Salt is so basic to our existence we often forget its life-saving role as an essential nutrient; consider oral rehydration therapy which has saved millions of lives, particularly in Africa. But salt is not only essential to life, it plays a key role combatting mental retardation; consider the enormous achievement of iodized salt.
New York Times columnist Nicholas D. Kristof does just that. In today's paper, he reviews the enormous paybacks of salt iodization, "Raising the World's I.Q ."
Salt does have a real downside, Kristof admits -- "it's so numbingly boring, few people pay attention to it or invest in it. (Or dare write about it!)." I guess we here at the Salt Institute are so insensate we didn't realize that salt was boring or unworthy of attention so count us among the few.
Thankfully, Kristof is one of the few as well. With his proselytizing, perhaps the few will become many.
Although the study was conducted in an at-risk population being treated for congestive heart failure (CHF) and, therefore, not directly comparable to healthy populations, yet another study has found reduced-sodium diets creating health risks.
A study by an Italian research team led by Salvatore Paterna and Pietro Di Pasquale on "Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure " in the October issue of Clinical Science asks: "Is sodium an old enemy or a new friend?"
Friend, according to the data. Lowering dietary sodium stimulated plasma renin activity (PRA) and aldosterone production.
The normal-sodium group had a significant reduction, P less than 0.05, in readmissions. BNP values were lower in the normal-sodium group compared with the low sodium group (685±255 compared with 425±125 pg/ml respectively; P
When PRA and aldosterone levels are high, multiple studies have shown subjects have significantly higher incidence of heart attacks and cardiovascular mortality.
Thus, the study concluded: "a normal-sodium diet improves outcome, and sodium depletion has detrimental renal and neurohormonal effects with worse clinical outcome in compensated CHF patients."
The 2010 Dietary Guidelines Advisory Committee has begun its five-year review of the science behind the government's recommendations for U.S. food consumers -- all of us!
In its latest Salt and Health newsletter, the Salt Institute examines "The Evidentiary Foundation of our Dietary Gudelines " and finds that foundation is built on sand, not rock. The article recounts a 2007 review of the process by the Institute of Medicine of the National Academy of Sciences which confirmed that the scientific review of the diet and disease data was based on the opinions of respected authorities -- the lowest level of evidence -- rather than on controlled trials of dietary interventions. That review drew on a New York Times Magazine story on "Why can't we trust much of what we hear about diet, health and behavior-related diseases?" The Salt Institute endorses an "evidence-based" approach as opposed to the "opinion-based" recommendations produced in the current process.
It appears that we finally have something that we can agree upon with the Center for Science in the Public Interest (CSPI) . According to a recent article prepared by Merrill Goozner of the at CSPI, and repeated by Marion Nestle in her blog , nearly half the new 2010 Dietary Guidelines Advisory Committee's 13 members have taken funding from the food and pharmaceutical industries. Of common interest is the Chairperson of the Committee, Dr. Linda van Horn, professor of preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago. We are not aware of any conflict of interest involving research funding, however, during the first public meeting of the DGAC, Dr. van Horn recalled an experiment that she had done as a graduate student, which she stated proved without doubt that children who were fed reduced salt diets ended up abhorring the typical salt levels in many foods. Thus, she revealed the personal bias she brings with her as she assumes the chair of a committee tasked with the 'objective' evaluation of all the data on salt and health to be used as a base for future recommendations.
It is interesting to note that CSPI, Marion Nestle, and the preponderance of professionals in the medical community choose to define conflict of interest almost exclusively in terms of funding received from outside (particularly industry) sources. What they seem to totally ignore is the overwhelming bias resulting from personal ego, and a lifelong investment in a particular point of view on a subject. Such an all-consuming passion usually results in a conflict of interest greater than any motivated by research funding. Clinical researchers who have promoted a particular theory for decades are very unlikely to change their minds easily. Many brazenly belong to advocacy groups that publicly espouse their positions. How can they be expected to objectively evaluate data that may make decades of their investment worthless? Yet, there they are - fully prejudiced by preconceived positions - and placed in a position of public trust to make objective evaluations.
Thus, we have one of the greatest hypocrisies in modern medicine - biased researchers sanctimoniously pointing their fingers at the 'conflicts of interest' of others.
Physician, heal thyself.
As we pointed out in an earlier article, the chairman of the sub-committee for Fluid and Electrolytes for the 2010 Guidelines is Larry Appel. Dr. Appel is one of the world's most outspoken anti-salt advocates and is listed as a member of World Action on Salt and Health (WASH) , an advocacy group whose singular aim is: "to achieve a reduction in dietary salt intake around the world." In their justification for salt reduction , WASH focuses almost exclusively on hypertension to the virtual exclusion of all other risk factors and biomarkers responsible for overall health outcomes. They systematically ignore all data (including the Cochrane review and its latest reissue - ) as well as the most recent evidence that demonstrates the net negative health outcomes from reduced salt diets. How any member of such an advocacy group could possibly be selected (much less lead) what is supposed to be an objective advisory group is quite astonishing and black mark on the Institute of Medicine as well as our National Academy of Sciences under which it operates. It is not as if the IOM were unaware of this conflict of interest. They simply choose to ignore it, confident in the belief that they can pass anything off as legitimate science.
And why not? When has the medical establishment ever been called out, no matter how egregious their behavior or advice has been? How many people marched on the IOM or the AMA offices to protest the countless deaths resulting from the hormone replacement therapy fiasco. When it comes to medicine, people suffer silently - and the establishment gets a free pass.
Such hypocrisy does not bode well for the future of objective medical science in this country.
Recently, the Department of Health and Human Services launched their first Physical Activity Guidelines for Americans . This was in direct response to the national obesity epidemic whose effects can be seen everywhere. The U.S. Centers for Disease Control have stated that adult obesity rates doubled since 1980, from 15 percent to 30 percent while childhood obesity has almost tripled during the same time period, from 6.5 percent to 16.3 percent.
While it is great that these new guidelines are here, it is fair to ask why it took so long for them to be published. The answer to that is clear. The responsibility for carrying out physical activity is almost entirely in the hands of individuals. If individuals don't make the effort to do physical exercise, then there is no one to blame but themselves. This is, of course, much more related to adults than children. For children, it is both the home and school environment that is largely responsible for the amount of exercise they do.
Because of the great degree of personal responsibility associated with physical exercise, there has been little attention paid to this issue on the part of consumer advocacy groups, whose political capital is largely the result of finding businesses and large institutions to blame for problems. With reference to the obesity epidemic, consumer advocacy groups invariably blame the food industry for producing high fat, empty calorie foods, and, to a lesser extent, they blame the government for not regulating the industry. It is a very rare occurrence when a consumer advocacy group calls on consumers to bear their share of the responsibility for managing their lifestyle and matching their food consumption with energy expenditure through physical activity.
Thus, while the Physical Activity Guidelines for Americans has just been published, the Dietary Guidelines for Americans is in the process of preparation of its sixth iteration since 1980.
It is strange that it is only since the first iteration of the Dietary Guidelines for Americans that we have experienced the obesity epidemic. This does not say much about the effectiveness of the Dietary Guidelines and the people or institutions that have developed them. Considering what has happened to our physical condition in the last quarter century, one wonders if Americans would have been better off without the Dietary Guidelines. Is it possible that this could have been corrected if the Physical Activity Guidelines were issued at the same time? Not likely.
As much as the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) assure us that the Dietary Guidelines are evidence-based, they are about the worst example of this that anyone might choose. The Dietary Guidelines are predominantly based upon opinion - the absolutely lowest level of evidence in the hierarchy of acceptable evidence. In fact, some of the evidence upon which the Guidelines are based is so subjective, there have been complaints that certain of the Guidelines should never have been issued. Unfortunately, there are certain segments of our society that have an burning desire to provide guidance, no matter how ill-advised.
If you consider both the Dietary and Physical Activity Guidelines, you will see that they don't really relate to one another. (It is interesting to note that the Physical Activity Guidelines are issued by the HHS alone, while the Dietary Guidelines are issued jointly by HHS and USDA - are there some issues at play here?) While food products carry labels that indicate the energy content (calories) of each serving, it is almost impossible for consumers to easily translate this into the amount of physical activity required to expend the energy taken. People who watch their weight and exercise regularly are an exception. They have a good idea of what extra energy will have to be burned off in order to make up for extra food consumption. If they treat themselves to a few extra chocolate chip cookies, then they put in the effort to jog for an extra half hour in order to burn the calories off.
Instead of putting calories on the food label, why don't they put the physical activity equivalent on, so that people will have an idea of what they have to do to get rid of that additional intake. That is the sort of thing that will link the Dietary and Physical Activity Guidelines together - calories by themselves simply don't convey the energy input/output message to consumers.
Getting consumers to relate their diet to physical activity and energy expenditure is not rocket science. It does, however, require a sensitivity to the needs and awareness of consumers rather than a focus on political expediency and a compulsion to give advice by a medical establishment that has still to learn what food and nutrition are all about.
Britain's Food Standards Agency (FSA) has a target to reduce average salt intakes across the population to 6g per day by 2010. It selected its targets, it says, on surveys from 2000-2001 claiming British men consume 11 g/salt/day and women, 8.1 gpd. The agency announced July 22nd the publication of a survey of Britons' urinary sodium -- the "gold standard" measure for salt intake, "which shows the UK's average daily salt consumption has fallen from 9.5g to 8.6g since 2000." FSA termed the results "an encouraging decline in salt levels," but conceded its pace would fail to achieve the 6 gpd target in 2010 so it unveiled a consultation to "make its voluntary 2010 salt reduction targets, for 85 categories of food, stricter, and set more challenging 2012 targets, for 80 categories of food."
The publication behind the news release tells a different story .
Entitled "An assessment of dietary sodium levels among adults (aged 19-64) in the UK general population in 2008, based on analysis of dietary sodium in 24 hour urine samples," the methodology explains the care taken to secure accurate samples and analysis. So, we can be pretty sure that the 2008 number is sound. The study actually didn't find 8.6 grams, but rather 8.728 grams; it is expressed as 148 mmol Na (a millimole of sodium being equal to 23 milligrams; this assumes, as they mistakenly do, that all the sodium comes from salt, which it doesn't -- no matter). So they misled on the achievement, but still, reduction from 9.5 grams salt (161 mmol Na) would be an impressive achievement. Indeed, FSA continues to boast that it "is encouraged that action to reduce the average amount of salt we are eating on a daily basis is clearly having a positive impact." This, of course is not the proper metric: salt reduction isn't an end it itself. The "positive impact" would be reduced incidence of heart attacks or better than projected cardiovascular mortality -- no matter, here.
The deception arises in the 9.5 gram (16 mmol) "starting point" which turns out to be a phone survey, not a carefully controlled collection of 24-hour urine samples with quality analysis (as was done in 2008).
Fortunately, we have another exceptionally well-done survey of a representative British population. And from a good deal more vantage point so we can see just how much improvement has been recorded. Its size is nearly comparable, 754 in the 2008 survey and 598 in the Intersalt Study published in the British Medical Journal, July 30, 1988. Intersalt sampled three British populations, carefully collected 24-hour urine samples and had them analyzed in a single laboratory. The results? One population had 149.9 mmol; one 150 mmol; and the third, 151.8 mmol. A far cry from the FSA's claimed 2000-01 starting point of 161 mmol. Instead of a 13 mmol reduction to 148 mmol, over the past 20 years Briton's have changed their salt intake virtually not at all (2 mmol, probably within the margin of error).
All evidence suggests that sodium/salt intakes are largely unchanged in most populations over the past century. The high-salt consuming Finns and Japanese claim signficant reductions, but it does lead one to wonder if the "starting points" are valid in those cases.
So, when FSA makes these bold pronouncements of their "progress" in reducing cardiovascular disease in the UK by cutting salt intake, take it with a grain of salt. Ask whether beating up food manufacturers about reducing salt in their foods is really working. Is a 1.3% reduction over twenty years (even if true) worth the effort? Even using the much-lower "real" starting point, the current pace would have Britons' achieving a 6 gpd target not in 2010, but a bit further down the road -- in 2205 if the current trend can be sustained. That is, another 197 years, not two, before reaching the target of 100 mmol (6 gpd of salt). They admit they're behind schedule, but that may just be classical British understatement, right?
Let's be honest in interpreting the data. FSA has made NO PROGRESS despite the enormous pain it has inflicted on British food manufacturers and diverting resources to supporting "Sid, the Slug" has postponed real progress in improving Britons' health. No wonder FSA prefers to make up number about salt intake than face the proper challenge of improving public health.
The UK Food Standards Agency (FSA) conducts mini surveys amongst consumers on a quarterly basis in order to monitor changes in consumer attitudes towards food related issues. The latest survey was just published and there were some interesting surprises.
Despite a costly public relations campaign demonizing salt, including many television ads, which named and shamed manufacturers for the salt content in their foods, the latest mini survey revealed that consumer concerns over salt has dropped dramatically. In fact, consumer concens with salt are at their lowest level since December 2003 - years before the FSA began its aggressive anti-salt campaigns, including "Sid the Slug " and "Your Food is Full of It ."
Bravo to the British consumer. It is a fitting tribute to the quote, "You can fool some of the people…."
Terri Coles of Reuters (Toronto) recently wrote an interesting article on the new Dietary Guidelines. Coles is one of the few writers who wisely made reference to the Yeshiva University study , written by Marantz, Bird and Alderman, from the Albert Einstein College of Medicine and published in January, 2008 in the American Journal of Preventive Medicine. The authors wrote that the members of the Dietary Guidelines Advisory Committee should use explicit standards of evidence in making their nutritional recommendations. If not, their recommendations could end up producing unintended consequences that may have a negative impact on public health.
Most importantly, the authors proposed that there should be alternative and more rigorous standard for evidentiary support, and went as far as to state that when adequate evidence is not available, the best option may be to issue no guidelines . Now, how courageous is that?
Imagine - saying that you should not make any recommendations until you have reliable data - extraordinary!
The New York Times, like the Washington Post, loves to "blow the whistle" on bad actors, be they corrupt politicians, greedy businessmen or hypocritical "public interest" groups. Yesterday's Science column by John Tierney on "'Misleading' Research From Industry ?" revisits a subject of repeated comment in our blogs. We've pointed out that every funding agency has an agenda when it ponies up to support health-related research. The solution: examine the methodology and the integrity of the analysis. Too often, industry-funded studies are dismissed for bias while government-funded studies are given a free pass (despite numerous examples of why they shouldn't).
Tierney briefly reviews the disparagement of industry-funded studies, lamented by the British Medical Journal as creating a "hierarchy of purity among authors," and reports:
Now some researchers have looked to see what kind of hierarchy actually exists. After analyzing weight-loss research conducted over four decades, they've found that the quality of data reporting in industry-sponsored research does seem to be different from that in other research: It's better.
The study, published in the International Journal of Obesity , concluded: "while continued efforts to improve reporting quality are warranted, such efforts should be directed at nonindustry-funded research at least as much as at industry-funded research."
Ironically, the article appeared concurrent to the first meeting of the new 2010 Dietary Guidelines Advisory Committee whose salt subcommittee chair has enjoyed millions of research dollars leading to reports that endorsed the official government policy of universal sodium reduction while specifically opposing release of the data in those studies for independent expert analysis. So, if the Gray Lady wants another whistle-blowing target there are surely many choices.
Before the age of science, the influence of the classical Greek philosophers was so overwhelming that their simple opinions were taken as divine edicts. Anaximander (610-647 BCE) spent a good part of his life teaching students that animals were miraculously formed out of pure moisture and Aristotle (384-322 BCE) proposed that animals spontaneously arose out of soil, plants or even other species of animals. These opinions resulted in the theory of the 'spontaneous generation' of life, which held sway until the Middle Ages and beyond. Even Van Helmont (1578-1644), the famous Belgian physician and chemist, recorded detailed recipes for the preparation of spontaneously generated mice. For 2,000 years, polemics were the only means of explaining nature, for never once in the history of the debate had anyone ever thought of actually carrying out experiments to prove or disprove the validity of their theories. Francis Bacon (1561-1626) was among the first to seriously question these dogmatic theories and insisted that only careful experimentation and precise observation would lead to the truth. He became the period's most eloquent proponent of methodical experimentation and has often been referred to as the 'Father of the Scientific Method'.
In applying the scientific method to the practice of medicine, the notion of "evidence-based" medicine developed. Although it is not a new concept, it has had a renaissance in recent years, and now everyone refers to their brand of practice as evidence-based medicine. The one institution that rigorously adheres to the strictest principles of evidence-based medicine is the Cochrane Collaboration . Unfortunately, within other organizations, the term "evidence-based" is often used rather loosely and routinely ignores the rigorous discipline upon which the practice is based. What is worse, there is a lack of understanding of what quality evidence actually is. The following is the accepted understanding of the hierarchy of evidence to be used in making evidence-based evaluations:At the very bottom of the quality of evidence pyramid are ideas and opinions. They are exactly the sort of pronouncements that Bacon railed against. Even expert opinion cannot be compared to scientifically generated evidence. Yet, the Dietary Guidelines and the Dietary Reference Intakes (DRIs) upon which the Guidelines are established are predominantly based on opinion - the lowest level of evidence. In fact, when the initial call for comments to the Dietary Guidelines Advisory Committee was announced, our input focused squarely on that issue. Quoting from "The Development of DRIs 1994-2004: Lessons Learned and New Challenges ," our comments (comment ID 000010) highlighted what a number of scientists originally involved with the development of the DRIs were now saying - that we have to get away from expert opinions and start basing our judgments and policies on much more rigorous science.
Unfortunately, that is not what we witnessed at the first meeting of the Dietary Guidelines Advisory Committee (DGAC) meeting held October 30-31, 2008.
As was the case with the 2005 Dietary Guidelines, the chairperson of the sub-committee for Fluid and Electrolytes for the 2010 Guidelines is Larry Appel. As it happens, Prof. Appel is listed as a member of WASH , an advocacy group whose singular aim is: "to achieve a reduction in dietary salt intake around the world." In their justification for salt reduction, WASH focuses almost exclusively on hypertension to the virtual exclusion of all other risk factors and biomarkers that are responsible for overall health outcomes. They systematically ignore all data (including the Cochrane review and its latest reissue - ) as well as the most recent evidence that demonstrates the net negative health outcomes from reduced salt diets . How a member of such an advocacy group could be selected to lead what is supposed to be an objective advisory group is quite astonishing.
At the opening meeting, Appel made his presentation to the Dietary Guidelines Advisory Committee selectively picking all evidence that supported his salt reduction agenda and ignoring all else that didn't. He mentioned a number of NHANES studies, but ignored the most recent one as well as all others that did not agree with his opinion.
When another DGAC member brought up the issue of the possible negative consequences of reduced iodized salt consumption, Prof. Appel repeated a statement he made at a recent FDA hearing. "There is no problem with iodine in this country. We don't have goiter anymore." This was a typical Greek philosopher's statement. As it happens, our iodine values have been dropping steadily during the past 30 years, and although they are not yet at a level that would be considered a public health emergency, they are tending that way . As a result of Appel's pronouncement, there was no further discussion of the iodine issue.
All in all, the first meeting of the DGAC was a great disappointment. It appears that we are once more headed towards a series of recommendations that will result from a process based far more upon opinion than on scientifically-derived evidence. It was like retreating to the notion of spontaneous generation. This is just not on, and we will continue to do whatever we can to ensure that this process get back on track and be the product of objective science, not subjective personal opinion.
As the Mark Twain observed: "Figures don't lie, but liars figure." You may have seen the headline recently heralding research that concluded that a third of all serious heart attacks can be attributed to the "fried and salty foods" in the "Western diet." Not so fast says Sandy Szwarc in Junk Food Science .
The analysis is classic "dredge data," Szwarc points out. The researchers excluded more than half the sample without explaining how the excluded subjects compared to those retained in the reported results. The data themselves were derived from a highly inaccurate post-heart attack dietary recall survey. And that typified a series of built-in biases that included "information bias," "selection bias," "observation bias," "recall bias and reverse causation." The analysis, too, confined to risk factors, was faulty with many key factors not controlled. She commends, as we do, a further read of the work of John P. Ioannidis, M.D., with the Institute for Clinical Research and Health Policy Studies at Tufts-New England Medical Center on "Why most published research findings are false ."
The way forward, she avers and we wholeheartedly agree, is with an evidence-based approach as pioneered by the Cochrane Collaboration. She explains how the process worked in a Cochrane Review of the role of anti-oxidants in cardiovascular disease . She doesn't mention it, but the Cochrane Review on salt and cardiovascular disease concluded there is no scientific basis for a population reduction of dietary sodium. First issued in 2003, that finding was reviewed and affirmed earlier this year.
This blog post should be required reading for every medical journal editor. Go figure.
Thirteen prominent scientists will constitute the 2010 Dietary Guidelines Advisory Committee (DGAC), just named today. All are content area experts. Their views on developing evidence-based recommendations instead of past DGACs' expert opinion summaries will be determined beginning at the first DGAC meeting next Thursday and Friday. Stay tuned.
Most discouragingly, the sole appointee with a "salt" background is Dr. Larry Appel, appointed despite an obvious conflict of interest not only as a partisan in the anti-salt lobbying fraternity, but the leader of the 2005 DGAC effort which included, for the first time ever, a numeric goal for sodium intake -- a level that further research has already found problematic.
From the USDA release, members of the 2010 DGAC consists of:
Linda V. Van Horn, PhD, RD, LD, (Chair) Professor and Interim Chair, Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. Dr. Van Horn has expertise extending across many areas of nutrition research and public health as a nutrition epidemiologist who has conducted population level research in the prevention and treatment of cardiovascular disease, obesity, and breast cancer. She is currently the principal investigator in the Women's Health Initiative Extension Study and the Dietary Intervention Study in Children.
Naomi K. Fukagawa, MD, PhD, (Vice Chair) Professor of Medicine and Associate Program Director of the Clinical Research Center, University of Vermont and Fletcher Allen Health Care, Burlington, VT. Dr. Fukagawa is a board-certified pediatrician and an expert in nutritional biochemistry and metabolism, including protein and energy metabolism; oxidants and antioxidants; and the role of diet in aging and chronic diseases, such as diabetes mellitus. She has chaired the National Institutes of Health Clinical Research Centers' Committee and is currently a member of the National Institutes of Health Integrative Physiology of Diabetes and Obesity Study Section.
Cheryl Achterberg, PhD, Dean and Professor, College of Human Sciences, Ohio State University, Columbus, OH. Dr. Achterberg's research has evaluated the impact of behavior on the dietary patterns of populations, including low-income and elderly Americans. She has served on panels for numerous groups, including the World Health Organization, the Institute of Medicine, and the United Nations as an expert in nutrition education and community interventions.
Lawrence J. Appel, MD, MPH, Professor of Medicine, Epidemiology, and International Health (Human Nutrition), Division of General Internal Medicine, and Director, ProHealth Clinical Research Unit, Johns Hopkins Medical Institutions, Baltimore, MD. Dr. Appel is a physician whose research pertains to the prevention of hypertension, cardiovascular disease, and kidney disease, typically through lifestyle modification, such as dietary intake of sodium and potassium. Dr. Appel served on the 2005 Dietary Guidelines Advisory Committee as a member of the science review subcommittee and Chair of the electrolytes subcommittee. He has also served on several committees for the Institute of Medicine, including the Dietary Reference Intake Panel for electrolytes and water, which he chaired.
Roger A. Clemens, DrPH, Associate Director, Regulatory Science, and Adjunct Professor, Pharmacology and Pharmaceutical Science, The University of Southern California, Los Angeles, CA. Dr. Clemens has extensive experience in functional foods and technology with a special emphasis on probiotics and prebiotics. He has expertise in toxicology and food safety, as well as knowledge of food processing and the food industry. He is a spokesperson for the American Society for Nutrition and the Institute of Food Technologists.
Miriam E. Nelson, PhD, Director, John Hancock Center for Physical Activity and Nutrition, Tufts University, Boston, MA. Dr. Nelson is a leading authority on physical activity and energy balance, with extensive research experience integrating the science of energy balance into behavior change programs. She recently served as Vice Chair of the first Physical Activity Guidelines for Americans Advisory Committee chartered by the Department of Health and Human Services.
Sharon M. Nickols-Richardson, PhD, RD, Associate Professor, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA. Dr. Nickols-Richardson's expertise focuses on dietary and physical activity determinants of muscle strength and bone density, as well as dietary interventions for obesity and nutrition over the lifecycle from child nutrition to older adults. She served the Institute of Medicine as a consultant on the Dietary Reference Intakes book "The Essential Guide to Nutrient Requirements."
Thomas A. Pearson, MD, PhD, MPH, Senior Associate Dean, Clinical Research and Albert D. Kaiser Professor, Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY. Dr. Pearson is an epidemiologist specializing in lipid metabolism and the prevention of cardiovascular disease. He contributed significantly to the American Heart Association's guidelines for prevention of heart disease and stroke, and is as a founding member of the World Heart Forum for Cardiovascular Disease Prevention.
Rafael Pérez-Escamilla, PhD, Professor, Nutritional Sciences and Public Health, University of Connecticut, and Director, Connecticut Center of Excellence for Eliminating Health Disparities among Latinos, Storrs, CT. Dr. Perez-Escamilla is an internationally recognized scholar in the area of community nutrition for his work in food safety, obesity, diabetes, and food security, with a specialty in Latinos and low-income American populations. He is currently serving the Institute of Medicine in re-examining the pregnancy weight gain guidelines.
Xavier Pi-Sunyer, MD, MPH, Professor, Applied Physiology, Columbia University Teachers College and Chief, Division of Endocrinology, Diabetes, and Nutrition, St. Luke's-Roosevelt Hospital Center, New York, NY. Dr. Pi-Sunyer has expertise in obesity, type 2 diabetes, carbohydrate and lipid metabolism, and general medicine with over 250 research papers on these topics. He chaired a National Heart Lung and Blood Institute obesity committee and has served on the Institute of Medicine Dietary Reference Intake Panel on macronutrients. He was also a member of the 2005 Dietary Guidelines Advisory Committee where he chaired the energy balance and weight maintenance subcommittee.
Eric B. Rimm, ScD, Associate Professor of Medicine, Harvard Medical School, and Associate Professor of Epidemiology and Nutrition, Harvard School of Public Health, Boston, MA. Dr. Rimm is an epidemiologist whose research evaluates the impact of lifestyle factors, particularly diet, that relate to the risk for obesity, diabetes, heart disease, and stroke. He is internationally known for his work on moderate alcohol consumption and health and has served on the Institute of Medicine Dietary Reference Intakes Panel for macronutrients.
Joanne L. Slavin, PhD, RD, Professor, Department of Food Science and Nutrition, University of Minnesota, Minneapolis, MN. Dr. Slavin is an expert in carbohydrates and dietary fiber. Her research expertise focuses on the impact of whole grain consumption in chronic diseases, such as cancer, cardiovascular disease, and diabetes, as well as the role of dietary fiber in satiety.
Christine L. Williams, MD, MPH, Vice President and Medical Director
Healthy Directions, Inc., and former Professor, Clinical Pediatrics, and Director, Children's Cardiovascular Health Center, Columbia University, New York, NY. Dr. Williams is an expert in nutrition in cancer prevention and preventive cardiology, especially hypercholesterolemia, in children. She received the prestigious Preventive Cardiology Academic Award from the National Heart Lung and Blood Institute of the National Institutes of Health for her work in preventive cardiology for children.
It would be easy to dismiss the premise of a talk delivered yesterday at the 2008 Joint Meeting of The Geological Society of America, Soil Science Society of America, American Society of Agronomy, Crop Science Society of America, and Gulf Coast Association of Geological Societies, in Houston. But the audience seems serious enough.
Entitled "Taking the salt out of sea water" sound shopworn, but there's no doubting the need for additional supplies of fresh water in many areas. The UN estimates that, globally, 1.1 billion people lack access to sustainable, clean drinking water and that 1.6 million children die each year because of that lack of access. University of Nevada, Las Vegas (UNLV) geoscientist David Kreamer, noting that 37% of the world's population lives within 100 km of a coastline, proposes that mothballed naval ships, such as the decommissioned US aircraft carrier John F. Kennedy, be retrofitted to become mobile desalination plants. He terms it "practical." Sounds like it's anything but that, but at least the idea is being vetted by relevant scientists.
Medical News Today has the October 1 story.
On several occasions, we have reported on the current research linking reduced salt consumption with increased plasma aldosterone levels and their negative health consequences . We have done this as transparently as possible because this observed phenomenon is never considered by salt-reduction advocates. They focus uniquely on blood pressure as a cardiovascular risk factor to the exclusion of all else. It is little wonder that they are at a loss to explain why more people on low salt diets are apt to die than those on regular salt diets. In fact, the BPO (Blood Pressure Only) anti-salt advocates are likely to totally ignore the LSHD (low-salt, high death-rate) linkage.
Well, the LSHD linkage is not going away. The scientific evidence is mounting as can be seen in the most recent publication of Atherosclerosis . In an article entitled, "Dietary salt restriction increases plasma lipoprotein and inflammatory marker concentrations in hypertensive patients," author Edna Nakandakare and co-authors describe the impacts of placing people on low-salt diets .
Their research demonstrated that serum triglycerides, chylomicron-cholesterol, tumor necrosis factors, renin activity, aldosterone and insulin values all increased. They concluded that reduced salt intakes induced alterations in the plasma lipoproteins and in inflammatory markers that are common features of the metabolic syndrome. Metabolic syndrome is the combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes.
It should be noted that this most recent example of the negative impact of reduced salt intakes also showed a drop in blood pressure. This was expected. The difference between this study and the countless salt-reduction advocacy papers that we have seen over the years is that this research went way beyond BPO. It looked at a great many other health outcomes. That's what overall health is - a composite of discrete health effects.
When reduced salt consumption is studied and a composite of health impacts is considered, the overall balance is negative. Yes, blood pressure may drop with reduced salt consumption, but at the same time, there is a cascade of negative health impacts that result on an overall negative health impact. The LSHD phenomenon is not an artifact - more and more research is taking place that will establish its reproducibility beyond any doubt.
It remains to be seen whether the scientists chosen to develop the new set of Dietary Guidelines will adequately consider this phenomenon in their evaluations - lives may depend on it.
Packaged and processed foods sold in the United States started carrying standardized nutrition labels in 1994 when the Nutrition Labeling and Education Act (NLEA) took effect. The major goal was to increase access to nutrition information and improve consumers' ability to make healthful food choices. Since NLEA took effect, technological change has introduced new sources of nutrition information and the consumption of food away from home has continued to increase. But have these measures been effective?
A new report examines how the consumers' use of nutrition labels have changed over the decade by looking at the trend in use of various nutrition label components and demographic groups. The U.S. experience may help policymakers in other countries who are considering mandatory nutrition labeling to achieve public health goals.
The study reveals that in the decade from 1996 to 2006, consumer use of nutrition labels declined. It declined 3% for the Nutrition Facts panel, 11% for the ingredient list, and 10% for the panel's information about calories, fat, cholesterol, and sodium. In fact, only fiber and sugar did not decline over the 10-year period. Sugar held steady while fiber increased by 2% - a telling result.
The decrease in use of the nutrition label was greatest for individuals in the 20-29 year-old bracket.
If you are wondering how the government possibly misunderstood the information desires of consumers, you need look no further that the new UK Food Standards Agency (FSA) report "Consumer Priorities for Sustainable Development "
Not satisfied with spontaneous answers to questions about what is important to consumers when buying food, the FSA researchers prompted them with specific responses. They then combined both the spontaneous and prompted answer for the final result. For example, only 7% of UK consumers were concerned with salt, but after prompting, an additional 27% said they were concerned. This resulted in a grand total of 34%. Talk about fudging!
Is it any wonder we always fail to recognize the consumers' genuine desires?
