Choose a few minutes when you want a pick-me-up -- and bookmark the URL for future reference; you'll want to read a new Junk Food Science blog post "Traffic tickets for salt -- does healthy eating mean low salt? "
In a word, "no." But here is author Sandy Szwarc's lead to give you the flavor:
Salt makes food taste good. Therefore, it must be bad for us. Enjoying food means people might eat too much and get fat.
Believe it or not, that is the logic behind beliefs that everyone - from children to adults - should reduce their salt intake as an important part of 'healthy' eating.
Fears of salt have become so widespread, even little kids are being told it's bad for them and given low-salt diets.
She quickly moves to explain why this matters:
But salt is another food ingredient where the science and the voices of medical experts have had a hard time breaking through myths, fears and pop ideologies.
What may seem inconceivable, given the Red Lights being given to salt, is that there is no credible evidence low-salt diets can help prevent heart disease, high blood pressure or premature death. Nor is there any sound evidence to support fears that we're eating too much salt and that high salt diets increase our risks for cardiovascular disease and deaths. Nor can we assume that putting everyone on low-salt diets "can't hurt" and are benign. In fact, the medical research suggests the very opposite.
She continues at length (more than 2,250 words) to explain the NHANES research results from the Albert Einstein Medical College as well as the just-reissued Cochrane Review on "Advice to reduce dietary sodium for prevention of cardiovascular disease." The advice, of course, is: don't bother; there's no evidence of a a heath benefit.
Significantly, Szwarc recounts the multiple risks for those who follow political convention and curtail their salt. Our short post cannot do it justice. You need to read it yourself.
She concludes with this warning:
There are a lot of urban legends about salt, from "salt kills" to "cutting salt can add years to your life." The scariest thing isn't salt, though. It's that scare-based legends and myths, rather than good science, are guiding public health policies, the "nutrition" education being given children, and the public health messages teaching everyone to fear salt. Agendas that are not about health.
We can see why the blog was a finalist for the best new medical blog. Happy reading.
Scotland's youth just received their health "report card " from the World Health Organization. The report was prepared by a Scottish doctor for WHO-Europe and represents rosy health results for Scottish youngsters (among others).
It presents the key findings on patterns of health among young people aged 11, 13 and 15 years in 41 countries and regions across the WHO European Region and North America in 2005/2006. Its theme is health inequalities: quantifying the gender, age, geographic and socioeconomic dimensions of health differentials. Its aim is to highlight where these inequalities exist, to inform and influence policy and practice and to help improve health for all young people.
The report clearly shows that, while the health and well-being of many young people give cause for celebration, sizeable minorities are experiencing real and worrying problems related to overweight and obesity, self-esteem, life satisfaction, substance misuse and bullying. The report provides reliable data that health systems in Member States can use to support and encourage sectors such as education, social inclusion and housing, to achieve their primary goals and, in so doing, benefit young people's health. Policy-makers and professionals in the participating countries should listen closely to the voices of their young people and ensure that these drive their efforts to put in place the circumstances - social, economic, health and educational - within which young people can thrive and prosper.
Yet, within a week, a local paper reported that the government's crusade to re-make Scots' diets will be accelerated. If the kids' "report card" was okay, clearly their parents need some shaping up. Among the new initiatives:
Ministers also want to change the way cooking is taught in the nation's catering colleges by getting young chefs to rely less on salt, sugar, butter and cream, and more on healthy alternatives.
Among the interventions planned is having every worker log in daily using government software to report to the government on his or her personal diet and health situation. The Confederation of British Industry objected.
Iain McMillan, the director of CBI Scotland, said: "I think we will want to look at the detail and we are in favour of promoting health. But it seems that some people are drinking far too much and some are eating far too much and it's everyone else's fault but their own. We need to have far greater regard for the fact that people are responsible for their own welfare. And this seems to be a very heavy-handed approach."
Regular readers will recall the earlier attempt in Glasgow to "lock down" schools at lunch time because students were going off-campus to avoid the "healthy" fare in their cafeterias -- and monitors were to check students' brown bag lunches for nutritional adequacy.
And this from the nation that gave the world the Magna Carta.
Our thanks to Junk Food Science for surfacing the issue.
Returning to an oft-posted theme -- that health and nutrition activists' efforts to demonize all science not funded by (friendly) government bureaucrats leads to politically-correct junk science -- I thought readers might find of interest an op ed piece from earlier this week in the Financial Post , part of the National Post, one of Canda's largest papers.
Author Dr. Beth Whelan, president of NYC-based American Council for Science and Health, decries "the witch hunt against corporate funding of research...." pointing out several recent example of how Health Canada has embraced junk science in order to address alleged health threats. She explains that the
latest unscientific legislation (was) made possible in part by a dangerous prevailing assumption: namely, that anti-corporate claims are by definition "good science" while claims made in defence of industry or new technology - by anyone with the slightest ties to industry - are by definition "suspect science."
Ironically, consumers end up paying higher prices as a result of such ostensibly consumer-protecting measures (as products need to be replaced or reformulated) or even end up using less-safe replacement products, such as old-fashioned glass bottles.
Because the insidious de-legitimizing has progressed so far, she laments:
CSPI and others, ignoring decades of productive collaboration between industry and science, can now delegitimize any scientist or scientific conclusion with which they disagree by showing that the scientist or research in question is tied to corporate money.
Our beef is the other side of this coin, namely that the converse of uncritically rejecting any privately-funded research as biased is the uncritical acceptance of publicly-funded research as immune from bias since its sponsors are public agencies. We've seen too many examples of government cooking the books and funding scientists who refuse to divulge their data for independent expert verification.
Economists well understand the perverse incentives that apply when government insists on owning the means of production. Will the public -- and public health practioners themselves -- recognize the perverse incentives inherent in the uncritical acceptance of junk science based on the supposedly-untainted funding from public agencies?
It was just yesterday that we noted the excellent paper, "Redefining Quality--Implications of Recent Clinical Trials ," published in the June 12 issue of the New England Journal of Medicine. Doctors Harlan Krumholz and Thomas Lee challenged their medical colleagues to design medical strategies that affect overall patient health outcomes - not simply isolated risk factors. Reluctantly, we stated that it was unlikely the article would get most of their colleagues to move away from the risk factor fixation.
It did not take long for that unfortunate prediction to be realized. It appeared in the supplement to the article "Cutting salt intake saves lives and money ". The Abstract which appears halfway down the page under the title, "The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 - therapy" describes a project to update the evidence-based recommendations for the prevention and management of hypertension in adults. It goes on to state:
"For lifestyle and pharmacological interventions, evidence was preferentially reviewed from randomized controlled trials and systematic reviews of trials. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field."
The very same crowd that have always protested that a large scale study to determine the impacts of low salt diets on health outcomes would be too costly, turns around and justifies the use of surrogate risk factors as outcomes because there is no data on health outcomes. How duplicitous is that? This approach is precisely what Krumholz and Lee were referring to.
The main article describes a set of model projections that predict the number of cardiovascular events that will be prevented if salt consumption is decreased. Using blood pressure as the sole marker, this is the same sort of mathematical manipulation that resulted in the statements made by the Center for Science in the Public Interest that 150,000 lives per year would be saved by reducing salt. It is difficult to understand how such work can receive any credibility in the face of our achievement of significantly improved cardiovascular and stroke performance, while consuming the same levels of salt we always have.
C'est curieux, n'est-ce pas?
Health outcomes are what matters.
Except to the news media. The Centers for Disease Control and Prevention just issued the latest data from the National Center for Health Statistics. Its news release trumpeted "U.S. Mortality Drops Sharply in 2006, Latest Data Show ." This "news" received as much media attention as last week's announcement that casualties in Iraq are the lowest since 2003 -- in short, a virtual news blackout. To turn around the saw: good news is no news.
For public health practitioners, health outcomes should be the consensus metric. The data show convincingly that 8 of the 10 leading causes of death in the U.S. all dropped significantly in 2006. This continues the trend of the past quarter century and trumps the fact that our aging population would be expected to fare worse; in fact, both the raw and age-adjusted rates reflect the improvement. In just the single past year, deaths due to heart disease dropped 5.5%; strokes, 6.4%; hypertension, 5%. The list goes on. But the media loves negativity and too many advocacy groups have a vested interest in (manufacturing and) peddling a mileau of health threats.
Just a month ago, a prestigious research team published another analysis of federal health outcomes statistics in a well-regarded, peer-reviewed journal examining the comparative health outcomes of Americans choosing low-salt diets compared to those choosing diets unchanged in the amount of salt customarily used over the past century. Mortality in the low-salt group was much higher. Low-salt diets didn't deliver promised benefits; they even may add risk. This wasn't news either. The data undermined the crisis advocates' politically-correct intervention.
We need to get beyond the rhetoric and look at the facts, the data. Clearly, the view through the prism of the media and at least some public health advocates is preventing us from focusing on evidence-based policy decisions.
Today, the field of medicine received a long-needed shot in the arm. In their article, "Redefining Quality--Implications of Recent Clinical Trials ," published in the June 12 issue of the New England Journal of Medicine, Doctors Harlan Krumholz and Thomas Lee challenged medical colleagues to improve their understanding of clinical trial results and to design medical strategies that affect overall patient health outcomes - not simply isolated risk factors.
Quoting study after study, including the ILLUMINATE (Investigation of Lipid Level Management to Understand Its Impact in Atherosclerotic Events) trials to lower LDL and increase HDL cholesterol, the ENHANCE (Effect of Combination Ezetimbe and High-Dose Simvastatin Versus Simvastatin Alone on the Atherosclerotic Process in Patients with Heterozygotes Familial Hypercholesterolemia) trials to reduce LDL cholesterol, the ACCORD (Action to Control Cardiovascular Risk in Diabetes) and the ADVANCE (Action in Diabetes and Vascular Disease) trials to reduce serum glucose levels and the Women's Health Initiative Hormone Replacement Therapy trials all achieved their primary goals. They all reduced the risk factor they were focused on, but in all cases, patients experienced increased cardiovascular mortality. Even though the specific risk factor was reduced, increased numbers of patients died. They were all classic cases of, "The operation was a success, but the patient died."
To quote from the Krumholz and Lee paper,
"A clinical trial is ultimately a test of strategy, and we should not be surprised that different strategies may have different effects on patients beyond their effect on risk-factor levels."
The problem is that this shot in the arm for logic and medical sense is unlikely to be the shot heard 'round the world. While many researchers and practitioners in the medical community have long proclaimed the same advice regarding consideration of risk factors versus overall health outcomes, they appear to be in the minority and are largely ignored by the medical 'establishment.' For decades, the issue of salt and health within the medical community has revolved around the impact of salt on one risk factor - blood pressure. Several eminent physicians and the Salt Institute have long stated that it's not blood pressure that has to be considered, but health outcomes - all to no avail. Despite the fact that evidence demonstrates that more people died on low-salt diets than on high salt intakes, the AMA, NIH, AHA and NHLBI all continued to keep their heads buried in risk factors. It's unlikely that this article by Krumholz and Lee in the NEJM will get them to lift up their heads and see the light.
However, it's good to see that the number of enlightened keep growing.