There was an interesting story on the front page in the print edition of today's Wall Street Journal with an eye-catching but gratuitously offensive and grossly inaccurate headline: "Maybe Mummy Should Have Laid Off the Salt." We had to respond :

There has been exactly one clinical trial of the effect of low-salt diets on cardiovascular morality and rehospitalization for congestive heart failure. That study confirmed observational studies and showed conclusively that low salt diets produced greater mortality. See the article in Clinical Science, "Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? " It concludes: "The results of the present study show that a normal-sodium diet improves outcome, and sodiumdepletion has detrimental renal and neurohormonal effects with worse clinical outcome...."

So, perhaps the mummy should have used more salt during life -- as well as the salts used in the mummification process.

It's headline writers like this that are responsible for newspapers coming in dead last in terms of consumer confidence .

Scientists generally accept that 24-hour urine samples are the most accurate means of measuring sodium intake -- the "gold standard" for dietary sodium just as randomized controlled trials are the "gold standard" in the hierarchy of levels of evidence.

With that as background, how should we understand the claim by the Heart and Stroke Foundation (Canada) which "revealed" today that "500,000 kilograms of salt have been removed from the food supply in the last four years by companies participating in the Health Check program." HSF's health policy director equated the amount to "20 dump trucks of salt."

On its surface, the claim is that the total food sold over the past four years bearing a Health Check logo contains a half million kilos less salt (that figures to 550 tons of salt). Every year, Canadians consume about 130,000 tons of salt. So over four years, Canadians consumed a half billion tons of salt (520,000). In other words, this effort is claimed to reduce Canadians' salt intake by 0.1%.

But is it true? The claim can only be evaluated if we also know the answers to these questions:

1. Compared to the baseline four years ago, what was the composition of the foods bearing the HSF label? If the quantities and/or configuration of the sales differed, what can be said about the 500,000 gram number? If people, for example, are eating less of these foods (because they don't taste good or cost more) the number is invalid. But even more:
2. Compared to baseline, what other foods are Canadians eating and in what quantities? If they are eating less salt in Health Check foods, are they simply eating that salt in other foods?

No, the entire exercise is entirely bogus.

What we need to test the proposition (and we're all for the test!) is to track the total sodium consumption for a representative sample of Canadians randomized to consume a diet including as much as possible all the Heart Check foods and compare that over a year or two, with those randomized into a control group which eats whatever they want. The outcome would be ascertained by frequent collection of 24-hour urine specimens and the analysis done in blinded fashion.

Evidence suggests that physiology determines sodium consumption, not package labels. If an individual consumes "low salt" foods, they may simply eat additional quantities of food (and extra calories) to satisfy this innate "salt craving" automatically determined by the body to reflect that individual's varying need. That's why research shows such a consistent pattern of salt intake between populations and over time .

Most visible among their food industry peers in claiming "credit" for reducing salt in their product lines, ConAgra Foods and Campbell Soup both have declining customer satisfaction scores from baseline, according to the American Customer Satisfaction Index released today. ConAgra, in fact, finished dead last among the 13 named larger companies (and below the "all others" category).

On a 0-100 point scale in the ACSI, food manufacturers averaged 83 points with Campbell Soup lagging in 12th place with 82 and ConAgra dropping 6 points to 78. Leaders were H.J. Heinz with 89 followed, at 87, by Hershey, Quaker (PepsiCo) and Mars.

ACSI produces indexes for 10 economic sectors, 44 industries, and more than 200 companies and federal or local government agencies. Among all industries , manufacturers earned 81.5. Laggards were newspapers, cable/satellite TV companies and airlines (63 and 64). They, together with telephone companies (69), were the only private sector businesses with customer satisfaction as low as the federal government at 69.

ACSI is sponsored by the American Society for Quality, the University of Michigan's Ross School of Business and Cloes Fornell International.

TheWashington Post just released a story that the U.S. Preventive Services Task Force has concluded that mammograms are unwise for younger women. Post reporter Rob Stein describes the USPSTF as "an influential federal task force" and "the federal panel that sets government policy on prevention."

We could only hope that his description was true. In fact, the USPSTF has been trying to steer the federal government away from "junk science" and towards "evidence-based" health interventions for years. This may be, as Stein sums up, a "radical change" in public health recommendations.

Perhaps now people will pay more attention to what the USPSTF concluded back in 2003 and maintains today: our present policy discouraging salt intake in the general population may be politically-correct, but it is a scientifically-flawed policy. The USPSTF has studied the question and found insufficient evidence to make a general recommendation for the public .

We'd all be better off if the US Prevention Services Task force was, indeed, the influential panel that sets government policy on prevention that the Post postulates.

William Grimes book Appetite City: A Culinary History of New York , reviews the City's rich ethnic heritage evolving out of humble beginnings as Nieuw Amsterdam. He cites the increasing popularity of "ethnic" dining as the City's greatest achievement as a "food city."

By ironic coincidence, the book appeared a year ago, when the City launched an initiative that would eviscerate the sale of ethnic foods in Big Apple grocery outlets and decimate ethnic dining in the city. The health department, basing its campaign more on political correctness than sound science, is trying to persuade grocers and restaurateurs to provide shoppers and diners only low-sodium versions of the foods they love. Imagine a low-salt salt bagel. How about a corned beef on rye or hot pastrami? No, can't have that, they're cured in saltwater. Choose your favorite ethnic cuisine and you'll find it impossible to enjoy without salt; it's the quintessential ingredient in ethnic foods.

Literally millions of immigrants entered the US through New York City and, for example, there are 3.3 million Italian-Americans in the New York metro area and extensive number who themselves or whose families emigrated from Greece or other Mediterranean countries -- whose diet is deemed the healthiest in the world (pdf 592.83 kB) . Even though newly-reelected, I doubt Mayor Bloomberg wants to tell them to turn their back on their ethnic culinary heritage -- or encourage them to dine in Hoboken, Hempstead or Yonkers.

Less than 2 years ago, China was paralyzed by a massive snowstorm resulting in $22 billion in economic losses , massive closures and disruption to transportation and travelers and significant loss of life and limb.

News this week shows the wake-up call to improve winter maintenance went unheeded.

On November 13, China Daily reported:

The country was blanketed by heavy snow and pummeled by severe weather yesterday during the third consecutive day of harsh weather.

The whiteout left several people dead and caused hundreds of injuries. It also froze traffic in many cities and grounded hundreds of flights.

Tens of thousands of people and vehicles were stuck along 21 expressways in seven provinces. Power supplies were lost in some parts of the country, the China Highway Information Service said on its website yesterday.

…

The heavy snow was the reason for at least six deaths and caused upheaval to around 630,000 people in Hebei (Province). The direct economic loss there has reached 400 million yuan ($59 million), according to the provincial civil affairs department.

…

Thousands of passengers were stranded at Beijing's two airports and its five railway stations.

Beijing Capital International Airport cancelled 59 flights and delayed hundreds of others.

Rush-hour traffic yesterday was heavily congested after several pileups and many expressways between the capital and Hebei province were closed.

Beijing's transport authority also canceled 44 bus routes from downtown to nearby destinations.

The next day, the same outlet reported worsening conditions :

The death toll rose to 21 in North China on Friday as storms continued to ravage the region.

The snowstorms left a trail of destruction that will cost more than half a billion dollars to repair, the Civil Affairs Ministry said on Friday.

Heavy snow, which has not been seen in the region for decades, left 21 people dead in seven provinces, the ministry said on its website.

The number does not include deaths came in traffic accidents that were connected to the storms that began on Nov 9, the ministry said.

China has come a long way in recent years and consumes more concrete every year than any other nation, much of it to build new, modern highways. One hopes they soon discover what developed countries well understand: operating the highways in winter weather is possible, and essential to preventing the kinds of economic disaster that unavoidable but predictable snowstorms can cause in the absence of effective winter maintenance.

Modeling losses from inadequate snowstorm response in the U.S. shows that economic losses from a single day’s snowfighting failure imposes greater costs than providing a full winter’s snowfighting service . That’s a massive “competitive advantage” for the U.S. economy.

At a Washington, D.C. panel hosted by the Pan American Health Organization (PAHO) November 3rd, panelists representing the International Council for the Control of Iodine Deficiency Disorders (ICCIDD), US Agency for International Development (US AID), Health Canada, PAHO, US Food and Drug Administration (FDA) and the International Life Sciences Institute (ILSI) affirmed unanimously that there is no conflict between the global campaign to iodize salt and efforts in many countries to moderate salt intake levels.

Representing ICCIDD Americas Regional Coordinator Eduardo Pretell, former minister of health from Peru, explained that as salt intake levels may vary, or as the iodine contribution of iodized salt changes within the overall diet, salt iodization programs have proved they can simply and easily adjust the level of iodine fortification. He emphasized the necessity of systematic monitoring of iodine sufficiency either through measuring the household use of iodized salt or, better, through regular population surveys of urinary iodine excretion.

Pretell also pointed out that there is no evidence that countries which iodize salt consume different amounts of salt from those that have inadequate iodization, nor has salt consumption changed when a country achieves salt iodization. He emphasized that special care must be taken to ensure adequate iodine intakes for pregnant and lactating women and educational efforts directed to these groups urging use of iodized salt as part of any population salt reduction effort.

He reminded the group that iodine deficiency is a perpetual threat for persons living in areas with iodine-deficient soils and that, for those areas, universal salt iodization is the consensus strategy to improve iodine nutrition because fortifying salt with iodine is the easiest and least expensive option.

Pretell’s comments were amplified by Dr. Omar Dary from US AID who spoke generally on micronutrient fortification, but chose virtually all his examples from salt iodization initiatives. Dary explained that salt is the ideal carrier for iodine and other vital nutrients because its intake is consistent and predictable. He warned that the U.S. is at risk of iodine deficiency, urged American food processors to use iodized salt and reiterated Dr. Pretell’s insistence that monitoring is the key to success in salt iodization.

The importance of Dr. Dary’s advocacy for food processors to use iodized salt was brought home by Dr. Eric Hentges, president of ILSI, who presented new data confirming that, in the U.S., about three-fourths of salt is consumed as part of processed foods (none of which is iodized).

The other speakers confined their remarks to advocacy of salt reduction, but all affirmed the importance of successful salt iodization.

This graph may be even better than the Marshall Foch quote in explaining Tuesday's election results. It's from today's Casey's Daily Dispatch . CBO is the Congressional Budget Office.

The image. The analogy. Perfect. Enjoy this blog, "Pelosi as Foch " by John Feehery featured in The Hill today. Another way to put it: the best defense is a good offense (if you can mount a good offense!).

Tiffany & Co, East Hampton, NY, will host a royal art exhibition November 7 through February 28 featuring the textured, colorized salt art of The Salt Queen, Bettina Werner. Tiffany manager Kristina Klug announced "Crystals of the Winter Sea ":

History has taught us the most accomplished artists are those that have a recognizable medium that one can spot from far away – a language of art. Bettina Werner has truly created an entire unique language with her textured salt technique translating to all who encounter her artwork around the globe. It is unmistakably and synonymously profound.

Ms. Werner’s striking paintings created with Salt crystals have been recognized and selected from prestigious collections in the U.S and Europe exhibited all over the world from the Whitney Museum, Pushkin Museum in Moscow, Portofino Museum Italy, The Detroit Institute of Arts, Triennale Museum in Milan, Chase Manhattan Bank, to the collection of Herbert and Dorothy Vogel.

House speaker Nancy Pelosi (D-CA) unveiled her version of healthcare reform at a highly-orchestrated news conference yesterday. Featured in coverage in the Washington Post was the fact that the event featured 50-pound bags of salt -- used to anchor the background staging for the outdoor event against gusty winds,

six 50-pound bags of salt -- ice-melting salt, to be specific -- placed on the bases of the six U.S. flags on the stage to keep them from toppling over in the wind and marring the event with unwanted visuals and ruinous metaphors.

The Post headlined the speaker's rollout: "Rally has a lot of salt, but little pep."

Who knew salt would get dragged into the healthcare debate?

Matthew Continetti's editorial, "The inevitability myth," in the November 2nd Weekly Standard asks: "Did the Democrats become Calvinists when we weren't looking?" Continetti discusses the Obama/Reid/Pelosi strategy to pass healthcare reform. They argue, he says, that passage is "inevitable" given the overwhelming partisan majorities on both sides of Capitol Hill. He notes "lately they've been talking a lot about predestination" and claim enactment is "foreordained."

Healthcare reform is a discussion for another forum. Some might find the same pattern for other issues like global warming or the electronic bombardment of those living under high-voltage transmission lines. As usual, I see a salt connection.

I was struck by the synergy of the Standard's construct with an observation noted here in the past: how salt reduction activists have been prying into citizen's lives and larders. We had in mind more the "fire and brimstone" Puritans seeking to affix the "Scarlet S" on the nutritionally/politically incorrect than the Puritans' Calvinist forebearers . But it's much the same.

Now that we think of it, the second strand of strategic embrace of predestination/foreordaination as a rhetorical tool would also characterize these salt nannies. While reasonable scientists find evidence of elevated risk for significant portions of the population with a one-size-fits-all salt reduction strategy and others find evidence that human's salt intake is a physiologic appetite not a choice that can be educated or regulated, these New Calvinists gloss over the scientific controversy and want to skip ahead to "implementation," churning up group endorsements to add momentum to their version of "the inevitability myth."

Science, like time, would seem to answer this myth. Over time, population salt intakes are unchanged. Moreover, it may not be due to sinful choices of salty foods nor the perfidy of food manufacturers who (take your choice) either stuff their products with hidden salt or make wild health claims that low-salt products have proven health benefits. Salt intake, the science now suggests, is the direct result of neural signals from the brain controlling an unconscious salt appetite. Some may see intelligent design. We think it's heavenly.

Pointing to recently published evidence that salt intakes are unchanged over decades and in a range above that recommended in the Dietary Guidelines for Americans and may, therefore, reflect physiological signals of need and not consumer behavior, the Salt Institute has renewed its call to abandon numeric targets for Americans' salt consumption.

In formal comments today to the Dietary Guidelines Advisory Committee (pdf 36.38 kB) , Richard L. Hanneman, president of the Salt Institute pointed out that the body's consistent physiological salt appetite has the perverse result of increasing caloric intake instead of curtailing dietary sodium.

The Institute called for further study and for replacing the numeric target in the 2005 Guidelines with a call for "moderation" as contained in Guidelines beginning in 1980 until 2000.

Detroit Salt Mine was awarded the Sentinel of Safety Award today by the National Mining Association (NMA) and the U.S. Department of Labor’s Mine Safety and Health Administration (MSHA). The award is presented annually to those mines with the best safety records in the country.

Sentinel of Safety winners are those mines that have worked the most employee-hours without experiencing a lost-time injury. Detroit Salt Mine worked 97,132 injury-free hours in 2008. The competition reflects the continuing commitment by mining companies to a goal of zero injuries and fatalities and a steadily improving safety record.

Detroit Salt Mine president, Janette Ferrantino, was in Washington to accept the prestigious award, stating, “We are extremely proud of our team and their dedication to safety and continuous improvement. They are dedicated to creating a safe work environment every minute of every day.”

Mining is inherently difficult work. Due to extensive training, education and technological advances there has been a 61 percent reduction in the rate of mining injuries from 1990 to 2008, according to MSHA data. Detroit Salt Mine vice president, E.Z. Manos commented on the challenges of underground mining: “Underground mining is demanding work, but employee safety is our number one priority, so this award means a great deal to our company.”

Sometimes when telling the truth isn't "politically correct," messages in the mainstream media receive short shrift. Elitism trumps the views of the "man on the street." We've seen it blatantly in coverage of the salt and health issue. But as Bobby Dylan famously sang "the times they are a-changin.'" Today's Times (London, UK) carried a story dismissing efforts to demonize salt intake ("Is salt really the devil's ingredient? "). No, concludes journalist Peta Bee, quoting the chief dietitian at London's St. Georges Hospital, Dr. Michael Alderman from the Albert Einstein College of Medicine and Dr. Paul Whelton of Loyola University.

While these experts weigh-in saying the scientific evidence against dietary salt has been over-interpreted and anti-salt campaigns overblown, the often missed story is found in the "Comments" that regular readers contribute. They may not be "informed" by the science, but they reflect well-earned experiences that offer practical tempering to elite PC opinion. Consider these:

• "I find it very annoying that I was forces to eat tasteless food throughout my childhood due to my bother's belief that salt is bad." -- Genevieve Wilkins
• "I have often wondered why salt licks were provided for animals. We are animals, aren't we?" -- alan burden
• "I have truly believed for many years that if the government says salt is bad fro us, in time the opposite would prove to be true...how much taxpayers' money is wasted on health propaganda campaigns." -- Nicholas Mayes
• "It's funny - my horse's vet tells me that adding salt to feed isn't a problem....Odd how it's so difference in humans - almost like it's just an excuse for the government to interfere and tell us all how to live our lives, isn't it?" - K Charlton
• "Nanny doesn't always know best." - Chris Palmer
• "Be extremely careful about the anti salt message. I cut out salt on this advice, then moved to a sub tropical country and became seriously ill, with low salt at least one of the causes." - Paul Flynn

There seems to be a bubbling up of resentment about dietary diktats that may make holding the line on the anti-salt message akin to the fall of the Berlin Wall -- its demise could be more sudden and complete than "intelligence" estimates.