a) they refuse to acknowledge that their decades-long advocacy of population-wide salt reduction has made them wholly committed to one particular interpretation of the evidence; b) they don’t concede that prejudicial bias is an unacceptable foundation from which to evaluate evidence, and; c) they appear to have little faith in the ability of science itself to describe the human response to salt intake and believe they have to interpret the data in a contrived fashion. In fact, the spinning of evidence by committed advocates has been a hallmark of the salt/health debate for more than a century – longer than any other health controversy.

The features of their arguments are classic. They refer to all published evidence that supports the salt reduction agenda as high-quality and disparage or rationalize all published evidence that contradicts it. In fact, the arguments presented in this paper are even more specious and desperate than many of the publication’s the authors have made in the past.

While it is plainly beyond the scope of this blog to analyze every declaration made in the paper, certain representative contradictions will be used to demonstrate the extent of this attempt to parse the evidence and mislead the public.

Amongst the conditions linked to excess sodium intake described in the paper is asthma. This is an old concern that was never adequately addressed through a randomized controlled trial until the study published in 2008 by researchers at the University of Nottingham. This study, long awaited by salt reduction advocates, concluded that low sodium diets had no therapeutic benefits for adults with asthma (1). The salt reduction advocates immediately pretended the study was never carried out and continue to repeat the purported link to asthma.

The AHA Presidential Advisory tries to reinterpret the Bernstein-Willett paper (2), which stated that sodium consumption in the US has not changed in 50 years . One of the authors of this Advisory (MacGregor) was the first to criticize the Bernstein-Willett paper when it was published, but it now appears that the paper has been ‘rehabilitated,’ since it apparently no longer means what it says. In fact, the Bernstein/Willett paper concluded, “Thus, despite the increase in processed foods in the US marketplace over the past 50 years, total caloric imbalance and the resultant epidemic of obesity may be a more important determinant of the increased prevalence of hypertension than sodium intake.” (Perhaps, if Bernstein-Willett were asked to make a short visit to the Gulag, this will result in a total withdrawal of this troublesome paper.)

The AHA Presidential Advisory expounds upon the analysis of dietary sodium and concludes that the best measure is the 24-hour urinary collection – something that all those who have cautioned against population-wide sodium reduction have said for years. They go on to say that the 24-hour dietary recall survey can still be used to estimate dietary sodium, but that it underestimates the amount consumed. Unfortunately, the authors of the Advisory don’t appear to be overly familiar with dietary habits and do not take into account the significant amount of food (>25%) left over on the plate, which is never adequately considered in recall surveys. This results in an overestimation of consumption. What is more important is that the effort to impugn the quality of the studies that caution against salt reduction equally applies to all those studies that support it and were used to justify the Dietary Guidelines in the first place.

There is a painful rationalization for discrediting what is considered to be amongst the best randomized controlled trials on the highly negative impact of salt reduction on congestive heart failure patients (3). In the end, the Advisory simply says that even if the results of this trial were to be repeated, such a study has no relevance for others in the population. It would have been much simpler for the Advisory to have repeated what the Chairman of the 2010 Dietary Guidelines Subcommittee on Electrolytes (who is also one of the authors of this Advisory) stated when first asked about the study, “It wasn't done in the United States. It was done in, I think it was in Italy. It was a European country.…. it's in a population and in a management strategy that is very different from what goes on in the United States. So that's the heart failure study . (4)” Surely that should be enough to disqualify any paper.

The rest of the Advisory is devoted to reinterpreting what the authors of the studies contradicting salt reduction are actually saying. The language is that of an Inquisition trying to account for mistaken and unrepentant ramblings of those that contradict the Dogma. “It seems likely that…” “A plausible explanation is…”

The fact that this group of authors was established specifically to make judgments on every scientific publication that contradicts the ongoing salt-reduction agenda makes it obvious that the agenda is the product of a well-organized plan by an international cabal in anticipation of the 2015 Dietary Guidelines. The authors provide absolutely no new evidence on the relationship of salt to human health, but have banded together for the express purpose of maligning any and all evidence that does not support the salt reduction agenda. What is even more strange is that the CDC, under the direction of Dr. Thomas Frieden (the former New York City Public Health Commissioner who instigated the National Salt Reduction Initiative), has just publicly funded a parallel Institute of Medicine project entitled, “Consequences of Sodium Reduction in Populations” designed to come to the very same conclusions that the authors of this Presidential Advisory have already done. To make matters even more questionable, one of the authors of this published Presidential Advisory is also a member of the Committee convened to carry out this new IOM project! It takes some brass to establish a Kangaroo Court with individuals who have already published their conclusions, to a study which they have yet to carry out for the IOM. We see before us an example of “putting the fix in” possibly for the FDA’s consideration of regulated sodium limits and definitely for the 2015 Dietary Guidelines. What a way to manage public funds that should be destined for the advancement of health science!

Considering the fact that the authors of this paper are the world leaders of the population-wide salt reduction movement, this paper provides some perspective on the (il)legitimacy of their entire agenda.

References

1. Pogson ZEK, Antoniak MD, Pacey SJ, Lewis SA, Britton JR, and Fogarty AW. Does a Low Sodium Diet Improve Asthma Control? A Randomized Controlled Trial. Am J Respir Crit Care Med. 2008: 178; 132–138.
2. Trends in 24-h urinary sodium excretion in the United States, 1957-2003: a systematic review. Bernstein AM, Willett WC. Am J Clin Nutr. 2010 Nov;92(5):1172-80. Epub 2010 Sep 8.
3. Paterna S, Gaspare P, Fasullo S, Sarullo FM, Di Pasquale P. Normal sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? Clin Sci. 2008; 114:221–230.
4. Transcript of the second meeting of the 2010 Dietary Guidelines Advisory Committee. January 29-30, 2009. Day 2, page 369.

When it comes to salt, the Dietary Guidelines process leaves a lot to be desired. In what should be an objective evaluation of the available evidence, the Institute of Medicine, one of the two organizations that run the Dietary Guidelines, has always managed to manipulate the process to support their population-wide salt reduction agenda. Their representatives have always made it a habit to acknowledge only that data which supports their case and disregard all the clinical evidence that weakens it. Well, they’re at it again!

With no fanfare, and behind closed doors, the IOM has constituted a Committee on the Consequences of Sodium Reduction in Populations whose task will be to develop a consensus on the quality of the publications describing the negative consequences of low sodium intakes. Normally, this would be an occasion to congratulate the IOM for turning a corner and finally recognizing the large body literature they have so long ignored - but have they?

This study will be financed by the CDC, currently directed by Dr. Thomas Frieden, the former New York City Health Commissioner who initiated the National Salt Reduction Initiative. Since he took over the helm of the CDC, population-wide salt reduction has become a priority for this organization. Thus, the money behind this IOM study comes from a source already committed to national salt reduction.

To pervert the situation further, the Committee is made up of individuals that are publicly on the record as actively supporting population-wide salt reduction. Fully 80% of the committee is down on paper as strongly supporting this. It would be difficult to find a more exaggerated case of conflict of interest then this Committee. After repeatedly supporting salt reduction in public, how can they objectively evaluate all the evidence that completely contradicts everything that they have said?

When it comes to the salt agenda, the IOM has not changed one bit. Their approach is as illegitimate and intellectually unethical as it always has been. Their goal is to degrade the credibility of all the evidence that counters their agenda and they have put together a Committee of hatchet men and women to do the job.

The IOM’s Kangaroo Court is now in session!

You can see the full Salt Institute’s response to the latest IOM initiative here (pdf 371.19 kB) .

There is a full blown crisis brewing at The Carron Fish Bar, a fish and chip shop in Stonehaven, a small town on Scotland's northeast coast. Originally known as the Haven Chip Bar, the infamous Fried Mars Bar was said to have been invented there in 1995. As one of the world’s preeminent sources of fat, sugar and calories, The Carron's Fried Mars Bar quickly became a worldwide epicurean phenomenon and spawned a range of wannabes including deep fried Snickers, Bounty and Moro bars. No stranger to controversy, the Fried Mars Bar even had its detractors . Nevertheless, it kept sliding forward, amply lubricated by its own drippings.

Now, however, the Fried Mars Bar faces one of the greatest challenges of its life. The international food giant, Mars, has sent a formal letter to The Carron Fish Bar demanding that a disclaimer be made for the product because it is not in line with their healthy lifestyles marketing code – a code responsible for other products such as Bounty, Snickers, Revels, M&Ms, Maltesers and Twix in addition to their astronomically successful (or successfully astronomical) line of Mars, Milky Way, Magic Stars, Galaxy and the lesser known, Planets.

At this stage, it is not known what will happen if The Carron refuses to display the demanded disclaimer. The restaurant has not responded as yet. It may very well be that they will no longer be able to call their specialty a Fried Mars Bar, however, in keeping with the enormously successful Mars astronomical theme, they may choose to call it a UFO or Unidentified Frying Object!

An obvious irony of the blame game is that it is directed towards the public. If you looking to asses blame, it is very difficult to point the finger at the very public you are trying to convince. This is the reason why so few blame articles focus on self-responsibility. After all, it’s much easier to blame external influences rather than consumers. The traditional whipping boy has been the food industry. They have been blamed for making foods taste too good, for serving up portions that are too large and for making foods that are too cheap. The food industry has countered by saying that this is what the public wants and by trying to modify foods to comply with the nutritional imperatives directed by public health and consumer advocacy groups.

But the blame game has just not resulted in any success on the obesity front.

Perhaps it is time to drop the blame game and start looking at the actual evidence. A recent publication, readily available online , describes an analysis of energy expenditures in the US since the 1960s. In the 1960s, this analysis indicates that almost half the jobs in US private industry required a moderate level of physical activity. This has dropped dramatically to the point where now less than 20% of the jobs require the same level of energy expenditure. The analysis shows that this difference in energy expenditure translates to more than an average of 100 calories per day for both men and women. For men, the difference was 142 calories per day. This difference was then inserted in models that predict weight changes resulting from daily energy expenditures and was found to closely match the weight changes that have actually taken place during the past five decades.

As an example, for anyone weighing 170 lbs. in 1968, a 142 calories per day reduction in energy expenditure would result in a new weight of 198 lbs. today. These figures correspond well with the actual NHANES figures on the obesity epidemic. There is no blame to assess here. Technological development, world economic shifts and a move away from manufacturing towards a service economy has resulted in us pushing pencils more than wheelbarrows – in fact, were not even pushing pencils anymore, we’re tapping keyboards. Northern Europeans have fared somewhat better in this transition because their demographics encourages a greater energy expenditure to get to and from the workplace and pride in appearance is generally greater than it is in the US.

So, if we resist engaging in the blame game and actually try to solve the problem what can we do? If we simply look at the numbers, a walk of ½ hour per day is all that’s needed to reverse the trend and completely make up for the lost energy expenditure which occurred during the last 50 years! While there will always be a few employees physically unable to walk ½ hour at lunch, most can certainly do so. Perhaps employers can subsidize part of the cost of lunch for those employees that walk a mile and a half at lunch. Certainly, we have the technology to track this if the honor system won’t work. The point is that employers prefer healthy employees and obesity is a major obstacle to this. Anything that will serve as a positive incentive would be useful. The small investment in employees’ health would pay significant dividends.

It’s time to end the blame game.

The obesity epidemic has evidence-based causes and using the ideological blame game instead of the actual epidemiological evidence to achieve a solution will only delay it. There are better ways and we must get to them.

There has been quite a bit of media coverage in the past week about Boston Market’s announcement that it has removed the salt shakers from its tables and replaced them with little cards hyping the company’s interest in reducing sodium. As highlighted in some articles , it was an interesting marketing ploy since it reaped the chain considerable publicity.

It also begs the question if Boston Market’s intention is to reject the notion that peoples tastes differ. One look at Boston Market’s nutritional information makes it clear that their products are brined. If you look at the ingredient listings right after the nutritional information, you will see that their chicken, turkey and beef products all contain up to 12-15% of brining solution (aka water and seasoning). Thus the seasoning levels are fixed at a particular level prior to getting to the client, as can be seen from the nutrition table.

It is unfortunate that Boston Market took this marketing tack at the very time that the preponderance of scientific evidence makes it clear that reducing salt in diets will increase the risk of morbidity and mortality . The fact that our public health institutions are in denial does not change the science.

But you can deny the facts only so long. When the scientific evidence becomes acknowledged, as it surely will be, in lightening speed the salt shakers will be back on the tables and the little cards pitched into the rotisserie.

There are many types of calendars in the world. The Julian calendar, the Gregorian calendar, the Lunar calendar and the Chinese calendar, etc. Some follow the sun and some follow the moon. More recently, there is the opportunist's calendar. This is the calendar where opportunists of every type pick a day to promote their own self-serving cause. The latest example (http://bit.ly/Sr4kEy) is the "More Herbs, Less Salt Day" set for August 29th - the same day that the Soviets exploded their first atomic bomb, Pizarro destroyed the Inca civilization and executed their last Emperor and the day that hurricane Katrina slammed into the Gulf coast and decimated New Orleans. Interesting day to choose!

The "More Herbs, Less Salt Day" is supposed to encourage people to reduce their salt and replace it with herbs . They seem to have ignored the fact that more peer-reviewed medical publications caution against population-wide salt reduction than support it. Furthermore, salt has never been shown to cause harm in the thousands of years we have been using it.

However, the case is not quite the same for herbs and spices. Herbs and spices have been implicated in several negative health conditions including cancer. For example chilli powder, which is laced with the deadly chemical, Sudan IV, (http://tinyurl.com/dxdexdc ); ginger, which can harbor carcinogenic aflatoxins (http://tinyurl.com/d2fd2pr ); basil, which contains estragole, a known carcinogen and teratogen (http://tinyurl.com/28mclj ); and black pepper, which contains N-nitrosopiperadine, a strong carcinogen (http://tinyurl.com/ccqsp5l ).

In other words, they are recommending four known carcinogens to replace salt!

Interesting advice for an interesting day.

In a perfect winter world, nothing would be simpler than plowing to remove all the snow and slush from the pavement. However, the reality is that winter conditions make it impossible to prevent snow pack or ice from developing on the pavement. This is where deicing materials are needed to restore safe pavement conditions. Deicers work by preventing ice from bonding to the pavement and help to remove any ice that has stuck to the pavement. And road salt is the most cost-effective material in the snowfighter's arsenal.

Abrasives don't melt snow and ice - they're inert and can't melt anything! So what can abrasives do? Well, they can increase traction, but in order to do so they must remain between the tire and the ice - impossibility in the presence of significant traffic. As a result, abrasives must be used in large quantities and applied frequently, making them far more expensive than salt in terms of material and manpower. Unfortunately, abrasives are poorly understood and often misused, resulting in wasted material and money, and reduced safety for the traveling public.

Abrasives are often used for the wrong reasons. It is nice to spread something that the public can see - it shows you're doing work and might stop complaints for a short period. But there is a growing list of negative environmental concerns with abrasives, including air pollution from the dusty fine particles. Abrasives can also pollute stream beds, ruining fish breeding. The costly post-season clean-up costs, problems with windshield damage claims and chipped auto paint make the use of abrasives a source of public irritation and criticism. It is a high price to have sand just to look at. These limitations in the application of abrasives are reflected in their rapidly declining pattern of use over the last two decades.

Abrasives can be a useful treatment in environmental conditions where conventional deicing chemicals don't work and they can be used to maintain safety at hills, curves and intersections on unpaved and low volume roads. But road salt remains the most widespread and practical deicer in use at any temperature above -6 F. Calcium chloride and magnesium chloride are used at lower temperatures and can also be added to road salt for rapid deicing and effective melting at a broader range of temperatures.

So if your agency is using a high percentage of abrasives, you should take the opportunity to review your practice and seek improvements in winter maintenance management. The public deserves nothing less.

See article (pdf 367.68 kB) ...

Once again, a respected medical journal has published a paper demonstrating that low salt diets cause more sickness and death than regular salt consumption. The most recent publication in the British medical journal, Heart, by Drs. DiNicolantonio, Di Pasquale, Taylor and Hackam was published online today (August 21, 2012). The details can be seen at http://heart.bmj.com/content/early/2012/08/21/heartjnl-2012-302337.abstract?papetoc . The medical researchers, from USA, Italy, UK and Canada, carried out a systematic review and meta-analysis of randomized trials with heart failure patients carried out up until April 2012. They concluded that low sodium diets significantly increases morbidity and mortality in patients with heart failure compared normal sodium diets.

This review follows on a recent Cochrane meta-analysis which demonstrated that sodium restriction did not reduce all-cause mortality or cardiovascular events.

Yet, North American guidelines for the management of heart failure consistently advise dietary sodium restriction for patients. The Guidelines for treatment of Heart Failure patients is hopelessly out of date. The letter I wrote to the American Heart Association two years ago asking them to reconsider their guidelines in light of new, peer-reviewed evidence, went completely unanswered. They, together with all our other public health institutions are in total denial of the evidence, and this latest publication confirms this once again. They have committed themselves so deeply to salt- reduction ideology, that no amount of new evidence will shake them from their pig-headed position. As a result, more people will die.

During the past three years there has been a great many medical publications cautioning against salt reduction in food. Peer-reviewed medical publications the world over have stated that salt reduction will result in higher rates of cardiovascular morbidity and mortality for Type I and Type II Diabetes patients. They have repeatedly shown that salt reduction down to the levels to the levels recommended in our dietary guidelines will result in greater all-cause cardiovascular mortality, losses in cognition, increase in unsteadiness and falls in the elderly and a host of other malignant conditions.

It is time our public institutions come clean and do what they are paid to do. They are in our employ to make recommendations based on the preponderance of scientific evidence – not to stake out an intractable position based on dogma and never veer from it, regardless of the consequence to consumers. They are not doing their jobs – even to the point of reading the published research. The position of our public health institutions was aptly described by Bill Watersson, author of the cartoon, Calvin and Hobbs, “It's not denial. I'm just selective about the reality I accept.”