The UN Development Program (UNDP) recently published its fifth Arab Human Development Report reviewing the state of affairs in the Arab world. Recently returned from a global meeting on salt iodization in Cairo, I eagerly plumbed the report, particularly Chapter 6 which described nutrition challenges. In that discussion, I found the pattern of the entire report -- and, I hope, a lesson for the rest of the world about the value of competitive ideas.
Chapter 6 on nutrition references iodine deficiency, but fails to make the iodine/brain development connection. It says lack of iodine and other vital nutrients "weaken children's bodies and impair their immune systems" and "reduces productivity." A missed opportunity.
The "missed opportunity" theme pervades the report. Fouad Ajami , professor at the School of Advanced International Studies at Johns Hopkins University, calls the report an "autopsy of the Arab condition," adding:
The first of these reports, published in 2002, was treated with deference. A group of Arab truth-tellers, it was believed, had broken with the evasions and the apologetics to tell of the sordid condition of Arab society—the autocratic political culture, the economic stagnation, the cultural decay. So all Arabs combined had a smaller manufacturing capacity than Finland with its five million people, and a vast Arabic-speaking world translated into Arabic a fifth of the foreign books that Greece with its 11 million people translates. With all the oil in the region, tens of millions of Arabs were living below the poverty line. Little has altered in the years separating the first of these reports from the most recent.
Ajami commends Iranians contesting the announced results of that country's recent presidential election. He would probably find joy in the purple-inked fingers of Iraqi voters as well. But he condemns (democratic, surely, not Islamist) activists in other countries for the ineffective opposition to authority. The lessons he draws are about truth-telling and free public discourse. While lamenting that the powers-that-be have eradicated dissent, he goes one step further, which struck me as instructive in our public health nutrition debate elsewhere in the world, particularly in the US and the UK. He declared:
The simple truth is that the Arab world has terrible rulers and worse oppositionists.
Let me use the contentious salt and health debate to illustrate this transference. In our instant debate, there are those who contend that because salt is related to blood pressure (lowering salt will reduce the blood pressure of some -- and more than the number for whom low-salt diets increase BP) and because populations with lower BP have lower risk of cardiovascular events like heart attacks and strokes, that this "proves" the efficacy of universal salt reduction. Opponents of a population intervention argue that studies of heart attack rates and cardiovascular mortality don't show those on low-salt diets fare better -- often they are placed at additional risk. Moreover, no amount of behavior modification has worked and the latest strategy, coercing the food industry into lowering the sodium density of its products, is untested and flies in the face of research showing that the unconscious brain sets the appetite for sodium.
The "rulers" here embrace the "sodium hypothesis" and endorse sodium reduction. Unfortunately, like the entrenched rulers of the Middle East, they are trying to stifle dissent and deny the legitimacy of the scientific debate. No matter that a recent presidential address to the International Society of Hypertension described the fundamentally-flawed basis for U.S. policy. No matter that the prestigious Cochrane Collaboration , inventors of "evidence-based medicine" finds no basis for the U.S. policy. No matter, even, that the government's own U.S. Preventive Services Task Force agrees that no evidence supports the strategy, the "rulers" press forward. In this regard, they are "terrible rulers," to use Ajami's term.
Worse, where is the opposition? If "the Arab world has terrible rulers and worse oppositionists," are we any better? True, some have decried the assault on sound science (see Taubes, "The (Political) Science of Salt ") and others lament the "nanny state " and "food police " second-guessing individual food choices and steamrolling the food industry on the salt content of its food. But until Kellogg's (html 54.86 kB) recently raised the prospect that the emperor had no clothes, the food industry has largely been content to ignore the science and pump pricier low-sodium foods into the marketplace, fellow-travelers willing to claim the government-bestowed "health" claim in return for their silence on issues of quality science.
Too often we point with disdain at the failings of others when what's needed is a harder look in the mirror. If we want science to guide health policy, we must become "truth-tellers" too.
A study just published in Hypertension documents that continuous activation of the renin-angiotensin system impairs cognitive function in mice. In humans, low-salt diets reliably predict increased activity of the renin-angiotensin system. The body produces these neurohormones when it senses inadequate salt intake -- and that "inadequacy" is far, far above the IOM's "adequate intake" level for sodium. Low-salt dieters can be assumed to have continuously high renin-angiotensin activity levels.
Other studies have suggested low-salt diets may produce mental impairment. This could be the mechanism.
All this is in addition to the contributions of iodized salt, the consensus solution to overcoming the most easily-prevented, but still-widespread cause of mental retardation: iodine deficiency
Salt is so basic to our existence we often forget its life-saving role as an essential nutrient; consider oral rehydration therapy which has saved millions of lives, particularly in Africa. But salt is not only essential to life, it plays a key role combatting mental retardation; consider the enormous achievement of iodized salt.
New York Times columnist Nicholas D. Kristof does just that. In today's paper, he reviews the enormous paybacks of salt iodization, "Raising the World's I.Q ."
Salt does have a real downside, Kristof admits -- "it's so numbingly boring, few people pay attention to it or invest in it. (Or dare write about it!)." I guess we here at the Salt Institute are so insensate we didn't realize that salt was boring or unworthy of attention so count us among the few.
Thankfully, Kristof is one of the few as well. With his proselytizing, perhaps the few will become many.