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.
