Reiterating a point the Salt Institute has raised for years, this December 14 post by NewsTarget.com explains the growing medical view that mineral deficiencies are responsible for high blood pressure more than "excess" dietary salt. We can't vouch for all the quotes, but the sentiment is mightily appreciated. Our reading of the DASH Study is that correcting deficiencies of calcium, magnesium and potassium in the diet largely eliminates "salt sensitivity" with regard to blood pressure.
Two articles in recent days in New York City newspapers caught my eye. On Dec. 16, the New York Post ran an op ed by Dr. Elizabeth Whelan, president of the American Council on Science and Health entitled "A Year of Public Health Lunacy ." She laments how public health advocates "seem to put politics before science," citing Iowa's ban on the preservative thimerosal in vaccines or banning soft drinks from schools to combat obesity (both regular and diet soft drinks). She notes the fall of the Harvard School of Public Health which has recently embraced junk science on at least a couple issues.
Then, today's New York Times story "Global Trend: More Science, More Fraud " highlights research shennanigans in South Korea. The Times story cautions: "To be sure, most scientists resist pressures to cut corners and adhere to the canons of science, honoring the truth above all else. But surveys shuggest that there are powerful undercurrents of misbehavior and, in some cases, outright fakery.
Just as we need strong and authoritative science so help us sort out issues like the healthfulness of dietary salt, science is under an attack that threatens its credibility. Preserving this credibility is of paramount importance, given the proclivity of both corporate marketers and "public interest" advocates, including those embedded in the federal bureaucracy, to cloak their policy preference in claims they are "evidence-based." It matters not whether the motivation is to increase market share for a product, raise funds by sounding a public alarm or protecting or advancing a professional reputation for advancing the frontiers of medical knowledge. Insidious "insider" manipulation of data and/or their interpretation risks depriving society of any authoritative source.
As in other areas where sophistication outstrips morality, we must "go back to basics." In this case, that means to strip away the pretense of "science" and looking at the fundamentals such as study design and standards of interpretation. Everyone says theirs is "high quality" science, of course, even high schoolers' science projects.
Fortunately, we can go back to basics by reviewing what it means to embrace "evidence-based" public health policy. Our Dietary Guidelines claimed to be evidence-based, but didn't hew to the definitive standard crafted by the Cochrane Collaboration . As governments slip into politicized health care policy, inviting scientists to explain their findings against the outcomes-based scientific method pioineered by the Cochrane Collaboration offers the most promising way to re-establish the credibility we need for science-based public health policy.
Using its rigorous methods, the Cochrane Collaboration offers its views on "advice to reduce dietary salt for prevention of cardiovascular disease ," specifically: "There was not enough information to assess the effect of these changes in salt intake (a reduction) on health or deaths."
Let's move away from scientific fraud and the public health lunacy that follows in its wake and insist on true evidence-based public health policies.
Marketers would have us believe that the self-selecting online community is composed of above average intelligence information sponges, perhaps suffering info overload, but certainly well informed. A recent poll suggests otherwise.
Last week, A.C. Nielsen reported results of an online survey of 21,261 "regular Internet users" conducted earlier this year asking about their views on functional foods. Not too surprisingly, pollsters found consumers skeptical of food manufacturers' health claims for foods. I'm sure they'd also be skeptical about carrots and broccoli, much less foods engineered or fortified to provide additional health benefits. U.S. consumers, incidentally, were far more accepting of enhanced foods than Europeans or the global sample.
But can we believe the pollsters? A look at the poll details suggests they may be wrong.
The survey asked whether consumers used functional foods. The first "functional food," many know, is salt fortified with potassium iodide or potassium iodate. American salt producers began adding iodine to salt in the 1920s in the U.S. and Switzerland to prevent goiters and mental retardation. Salt iodization has been promoted heavily since then; it was UNICEF's top children's health initiative in the 1990s. Iodizing salt is the public health community's preferred choice because it is very inexpensive and iodine-fortifying salt changes neither the taste nor food properties of the salt. Unless they read the label on the container, consumers cannot know whether the salt is iodized or not - except in those countries which require ALL table salt to be iodized (e.g. Canada).
In the U.S., 70% of table salt is iodized - that percentage has been stable for several generations. That means more than two out of three "round cans" purchased are iodized and it follows, since salt is consumed, on average, in a relatively narrow range, that about seven in ten consumers are using iodized salt.
U.S. consumers told pollsters, however, that only 3 in 10 were using iodized salt, 30% - a somewhat lower percentage than globally (33%). Almost more shockingly, when the U.S. and Canada were combined, only 24% reported using iodized salt - despite the fact that all Canadian table salt is iodized. Since the Salt Institute collects comprehensive market statistics, the certain conclusion is respondents knowledge is the exact reverse of the dictum that "the customer is always right."
It's quite discouraging that there are 70% who claim not to be using iodized salt when actually 70% Americans and virtually all Canadians DO use iodized salt. What is more discouraging is that these erring respondents go on to prove just how clueless they are. Asked about why they chose plain salt over iodized salt, 35% doubted that iodine-fortified salt was any healthier (obviously none were endocrinologists! Iodized salt is the consensus public health solution for iodine deficiency). An additional 17% said they didn't like the taste of iodized salt (fact: the iodine has no taste whatsoever); 6% said the fortified salt is too expensive (fact: it's sold at retail for exactly the same price as plain salt); 5% said it wasn't available where they shop (check this out yourself: iodized salt is always available even if plain salt isn't) and, finally, 1% complained of poor quality (I won't even dignify that with an answer).
Bottom line: consumers mistakenly think they're not using iodized salt and provide nonsensical reasons for their fallacious opinions. Why? Could the answer be as simple as the likelihood that "regular Internet users" aren't as well-informed as previously thought? In mid-19th century U.S. politics, the "American Party" was nicknamed the "Know Nothings." They had nothing on Americans in the Nielsen Poll.
For more on iodized salt, see http://www.saltinstitute.org/37.html .
Everyone's afternoon's headlines report a mistrial in the Merck Vioxx case. A few days ago, the New York Times and the Wall Street Journal reported complaints by the New England Journal of Medicine that Merck had withheld health outcomes data on the NEJM-published Vioxx trial. NEJM editors expressed outrage that adverse cardiovascular events (heart attacks, strkes and deaths) were excluded from the Merck analysis.
The editors said they were concerned that not reporting the adverse health outcomes and selectively reporting the study results "made certain calculations and conclusions in the article incorrect." Serious charges with serious consequences. Money wasted. Lives lost. Opportunities for better health alternatives ignored. Important story.
OK, you can read all that somewhere else. What in the world does that have to do with salt?
It turns out that this same journal, these same editors, earlier published another important study where the data were incomplete and the resulting highly-heralded "calculations and conclusions in the article (were) incorrect." Two differences, however. First, the NEJM has not insisted that the authors fill in the blanks and publish the missing data. And, second, the reason may be that in the Merck Vioxx case, the allegations fingered a money-loving corporation while the research in the other case was funded by a federal agency with motives presumed as pure as those puffy white crystals falling from our winter skies.
The earlier study is the DASH-Sodium trial and the failure to voluntarily publish enough data to enable objective outside observers to verify (or "replicate," the relevant standard in the applicable federal Data Quality Act) has led the Salt Institute and the U.S. Chamber of Commerce to challenge withholding the relevant data. That case is in federal appeals court and will be heard on February 2nd.
To repeat: Money wasted. Lives lost. Opportunities for better health alternatives ignored. Important story. Whether the funding agency is a private corporation or a public agency, we need transparency to ensure that motive, means and opportunity to abuse science don't criminally sacrifice our opportunties to promote improved public health.
Most readers probably heard about the death this past week of former South Carolina Gov. Carroll Campbell, an exemplary political leader. The same day Gov. Campbell died of a heart attack, I received an invitation to attend an awards ceremony on Dec. 14 sponsored by the New York Academy of Medicine and Greater New York Hospital Association honoring Dr. John H. Laragh, Director of the Cardiovascular Center, New York-Presbyterian Hospital Weill Cornell Medical Center. Dr. Laragh is revered for his pioneering leadership in preventing heart attacks.
Dr. Laragh also founded and led the American Society of Hypertension for years and oversees the editorial quality of The American Journal of Hypertension. Many Americans were introduced to his achievements through a cover story in Time magazine nearly 31 years ago, January 13, 1975.
Despite our great advances in many areas of medical science, when it comes to preventing heart attacks, the promises of Dr. Laragh's early research have been realized only inconsistently because "politically correct" decisions have misdirected our attention.
Disclaimer: I've known and respected Dr. Laragh for nearly 20 years and am pleased and proud to have been able to include an affidavit from him supporting the Salt Institute's petition to the National Heart, Lung and Blood Institute seeking correction of NHLBI's improper characterization of the DASH-Sodium Study, which decision has been through a regulatory and now judicial process and will be argued before the U.S. 4th Circuit Court of Appeals in Richmond, VA on February 2, 2006.
At the awards ceremony honoring Dr. Laragh next week, he will deliver a lecture on "The Laragh Blood Pressure Equation: BP = (body salt) x (plasma renin)." The message is as important as when he enunciated its principles more than 30 years ago: hormonal factors are crucial to understanding hypertension and the importance of focusing on heart attack risk, not blood pressure alone.
I've extracted key, relevant quotes from the Time cover story, below, that make it clear that today's controversies over whether it is a good idea to reduce dietary salt to lower the risk of heart attacks, reflect a turning-away from the sage insights Dr. Laragh contributed long years ago. It's a great story... and a cautionary tale of progress in preventing heart attacks that was undone by an unsophisticated, non-scientific, but "politically correct" assault on salt.
Hypertension - Conquering the Quiet Killer"
"Much of the credit for this successful treatment belongs to a perky professor of medicine named John Henry Laragh. Best known for untangling the hormonal relationships that control blood pressure, Laragh, 50, pioneered in the treatment of high blood pressure by founding the nation's first hypertension center, at Manhattan's Columbia Presbyterian Medical Center, in 1971." ... He had just announced his move to Cornell Medical Center.
"Laragh's move comes at an appropriate time. Medicine is better equipped than it has ever been to handle hypertension. Yet the disease remains perhaps the most neglected of health problems. Many physicians, in fact, still believe that moderately elevated blood pressure need not be treated. Laragh is determined to change all that. 'Hypertension does not have to be the single leading factor in disability and deaths in the U.S. today,' he insists. 'We have the means to control it. What we have to do is use them. We're ready for an all-out attack.'
"That attack has been a long time coming, for high blood pressure has been an enemy of men throughout recorded history. A Chinese medical text, dating back to 2,600 B.C. noted that a diet high in salt (now know to affect blood pressure) could cause changes in pulse and complexion." ...
Since (1929 with the invention of the means to measure blood pressure, doctors) have become considerably more sophisticated about both blood pressure and its effects on the body." ...
"To Laragh, the explanation is obvious. 'Salt is the hydraulic agent of life,' he explains. 'It is salt that hold the water in humans, causes welling and a high fluid volume.' This means an increased blood pressure.' ...
"Until the end of World War II, doctors treated hypertensives, if they treated them at all, mainly by diet. Patients with high blood pressure were told to take off weight and lower their salt intakes. ...
Laragh, a cardiologist by training, "looked elsewhere in the circulatory system, and in 1955 he made an important discovery: he learned that increases in the blood levels of potassium can stimulate the production of aldosterone, an adrenal hormone that raises blood pressure by causing the kidneys to retain salt.
"In the years that followed, Laragh made even more spectacular findings, which like so many other achievements in science, were serendipitous. Doctors had been aware of the role of aldosterone for some time. But they had been puzzled by the part played by renin, a kidney hormone produced in response to a drop in blood pressure. Laragh solved the puzzle. In 1958, he and his colleagues began treating a man with malignant hypertension, a rare form of the disease that is characterized by the kidney damage and usually kills its victims within a year. Tests showed that the man was, to their surprise, producing far more than the normal amount of aldosterone. This finding led to another series of tests that proved even more revealing. They showed that high aldosterone was probably due to increased secretion of renin." ...
This discovery won Laragh a share of the Stouffer Prize in 1969 and "explained the hormonal controls of blood pressure for the first time. They also permitted the development of a renin profile - a computer-aided analysis of the patient's hormonal output." ...
"Laragh's finding also cleared up another of the mysteries surrounding hypertension. Many hypertensives dismiss the seriousness of their conditions by citing the case of a relative who lived to be 80 despite a blood pressure that nearly popped the mercury out of the doctor's sphygmomanometer. Laragh's work indicates that these exceptions, which seemingly violate the rule that high blood pressure is dangerous, were probably low-renin hypertensives. Patients with this condition are less likely to suffer strokes and heart attacks than high-renin types."
The article also credits Dr. Laragh with discovering that "The Pill" with its estrogen-like ingredients, stimulated renin system and induced HBP and noted, in 1975, that the government was launching the "MRFIT" study, "designed to prevent heart attacks." Interestingly, government analyses of this government-funded database have not identified that those on low-salt diets achieve any reduction in cardiovascular events or live longer. For more, see the Salt Institute website, http://www.saltinstitute.org/28.html and http://www.saltinstitute.org/healthrisk.html .
For information on the Laragh award, contact the New York Academy of Medicine at http://www.nyam.org/events/?id=108@click =