Salt has certainly captured a great deal of news in the past 10 days. Since the release of the IOM report on "Strategies to Reduce Sodium Intake ," we have been deluged with countless media reports and numerous requests for interviews. With so much going on, you can't help but wonder how consumers are reacting to all the hype.

It is interesting to examine the reader comments that often follow a news article. The identities of most of the authors who comment are not readily apparent, so it is understandable if their remarks are a bit spirited and sometimes off the point. Many use the occasion to vent their anger and frustration over issues that may not be directly related to salt and health.

As a result, it is sometimes hard to get a sense of how consumers are really reacting to the coordinated attack on salt by our medical institutions and the initiatives under way by many large food companies to reduce the salt content of the products. In other words, how can we tell what's happening where the rubber meets the road?

Two new reports that came out yesterday may give us some insight.

The first was a report in the Food Navigator entitled, "Low-sodium products declined in popularity, says NPD . The NPD Group is a leading provider of reliable and comprehensive consumer and retail information for a wide range of industries. Harry Balzer is vice president of The NPD Group and chief industry analyst specializing on food and diet trends. Balzer and The NPD Group have been tracking the eating and drinking patterns of Americans for nearly 30 years.

The article describes the NPD research, which examined US consumer behavior over the past 30 years and found that, although consumers increasingly say they are concerned about the amount of sodium in their diets, the number of people actually buying products that claim to have low or no sodium has steadily declined. Quoting from the article, “Chief industry analyst at the NPD Group Harry Balzer said: “In my 30 years of observing Americans eating behaviors, there is often a gap between what consumers say and what they do. It’s easier to aspire to a positive behavior than to actually do it."”

The second report was the latest Rasmussen Report just released. The headline read “55% Oppose Government Limits On How Much Salt Americans Consume ." The data from a national telephone survey shows that just 33% of Americans think the government should set limits on how much salt Americans can eat. Most adults (55%) disagree and don't think it's any of the FDA's business. Another 12% are not sure.

It's clear that the huge, coordinated effort by salt reduction advocates around the world have had a very limited impact on the public thus far. That is not to say that the situation will not change, however, we are now getting to a point where some basic truths will start to emerge. In fact, the issuance of the IOM report "Strategies to Reduce Sodium Intake " has transparently revealed what I have been saying for years now – that the IOM fully intends to put the population of the United States into the largest clinical trial ever carried out in history without the knowledge or consent of the people. As stated in their report, a central element of their strategy will be to gradually lower salt intake in stages and then check if any particular stage has demonstrated unintended negative consequences for the population. That is what a clinical trial does! And with very few exceptions the media, which have made the transition from watchdogs to lapdogs, have gone along with it, hook, line and sinker.

We live in interesting times. As you can imagine, the last week was a very busy one filled with numerous television, newspaper and radio interviews. After the IOM press conference to release their report on "Strategies to Reduce Sodium Intake," a key message that we felt was necessary to get out, was the admission on the part of the lead author that the Committee studying the matter never considered the science behind the salt and health issue - but only the strategies required to reduce salt in foods. This was a rather strange admission, since the major part of the IOM Committee consisted of epidemiologists and physicians rather than industry professionals who actually had some knowledge about food formulation. The centerpiece of the IOM 'Strategy' was the recommendation for the FDA to start regulating the salt contents of processed foods and foods prepared in restaurants and foodservice establishments. This would be a dramatic reconsideration of what is an essential nutrient and the oldest and most ubiquitous food ingredient known to humankind. One would expect that a move of this magnitude would be based upon a substantial body of uncontested scientific evidence, but that is very far from the case.

One of the interviewers from a Los Angeles radio station asked me how I might dare to challenge the medical authorities on this matter. I thought it best to ask him for a clarification. Was he referring to the medical authorities that recommended hormone replacement therapy for women and 30 years later admitted that such a strategy had disastrous consequences for women? Or was it the medical authorities that emphatically stated that the consumption of any more than one egg a week would lead to a very ugly and early death from cholesterol-blocked arteries - only to completely recant this advice 20 years later? Or perhaps he was referring to the medical authorities that decreed that frequent PSA measurements were the answer to prostate cancer, only to come out with their most recent recommendations that perhaps it's best not to do PSA tests at all because they can be misleading? Precisely which medical authorities was he referring to? The interviewer admitted that he got the message and dropped the question.

During the course of the actual press conference, I pointed out to the senior author that the impact of salt on health has been reviewed on a number of occasions over the years with mixed results. The latest meta-review of the evidence was commissioned by the German Ministry of Health just last year and concluded that population-wide salt reduction was not justified from a public health point of view. Indeed, it would have been wise for the US to do the same before going ahead with strategies to reduce sodium. Because of the controversial nature in which the evidence has been interpreted, I went on to ask if the international trade implications of salt regulation in food was ever considered in the deliberations of the IOM ‘Strategies’ Committee. The lead author appeared stunned at this question and admitted that the question of trade never entered into their deliberations.

In establishing the Sanitary and Phytosanitary Agreement (SPS) on trade, the United States was one of the leading countries to insist that unjustified measures could not be used to limit trade between countries. Countries would not be able to ban products for public health or safety issues unless it was proven beyond doubt that these measures were fully justified on a sound, scientific basis. For example, because Italians and Greeks have excellent cardiovascular health, exporters of many traditional high salt foods from these countries may find full justification under the World Trade Organization SPS Agreement to declare the regulation of salt in food as a non-tariff barrier to trade and launch an action against the US at the WTO. Since the US has never carried out a large-scale trial on the overall health impacts of salt reduction, and since the sum of evidence remains controversial, the WTO is likely to consider such a complaint valid.

As I said, we live in interesting times.

Relieving the pressure on water authorities to deliver the quality and quantity of water needed for California city-dwellers, winter snows and the state of California's snowpack has allowed the CA Department of Water Resources to increase the 2010 allocation of State Water Project deliveries to 30%.

As recently as February 26, the allocation was a puny 5% reflecting a three-year drought. April snows in the Sierras are responsible for total winter snowfall far above normal. This year, the state received 132% of its normal snowfall; last year, it was only 80% of normal. As late as early April, the allocation had been set at 20%. The state reservoir system had been dangerously low, as this graphic shows (click for a larger version ). Even with the heavy snow, Lake Oroville, the key reservoir, remains at 55% of capacity.

A final snow survey will be done this week and final allocations made.

This won't lead to any short-term changes in the politics of California's water and the struggles of citizens with hard water threats to their home plumbing and appliances, but it's welcome news nonetheless.

The proverb avers: failing to plan is planning to fail." So true. The Federal Highway Adminstration has a new Primer on Safety Performance Measures for the Transportation Planning Process . It's worth a read.

Recently, the American Highway Users Alliance issued an important report on the economic costs caused by the paralysis or congestion caused by failed snowfighting efforts . It mirrors results from earlier studies (1999 and 2004) commissioned by the Salt Institute.

The new FHWA report points out that these economic costs of impaired mobility are overshadowed by the economic savings generated by safe roads. Safety benefits in 85 US metro areas are 1.3 to 4 times greater than congestion costs. Again, the Salt Institute has commissioned the definitive study of the safety benefits of proper winter maintenance, the Marquette Report .

As you read this report, we hope you'll be struck with two facts: 1) performance measures are what drives performance by making possible an understanding of the difference which different interventions produce and 2) that the current crop of performance measures are too blunt an instrument for the delicate operation of timely and effective winter maintenance. The state and federal databases being used may be suitable for many purposes, but their infrequent updating renders then useless for snowfighting planning and operations management. They measure most of the right variables, but an annual figure identifying an at-risk location is inadequate to identify the relationship between, for example, severe winter weather and the consequent snowfighting operations and the safety outcomes.

Special studies like the Marquette Report and a new study underway in Ontario can pinpoint the benefit of applying salt and plowing winter roads, but none of the recommended data sets can produce time- and weather/snowfighting-sensitive data.

A few years ago, a survey of state DOT Safety Management Plans found that none included snowfighting operations among the proven technologies to keep roads safe. That was a travesty then; its even worse today when ever more people depend on highways to deliver safely themselves and the goods and services they demand.

We need every jurisdiction to implement a winter operations component into their community and state/provincial roadway safety plan to identify not only WHERE crashes occur, but WHEN, as in during winter storms on untreated roads.

During the 2008 presidential campaign, candidate Obama complained about how scientists and policymakers in the George W. Bush Administration were perverting the free expression of science. While our choice of examples may have differed, we were in hearty agreement that the government had turned its back on science in the one area we track intensively: science pertaining to salt and health. In fact, the Salt Institute was forced to ask the federal courts to prevent the executive branch from ignoring the data quality standards of the federal Data Quality Act – and the courts demurely determined that the executive branch was immune to judicial oversight in the way it uses scientific data – the final arbiter of its own DQA compliance.

Unsurprisingly, one of President Obama’s early initiatives was to issue, in March 2009, a Memorandum on Scientific Integrity with a promise to have a plan in place to correct the problem by mid-2009. The plan has not yet been released. Examples of impaired integrity in government use of science continue.

One of the most vocal proponents of improving scientific integrity has been Bush-bashing investor George Soros (disclosure: at one time, Mr. Soros was a part-owner of a Venezuelan salt production facility). Soros’ Open Society Institute funded a study to document the threat to scientific integrity within the federal government (“The Scientists in Government Project”) run by George Washington University . The Federation of American Scientists , Government Accountability Project , Scientists & Engineers for America and Union of Concerned Scientists also provided support.

The Project just released its report, Strengthening Science in Government: Advancing Science in the Public’s Interest , and it makes the case that citizens should be very concerned about the integrity of science as portrayed by government scientists. And, we would add: and science controlled and funded by those same government scientists.

The Report takes as its theme Albert Einstein’s observation about the duty of scientists: “One must not conceal any part of what one has recognized to be true.” Tellingly, the Report also quotes a senior manager at the Centers for Disease Control and Prevention (CDC) complaining that “We need supervisors who have the courage to speak up for the science.” (Indeed, when the agency head assiduously leads in the opposite direction).

The Report effectively articulates the challenge:

The (Einstein quote) statement above serves not only as a guiding principle of good science, but as a framework for effective, science-based policy-making. The best public policies are built on a foundation of rigorous data and analyses, widely shared among scientists and the public. The fundamental obligations of a science-based society – advancing the public health, protecting the workforce, safeguarding the environment, developing appropriate energy technologies, defending the nation, and much more – depend on a full and open exchange of ideas, methods, findings, and interpretations.

New scientific knowledge constantly builds on existing scientific knowledge. When information is readily shared, new findings can be analyzed and new hypotheses vetted in an ongoing process that continually generates opportunities for further study and analysis. Science flourishes when scientific ideas are given a fair hearing by colleagues, debated on their merits, tested through replication and further research, and revised in light of new understanding.

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Beyond the merits of advancing science, the open exchange of ideas is also cherished because it is concordant with the ideals of a democratic society. Freedom of information is a core belief in the American system.

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An analysis of the approach to science taken by the five White House administrations that preceded that of President Barack Obama explains, “It is naïve to believe that scientific findings are the sole determinant of policy . . . Much of the funding, direction and use of American science is determined by the federal government and the political biases of the dominant party invariably influence the decisions that get made.

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Policy decisions may be based on science, but they are not purely scientific. Preferences and political considerations shape decisions about regulation, research priorities, service delivery, and program development and evaluation. Nonetheless, the integrity of the science and the validity of the data that informs these decisions must be preserved.

But the report then goes on to explain the "pressures on scientists" employed by government (or hired by government scientists, we'd add):

A "unique challenge" for them is that "they may be expected to represent and advocate for official agency positions, regardless of their personal perspective on an issue. Conversely, they may be barred from presenting conclusions or analyses that are inconsistent with an agency’s stance, even if they are speaking as private citizens."

Okay. We agree on the statement of the problem. And we hope the supporters of the report are sincere. Let’s see if the “solution” is more government-knows-best or whether the new Administration is willing to be measured by the metrics of its lofty rhetoric.

Early indications from CDC on the salt issue haven’t been encouraging, but hope springs eternal.

Last fall, New Yorker science writer and former NY Times correspondent Michael Specter released an important book entitled Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens our Lives . In the NY Times book review, Janet Maslin captured the essence his thesis: "Firing Bullets of Data at Cozy Anti-Science ."

When the IOM produced its report earlier this week on how to implement salt reduction, questions at the news conference about the impacts on health and international trade in processed foods evoked artful non-answers. The authoring panel's chair conceded that the group had not examined the science on whether such a policy would improve public health. And she admitted that the group had not considered how the U.S. would defend its action against the World Trade Organization should FDA be so foolish as to adopt the IOM recommendation.

Though Specter's book deals with a myriad of junk science issues, it is silent on salt. Specter takes jab at celebrity know-nothings like Britain's Prince Charles and targets Dr. Andrew Weil's promotion of vitamin supplements as raising a larger concern -- undermining valid science by equating it with pseudo-science. Says Specter: “The idea that accruing data is simply one way to think about science has become a governing tenet of the alternative belief system....When Weil writes about ‘a great movement toward evidence-based medicine’ as if that were regrettable or new, one is tempted to wonder what he is smoking.”

We expect that a scientist with the appropriate credentials will act like a scientist, not a shaman. But on salt, the quasi-religious fervor has an unstable foundation of pseudo-science and the denialism of the politico-medical establishment -- as rendered in the IOM report -- is, indeed, "hindering scientific progress" and, arguably, "threatening our lives."

Let's "fire bullets of data at the cozy anti-science" behind the IOM report and ask ourselves what data are available to explore the two key questions:

1. While salt intake is related to blood pressure, the relationship is heterogeneous and, more importantly, blood pressure is only one of several important health risk factors impacted by changes in salt intake (others being insulin resistance, plasma renin activity, aldosterone production, sympathetic nervous system activity,etc.) so the proper end point is not BP but rather some "hard" end point like cardiovascular mortality or all-cause mortality or incidence of heart attack, etc. Dr. Alderman, former president of the International Society of Hypertension and current editor-in-chief of the American Journal of Hypertension , summarized this argument in a JAMA piece a couple months ago. The only controlled trial of this question showed low-salt diets had worse outcomes. The observational studies are split with most showing no health benefit of reducing dietary salt.
2. Any health impact of dietary salt depends not on the amount of salt (sodium) in any particular food, but rather on the amount of sodium in the diet. No studies have been done to establish that persons choosing diets replete with "low-salt" foods instead of those foods with "regular" sodium content are able to reduce and sustain their total sodium intake. On the other hand, evidence by Drs. Joel Geerling and David McCarron have found a physiological signal for "salt appetite" based on the body's need for sodium and that this "need" results in sodium intake levels within a relatively narrow range which is unchanged over time and independent of government dietary guidance.

So, to quote the McCarron-Geerling paper's title: "Can Dietary Sodium Intake Be Modified by Public Policy?" Let's get the evidence before we launch a madcap -- and anti-scientific -- effort to make a massive, untested change in our national diet.

Back to the larger point and in conclusion, this from Kevin Shapiro's review of the Specter book in Commentary magazine:

In Specter’s parlance, “denialists” are those who reject the substantive technological benefits of modern science—medicines and vaccines to treat and prevent illnesses, or techniques to enhance the quality and quantity of agricultural yields. At the same time, they cling to an unsubstantiated faith in the advantages of “natural” alternatives such as vitamins, supplements, and organic foods. The term e-ncompasses a diverse array of quacks and crackpots, ranging from New Age celebrities like Andrew Weil to reactionary patricians like Charles, Prince of Wales. What unites them is a hostility to reason that, when amplified in society, threatens the ability of scientists to pursue real solutions to such problems as disease, hunger, and malnutrition.

We have often looked at desalination technology as a source for future ideas of mitigating any possible environmental impacts of salt from winter maintenance or water softening operations. With the advent of nano-technology, high hopes were pinned on the potential for this branch of applied science to contribute a solution. Now a team has created a salt-removing gadget so small that hundreds of them could fit onto a penny. Ion Channel Polarization or ICP has been around for years, but never applied to desalination. With ICP, a liquid with charged and neutral ions, such as seawater, is run through a channel. Along the channel is an electrical potential that repels charged particles. This causes the liquid to split, creating one stream with charged particles and another with neutral particles. A review on the research can be found at ScienceMagazine .

Data may be just another “four letter word” to some. And for some advocates, data gets in the way of a good story. That’s what’s been happening as evidence unfolds about the bogus “salt hypothesis” where blood pressure-based computer modeling projecting health benefits from cutting back on dietary salt have been crushed by peer-reviewed studies showing worse outcomes and questioning even the physiologic possibility of modifying salt intakes .

Well, data is happening in other areas, too.

Recently, the American Heart Association journal Circulation published an analysis of 30 million Medicare beneficiaries’ data (repeat, 30 million Americans’ actual experience, not a computer projection). The data clearly documented that (surprise!) heart attack rates are in decline – just the opposite of what computer projections and prominent public health “experts” have claimed.

Dr. Harlan Krumholz of the Yale University of Medicine and principal investigator for the study told the Wall Street Journal that the findings “breathtaking” and attributable to evidence-based prevention strategies. The same results are found in the general population, he claimed.

Of course, the new data came after the fear-mongers’ success in enacting a government takeover of healthcare arguing the current situation was deteriorating. And consider a second point: these same big-government-knows-best “experts” are telling us we have a crisis in salt intake causing, according to recent headlines, a half million heart attacks a year based on their computer projections – when salt intake levels are unchanged over many decades and now we know that heart attack rates are in decline.

As Jeff Stier of the American Council on Science and Health notes: “This isn’t consistent with their storyline that we need more government intervention like fast food bans to keep us healthy.”

So, who to believe? The “experts” or the data?

Today, at the National Press Club, American Highway Users Alliance released a study by IHS Global Insight estimating the economic impact of snowstorms in sixteen U.S. states and two Canadian provinces. The study found that "hundreds of millions of dollars in economic opportunity are lost each day that a state is shuttered by impassable roads."

“Lost wages of hourly workers account for about two-thirds of the direct economic impact of a major snowstorm,” said James Gillula, Managing Director of Global Insight and the principal researcher of the study. “Among all workers, hourly wage workers can suffer the most painful economic losses and the indirect economic effects of their lost wages can ripple through the economy.”

The study, the Highway Users noted, gives needed perspective on the true costs of what is often thought of as harmless and fun. For state and local authorities, they suggested, it could serve as a wakeup call for bigger snow removal budgets.“Although snow days often conjure happy childhood memories, this study makes it crystal clear that they have a tangible and serious negative impact on real working people and a wide range of businesses,” said Greg Cohen, Highway Users President and CEO. “The shocking losses estimated by this study should light a fire under state and local authorities nationwide to get serious about investing in quicker and more effective snow and ice removal. When roads are left unsafe or impassible, it is like money being thrown down the drain.”

This study highlights the economic necessity of snowfighting and the fact that one successful day of snowfighting can more than repay the entire costs of a year of snowfighting in economic benefits. As we exit one of the most devastating years for snowstorms in recent memory and a difficult year economically, the press is covering this story with gusto, as they should. State and local authorities cannot afford to sacrifice commerce and safety as they make budget decisions for next year.

The last official day of "winter" certainly lived up to its billing, dumping 7 inches of snow in the northern suburbs of Dallas, TX. The area thus records its snowiest winter in history. Savor the picture. It may have to last you until next November..

On January 11 of this year, you announced an ambitious program dubbed the "National Salt Reduction Program." This program was patterned after the Food Standards Agency salt reduction program in the UK, which you characterized as a success. Considering the economic, social and infrastructural problems that New York City faces, you clearly believe that a population-wide reduction of salt intake is a very high priority issue. Yet, the issue of population-wide salt reduction remains deeply mired in controversy. The majority of meta-analyses on the subject do not conclude that population-wide salt reduction is warranted. Some even state that there may be an unintended consequence resulting from such an action.

As you are so devoted to this program, I believe that you should have an opportunity to openly demonstrate the depth of this commitment. It would certainly not be the first time that political leaders have stood up to demonstrate the courage of their convictions. In 1991, in an effort to stave off international criticism regarding Peru's polluted fishery, President Alberto Fujimori dined on local ceviche in front of news cameras to demonstrate his faith in the quality of their fish. It is of no consequence that he came down with cholera the next day - the important thing is he had the courage to stand up for what he believed in.

As a public leader, I feel that you should have the same opportunity and hope that you would demonstrate the same degree of courage. I propose that you go on a 1,500 mg sodium/day diet, as recommended by the CDC and I will maintain my 3,500-4,500 mg sodium/day level for a full month. During that time, we should have our blood chemistry (renin, aldosterone, cortisol, etc.), blood pressure, arterial pulse wave velocity (a measure of arterial stiffness) and urinary sodium levels checked weekly. I would further invite Drs. Larry Apell, Chairman of the Dietary Guidelines Sub-Committee on Electrolytes and Michael Jacobson of the Center for Science in the Public Interest, two individuals who have repeatedly stated that humans do not require more than 500 mg of sodium/day to join in this demonstration by consuming that 500 mg sodium/day for one month as well and undergo the same tests.

Finally, I propose that Dr. Mehmet Oz use his good facilities to manage the clinical tests and report the results on his television program.

Mr. Mayor, I have no doubt that you wish to do what is right. I do as well, however, we are operating from a totally different set of peer-reviewed data. A task as simple as the one I suggest may well resolve this issue to everyone's satisfaction and will set the salt and health debate upon a course that should benefit all citizens.

Yours sincerely,

Morton Satin

Technical Director

Salt Institute

Alexandria, VA 22314

This year has brought an avalanche of salt reduction papers in the medical journals, together with supporting editorials and letters from well-known and influential anti-salt activists. The effort appears to have been coordinated and I would not be at all surprised if WASH (World Action on Salt and Health) and CSPI (Center for Science in the Public Interest) were associated with it.

The rather odd thing is, despite all the published text calling for stronger regulatory action to reduce salt due to all the projected morbidity, mortality and health care costs this would result in, not a shred of actual new evidence was published. The papers published were simply statistical models based upon evidence we know was highly flawed. Obviously, the laudatory op eds and letters that followed were more a show of desperation trying to shore up the flimsy house of cards.

I sent a letter to the Annals of Internal Medicine criticizing the current state of affairs, where leaders in public health policy appear to have become so political that they no longer demand evidence to develop public policy. It is a sorry state of affairs when academics resort to statistical models with fancy nine dollar words instead of simply going out and getting the data which is easily available. The letter can be seen here . Scroll down the page to the letter and click the "more" link to see the full content.

Caught up in this frenzy of scientific folly and compulsion to regulate, New York Assemblyman Felix Ortiz introduced Bill A10129 stating that no restaurant should be allowed to add salt to the food they prepare. I blogged this item and he is apparently rethinking his position coming out with the inevitable statement that he was totally misunderstood by all – that’s not what he meant…..he really meant…..not too much salt…..maybe not on Tuesdays or Thursdays…..only at Happy Hour……or no more rice in the salt shaker…… or something equally stupid!

In fact, Ortiz was highly criticized by Bloomberg for his bill with Bloomberg saying he was only working with manufacturers to gradually reduce salt over time. You know, “slowly, slowly, catchee monkey.” That way no legislation has to be developed and if it all goes south and people start exhibiting signs of cardiovascular illness, metabolic syndrome or stress or reduced cognition or alzheimer’s (all possibilities described in the medical literature), then no one has to take responsibility for it. He can simply say “We were only suggesting salt reduction – it was the industry that actually did it!”

Growing up in Montréal was a gastronomic delight. Like most other cities in North America, there was a great variety of ethnic foods, but this city's French flavor seemed to demand more of its restaurants. One day my older brother dragged me over to see a new restaurant that had just opened. It was the city's first pizzeria and he thought that the sign in the window was hilarious. There in all its colorful neon splendor was a large sign that blared "Genuine Italian Pizza - Just like in New York!!" On a smaller printed sign in a corner of the window I read the ingredients: anchovies, capers, mozzarella, prosciutto and then glanced up to my brother for an explanation of each. Real Italian pizza - just like in New York.

Earlier this week, New York Assemblyman Felix Ortiz introduced Bill A10129 stating that “No owner or operator of a restaurant in this state shall use salt in any form in the preparation of any food for consumption by customers of such restaurant, including food prepared to be consumed on the premises of such restaurant or off of such premises.” The penalty for each infraction will be $1,000.

How would such a bill affect New York's famous pizza? Could they still say real Italian pizza - just like in New York? Salt is an integral part of almost every ingredient in pizza. Salt has to be added to the dough in order to condition it so that it will be pliable enough to be stretched, tossed in the air and twirled into a pizza. Omit the salt and the dough will contract back into a ball of tough rubber. Salt has to be added to the tomato sauce in order to moderate the mild bitterness that is normally found in all tomatoes. That is why a slice of fresh tomato tastes so much better with a smidge of salt. Mozzarella, like all other cheese is cured with salt. Both anchovies and capers are packed in salt (at least the best ones are). Salt is also used to cure prosciutto and is the reason that trichinosis has never been found in this type of Italian ham. Can anyone imagine Italian sausages and any type of edible olives made without salt?

Without salt, all dressed would mean a crustless pizza topped with the emperor’s clothes. Is that real Italian pizza? Of course not - so why change it? What's wrong with Italian pizza? Is it making Italians ill? Does pizza give Italians hypertension?

In fact, Italians eat far more salt than we do here. Aside from olives, which can only be consumed if the bitterness is removed by soaking in brine for almost a month, there is Parmesan - the king of cheeses, which happens to be cured for 20 days in saturated salt brine baths, Gorgonzola cheese whose blue mold will only grow in a high salt medium, bacalla or salt cod, bottarga or salted tuna row, and anchovies, capers, salami, etc. etc. etc. Yet, Italians have amongst the best cardiovascular figures in the world because they eat a balanced diet, replete with salads and vegetables. In fact there have been several publications attributing the decline of disease to the consumption of vegetables and fruit. In North America, of course, there is full access to vegetables and fruits, however, our leaders prefer to hype approaches based on magic bullets, such as salt reduction, instead of promoting a balanced diet that every nutritionist knows will be far more effective. Assemblyman Felix Ortiz' bill is just such an example. Had Ortiz looked into the matter a little more deeply, he would have learned that salt is an essential nutrient and that the medical and scientific literature demonstrates that low salt intakes can lead to a cascade of negative health impacts including increased stress, reduced cognition and metabolic syndrome.

But man does not live by pizza alone. How will a ban on salt affect other foods in New York? How would New York's famous deli's such as Katz' or the Stage fare? Pastrami, corned beef and dill pickles will have to go by the wayside - no question. A Reuben sandwich will be no different than a skinless frankfurter without any meat in it. Well, maybe New York can live without deli's.

What about Italian restaurants? There may not be pizza but what about prosciutto e melone? Perhaps that can be changed to melone e melone and be served as a dessert instead as an appetizer? Spaghetti bolognese might work if the bolognese sauce and the parmesan cheese are left out; but plain spaghetti boiled in unsalted water will have to fill both sides of the menu page. You might try Chinese or Japanese foods, but without the vast array of soy-based sauces, what will they taste like? How’s about....Mexican....Tunisian.....Indian....? There must be something? Hmmm....got it! New York will no longer out be dubbed the Big Apple. Henceforth, New York will be known as the Big Boiled Egg.

What does the future hold for New York? Don’t be surprised if you see notices affixed to the walls of post offices declaring, “The authorities are offering a reward of $50,000 leading to the arrest of the owners of Pizza Romano, the illegal restaurant operation that has openly defied Bill A10129. Every time police close in on them, these fly-by-night operators close up shop and open elsewhere. They can be easily identified by the sign in their window, “Genuine Italian Pizza – Just Like in Montreal!!””

Years ago, when “GAO” stood for “General Accounting Office,” that arm of Congress focused its reviews on how well government agencies were spending taxpayers’ resources. A new GAO report suggests FDA should expend more resources on substances earlier determined to be safe, some, like salt, of proven safety since before the founding of FDA or even the founding of the United States. GRAS has been a prime achievement in wise use of taxpayer monies in that it has allowed the agency to accept substances in foods which had been used safely for centuries, enabling FDA to focus on substances with unproven food safety.

Salt was the original, archetypical GRAS substance.

No one should doubt the safety of salt. The petitioners would have FDA regulate the amount of salt allowed in each serving of food. There is no evidence that this would produce either of the benefits the petitioners assert. No studies have been done that show that those consuming diets incorporating low-salt foods result in lower overall salt consumption. Evidence shows that salt appetite responds to an individual’s physiologic need. Neither is there any controlled trial of whether diets lower in salt or sodium produce better health outcomes. Nearly every one of the few studies that have been done show either no benefit or even increased risk. In fact, the two controlled trials reported to date both show worse outcomes for those on lower sodium intakes.

GAO should go back to serving the taxpayers in assessing whether government agencies are using good judgment in prioritizing limited resources on real problems. The GRAS status of salt is a PR sideshow unworthy diverting FDA from its vital mission of ensuring the safety of America’s food supplies. GAO would be well served to ask why NHLBI continues to fund PR-oriented studies offering computer models of blood pressure impacts of low-salt diets when that question is well-studied and by NHLBI continues to frustrate efforts, including those of the 2005 Dietary Guidelines Advisory Committee, to have the federal government conduct a meaningful controlled health outcomes study of whether lower sodium diets would improve public health. Until that study is done, FDA is right to prioritize its resources to questions where evidence suggests the public will get better bang for its buck.

It remains hard to believe, when the daily newspapers are screaming for action to curtail population sodium intakes, that until this month, only one controlled trial has ever examined the actual health outcomes of salt reduction . Sure, we've seen computer models based solely on blood pressure projections that predict fewer heart attacks and lower cardiovascular mortality. But this fantasy has been "mugged by reality" as the data begin to appear in the peer-reviewed literature.

This month's Clinical Journal of the American Society of Nephrology published the results of a second health outcomes study of low salt diets in a vulnerable population. The first study found low-salt diets caused more hospitalizations and greater mortality among congestive heart failure patients. This new study, by a Chinese research team headed by Dr. Jie Dong, "Low dietary sodium intake increases the death risk in peritoneal dialysis." It's conclusion:

This study revealed that low dietary sodium intake independently predicts the high overall and cardiovascular mortality in dialysis patients.

The researchers suggested a J-shaped curve as described by Dr. Michael H. Alderman in his presidential address to the International Society of Hypertension . Dong et al termed it "another example of 'reversal epidemiologic phenomenon," continuing:

In the case of dialysis patients, harm may outweigh benefit ... Low sodium intake is significantly related to overall and CVD mortality. Sodium restriction did generate undesirable effects in previous studies including increased insulin resistance, activation of the renin-angiotensin system and increased sympathetic nerve activity. ... We reveal for the first time that low sodium intake is not necessarily a good thing....