Researchers at the Medical College of Georgia have documented a chain of events showing that excess fat can cause the body to retain more sodium and, consequently, more fluid resulting in higher blood pressure.
Their findings point toward a biomarker in the urine that could one day help physicians identify the most effective therapy for these patients.
Team leader Yanbin Dong said, "It's well established that obesity increases inflammation, salt sensitivity and high blood pressure," referring to the study in the American Journal of Physiology Regulatory - Integrative and Comparative Physiology .
Dong's team outlined the process that appears to start with fat producing more inflammatory factors, such as interleukin-6, or IL-6.
When he and his colleagues exposed mouse kidney cells to the fat inflammatory factor, interleukin-6, they found increased salt reabsorption.
Whether the mouse reactions function the same way in humans remains to be seen, but it appears Dong may have found a way to gauge this activity in humans. Dong already is measuring obese people with and without hypertension as well as normal-weight individuals. A simple urine test could one day help identify those at risk for or experiencing this type of inflammation-based hypertension, he said.
We live in interesting times. As you can imagine, the last week was a very busy one filled with numerous television, newspaper and radio interviews. After the IOM press conference to release their report on "Strategies to Reduce Sodium Intake," a key message that we felt was necessary to get out, was the admission on the part of the lead author that the Committee studying the matter never considered the science behind the salt and health issue - but only the strategies required to reduce salt in foods. This was a rather strange admission, since the major part of the IOM Committee consisted of epidemiologists and physicians rather than industry professionals who actually had some knowledge about food formulation. The centerpiece of the IOM 'Strategy' was the recommendation for the FDA to start regulating the salt contents of processed foods and foods prepared in restaurants and foodservice establishments. This would be a dramatic reconsideration of what is an essential nutrient and the oldest and most ubiquitous food ingredient known to humankind. One would expect that a move of this magnitude would be based upon a substantial body of uncontested scientific evidence, but that is very far from the case.
One of the interviewers from a Los Angeles radio station asked me how I might dare to challenge the medical authorities on this matter. I thought it best to ask him for a clarification. Was he referring to the medical authorities that recommended hormone replacement therapy for women and 30 years later admitted that such a strategy had disastrous consequences for women? Or was it the medical authorities that emphatically stated that the consumption of any more than one egg a week would lead to a very ugly and early death from cholesterol-blocked arteries - only to completely recant this advice 20 years later? Or perhaps he was referring to the medical authorities that decreed that frequent PSA measurements were the answer to prostate cancer, only to come out with their most recent recommendations that perhaps it's best not to do PSA tests at all because they can be misleading? Precisely which medical authorities was he referring to? The interviewer admitted that he got the message and dropped the question.
During the course of the actual press conference, I pointed out to the senior author that the impact of salt on health has been reviewed on a number of occasions over the years with mixed results. The latest meta-review of the evidence was commissioned by the German Ministry of Health just last year and concluded that population-wide salt reduction was not justified from a public health point of view. Indeed, it would have been wise for the US to do the same before going ahead with strategies to reduce sodium. Because of the controversial nature in which the evidence has been interpreted, I went on to ask if the international trade implications of salt regulation in food was ever considered in the deliberations of the IOM ‘Strategies’ Committee. The lead author appeared stunned at this question and admitted that the question of trade never entered into their deliberations.
In establishing the Sanitary and Phytosanitary Agreement (SPS) on trade, the United States was one of the leading countries to insist that unjustified measures could not be used to limit trade between countries. Countries would not be able to ban products for public health or safety issues unless it was proven beyond doubt that these measures were fully justified on a sound, scientific basis. For example, because Italians and Greeks have excellent cardiovascular health, exporters of many traditional high salt foods from these countries may find full justification under the World Trade Organization SPS Agreement to declare the regulation of salt in food as a non-tariff barrier to trade and launch an action against the US at the WTO. Since the US has never carried out a large-scale trial on the overall health impacts of salt reduction, and since the sum of evidence remains controversial, the WTO is likely to consider such a complaint valid.
As I said, we live in interesting times.
During the 2008 presidential campaign, candidate Obama complained about how scientists and policymakers in the George W. Bush Administration were perverting the free expression of science. While our choice of examples may have differed, we were in hearty agreement that the government had turned its back on science in the one area we track intensively: science pertaining to salt and health. In fact, the Salt Institute was forced to ask the federal courts to prevent the executive branch from ignoring the data quality standards of the federal Data Quality Act – and the courts demurely determined that the executive branch was immune to judicial oversight in the way it uses scientific data – the final arbiter of its own DQA compliance.
Unsurprisingly, one of President Obama’s early initiatives was to issue, in March 2009, a Memorandum on Scientific Integrity with a promise to have a plan in place to correct the problem by mid-2009. The plan has not yet been released. Examples of impaired integrity in government use of science continue.
One of the most vocal proponents of improving scientific integrity has been Bush-bashing investor George Soros (disclosure: at one time, Mr. Soros was a part-owner of a Venezuelan salt production facility). Soros’ Open Society Institute funded a study to document the threat to scientific integrity within the federal government (“The Scientists in Government Project”) run by George Washington University . The Federation of American Scientists , Government Accountability Project , Scientists & Engineers for America and Union of Concerned Scientists also provided support.
The Project just released its report, Strengthening Science in Government: Advancing Science in the Public’s Interest , and it makes the case that citizens should be very concerned about the integrity of science as portrayed by government scientists. And, we would add: and science controlled and funded by those same government scientists.
The Report takes as its theme Albert Einstein’s observation about the duty of scientists: “One must not conceal any part of what one has recognized to be true.” Tellingly, the Report also quotes a senior manager at the Centers for Disease Control and Prevention (CDC) complaining that “We need supervisors who have the courage to speak up for the science.” (Indeed, when the agency head assiduously leads in the opposite direction).
The Report effectively articulates the challenge:
The (Einstein quote) statement above serves not only as a guiding principle of good science, but as a framework for effective, science-based policy-making. The best public policies are built on a foundation of rigorous data and analyses, widely shared among scientists and the public. The fundamental obligations of a science-based society – advancing the public health, protecting the workforce, safeguarding the environment, developing appropriate energy technologies, defending the nation, and much more – depend on a full and open exchange of ideas, methods, findings, and interpretations.
New scientific knowledge constantly builds on existing scientific knowledge. When information is readily shared, new findings can be analyzed and new hypotheses vetted in an ongoing process that continually generates opportunities for further study and analysis. Science flourishes when scientific ideas are given a fair hearing by colleagues, debated on their merits, tested through replication and further research, and revised in light of new understanding.
***
Beyond the merits of advancing science, the open exchange of ideas is also cherished because it is concordant with the ideals of a democratic society. Freedom of information is a core belief in the American system.
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An analysis of the approach to science taken by the five White House administrations that preceded that of President Barack Obama explains, “It is naïve to believe that scientific findings are the sole determinant of policy . . . Much of the funding, direction and use of American science is determined by the federal government and the political biases of the dominant party invariably influence the decisions that get made.
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Policy decisions may be based on science, but they are not purely scientific. Preferences and political considerations shape decisions about regulation, research priorities, service delivery, and program development and evaluation. Nonetheless, the integrity of the science and the validity of the data that informs these decisions must be preserved.
But the report then goes on to explain the "pressures on scientists" employed by government (or hired by government scientists, we'd add):
A "unique challenge" for them is that "they may be expected to represent and advocate for official agency positions, regardless of their personal perspective on an issue. Conversely, they may be barred from presenting conclusions or analyses that are inconsistent with an agency’s stance, even if they are speaking as private citizens."
Okay. We agree on the statement of the problem. And we hope the supporters of the report are sincere. Let’s see if the “solution” is more government-knows-best or whether the new Administration is willing to be measured by the metrics of its lofty rhetoric.
Early indications from CDC on the salt issue haven’t been encouraging, but hope springs eternal.
Last fall, New Yorker science writer and former NY Times correspondent Michael Specter released an important book entitled Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens our Lives . In the NY Times book review, Janet Maslin captured the essence his thesis: "Firing Bullets of Data at Cozy Anti-Science ."
When the IOM produced its report earlier this week on how to implement salt reduction, questions at the news conference about the impacts on health and international trade in processed foods evoked artful non-answers. The authoring panel's chair conceded that the group had not examined the science on whether such a policy would improve public health. And she admitted that the group had not considered how the U.S. would defend its action against the World Trade Organization should FDA be so foolish as to adopt the IOM recommendation.
Though Specter's book deals with a myriad of junk science issues, it is silent on salt. Specter takes jab at celebrity know-nothings like Britain's Prince Charles and targets Dr. Andrew Weil's promotion of vitamin supplements as raising a larger concern -- undermining valid science by equating it with pseudo-science. Says Specter: “The idea that accruing data is simply one way to think about science has become a governing tenet of the alternative belief system....When Weil writes about ‘a great movement toward evidence-based medicine’ as if that were regrettable or new, one is tempted to wonder what he is smoking.”
We expect that a scientist with the appropriate credentials will act like a scientist, not a shaman. But on salt, the quasi-religious fervor has an unstable foundation of pseudo-science and the denialism of the politico-medical establishment -- as rendered in the IOM report -- is, indeed, "hindering scientific progress" and, arguably, "threatening our lives."
Let's "fire bullets of data at the cozy anti-science" behind the IOM report and ask ourselves what data are available to explore the two key questions:
- While salt intake is related to blood pressure, the relationship is heterogeneous and, more importantly, blood pressure is only one of several important health risk factors impacted by changes in salt intake (others being insulin resistance, plasma renin activity, aldosterone production, sympathetic nervous system activity,etc.) so the proper end point is not BP but rather some "hard" end point like cardiovascular mortality or all-cause mortality or incidence of heart attack, etc. Dr. Alderman, former president of the International Society of Hypertension and current editor-in-chief of the American Journal of Hypertension , summarized this argument in a JAMA piece a couple months ago. The only controlled trial of this question showed low-salt diets had worse outcomes. The observational studies are split with most showing no health benefit of reducing dietary salt.
- Any health impact of dietary salt depends not on the amount of salt (sodium) in any particular food, but rather on the amount of sodium in the diet. No studies have been done to establish that persons choosing diets replete with "low-salt" foods instead of those foods with "regular" sodium content are able to reduce and sustain their total sodium intake. On the other hand, evidence by Drs. Joel Geerling and David McCarron have found a physiological signal for "salt appetite" based on the body's need for sodium and that this "need" results in sodium intake levels within a relatively narrow range which is unchanged over time and independent of government dietary guidance.
So, to quote the McCarron-Geerling paper's title: "Can Dietary Sodium Intake Be Modified by Public Policy?" Let's get the evidence before we launch a madcap -- and anti-scientific -- effort to make a massive, untested change in our national diet.
Back to the larger point and in conclusion, this from Kevin Shapiro's review of the Specter book in Commentary magazine:
In Specter’s parlance, “denialists” are those who reject the substantive technological benefits of modern science—medicines and vaccines to treat and prevent illnesses, or techniques to enhance the quality and quantity of agricultural yields. At the same time, they cling to an unsubstantiated faith in the advantages of “natural” alternatives such as vitamins, supplements, and organic foods. The term e-ncompasses a diverse array of quacks and crackpots, ranging from New Age celebrities like Andrew Weil to reactionary patricians like Charles, Prince of Wales. What unites them is a hostility to reason that, when amplified in society, threatens the ability of scientists to pursue real solutions to such problems as disease, hunger, and malnutrition.
Data may be just another “four letter word” to some. And for some advocates, data gets in the way of a good story. That’s what’s been happening as evidence unfolds about the bogus “salt hypothesis” where blood pressure-based computer modeling projecting health benefits from cutting back on dietary salt have been crushed by peer-reviewed studies showing worse outcomes and questioning even the physiologic possibility of modifying salt intakes .
Well, data is happening in other areas, too.
Recently, the American Heart Association journal Circulation published an analysis of 30 million Medicare beneficiaries’ data (repeat, 30 million Americans’ actual experience, not a computer projection). The data clearly documented that (surprise!) heart attack rates are in decline – just the opposite of what computer projections and prominent public health “experts” have claimed.
Dr. Harlan Krumholz of the Yale University of Medicine and principal investigator for the study told the Wall Street Journal that the findings “breathtaking” and attributable to evidence-based prevention strategies. The same results are found in the general population, he claimed.
Of course, the new data came after the fear-mongers’ success in enacting a government takeover of healthcare arguing the current situation was deteriorating. And consider a second point: these same big-government-knows-best “experts” are telling us we have a crisis in salt intake causing, according to recent headlines, a half million heart attacks a year based on their computer projections – when salt intake levels are unchanged over many decades and now we know that heart attack rates are in decline.
As Jeff Stier of the American Council on Science and Health notes: “This isn’t consistent with their storyline that we need more government intervention like fast food bans to keep us healthy.”
So, who to believe? The “experts” or the data?
On January 11 of this year, you announced an ambitious program dubbed the "National Salt Reduction Program." This program was patterned after the Food Standards Agency salt reduction program in the UK, which you characterized as a success. Considering the economic, social and infrastructural problems that New York City faces, you clearly believe that a population-wide reduction of salt intake is a very high priority issue. Yet, the issue of population-wide salt reduction remains deeply mired in controversy. The majority of meta-analyses on the subject do not conclude that population-wide salt reduction is warranted. Some even state that there may be an unintended consequence resulting from such an action.
As you are so devoted to this program, I believe that you should have an opportunity to openly demonstrate the depth of this commitment. It would certainly not be the first time that political leaders have stood up to demonstrate the courage of their convictions. In 1991, in an effort to stave off international criticism regarding Peru's polluted fishery, President Alberto Fujimori dined on local ceviche in front of news cameras to demonstrate his faith in the quality of their fish. It is of no consequence that he came down with cholera the next day - the important thing is he had the courage to stand up for what he believed in.
As a public leader, I feel that you should have the same opportunity and hope that you would demonstrate the same degree of courage. I propose that you go on a 1,500 mg sodium/day diet, as recommended by the CDC and I will maintain my 3,500-4,500 mg sodium/day level for a full month. During that time, we should have our blood chemistry (renin, aldosterone, cortisol, etc.), blood pressure, arterial pulse wave velocity (a measure of arterial stiffness) and urinary sodium levels checked weekly. I would further invite Drs. Larry Apell, Chairman of the Dietary Guidelines Sub-Committee on Electrolytes and Michael Jacobson of the Center for Science in the Public Interest, two individuals who have repeatedly stated that humans do not require more than 500 mg of sodium/day to join in this demonstration by consuming that 500 mg sodium/day for one month as well and undergo the same tests.
Finally, I propose that Dr. Mehmet Oz use his good facilities to manage the clinical tests and report the results on his television program.
Mr. Mayor, I have no doubt that you wish to do what is right. I do as well, however, we are operating from a totally different set of peer-reviewed data. A task as simple as the one I suggest may well resolve this issue to everyone's satisfaction and will set the salt and health debate upon a course that should benefit all citizens.
Yours sincerely,
Morton Satin
Technical Director
Salt Institute
Alexandria, VA 22314
This year has brought an avalanche of salt reduction papers in the medical journals, together with supporting editorials and letters from well-known and influential anti-salt activists. The effort appears to have been coordinated and I would not be at all surprised if WASH (World Action on Salt and Health) and CSPI (Center for Science in the Public Interest) were associated with it.
The rather odd thing is, despite all the published text calling for stronger regulatory action to reduce salt due to all the projected morbidity, mortality and health care costs this would result in, not a shred of actual new evidence was published. The papers published were simply statistical models based upon evidence we know was highly flawed. Obviously, the laudatory op eds and letters that followed were more a show of desperation trying to shore up the flimsy house of cards.
I sent a letter to the Annals of Internal Medicine criticizing the current state of affairs, where leaders in public health policy appear to have become so political that they no longer demand evidence to develop public policy. It is a sorry state of affairs when academics resort to statistical models with fancy nine dollar words instead of simply going out and getting the data which is easily available. The letter can be seen here . Scroll down the page to the letter and click the "more" link to see the full content.
Caught up in this frenzy of scientific folly and compulsion to regulate, New York Assemblyman Felix Ortiz introduced Bill A10129 stating that no restaurant should be allowed to add salt to the food they prepare. I blogged this item and he is apparently rethinking his position coming out with the inevitable statement that he was totally misunderstood by all – that’s not what he meant…..he really meant…..not too much salt…..maybe not on Tuesdays or Thursdays…..only at Happy Hour……or no more rice in the salt shaker…… or something equally stupid!
In fact, Ortiz was highly criticized by Bloomberg for his bill with Bloomberg saying he was only working with manufacturers to gradually reduce salt over time. You know, “slowly, slowly, catchee monkey.” That way no legislation has to be developed and if it all goes south and people start exhibiting signs of cardiovascular illness, metabolic syndrome or stress or reduced cognition or alzheimer’s (all possibilities described in the medical literature), then no one has to take responsibility for it. He can simply say “We were only suggesting salt reduction – it was the industry that actually did it!”
Years ago, when “GAO” stood for “General Accounting Office,” that arm of Congress focused its reviews on how well government agencies were spending taxpayers’ resources. A new GAO report suggests FDA should expend more resources on substances earlier determined to be safe, some, like salt, of proven safety since before the founding of FDA or even the founding of the United States. GRAS has been a prime achievement in wise use of taxpayer monies in that it has allowed the agency to accept substances in foods which had been used safely for centuries, enabling FDA to focus on substances with unproven food safety.
Salt was the original, archetypical GRAS substance.
No one should doubt the safety of salt. The petitioners would have FDA regulate the amount of salt allowed in each serving of food. There is no evidence that this would produce either of the benefits the petitioners assert. No studies have been done that show that those consuming diets incorporating low-salt foods result in lower overall salt consumption. Evidence shows that salt appetite responds to an individual’s physiologic need. Neither is there any controlled trial of whether diets lower in salt or sodium produce better health outcomes. Nearly every one of the few studies that have been done show either no benefit or even increased risk. In fact, the two controlled trials reported to date both show worse outcomes for those on lower sodium intakes.
GAO should go back to serving the taxpayers in assessing whether government agencies are using good judgment in prioritizing limited resources on real problems. The GRAS status of salt is a PR sideshow unworthy diverting FDA from its vital mission of ensuring the safety of America’s food supplies. GAO would be well served to ask why NHLBI continues to fund PR-oriented studies offering computer models of blood pressure impacts of low-salt diets when that question is well-studied and by NHLBI continues to frustrate efforts, including those of the 2005 Dietary Guidelines Advisory Committee, to have the federal government conduct a meaningful controlled health outcomes study of whether lower sodium diets would improve public health. Until that study is done, FDA is right to prioritize its resources to questions where evidence suggests the public will get better bang for its buck.
It remains hard to believe, when the daily newspapers are screaming for action to curtail population sodium intakes, that until this month, only one controlled trial has ever examined the actual health outcomes of salt reduction . Sure, we've seen computer models based solely on blood pressure projections that predict fewer heart attacks and lower cardiovascular mortality. But this fantasy has been "mugged by reality" as the data begin to appear in the peer-reviewed literature.
This month's Clinical Journal of the American Society of Nephrology published the results of a second health outcomes study of low salt diets in a vulnerable population. The first study found low-salt diets caused more hospitalizations and greater mortality among congestive heart failure patients. This new study, by a Chinese research team headed by Dr. Jie Dong, "Low dietary sodium intake increases the death risk in peritoneal dialysis." It's conclusion:
This study revealed that low dietary sodium intake independently predicts the high overall and cardiovascular mortality in dialysis patients.
The researchers suggested a J-shaped curve as described by Dr. Michael H. Alderman in his presidential address to the International Society of Hypertension . Dong et al termed it "another example of 'reversal epidemiologic phenomenon," continuing:
In the case of dialysis patients, harm may outweigh benefit ... Low sodium intake is significantly related to overall and CVD mortality. Sodium restriction did generate undesirable effects in previous studies including increased insulin resistance, activation of the renin-angiotensin system and increased sympathetic nerve activity. ... We reveal for the first time that low sodium intake is not necessarily a good thing....
Saline drip
Hyponatremia is a far more serious condition than was originally thought. While reviewing some of the standard therapies associated with symptoms, I came across some facts that caused me to do a double take. As anyone who has ever been admitted to hospital for treatment knows, the intravenous saline drip is standard therapy and the fastest way to deliver fluids and medications throughout the body. Normal saline drip is the commonly-used term for a solution of 0.91% salt (sodium chloride). The amount of saline infused depends largely on the particular needs of a patient, but on average is typically between 1.5 and 3 liters a day for an adult. So, in order to maintain an average adult in optimum health during a hospital stay, somewhere between 13.7 – 27.3 grams of salt per day is administered. Of course, that doesn't even include the salt that is consumed along with the food. If the hospital dieticians were able to provide meals that corresponded to the current recommended levels, this would add an additional 6 grams of salt for a total of somewhere between 20 and 33 grams of salt a day. And don't forget, every four hours or so, they come by to check on your blood pressure.
I wonder how hospitals will comply with the salt intakes recommended by the Dietary Guidelines Advisory Committee? After all, the Dietary Guidelines recommend 4 - 6 grams of salt per day, about 1/5 of what is currently administered in hospitals!!
Today's NY Times (free subscription) carries an opinion column by science editor John Tierney, "Salt Wars." It recounts the exchanges between medical experts over the advisability of asking the general population to reduce dietary salt and hits both of the key issues, which are:
- Is salt reduction even possible or is "salt appetite" a hard-wired physiological response by the body to its need for this necessary nutrient?
- If population salt reduction were achieved, would public health be improved?
The most interesting aspect of this debate among medical professionals is that those advocating for population salt reduction want to skip over these two questions. Tierney blows the whistle on them, quoting America's leading salt reductionist, Dr. Larry Appel, conceding that the data a "murky" and that there is no evidence of any change in American salt consumption, up or down, in recent decades. Said Appel: “We just don’t have great data on sodium trends over time. I wish that we did. But I can’t tell you if there’s been an increase or decrease.”
To oblige Dr. Appel, while the data on any putative benefit of salt reduction is clearly all over the map with some studies supporting a benefit but more finding no benefit or even heightened risk, the data on the immutability of salt appetite is rather consistent and compelling -- government policies do not move salt consumption among people eating normal amounts of sodium (the U.S. intake is absolutely dead center among nations around the globe).
Recognizing the volatility of the issue, Tierney invited his readers to comment:
You’re welcome to weigh in on any of these issues, especially the question of what scientists really know about the effects of restricting salt. Should Washington follow New York City’s lead in pressuring food companies to take salt out of their products? Or has New York gone beyond what the evidence warrants, as argued by Elizabeth Whelan of the American Council on Science and Health ?
We have heard a lot in the media lately about salt and health. In fact, there has been an unceasing parade of talking heads and cranks that have emerged from the woodwork to repeat the urban legends on blood pressure and cardiovascular deaths that will result from our continued consumption of salt. The fact that cardiovascular disease death rates have plummeted in the last 30 years seems to be lost on these soothsayers. Another fact they conveniently ignore is that the Mediterranean countries that have such excellent cardiovascular figures eat far more salt than we do here in America and at that countries, which consume the highest levels of salt, such as Japan and Switzerland, also have the longest life expectancies. Oh well, how can actual evidence ever compete with a good scare story?
We're beginning to hear about the importance of reducing salt in the diets of young children. Unfortunately, much of what we hear does not coincide with what is being demonstrated in the medical literature.
In particular I refer to a review paper very recently published in Pediatrics, the Journal of the American Academy of Pediatrics, in November 2009. The article is titled Hyponatremia in Preterm Neonates - Not a Benign Condition . In this paper, authors Michael Moritz and Juan Carlos Ayus state that hyponatremia, or low sodium levels in the neonates pose a significant risk for future childhood development. These risks include reduced neuromotor abilities from infancy through later years as well as impaired growth and mental development. Hyponatremia has also been found to be a significant factor for hearing loss, cerebral palsy, intracranial hemorrhage and increased mortality - all because of low sodium levels in the blood resulting from decreased salt intakes.
Furthermore, the authors quoted research carried out in Israel demonstrating that low sodium levels lead to hyponatremic neonates weighing 30% more than their peers maintained at normal sodium levels and that hyponatremia in infants was predictive of increased salt appetite in adolescence and later years. So, once again, contrary to the urban legend of salt consumption leading to obesity, the evidence is exactly the opposite – it is low salt levels in neonates that lead to obesity.
The authors then went on to stress that the emerging literature also suggests that hyponatremia in adults can have very deleterious effects and may be an independent predictor of mortality in hospital patients, those with community acquired pneumonia, with congestive heart failure and liver disease. Chronic low salt levels produces neurologic impairment that affects both balance and attention deficit conditions in the elderly - effect similar to alcohol ingestion. These data were able to explain why low-salt levels are such an important cause of falls and bone fractures in the elderly. This is clinical evidence, not urban legend.
Nutrition and nutrition-related policy initiatives are not things to be trifled with and it's certainly not anything to be left to in competent activists and minimally-trained physicians parading around as nutritionist-wannabes. Neither should they be matters of gratuitous opinion. Nutrition is a key to health and any policies regarding nutrition have to be based upon strong, clinical evidence.
The USDA's Supplemental Program for Women, Infants and Children or WIC program provides food and nutritional information to low-income people who are at nutritional risk - yet, to qualify for the program, WIC foods must contain little or no added salt . Just look at the regulatory requirements for WIC-eligible foods. In particular, there is great concern over products such as vegetables and instant preparations containing vegetables that are required to be made without salt. Not only does this increase the chances for hyponatremia, but because children are so sensitive to the natural bitterness in vegetables, it is unlikely that they will eat them without the addition of salt, thereby robbing of the natural goodness these products contain.
Here again, falling victim to anti-salt propaganda, government bureaucrats in charge of this program have backed away from their responsibilities and blindly gone along with the urban legends and myth-information regarding salt, rather than heeding the published evidence in the medical literature.
As a result, the low income women, infants and children, who are most at nutritional risk have had these risks compounded by the additional risks related to low salt intakes and hyponatremia - risks leading to poor neuromotor development, impaired growth and mental development, hearing loss, cerebral palsy, brain hemorrhage and increased mortality – now how's that for government assistance?
Click the image to see the Vlog or check out the full SaltGuru video .
The UK's Food Standards Agency has made since-disproven claims to have achieved population sodium reduction. This week FSA and the Department of Health rolled out a new National Diet and Nutrition Survey .
The NDNS promises to use 24-hour urine samples (UNaV) to measure population sodium intakes -- the approach advocated by the Salt Institute in place of the dietary recall surveys FSA used to claim an overall sodium reduction. But, surprise, the results apparently didn't confirm the rosy projections of the press office. The report is silent on sodium with the excuse that "results from the urine analysis are not included in the current report as the sample size for year one is too small to report."
Not to worry, scientists have reviewed the data already -- and published an analysis that documents no reduction in sodium intake . So, Britons are safe from their government's mindless meddling -- at least for now. Last Fall, researchers reported in the Journal of the American Society of Nephrology:
UNaV and, thus, dietary sodium intake has varied minimally in the UK over the 25 yr encompassing these surveys. The mean sodium intake over the time period 1984 to 2008 was 150 mmol/d. Second, more than 6300 subjects, many providing multiple samples, are the source of these 24 h UNaV measurements from a variety of regions of the UK and Ireland, and they fall within a relatively narrow range.
Not shown, but assessed by us, was the individually determined mean and range of UNaV for women and men where the gender breakdown was available from the survey. Sodium intake for women was 129. Likewise, male sodium intake, which included a 1982 survey of only men living in London, was constant over the same period, although, as would be expected on a caloric basis, higher than that of women, 169.4. The male and female analyses excluded the three Intersalt sites, as the published data provided only the mean for the combined cohort. This statistical analysis of all available 24 h UNaV from the UK does not support recent FSA pronouncements that their national campaign directed at sodium reduction has achieved a significant reduction in the population.
Perhaps the next NDNS will "find" the urinary data these other scientists have already reported in the peer-reviewed literature.
The Mayor Bloomberg initiative (grandiosly referred to as the National Salt Reduction Program), possibly dreamed up by activist groups and leveraged through cronies at New York's health department and their friends at health commission offices around the country, reminds me of something I wrote some time back when I did the history of “Typhoid Mary.” It concerns the abuse of power exercised by Boards of Health and Health Commissions who feel they can, without fear of repercussion, dispense with civil rights in order to execute policies, even if there is no solid evidence to support them. In doing so, these bureaucrats make the self-indulgent leap from civil servants to civil masters without any permission from those they swore to serve.
The quote I am reminded of was by Dr. Josephine Baker, the person who first managed to take 'Typhoid' Mary Mallon into custody. Everyone else looked at Mary's decades-long illegal detention with a clear conscience after her death in custody. Only Dr. Baker spoke up and soberly stated what Mary, a poor Irish immigrant, was up against.
“Typhoid Mary made me realize for the first time what sweeping powers are vested in Public Health authorities. There is very little that a Board of Health cannot do in the way of interfering with personal and property rights for the supposed protection of the public health. Boards of Health have judicial, legislative and executive powers... There have been many typhoid carriers recognized since her time, but she was the first charted case and for that distinction she paid in a life-long imprisonment.”
We see the same mindless, hob-nail boot trampling going on with salt today. C.S. Lewis once said, "Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive... those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."
A muddle of disingenuous advocates, ambitious civil servants and politicians, operating with manipulated evidence, has chosen salt reduction as their cause célèbre. These make-believe crusaders are infused with thought, “Focus on the journey, not the destination.”
Unfortunately, for the public there is a destination, and it is their freedoms and their health.
The former president of Canada's largest science based regulatory agency, the Canadian Food Inspection Agency, cautioned the public recently: "Don't be fooled. Science is always politicized." Ronald Doering argues in the National Post that we should not expect scientists to put aside their policy biases nor confess using their scientific credentials as participants in the policy arena:
That scientists should dress up their science advice as pure neutral science is understandable. For those with scientific expertise, it makes perfect sense to wage political battles through science because it necessarily confers to scientists a privileged position in political debate.
But, does it? Must we lower our high expectations that scientific experts can give us the "straight scoop" without injecting their personal policy preferences to bias their "scientific findings"? I think we can expect more from scientists. Dumbing down our sensibilities in considering scientific studies would result in substituting our own, non-expert biases and thwart progress in embracing new understandings of the reality of the world around us. Count us pro-science.
What can be said of the charge, then, that scientists have biases and their work can only be considered as a political statement? The scientific method is value-neutral. Every scientific study recognizes that the investigator has a "bias" in that the hypothesis to be tested is proposed because the scientist thinks it may offer explanatory value. It is the method itself that will save science from the bias towards confirming the hypothesis. The key here is to get agreement on the quality standards for performing the study and analyzing the results. Those, like Dr. Doering, so insist that we prioritize our understanding of "how policy is scientized and science is politicized" suggest that there is no consensus on standards of scientific inquiry. That's just plain wrong.
A generation ago, the late Dr. Archie Cochrane at Oxford University confronted this question: that scientists seemed to be reaching differing conclusions from the same body of evidence and he devised procedures that grew into the global "evidence-based medicine" movement currently promoted by his eponymous Cochrane Collaboration .
The critical component of evidence-based science is the rigorous separation of method and data. The method must be set out first and the data then gathered and analyzed using that method. It's the opposite of choosing the analytic method after the data have been examined to "discover" that the post-hoc hypothesis is confirmed.
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