For years, the anti-salt advocates have ducked the scientific evidence and relied on the support of the largest medical and health institutions to prop up their contention that there is an unassailable link between salt intake and cardiovascular disease. This fallacious strategy is known as Argumentum ad Verecundiam - the reliance on known institutions and entrenched doctrines, rather than experimental data - the sort of thing that Francis Bacon grappled against in his struggle to bring us the scientific method.
Predictably, science eventually finds it way to the surface and in this case, the Argumentum ad Verecundiam is showing signs of collapse in the face of mounting evidence against a link between salt intake and cardiovascular disease.
In the most recent issue of the Journal of Interactive Cardiovascular and Thoracic Surgery , Drs. Jay Walker, Alastair MacKenzie and Joel Dunning of the Department of Cardiothoracic Surgery at James Cook University Hospital, in Middlesbrough, UK carried out an in-depth study of all available evidence to determine if restricting dietary salt intake would provide protection from adverse cardiovascular events or mortality. Using reported search parameters, 462 papers were identified of which 14 papers represented the best evidence on the subject. They concluded that restricting sodium intake to levels below 6 g per day as most international guidelines, such as those of the AHA, the US Dietary Guideline Committee and the Scientific Advisory Committee on Nutrition recommend may reduce blood pressure, but found it impossible to find a link between salt and heart disease due to a "lack of adequately powered randomised trials or observational studies conducted with sufficient rigor."
This information corresponds with the recent publication of the Rotterdam Study by Geleijnse et al, as well as the evaluation of the health outcomes from Finland's three decade long salt reduction program .
The myth-information about salt and cardiovascular health outcomes has gone on for a long time and misdirected our focus from more practical and effective approaches to achieving good health. It's time we start devoting our resources to solutions that have scientific merit, such as improving the overall diet through systems and products that encourage greater consumption of fruits, vegetables and low-fat dairy products.
A new Dutch study of 2,896 subjects studied for 5-6 years has concluded that there is no health benefit for healthy subjects to reduce dietary salt. The risk for subjects with cardiovascular disease and diabetes was not reported.
This, the 16th study of the health outcomes of reduced-salt diets, examined the incidence of heart attacks and strokes, cardiovascular mortality and all-cause mortality. Unfortunately, all the studies are observational (this is a case-cohort analysis); a controlled trial is required to address the question. The paper was published in the October issue of the European Journal of Epidemiology .
The research team headed by Diederick E. Grobbee examined a large, high-quality and much-admired database that contains data unavailable to some of the earlier studies. The authors reported:
Urinary sodium was not significantly associated with incident myocardial infarction, incident stroke, or overall mortality. For CVD mortality, however, a borderline significant inverse association was observed (RR = 0.77 (0.60-1.01) per 1-SD, model 3) but the relationship was attenuated after excluding subjects with a history of CVD or hypertension (RR = 0.83 (0.47-1.44) per 1-SD, model 3). In subjects initially free of CVD, the risk of all-cause mortality was also examined across quartiles of 24-h urinary sodium (median values: 45, 87, 125 and 190 mmol, respectively). RR in consecutive quartiles, using the lower quartile as the reference, were 0.80 (0.43-1.49), 0.66 (0.34-1.27) and 0.98 (0.54-1.78), respectively (model 3). In a subgroup analysis of CVD free subjects with a body mass index ≥25 kg/m2, the association of urinary sodium with CVD mortality or all-cause mortality was neither statistically significant (RR = 0.91 (0.44-1.89) and RR = 1.19 (0.86-1.66) per 1-SD, respectively; model 3).
... the biggest threat to science has been quietly occurring under the radar, even though it may be changing the very foundation of American innovation. The threat is money-specifically, the decline of government support for science and the growing dominance of private spending over American research.
In 1965, the federal government financed more than 60 percent of all R&D in the United States. By 2006, the balance had flipped, with 65 percent of R&D in this country being funded by private interests.
That's the complaint in a story by Jennifer Washburn in this month's Discover magazine on "Science's Worst Enemy: Corporate Funding ."
I haven't checked her figures, but I doubt that the government ever funded two-thirds of US R&D; a more reasonable figure is the 40% today. But worse than the math is the author's implicit assumption that socializing the country's research and development investments is a good thing -- that private investments reflect a for-profit bias while government investments are "pure" and "untainted." Washburn fears that "if the balance tips too far, the 'public interest' side of the science system-known for its commitment to independence and objectivity-will atrophy."
Some would question the "commitment to independence and objectivity" of federal researchers and those enjoying their largesse. Rather than rehearse the numerous and egregious examples, I'd suggest a simple reflection on the wisdom of our Founding Fathers in setting up a government recognizing that every person and institution has self-interests. The question is how they pursue them and how we can sort through competing interests to get the truth upon which to base our decisions and public policies.
In the salt area, we badly need explicit "evidence-based" policy based not on passion and emotion, but on replicable, quality science. We need to look at evidence to answer the question: would reducing population salt intakes improve health? It turns out that virtually all the studies in this area are government-funded. While often characterized by government-convened "expert" groups, the actual research does not find a health outcomes benefit to salt reduction .
Without doubt, corporate-funded research employed to support public policy deserves to be held to the highest standard and its analysis held to the standards of the Data Quality Act. So, too, does government-funded research. There should be no comfort taken -- nor relief granted -- to conclusions of government-funded scientists because they work for "the public." Sorry, Jennifer.
Reading Gina Kolata's New York Times book review of Gary Taubes' new book, Good Calories, Bad Calories, I'm struck that the book is really two-in-one. The first "book" is the heavily-researched and compellingly-argued critique of the scientific foundation of current dietary guidance. As Kolata summarizes his argument: "nutrition and public policy research and policy have been driven by poor science and a sort of pigheaded insistence on failed hypotheses." Sounds like the sodium and health debate to me. Kolata says "much of what Taubes relates will be eye-opening to those who have not closely followed the science, or lack of science, in this area." The second "book" is Taubes argument favoring low-carb diets.
I fear too many may neglect the impeccable research buttressing "book one" if they don't accept Taubes' answer to the narrower question of the role of carbohydrate, fat and protein as causes of heart disease. That would be a great loss. "Book one" is a great stand-alone read and a devastating critique of the "consensus" method - as opposed to an "evidence-based" method - of formulating dietary recommendations.
Taubes concludes: "From the inception of the diet-heart hypothesis in the early 1950s, those who argued that dietary fat caused heart disease accumulated the evidential equivalent of a mythology to support their belief. These myths are still passed on faithfully to the present day." Kolata adds: "The story is similar for salt and blood pressure, and for dietary fiber and cancer," concluding "Taubes convincingly shows that much of what is believed about nutrition and health is based on the flimsiest science."
There's much more in Taubes' 450-page book. Make sure you read at least "book one."
Gary Taubes' new book prompted a second article in The New York Times in which NYT science writer John Tierney explains how the science underlying our dietary guidelines departed so sharply from quality science. He attributes it to the process of soliciting "expert opinion" and declares the process an "informational cascade" where an initial error is compounded and implanted as policy as successive "experts" sign-on.
"Cascades are especially common in medicine as doctors take their cues from others, leading them to overdiagnose some faddish ailments (called bandwagon diseases) and overprescribe certain treatments (like the tonsillectomies once popular for children)." Tierney recounts several of Taubes' examples, in particular that eating fat has produced an epidemic of heart disease. The original hypothesis was embraced by politicians (Sen. George McGovern (D-SD) and President Jimmy Carter's USDA activist Carol Tucker Foreman leading to the Dietary Guidelines for Americans and, eventually, today, to the Food Guide Pyramid. Unconvinced scientists were intimidated by politicians and the media; Tierney quotes economist Timur Kuran's description as "a reputational cascade, in which it becomes a career risk for dissidents to question the popular wisdom." Taubes' book includes the anecdote of an exchange of a prominent nutrition scientist responded to Sen. McGovern when McGovern asked him why he refused to accept the conclusions of "92% of the world's leading doctors." The scientist called for policy based on science, not "by anything that smacks of a Gallup poll."
Whether you take advantage of the salt-centered recipes on the Salt Institute's website via the home page drop-down menu or go direct to the recipes page , you'll want to check out the new page on salt roasting of fish, meats and vegetables. Then head for the kitchen with your bulk salt in hand!
Since fish are especially flavorful when salt-roasted and since fish are consumed in North America only a fraction as much as in Europe, salt -roasting -- simple, quick and easy -- may stimulate more Americans to improve the quality of their diet by increasing their intake of fish. Just today, Sally Squires in the Washington Post reported that nutritionists are concerned that more Americans aren't eating fish.
Today, Norway's Aftenposten News announced that the government energy provider, Statkraft, has made the decision to build the world's first pressure retarded osmosis (PRO) power plant prototype in Hurum, Norway. In the process, two solutions with different salt-concentrations are used (often freshwater and salt-water). A semipermeable osmotic membrane separates the solutions and only lets small molecules like water-molecules pass through. The water attempts to decrease the salt-concentration on the side of the membrane that contains the most salt. The water therefore streams through the membrane and creates a pressure on the other side. This pressure can be utilised in order to gain energy, for example by using a turbine and a generator.
Here is a simple schematic of such a system to be used in a 100 kW plant :
This new development marks the first step in a technology that may one day provide a significant portion of the world's energy. Statkraft is the first company to venture into this technology because it is far more costly than fossil fuel. (However, if the total cost to the environment of fossil fuels were to be calculated, these differences may disappear.) Norway is seriously committed to reducing global warming and this new technology is in keeping with that commitment.
While freshwater/seawater gradients are rather costly, there is a much greater short term economic potential for freshwater/brine and seawater/brine gradients . As a result, utilizing brine from inland salt lakes, solution mines and solar salt operations may be a more economically feasible approach than the Statkraft operation. Whatever the case, through this new development, we can look forward to a green future with the incredible Saline Turbine!
Anti-salt zealots display a religious fervor for their cause, trampling scientists who remind them that actual evidence of a health benefit exists only in the end product of elaborate mathematical models extrapolating only blood pressure effects (and even those are often shrouded in withheld statistics preventing replication). There's an arrogance to their advocacy. And a familiarity.
Investigative science reporter Gary Taubes published the lead story in the New York Times Magazine on September 16, asking "Do We Really Know What Makes Us Healthy?" It's the tragic story of well-intended, plausible advocacy of hormone replacement therapy (HRT) for post-menopausal women. The bright promise, the powerful claims and the glittering possibilities all came crashing down a few years ago when it was found that for many if not most of the target audience, the "cure" was killing far more than it was helping.
Taubes called for more "self-doubt" and recommital to the discipline of scientific investigation, foregoing the passion of the righteous objective for the surer cycle of scientific advance -- proposing hypotheses, testing them to discard most of them and then repeating the cycle to refine those who pass muster.
As he pointed out:
While it is easy to find authority figures in medicine and public health who will argue that today's version of H.R.T. wisdom is assuredly the correct one, it's equally easy to find authorities who will say that surely we don't know. The one thing on which they will all agree is that the kind of experimental trial necessary to determine the truth would be excessively expensive and time-consuming and so will almost assuredly never happen. Meanwhile, the question of how many women may have died prematurely or suffered strokes or breast cancer because they were taking a pill that their physicians had prescribed to protect them against heart disease lingers unanswered. A reasonable estimate would be tens of thousands.
In conclusion, Taubes cautions:
All of this suggests that the best advice is to keep in mind the law of unintended consequences. The reason clinicians test drugs with randomized trials is to establish whether the hoped-for benefits are real and, if so, whether there are unforeseen side effects that may outweigh the benefits. If the implication of an epidemiologist's study is that some drug or diet will bring us improved prosperity and health, then wonder about the unforeseen consequences. In these cases, it's never a bad idea to remain skeptical until somebody spends the time and the money to do a randomized trial and, contrary to much of the history of the endeavor to date, fails to refute it.
You can't discern the cankers and the warts at 30,000 feet, but taking in the big picture often helps us understand the motivations that play out as the tangled inconsistencies of daily news stories about health. There are some whose mission in life is to point in alarm at instances where individuals or society comes up short -- where problems mar perfection. These professional and persistent pessimists, in the health arena, would have us focus attention and resources on such interventions as dietary changes ostensibly to effect improved health outcomes, but based only on plausible, but unproven scientific evidence.
A blog today on JunkFoodScience hits the nail on the head:
There's been so much good news recently about the state of our health and that of children. This has clearly distressed alarmists. To keep their gloomy myths alive, they've tried to: A). bury the news and B). convince us that good is really bad.
With people not buying any of that, they've added plan C: scream louder. As Dr Ian Campbell, medical director of Weight Concern, told the BBC news this week: "We are not making enough progress!"
Facts have such a troublesome habit of getting in the way of agendas. Let's look at three major new health reports that all brought good news.
Author Sandy Szwarc points out that the 2006 National Health Interview Survey released recently found 88% of Americans self-report good or excellent health, new figures released this past week from the Centers for Disease Control and Prevention showing strong historic trends of lengthening life expectancies and falling rates of heart disease, and a UNCEF announcement this week that more children are surviving today than ever before in history.
We think the glass is at least half full, and filling steadily.
During our daily review of all legislation related to salt, it was a pleasant surprise to come across the final filing and adoption of the West Virginia division of health nursing home licensure rule that became effective July 1, 2007. The purpose of this legislation was to implement state and federal law governing the licensing, operation, and standard of care in nursing homes located in the State of West Virginia. The goal is to help each nursing home resident attain or maintain the highest practicable physical, mental and psychosocial well-being.
Among the requirements explicitly stated are:
8.15.d. - A nursing home shall provide each resident with: Food prepared with salt, unless contraindicated by a physician's order; and, the salt should be iodized.
Finally, legislation based on the genuine requirements of a person rather than a politically correct interpretation of populist nutrition. Time and time again we have read of the negative effects of low salt diets prescribed to nursing home residents leading to chronic dehydration and hyponatriumia (salt deficiency). Often, these low salt diets lead to other major complications including bone fragility and increased cardiovascular risk. The insistence that the salt be iodized is an additional indication that whoever wrote up this rule did their homework. Bravo!It is refreshing to see that there are still legislators out there willing to take on the responsibility of doing things right.
Perhaps you read the article published this week in the online Journal of Human Hypertension (paid subscription required) by Dr. Graham MacGregor claiming dietary salt was responsible for high blood pressure in children. MacGregor and colleagues claim their results support "a reduction in salt intake for children and adolescents."
Not so fast. Though the media carried the author's conclusions from the study, an accompanying editorial (free) by Dr. Michael H. Alderman, immediate past president of the International Society of Hypertension, in the same edition points out that the entire relationship is due to the fact that those who ate more salt ate more food. Adjusting for caloric intake wiped out the significance of the relationship. Nor was there any difference between the high-salt and low-salt groups in terms of preference for adding salt at the table. Alderman pointed out that those consuming more salt and calories may also have had more adequate intakes of other vital, growth-related nutrients, but that the study did not include these data. Thus, Alderman concludes that the data "support the Cochrane Collaboration conclusion that there was not sufficient evidence for a general dietary recommendation to reduce sodium intake."
Alderman cautioned against following MacGregor's prescription of having children reduce dietary salt.
...randomized clinical trials in adults have shown that lowering sodium intake increases sympathetic nerve activity, reduces insulin sensitivity, increases the activity of the renin-angiotensin system and increases aldosterone secretion.
Do these or other changes occur in children? This is critical because, of course, the health impact of any intervention is the sum total of all its consequences. While I remain an agnostic on that score, I continue to believe firmly that solid knowledge based on evidence of benefit and risk must precede any clinical or public health intervention -- particularly when it comes to dependent children. Good observational studies such as this one generate hypotheses. They need to be tested in clinical trials. Absent such evidence, and absent some pressing public health challenge, therapeutic restraint may be the best and safest way to avoid doing harm.
Alderman may be "agnostic" with regard to his pursuit of an evidentiary basis for an intervention. It's too bad too many proponents of salt reduction seem to advance their arguments with strong faith and religious zeal -- and without scientific basis. We've heard no better argument against the establishment of a state religion.
The U.K. Telegraph reported the story of 110 year old Mary Brown, of Surrey, who attributes her cenetenarian plus status to sprinkling all of her food with plenty of salt . Despite all the negative publicity issued by the Food Sandards Agency's anti-salt campaign , Mary kept to her regular consumption of salt and has lived far beyond the average life expectancy. We wish her continued life and good health.
This is not the first time we hear that salt contributes to continued good health in later years. One Canadian cardiologist wrote us that he felt the low salt diets often prescribed to the elderly led to chronic dehydration and hyponatriumia (salt defficiency). As a result. people became very drowsy and suffered a range of salt-defficiency-related metabolic disorders. Often, this led to instability in walking or standing and a significant jump in the risk of large bone or pelvic fractures - all due to a low-salt diet. The cadiologist in question had been treating patients for 65 years - more than a lifetime of experience. He finishes his letter by saying,
"Spending your golden years in a retirement home with a low-salt diet will convert your last years to a long chronic illness."
Despite her love for salt, 110 year old Mary Brown says, "Everything else should be taken in moderation, except family and friends.
Mort Satin sent in this blog.
This past week saw the announcement of the European Food Safety Authority (EFSA) Scientific Colloquium 9 - Nutrient Profiling for foods bearing Nutrition and Health Claims, to be held from 11 - 12 October 2007 in Parma, a city best known for its fabulous Parma Ham*, as well as the King of cheeses, Parmigiano Reggiano**.
Not surprisingly, the European food agency at the forefront of the nutrient profiling is the Food Standards Agency (FSA) of the UK. Concerned with the rise in obesity, the FSA looked for approaches to nutrition that had the potential to make it easier for consumers to make healthy choices. They argued that it was really the 'imbalance' in the consumption of individual foods that caused health problems, not the overall balance of the diet. It's really not the Mediterranean Diet, it's the fish…or is it the olive oil….the fruits and vegetables….the capers…..truffles…?
In other words, food is considered to be little more than an independent carrier of nutrients. Depending upon the 'balance' of these nutrients, foods would be characterized in a nutrient profile. That not being enough, the profiles would be accompanied by decision signals such as traffic lights that would make it even easier for the consumers to make an "informed" decision. Traffic lights are considered to be useful signals for any being at or above the intelligence of a magpie.
It now appears that, in Europe, this concept has reached a point of no return. The ultimate price that Europe, formerly the global pedestal of fine food, had to pay for nutrition and health claims regulation. The rest will be tedious bureaucracy.
In her landmark book, "The March of Folly," historian Barbara Tuchman defines the characteristics of folly as initiatives that: 1) are contrary to the self-interest of the society pursuing them; 2) are conducted over a period of time, not simply a burst of irrational behavior; 3) are conducted by a number of individuals, not just one deranged maniac and, most importantly; 4) are cautioned by a considerable number of people alive at the time who pointed out correctly why the initiative in question was folly.
In future blogs, we hope to examine the folly of nutrient profiling in detail. If foods were nothing more than carriers of nutrients the future of eating will be little more than a large, perfectly balanced food pill accompanied by a glass of water, and, if you really felt nostalgic, a glass of water and a gelcap of wine concentrate. Good food culture does exist and doesn't require a traffic light to legitimize it. Rather than invent a new model, perhaps it would have been better to copy another neighbor's successful model - but I guess that's not what the sweeping powers vested in public authorities do.
We will also look at the science of nutrient profiling. Our entire base of knowledge for nutrients in foods comes from chemical analysis. To make matters worse, the nutrient profiles reflect laboratory analytical results, not the bioavailability of nutrients in living systems. The impact of one food component upon the other in the gut is never determined for the profiles. Fiber decreases digestibility and consequently bioavailability - how is this factored into the profiles? In fact the profiles never consider indigestibility - a total disgrace from a nutrition science point of view and a matter that would make Dennis Burkitt, discoverer of Burkitt's Lymphoma and one of Britain's most intuitive scientists of the 20th century turn over in his Bisley, Gloucestershire grave.
The nutrient profiles give no indication of the interactions and dynamics taking place in the gut when normal diets are consumed. Dietary regimes incorporate particular food combinations and we have never determined how indigestibility of one component may affect nutrient availability of all other components in the diet. Because the nutrient data tables we use don't relate to this issue at all and, by use of these tables, we incorrectly presume that there is no such interaction - even though not single a nutritionist would agree with this. Thus, the inexorable march of folly rolls along.
*Pig meat profile #4276 (water 50,84%; protein 22,75%; salt 4,84%; fat 21,01%) ** Salt-cured cow milk curd profile #76383 (water 31.98%; protein 36.14%; salt 2.28%; fat 28.6%)
With the current woes of Wall Street feared trickling down to Main Street, at least some folks on Madison Avenue must be smiling. Marketers dream of converting dreary commodities into exciting products. And now, a "salt revolution" has come to our industry. "Everyone" is talking about salt, the media agree. For example, Amy Culbertson of the Ft. Worth (TX) Star-Telegram, publishes yesterday on Seattlepi.com , told readers:
Flor de sal hibiscus. Danish Viking-Smoked. Peruvian pink. Hawaiian red alaea. Black Cyprus. Australian Murray River.
Salts worth splurging on There are practically as many varieties of salt to choose from as there are oils and vinegars. Chefs are sprinkling them over ceviches, steaks and sometimes desserts; detailing their provenance on menus; offering tastings of them instead of filling saltshakers with them.
The salt revolution has really taken hold. No longer can you feel smug about cooking with kosher salt or sea salt instead of pedestrian old Morton. If you're cutting-edge, you'll be touting your French fleur de sel smoked over oak wine barrels.
But Culbertson wasn't satisfied, asking whether the highly-touted (and -priced) salts are more hype than hip. She interviewed a local restaurant owner, Jon Bonnell, owner/chef at Bonnell's Fine Texas Cuisine in Fort Worth, who told her:
"I think it's more about giving fun gourmet gifts than a genuine difference in taste," says Bonnell, who uses basic kosher salt for cooking at his restaurant. "That being said, however, I have six or seven different kinds of salts by my cutting board at home," listing as his favorites Danish smoked sea salt, Cyprus flakes and Australian pink salt.
And, if much of the appeal of the exotic salts is essentially theatrical -- well, dining has always been partly about theater.
Bonnell still uses kosher salt most frequently at home as well, but occasionally he'll grab a pinch of one of the exotic types when he's feeling playful. And it's the play factor that provides the intangible appeal of these colorful crystals. We humans have always been fascinated with gems and crystals, so it's no wonder these salts have such allure for cooks.
"It's kind of fun that even salt can be a playful ingredient these days," says Bonnell, who happily recalls a recent dinner at a boutique Napa Valley winery where heirloom tomatoes from the winery's garden were served with a half-dozen different salts for tasting, served in a gadget reminiscent of the carousel-style server restaurants used to use for baked-potato toppings. "That was pretty fun," he says.
Being "hip" may be mostly hype, but let's enjoy the ride!
The growing shortage of water around the world is no laughing matter. As highlighted in the article, "A Glass Half Full ," over the next 20 years, it is highly likely that many areas of our country and the rest of the world will face dramatic changes in the availability, quality, disposal and regulation of our water supplies. There are few new sources of conventional fresh water left to exploit. Everything we have is already allocated to specific uses.
On the other hand, there are unlimited supplies of sea water, brackish water and impaired groundwater available for desalination. While the desalination process removes salt from water, it likewise removes all other minerals. Since the process was growing so rapidly on an international basis, the World Health Organization decided to seek advice on the value of remineralizing desalinated water. They organized a workshop in Rome in 2003 as well as a symposium in Baltimore and follow-on Expert Consultation in Washington in 2006.
After spending close to 20 years with the largest UN agency, I am intimately familiar with UN Expert Consultations, Workshops and Symposia - all too often they are designed to reinforce the agenda of the staff members that organize these events. It is a rare occasion when objectivity surfaces. In this case, although several well thought out interventions were presented by competent professionals from around the world, WHO ignored them in their drive to establish recommendations to have desalinated water remineralized.
Their draft report, "Desalination for Safe Water Supply " repeats their recommendation for the remineralization of desalinated water. The Salt Institute responded that the goal of this initiative was to improve health, yet the draft report does not provide any evidence that the suggested proposals will yield any beneficial results. Even at the recommended levels of calcium and magnesium remineralization, less than 10 percent of the Daily Recommended Intake amounts can be obtained from drinking water. Just as with fluorides, there are more practical vehicles for delivery of trace mineral nutrients than public water supplies - a good deal of which is used for purposes other than drinking.
Food is clearly the appropriate vehicle for magnesium . A good food source of magnesium contains a substantial amount of magnesium in relation to its calorie content and contributes at least 10 percent of the U.S. Recommended Dietary Allowance (U.S. RDA) for magnesium in a selected serving size. The U.S. RDA for magnesium is 400 milligrams per day. The most recent research confirms that food should remain the best vehicle for magnesium delivery.
The Salt Institute also believes that it would have been prudent for WHO to consult with the Nutrition and Consumer Division of FAO on this matter. FAO has a fertilizer group dedicated to soil nutrition and an essential part of its goals focus upon the benefits for human and animal nutrition. Magnesium is an essential soil nutrient in all sustainable agriculture. Had there been a joint WHO/FAO study group and call for better soil management practices, particularly regarding magnesium and calcium fertilization, agricultural yields would increase and, more importantly from a nutritional point of view, there would be an immediate increase in the levels of calcium and magnesium in a very broad range of foods, thus achieving WHO's goals.
While we wholeheartedly support the overall goals of WHO, the Organization's tunnel vision approach on magnesium and calcium nutrition for desalinated water does not reflect what should have been the functional synergies to be gained through working together with FAO and other cogent UN sister agencies.
