The media comments we have seen regarding recent research on the relationship of very high salt concentrations to the development of autoimmune diseases are a classic example of exaggeration and myth-information. Dr. David Hafler, the author of one of the studies stated that the salt concentrations employed were at the very high end of salt ingestion limits, higher than what is consumed in current high salt diets, such as the classic Mediterranean diet, and way above the levels in the American diet. Because these extremely high salt concentrations seems to activate the immune system, Hafler went on to theorize that some people may actually benefit from them.
In reality, based upon the current World Health Organization figures, those populations that consume higher levels of salt in their diets have longer life expectancies, which is the only practical measure of lifelong health. Of course, total life expectancy is the result of many factors such as genetics, social development, etc., but these data conclusively demonstrate that current levels of salt consumption are fully compatible with increasing life expectancies.
The most recent research, just published in the peer-reviewed scientific journal, Cell Metabolism, has shown that the Government’s dogmatic salt reduction agenda is not based on sound science (1). An international team of researchers, working on the long-term space simulation projects, Mars105 and Mars520 at the Institute for Biomedical Problems in Moscow, have determined that all the studies relating hypertension to salt consumption are critically flawed .
Up until now, it has been assumed that the gold standard for calculating salt consumption is the amount of sodium found in a 24 hour urinary analysis. However, in what was the largest and most highly controlled, long-term study of salt metabolism ever carried out in a fully enclosed system, these researchers found that that the body does not eliminate the sodium from consumed salt on a regular basis, but stores and releases it in a fixed biological cycle. So measuring the amount of sodium excreted in any 24 hour period is meaningless. Sodium excretion has to be measured over a much longer time period to accurately estimate salt intake. This explains why so many previous studies have been so inconsistent.
(1) Rakova, N. et al. Long-Term Space Flight Simulation Reveals Infradian Rhythmicity in Human Na+ Balance.Cell Metabolism. 2013; 17: 125–131. (January 8, 2013)
Health advocates, who do not have a firm scientific basis upon which to promote their cause, often elect to characterize available data completely out of context in order to further their case. Followers of this column have often read how members of the global anti-salt groups CASH (Consensus Action on Salt and Health) and WASH (World Action on Salt and Health) are willing to say anything and attack anyone in order to further their population-wide salt-reduction agenda. They approach the issue of salt and health as if they were members of a religious cult and consider all scientists who question the public-health value of salt reduction as infidels.
Today brings us another picture-perfect example of this. BMJ Open has just published an article entitled, “Spatial variation of salt intake in Britain and association with socioeconomic status ,” by Chen Ji, Ngianga-Bakwin Kandala, and Francesco P Cappuccio. The senior author and correspondent is Professor Cappuccio, a longtime member of WASH. The key conclusion of this study was that low socioeconomic status was associated with higher levels of sodium (or salt) intake. The authors went on to state, “…measures of low socioeconomic status are associated with higher salt intake, indicating a higher risk of hypertension and CVD.” In other words, the authors contend that if you reduce the amount of salt that poor people eat, you will reduce their risk of hypertension and cardiovascular disease. It’s that simple, is it?
But wait. We have long known that low socioeconomic status was associated with a great many risk factors for health and mortality. Epidemiological studies have repeatedly shown that increasing wealth is associated with less heart disease and better overall health.
Dr. George Davey Smith and colleagues have made it clear that socioeconomic hardships are grouped or clustered together [i] . Low economic status is characterized by a multitude of adversity. The poor work harder and are less educated than the well-off; they smoke more; they eat cheaper foods that are higher in calories and lower in essential nutrients; they eat more processed foods that last longer; they can’t afford to eat the same ratio of healthy fresh green vegetables and fruits than better-off individuals do, so they weigh more; they worry more about paying bills, their children’s education, medical costs and simply surviving than richer people do. They live in nastier conditions with far more noise, crime and environmental pollution. Is it any wonder that they’re more prone to hypertension and other cardiovascular disease?
Anyone who believes that the answer to improving the health of people at low socioeconomic status is salt reduction can’t be serious. The answer is as complex as the problem. If anyone were to insist on a single solution, it can only be to improve their overall economic status. But nothing is that simple. If one were to look to changes in the diet that could significantly reduce the risk of hypertension and CVD, then the very first action to take would be to give the poor greater access to fresh vegetables and fruits – the single most important dietary factor to lowering the overall burden of disease.
Effective public health policy development will never result from a myopic view of risks, particularly if it is not supported by the preponderance of science. The authors of the BMJ Open article would be far more effective if they placed people ahead of their parochial salt-reduction agenda.
__________
[i] Bruna Galobardes, John W. Lynch, and George Davey Smith. Childhood Socioeconomic Circumstances and Cause-specific Mortality in Adulthood: Systematic Review and Interpretation. Epidemiol Rev 2004;26:7–21.
An American Heart Association Presidential Advisory on salt and health is in the process of being published. The stated purpose of this AHA Presidential Advisory is to review all the recent studies that contradict the ongoing population-wide salt reduction agenda. It is fitting that the Advisory is being published at the height of the Presidential election campaign, which has been characterized by negative propaganda, innuendo and half-truths. This AHA Presidential Advisory follows that paradigm closely. If the fact-checkers went to work on this paper, they would surely award it all four Pinocchios !
The authors of this paper, almost half of whom are listed as members of the anti-salt activist group WASH ( World Action on Salt and Health (vnd.ms-excel 529.00 kB) ) seem to share certain particular characteristics: a) they refuse to acknowledge that their decades-long advocacy of population-wide salt reduction has made them wholly committed to one particular interpretation of the evidence; b) they don’t concede that prejudicial bias is an unacceptable foundation from which to evaluate evidence, and; c) they appear to have little faith in the ability of science itself to describe the human response to salt intake and believe they have to interpret the data in a contrived fashion. In fact, the spinning of evidence by committed advocates has been a hallmark of the salt/health debate for more than a century – longer than any other health controversy.
The features of their arguments are classic. They refer to all published evidence that supports the salt reduction agenda as high-quality and disparage or rationalize all published evidence that contradicts it. In fact, the arguments presented in this paper are even more specious and desperate than many of the publication’s the authors have made in the past.
While it is plainly beyond the scope of this blog to analyze every declaration made in the paper, certain representative contradictions will be used to demonstrate the extent of this attempt to parse the evidence and mislead the public.
Amongst the conditions linked to excess sodium intake described in the paper is asthma. This is an old concern that was never adequately addressed through a randomized controlled trial until the study published in 2008 by researchers at the University of Nottingham. This study, long awaited by salt reduction advocates, concluded that low sodium diets had no therapeutic benefits for adults with asthma (1). The salt reduction advocates immediately pretended the study was never carried out and continue to repeat the purported link to asthma.
The AHA Presidential Advisory tries to reinterpret the Bernstein-Willett paper (2), which stated that sodium consumption in the US has not changed in 50 years . One of the authors of this Advisory (MacGregor) was the first to criticize the Bernstein-Willett paper when it was published, but it now appears that the paper has been ‘rehabilitated,’ since it apparently no longer means what it says. In fact, the Bernstein/Willett paper concluded, “Thus, despite the increase in processed foods in the US marketplace over the past 50 years, total caloric imbalance and the resultant epidemic of obesity may be a more important determinant of the increased prevalence of hypertension than sodium intake.” (Perhaps, if Bernstein-Willett were asked to make a short visit to the Gulag, this will result in a total withdrawal of this troublesome paper.)
The AHA Presidential Advisory expounds upon the analysis of dietary sodium and concludes that the best measure is the 24-hour urinary collection – something that all those who have cautioned against population-wide sodium reduction have said for years. They go on to say that the 24-hour dietary recall survey can still be used to estimate dietary sodium, but that it underestimates the amount consumed. Unfortunately, the authors of the Advisory don’t appear to be overly familiar with dietary habits and do not take into account the significant amount of food (>25%) left over on the plate, which is never adequately considered in recall surveys. This results in an overestimation of consumption. What is more important is that the effort to impugn the quality of the studies that caution against salt reduction equally applies to all those studies that support it and were used to justify the Dietary Guidelines in the first place.
There is a painful rationalization for discrediting what is considered to be amongst the best randomized controlled trials on the highly negative impact of salt reduction on congestive heart failure patients (3). In the end, the Advisory simply says that even if the results of this trial were to be repeated, such a study has no relevance for others in the population. It would have been much simpler for the Advisory to have repeated what the Chairman of the 2010 Dietary Guidelines Subcommittee on Electrolytes (who is also one of the authors of this Advisory) stated when first asked about the study, “It wasn't done in the United States. It was done in, I think it was in Italy. It was a European country.…. it's in a population and in a management strategy that is very different from what goes on in the United States. So that's the heart failure study . (4)” Surely that should be enough to disqualify any paper.
The rest of the Advisory is devoted to reinterpreting what the authors of the studies contradicting salt reduction are actually saying. The language is that of an Inquisition trying to account for mistaken and unrepentant ramblings of those that contradict the Dogma. “It seems likely that…” “A plausible explanation is…”
The fact that this group of authors was established specifically to make judgments on every scientific publication that contradicts the ongoing salt-reduction agenda makes it obvious that the agenda is the product of a well-organized plan by an international cabal in anticipation of the 2015 Dietary Guidelines. The authors provide absolutely no new evidence on the relationship of salt to human health, but have banded together for the express purpose of maligning any and all evidence that does not support the salt reduction agenda. What is even more strange is that the CDC, under the direction of Dr. Thomas Frieden (the former New York City Public Health Commissioner who instigated the National Salt Reduction Initiative), has just publicly funded a parallel Institute of Medicine project entitled, “Consequences of Sodium Reduction in Populations” designed to come to the very same conclusions that the authors of this Presidential Advisory have already done. To make matters even more questionable, one of the authors of this published Presidential Advisory is also a member of the Committee convened to carry out this new IOM project! It takes some brass to establish a Kangaroo Court with individuals who have already published their conclusions, to a study which they have yet to carry out for the IOM. We see before us an example of “putting the fix in” possibly for the FDA’s consideration of regulated sodium limits and definitely for the 2015 Dietary Guidelines. What a way to manage public funds that should be destined for the advancement of health science!
Considering the fact that the authors of this paper are the world leaders of the population-wide salt reduction movement, this paper provides some perspective on the (il)legitimacy of their entire agenda.
References
- Pogson ZEK, Antoniak MD, Pacey SJ, Lewis SA, Britton JR, and Fogarty AW. Does a Low Sodium Diet Improve Asthma Control? A Randomized Controlled Trial. Am J Respir Crit Care Med. 2008: 178; 132–138.
- Trends in 24-h urinary sodium excretion in the United States, 1957-2003: a systematic review. Bernstein AM, Willett WC. Am J Clin Nutr. 2010 Nov;92(5):1172-80. Epub 2010 Sep 8.
- Paterna S, Gaspare P, Fasullo S, Sarullo FM, Di Pasquale P. Normal sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? Clin Sci. 2008; 114:221–230.
- Transcript of the second meeting of the 2010 Dietary Guidelines Advisory Committee. January 29-30, 2009. Day 2, page 369.
When it comes to salt, the Dietary Guidelines process leaves a lot to be desired. In what should be an objective evaluation of the available evidence, the Institute of Medicine, one of the two organizations that run the Dietary Guidelines, has always managed to manipulate the process to support their population-wide salt reduction agenda. Their representatives have always made it a habit to acknowledge only that data which supports their case and disregard all the clinical evidence that weakens it. Well, they’re at it again!
With no fanfare, and behind closed doors, the IOM has constituted a Committee on the Consequences of Sodium Reduction in Populations whose task will be to develop a consensus on the quality of the publications describing the negative consequences of low sodium intakes. Normally, this would be an occasion to congratulate the IOM for turning a corner and finally recognizing the large body literature they have so long ignored - but have they?
This study will be financed by the CDC, currently directed by Dr. Thomas Frieden, the former New York City Health Commissioner who initiated the National Salt Reduction Initiative. Since he took over the helm of the CDC, population-wide salt reduction has become a priority for this organization. Thus, the money behind this IOM study comes from a source already committed to national salt reduction.
To pervert the situation further, the Committee is made up of individuals that are publicly on the record as actively supporting population-wide salt reduction. Fully 80% of the committee is down on paper as strongly supporting this. It would be difficult to find a more exaggerated case of conflict of interest then this Committee. After repeatedly supporting salt reduction in public, how can they objectively evaluate all the evidence that completely contradicts everything that they have said?
When it comes to the salt agenda, the IOM has not changed one bit. Their approach is as illegitimate and intellectually unethical as it always has been. Their goal is to degrade the credibility of all the evidence that counters their agenda and they have put together a Committee of hatchet men and women to do the job.
The IOM’s Kangaroo Court is now in session!
You can see the full Salt Institute’s response to the latest IOM initiative here (pdf 371.19 kB) .
An obvious irony of the blame game is that it is directed towards the public. If you looking to asses blame, it is very difficult to point the finger at the very public you are trying to convince. This is the reason why so few blame articles focus on self-responsibility. After all, it’s much easier to blame external influences rather than consumers. The traditional whipping boy has been the food industry. They have been blamed for making foods taste too good, for serving up portions that are too large and for making foods that are too cheap. The food industry has countered by saying that this is what the public wants and by trying to modify foods to comply with the nutritional imperatives directed by public health and consumer advocacy groups.
But the blame game has just not resulted in any success on the obesity front.
Perhaps it is time to drop the blame game and start looking at the actual evidence. A recent publication, readily available online , describes an analysis of energy expenditures in the US since the 1960s. In the 1960s, this analysis indicates that almost half the jobs in US private industry required a moderate level of physical activity. This has dropped dramatically to the point where now less than 20% of the jobs require the same level of energy expenditure. The analysis shows that this difference in energy expenditure translates to more than an average of 100 calories per day for both men and women. For men, the difference was 142 calories per day. This difference was then inserted in models that predict weight changes resulting from daily energy expenditures and was found to closely match the weight changes that have actually taken place during the past five decades.
As an example, for anyone weighing 170 lbs. in 1968, a 142 calories per day reduction in energy expenditure would result in a new weight of 198 lbs. today. These figures correspond well with the actual NHANES figures on the obesity epidemic. There is no blame to assess here. Technological development, world economic shifts and a move away from manufacturing towards a service economy has resulted in us pushing pencils more than wheelbarrows – in fact, were not even pushing pencils anymore, we’re tapping keyboards. Northern Europeans have fared somewhat better in this transition because their demographics encourages a greater energy expenditure to get to and from the workplace and pride in appearance is generally greater than it is in the US.
So, if we resist engaging in the blame game and actually try to solve the problem what can we do? If we simply look at the numbers, a walk of ½ hour per day is all that’s needed to reverse the trend and completely make up for the lost energy expenditure which occurred during the last 50 years! While there will always be a few employees physically unable to walk ½ hour at lunch, most can certainly do so. Perhaps employers can subsidize part of the cost of lunch for those employees that walk a mile and a half at lunch. Certainly, we have the technology to track this if the honor system won’t work. The point is that employers prefer healthy employees and obesity is a major obstacle to this. Anything that will serve as a positive incentive would be useful. The small investment in employees’ health would pay significant dividends.
It’s time to end the blame game.
The obesity epidemic has evidence-based causes and using the ideological blame game instead of the actual epidemiological evidence to achieve a solution will only delay it. There are better ways and we must get to them.
There are many types of calendars in the world. The Julian calendar, the Gregorian calendar, the Lunar calendar and the Chinese calendar, etc. Some follow the sun and some follow the moon. More recently, there is the opportunist's calendar. This is the calendar where opportunists of every type pick a day to promote their own self-serving cause. The latest example (http://bit.ly/Sr4kEy) is the "More Herbs, Less Salt Day" set for August 29th - the same day that the Soviets exploded their first atomic bomb, Pizarro destroyed the Inca civilization and executed their last Emperor and the day that hurricane Katrina slammed into the Gulf coast and decimated New Orleans. Interesting day to choose!
The "More Herbs, Less Salt Day" is supposed to encourage people to reduce their salt and replace it with herbs . They seem to have ignored the fact that more peer-reviewed medical publications caution against population-wide salt reduction than support it. Furthermore, salt has never been shown to cause harm in the thousands of years we have been using it.
However, the case is not quite the same for herbs and spices. Herbs and spices have been implicated in several negative health conditions including cancer. For example chilli powder, which is laced with the deadly chemical, Sudan IV, (http://tinyurl.com/dxdexdc ); ginger, which can harbor carcinogenic aflatoxins (http://tinyurl.com/d2fd2pr ); basil, which contains estragole, a known carcinogen and teratogen (http://tinyurl.com/28mclj ); and black pepper, which contains N-nitrosopiperadine, a strong carcinogen (http://tinyurl.com/ccqsp5l ).
In other words, they are recommending four known carcinogens to replace salt!
Interesting advice for an interesting day.
Once again, a respected medical journal has published a paper demonstrating that low salt diets cause more sickness and death than regular salt consumption. The most recent publication in the British medical journal, Heart, by Drs. DiNicolantonio, Di Pasquale, Taylor and Hackam was published online today (August 21, 2012). The details can be seen at http://heart.bmj.com/content/early/2012/08/21/heartjnl-2012-302337.abstract?papetoc . The medical researchers, from USA, Italy, UK and Canada, carried out a systematic review and meta-analysis of randomized trials with heart failure patients carried out up until April 2012. They concluded that low sodium diets significantly increases morbidity and mortality in patients with heart failure compared normal sodium diets.
This review follows on a recent Cochrane meta-analysis which demonstrated that sodium restriction did not reduce all-cause mortality or cardiovascular events.
Yet, North American guidelines for the management of heart failure consistently advise dietary sodium restriction for patients. The Guidelines for treatment of Heart Failure patients is hopelessly out of date. The letter I wrote to the American Heart Association two years ago asking them to reconsider their guidelines in light of new, peer-reviewed evidence, went completely unanswered. They, together with all our other public health institutions are in total denial of the evidence, and this latest publication confirms this once again. They have committed themselves so deeply to salt- reduction ideology, that no amount of new evidence will shake them from their pig-headed position. As a result, more people will die.
During the past three years there has been a great many medical publications cautioning against salt reduction in food. Peer-reviewed medical publications the world over have stated that salt reduction will result in higher rates of cardiovascular morbidity and mortality for Type I and Type II Diabetes patients. They have repeatedly shown that salt reduction down to the levels to the levels recommended in our dietary guidelines will result in greater all-cause cardiovascular mortality, losses in cognition, increase in unsteadiness and falls in the elderly and a host of other malignant conditions.
It is time our public institutions come clean and do what they are paid to do. They are in our employ to make recommendations based on the preponderance of scientific evidence – not to stake out an intractable position based on dogma and never veer from it, regardless of the consequence to consumers. They are not doing their jobs – even to the point of reading the published research. The position of our public health institutions was aptly described by Bill Watersson, author of the cartoon, Calvin and Hobbs, “It's not denial. I'm just selective about the reality I accept.”
The most recent review on blood pressure reduction by the world-renowned Cochrane Collaboration reveals that chocolate has a greater impact on reducing blood pressure than all the combined effects of salt reduction. Although the majority of Cochrane review articles on the subject have never supported population-wide salt reduction, a 2008 review (1) carried out by two of the world's most outspoken anti-salt advocates, stated that cutting the salt intake of normal people by half would result in a 2 millimeter drop in systolic blood pressure and a 1 mm drop in diastolic blood pressure. That review continues to be cited by salt-reduction activists.
Just today, however, the Cochrane Collaboration published a review (2) on the impact of chocolate on blood pressure and the results indicated a reduction of 2.8 mm in systolic blood pressure and a 2.2 mm drop in diastolic blood pressure demonstrating that chocolate is considerably more effective in reducing blood pressure than reducing salt intakes.
So if you are looking to reduce your blood pressure by a millimeter or so, you can forget about those tasteless, low salt cheeses, soups and snacks and try a bit of chocolate. You’ll have your cake – and eat it too!!
1) He FJ, MacGregor GA. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004937. DOI: 10.1002/14651858.CD004937
2) Ried K, Sullivan TR, Fakler P, Frank OR, Stocks NP. Effect of cocoa on blood pressure. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD008893. DOI: 10.1002/14651858.CD008893.pub2.
The last blog I posted, Rule Britannia, http://www.saltinstitute.org/News-events-media/Salt-Sensibility/Health/Rule-Brittania was taken directly from a comment I made to a HealthCanal story (which was linked in the blog). When I checked the HealthCanal story a few days later, my comment had not been published, so I sent it in once more. Two days later, my comment still did not appear, however, multiple reactions from WASH (World Action on Salt and Health) and CASH (Consensus Action on Salt and Health) were published.
This serves as an excellent example of the cozy relationship between publishers and their ideological beliefs. It is an example of ‘the ends justifying the means.’ You can lie, cheat, obfuscate, hide evidence and stifle opinion as long as you believe that the cause you serve overrides all ethics. It is the sort of thing that leads to the great medical blunders we have seen, such as hormone replacement therapy. It is also a common characteristic of those who are possessed by both their cause and their sense of self-importance and is quite typical of those currently promoting the salt-reduction agenda.
It the end, just as in the beginning, the only thing that matters is the preponderance of scientific evidence. And that, they will never conceal permanently.
Once again, the British are off to show the rest of the world how things should be done. http://www.healthcanal.com/public-health-safety/31407-Researchers-win-funding-reduce-salt-intake-for-children-and-their-families-China.html What a wonderful development! Queen Mary’s MacGregor and He are off on a Wolfson-funded expedition to spread the gospel to China. Armed with a heavy dose of paternalistic zeal, they want little more than to teach the natives how life should be lived.
And, of course, we have centuries of history to back them up. Not satisfied with managing their own little isle, the indomitable Brits forcibly enlightened much of world for centuries. Their greatest triumph was India, where their particular manner of influence dominated one of the largest populations in the world. The gratitude of the nation was keenly demonstrated with the humble demise of the Raj.
Unable to learn from history, these tireless anti-salt zealots have now set their sights on even bigger game. It is one of life’s ironies that their broad vision of proselytization is attended by such a myoptic view of the actual medical evidence on salt and health.
Having botched their efforts in the cloudy and chaotic food culture of the UK – this indefatigable duo, pockets stuffed with herbs and tattered stethoscopes held high, will now attempt to demonstrate how life ought to be lived in the largest and one of the oldest cultures in the world.
Rule Brittania!
Most consumers have placed great faith in their government health agencies and consumer activists’ abilities to keep them up to date with rational and meaningful nutrition data. Incredible amounts of money have been spent on labeling systems claiming to do just that.
Unfortunately, the reality is that the very institutions and people that consumers have depended on to provide them with this information have let them down miserably. An excellent example is the recent work coming out of the USDA that has demonstrated that our calorie counts on food labels are all wrong and have been so from the very beginning. See http://prn.to/OyfQOy
This is not a new revelation. Professionals in the food industry have known for decades that our understanding of calories is bogus. Calories are determined by a technique called oxygen bomb calorimetry – a fancy term to describe the complete oxidation of a food substance. The amount of heat produced is measured as calories. BUT THAT IS NOT THE WAY WE EAT FOOD. There is such a thing as digestibility! The structure of a food will affect its digestibility, and any undigested food will NOT be oxidized. But digestibility is never considered in the calorie listing on the label. I have complained about this for years at public meetings, only to be totally ignored by our public health bureaucrats. See http://bit.ly/PiHQ3t and http://bit.ly/M8tAKf . In the animal feed industry, this has been understood for decades, but not for human foods.
Why hasn’t the government accounted for this information known for decades? One reason – sloth! Accounting for digestibility means a lot more work, which they are not interested in doing. They have justified this by saying it is an unnecessary complication that consumers will not understand. As long as there was no public pressure to get it right, they didn’t want to rock the boat.
Why haven’t our consumer advocates told us about this? I can think of two reasons. Either they know so little about food that they were unaware that digestibility was never calculated in the calorie declarations or because of their ‘Merchant of Menace’ agenda, they preferred to have consumers believe that the calorie content of foods were higher than they actually were.
In fact, food digestibility has even greater implications. Foods that are less digestible have a lower bioavailability of all their nutrients, not just calories, so the entire label is wrong. Worse, in the dynamic digestions system we all have, eating low digestibility foods will hasten the passage of whatever else we are eating along with them through our system and will lower the bioavailability and calories of those foods as well. This is not rocket science! It is clear to anyone that takes the trouble to see what is going on.
Come to think of it, it’s not only time that our nutrient labeling system is overhauled; it’s time to replace those we depended on for years.
Today’s MoM (Merchant of Menace) health headlines blared out, “Diets High in Salt Could Deplete Calcium in the Body.” (http://tinyurl.com/brrsj89 and http://tinyurl.com/cae6oxv ) It was even reported that way throughout Asia. While this important issue is worthy of study, the reported conclusions of the research appeared to be driven more by an anti-salt ideology than by actual evidence. The giveaway was the statement in the University’s press release, “This is significant because we are eating more and more sodium in our diets, which means our bodies are getting rid of more and more calcium. Our findings reinforce why it is important to have a low-sodium diet and why it is important to have lower sodium levels in processed foods.”
Wrong!
The actual evidence shows that our salt consumption has remained unchanged since the 1950s (Bernstein & Willett, Am J Clin Nutr, 2011). Therefore, any growing impact resulting from calcium depletion cannot be attributed to increased salt consumption. In fact, we now eat less salt than we did 200 years ago (http://tinyurl.com/cmaaq4d ). The reason is that refrigeration has replaced salt as the primary means of food preservation.
What makes the press release even more bizarre is that the actual publication in the American Journal of Physiology stated that all the experimental research was carried out on opossum cells and genetically modified mice! The rest of the story on calcium loss in humans was pure hypothetical speculation! No fooling, opossum cells and GM mice. Would you say that the headline, “Diets High in Salt Could Deplete Calcium in the Body,” was somewhat exaggerated? Do you have any reason to trust what the University press releases say in future? Better to go back to the original study and eliminate all the gratuitous speculation and opinion and stick with the evidence. You will be better informed.
You can read many more exaggerations in the salt:health debate at http://tinyurl.com/7v48267 , where you will also have reference to all the peer-reviewed studies.
The British newspapers headlined a report issued today by the World Cancer Research Fund (WCRF) that stated if people consumed foods according to the Dietary Guidelines, one-in-seven cases of stomach cancers would be prevented. Now, there are 6,000 cases of stomach cancer every year in the UK and the WCRF estimated that around 800 could be avoided if everyone stuck to their 6g of salt a day.
However, looking at British heath statistics, it has been variously estimated by researchers that approximately 46,227 cases of stomach cancer could be avoided if we gave up the carcinogens in coffee, tea, cocoa, meats, all fried, grilled, bbq'd and broiled foods, sugar and sweeteners.
Fortunately, as most people are unaware of this, they continue to consume these foods to their heart's content and have thus greatly reduced the total number of potential cases.
We are now living longer than we ever have in history. Between 1940 and 2040 the population above the age of 85 will increase 40-fold. In fact, one of the fastest growing segments of the US population is people over the age of 85. They accounted for about 12% of all elderly people in 2000 and are expected to grow to 20% by the year 2040 (1).
Because of this meteoric rise in the number of elderly people, geriatric problems are on a steep and steady rise. Dehydration, falls, fractures, cognition, attention deficits and sensory disorders are now becoming much more commonplace.
The latest information on the subject was presented last week at the 20th annual meeting of the Society for the Study of Ingestive Behavior held in Zurich, Switzerland. In a presentation entitled, “Salt appetite across generations: aged and middle-aged,” researchers Khadeja Hendi and Micah Leshem of the Department of Psychology, University of Haifa, confirm that, in the elderly, impaired thirst results in a greatly increased the risk of dehydration. However, salt appetite does not diminish with age. In light of the risks to cardiovascular health and longevity from consuming any less than 6.5 g or more than 15 g of salt per day, increasing intake in the elderly prone to dehydration should be examined (2). Their findings show that the healthy salt appetite in most aged may be harnessed to sustain hydration status. This should serve as an additional reminder to assisted living care givers to be very cautions before recommending a ‘low-salt’ diet for the elderly.
Furthermore, in older people, mild hyponatremia is the most common form of electrolyte imbalance and has been shown to be associated with walking impairment, attention deficits and a much higher frequency of falls. Indeed, there have recently been a number of publications that found a direct relationship between mild hyponatremia and falls, bone fractures, unsteadiness and attention deficits (3, 4). Falls are a major socioeconomic problem in the elderly. About 30% of people over 65 fall every year (5, 6). Fall-related injury in the elderly is associated with numerous psychological and physical consequences and is a leading cause of death and disability. Falls are also associated with bone fracture in 4–6% of cases and death occurs from complication of fall in around 2% of cases mostly in patients with hip fracture (7). Almost 5.3% of all hospitalizations in people aged 65 years or older are due to fall related injuries (8).
Mild hyponatremia in the elderly is no longer considered as an asymptomatic condition. Evidence clearly points to significantly increased attention deficits, loss of cognitive function, increased falls and fractures – a cascade of conditions resulting in a highly diminished quality of life and a reduced life span. It is a significant threat that can be treated by simply adding salt to the diet.
The elderly should very carefully consider any broad, sweeping recommendations to go on a low salt diet. A well balanced diet, replete with salads, vegetables and fruit is the best approach to enjoying a healthy, active retirement.
References
1) www.merck.com/mkgr/mmg/contents.jsp also CDC figures
2) Alderman, MH, and Cohen, HW, Dietary Sodium Intake and Cardiovascular Mortality: Controversy Resolved? Am J Hypertens, 25 (7), 727-734, (2012).
3) Gankam Kengne, F., Andres, C., Sattar, L., Melot, C., and Decaux, G., “Mild hyponatremia and risk of fracture in the ambulatory elderly,” QJ Med, 101, 583–588, (2008).
4) Renneboog, B., Musch, W., Vandemergel, X., and Manto, M. U., “Mild Chronic Hyponatremia is Associated with Falls, Unsteadiness, and Attention Deficits,” The American Journal of Medicine, 119, 71.e1-71.e8, (2006).
5) Graafmans, W.C., Ooms, M.E., Hofstee, H.M., Bezemer, P.D., Bouter, L.M., Lips, P., “Falls in the elderly: a prospective study of risk factors and risk profiles,” Am J Epidemiol, 143, 1129–36, (1996).
6) Sattin, R.W., “Falls among older persons: A public health perspective,” Ann Rev Public Health, 13, 489–508, (1992).
7) Sattin, R.W., Lambert, D.A., DeVito, C.A., Rodriguez, J.G., Ros, A., Bacchelli, S., et al, “The incidence of fall injury events among the elderly in a defined population,” Am J Epidemiol, 131, 1028–37, (1990).
8) Alexander, B.H., Rivara, F.P., Wolf, M.E., “The cost and frequency of hospitalization for fall-related injuries in older adults,” Am J Public Health, 82, 1020–23, (1992).
