Okay, it's still early, but Junk Food Science has raised the bar in its report this week on "Who decides what you can eat? Sating on salt ." Read it all. Twice.

Noting that New York City has announced a campaign to reduce dietary salt in the Big Apple, nurse-blogger Sandy Szwarc laments that the "significance of this initiative may have been lost on media" and capsulizes why people should care:

It deserves to be out in the open, though, because the best science for nearly half a century — including the government’s own findings on examinations reflecting 99 million Americans; more than 17,000 studies published since 1966; and even a recent Cochrane systematic review of the clinical trial evidence — fails to support the hypotheses that salt reductions offer health benefits for the general public. Cochrane’s reviewers specifically concluded that such interventions are inappropriate for population prevention programs.

It’s not just that the salt reductions being proposed will be costly programs that won’t be of much help to people, but that they could hurt people. Even more troubling, the public health messages in this new campaign appear to be most targeting minorities, fat people, the elderly and poor.

Szwarc sums the NYC campaign quoting from the New York Times : “Dr. Frieden says a quiet, mass reduction in sodium levels — stealth health, they like to call it around the department — might be more effective.” She then continues to skillfully excoriate the city health department's scientific summary: "None of these claims can be scientifically supported," she declares.

She then explains how heart disease rates are improving, how population blood pressure has been unchanged over the past 20 years and how salt usage, also, has not increased over the past 20 years. Then she turns to health outcomes, summarizing the findings by a team at the Albert Einstein Medical College who studied the biggest and best federal government database, the National Health and Nutrition Examination Survey (NHANES):

The lowest sodium intakes — the 1500 mg/day that the New York health department says everyone should be eating — were associated with an 80% higher risk of cardiovascular disease compared with those consuming the highest salt diets. The lowest salt intakes were also associated with a 24% higher risk of all-cause mortality. Clearly, low-salt diets are not associated with lower risks for the general population. Conversely, the Albert Einstein researchers were unable to show that even the highest salt intakes were associated with increased risks for developing cardiovascular disease or high blood pressure or for premature death.(emphasis in original)

She explores the "unintended risks" of low-salt diets, the many scientists who question universal salt reduction and queries: "What is it all about?" answering:

As the New York City-led nationwide low-salt initiative is clearly not founded on a true health crisis, on the medical evidence, or on proven health interventions for the primary prevention of high blood pressure or heart disease, what might it really be about?

As the New York Times pointed out today, the target is going after packaged foods and chain restaurant meals. Reducing salt to levels unpalatable to their consumers appears to primarily be about getting people to eat less of foods these public officials don’t think people should eat or others should sell.

Szwarc rarely deals with salt. She's been a consistent and effective proponent of evidence-based health decisions on a broad range of nutrition issues. Her insights earned Junk Food Science "silver medal" runner-up recognition for the best medical/health issues blog for 2008. This could vault her to "gold" in 2009!

President George W. Bush's first director of his White House Office of Information and Regulatory Affairs (OIRA), Harvard professor John Graham, exercised an activist role in promoting better science in federal decision-making. President Obama's OIRA choice, another Harvard professor, Cas Sunstein, could do the same.

Graham directed the Harvard Center for Risk Analysis. Sunstein has been on the faculty of the Harvard Law School and directs its Program of Risk Regulation. He taught earlier at the University of Chicago and is the author of a recent book, Nudge.

A devout liberal who writes for New Republic regularly, he also advocates some positions (judicial minimalism and support of such Bush nominees as now-Chief Justice John Roberts, among them) that have worried left-leaning environmentalists like Chris Mooney, author of the anti-Bush diatribe The Republican War on Science. Mooney admits he's impressed with Sunstein's intellect. "I'm interested to hear whether any environmentalists are going to be rattled by this choice. Sunstein is an ingenious scholar, and continues the whole "best and brightest" motif of the Obama administration...Important question: Will he roll back the Bush administration's overuse of the Data Quality Act?"

Good question. Our concern was that, after Graham’s departure, the Bush Administration failed to push the Data Quality Act far enough. But Sunstein is a believer in behavioral economics and its contention that the theoretical assumptions of law and economics should be modified by new empirical findings about how people actually behave. This might lead to the kind of confident assumption that government policy manifestos to change Americans’ diets will trump human physiology. Stay tuned.

Perhaps you saw the headlines like "salt reduction benefits go beyond blood pressure." We did, so we read the study by Kacie Dickinson et al, "Effects of a low-salt diet on flow-mediated dilation in humans ." The study of 29 overweight and obese Australians in this month's American Journal of Clinical Nutrition is being portrayed as yet another reason to reduce dietary salt.

Not so fast. We recognize that there are many changes that occur when dietary salt is reduced, some well understood (e.g. renin, aldosterone, insulin resistance, blood pressure), others less so. So it may be that this study adds to our understanding.

Keep in mind one key finding: "There was no correlation between change in FMD (flow-mediated dilation) and change in 24-h sodium excretion or change in blood pressure. No significant changes in augmentation index or pulse wave velocity were observed."

As we push for risk factors of risk factors, let's not lose sight of the other competing mechanisms that are activated by lowering dietary sodium and reaffirm our commitment to examining the sum total, the net outcome of all these interventions in terms of cardiovascular health.

Forecast for New York City: flurries. While many New Yorkers may worry more about whether salt is being used to keep their streets safe, city health commissioner Thomas Frieden is concocting a plan to put less of it in their diets.

Today's New York Times carries a story by Kim Severson, "Throwing the book at salt " which describes Frieden's effort to reduce salt in packaged foods and restaurant meals with an aim to reduce salt intake by 25% over the next five years. He's talked to the food industry (mentioned) and the Salt Institute (unmentioned) and warns: "If there's not progress in a few years, we'll have to consider other options, like legislation."

Severson continues to point out the campaign will be "difficult for Dr. Frieden, both practically and politically."

It's actually more difficult than Frieden and his cardiovascular advisor Sonia Angell imagine. Severson quotes Angell presuming that salt intake is a matter of taste: "We've creatd a whole society of people accustomed to food that is really, really salty. We have to undo that." The plan is for "stealth" reductions in the salt content of processed foods "based on one in the United Kingdom (where) targets for sodium reduction will be set for certain food categories."

All this in blithe ignorance of the evidence. Well, not really ignorance, self-deception. Last week, the Salt Institute met with Dr.Frieden and his senior staff and laid out the problems he's facing, none of them "political" but all "practical" since the campaign is based on pseudo-science. The Institute confirmed its representation in a letter, as usual, posted on its website . The letter warns that Frieden's disregard of the science amounts to "using the citizesn of New York as a grand experiment of this generally-believed but as-yet untested hypothesis."

The Institute told Frieden that sodium-reduced diets raise the blood pressure in a significant number of people and will increase in most people insulin resistance, sympathetic nervous system activity and activate productin of renin and aldosterone, well-demonstrated to increase their risk of teh very cardiovascular events your program is intended to reduce." Bottom line: "Salt reduction may actually increase the risk of a significant portion of those New Yorkers who adopt your recommendations since teh lower sodium intake stimulates these known physiologic factors for heart attacks, congestive heart failure and metabolic syndrome."

The Institute lamented the predictable but "unintended consequences" since the medical literature is discovering more and more adverse impacts of salt reduction. "Since it is your mandate to improve the public health of the citizens of New York, we remind you that it si these physiological facts, not political policies that will ultimately determine health outcomes," the Institute warned.

Frieden's campaign also ignores strong evidence that the UK model has been a total waste of money and has achieved no sodium reduction and that medical evidence shows that humans' salt appetite is "hard-wired" in the brain, not a behavioral choice. Unmentioned in the letter was a new study released just yesterday showing that the "human brain makes snap decision on fat content" -- the headline on a new study in NeuroImage .

NHLBI scientists and their taxpayer-funded university researchers released a follow-up study for the important Trials of Hypertension Prevention trial . The authors claimed "a higher soidum to potassium excretion ratio is associated with increased risk of subsequent CVD (cardiovascular disease)." Headline writers fell in line.

A summary analysis of the article published in the January 12 Archives of Internal Medicine would have been more accurate had it stated: There was no statistically significant relationship between sodium excretion and cardiovascular risk and even the reported non-significant association evaporated when the researchers adjusted for known confounding factors. A "p-value" (calculating the likelihood that the reported association was accurate) is usually considered valid when it is 0.05 or less, meaning a 95% chance that the result is accurate. The sodium:blood pressure "p-value" for men was 0.49 and for women 0.98. This means that there was only a 51% chance of a valid relationship between sodium among men and a miniscule 2% chance in women. Hardly the conclusion drawn by the authors or the headline writers.

With the Dietary Guidelines for Americans up for review, we can hope the process deals more with data than headlines. But don't hold your breath.