Salt debate leaves bitter taste
This weekly commentary piece by Anthony Fletcher in foodnavigator.com contends that the public may loose a proper focus on the iinherent danger of dietary salt in the current debate in the UK over sodium reduction targets in various foods. Mr. Fletcher is right to worry about missing the forest for the trees -- but, overall, is only half right.
I totally agree with him that it would be a dangerous public policy mistake to re-focus the "salt debate" on the UK Food Safety Agency's targets for foods away from the scientific rationale for reducing dietary salt. The public deserves to know what medical science informs us of the prospective benefits that achieving compliance with these targets will deliver, not just how hard it will be to accomplish.
Where we part company becomes apparent in his cheery contention: "The vital important message that salt consumption must be reduced will be lost in detail and voluntary detail at that." Wrong. The vital important message that would be lost in detailing the FSA target debate is the crucial and paramount question of whether reducing dietary salt will improve public health. You jump too quickly to the conclusion that "everyone knows" salt should be reduced.
In fact, there have been only thirteen studies reported which examine the amount of salt in the diet with relation to the incidence of cardiovascular events or mortality. All of them are observational studies; none is a controlled trial. If all thirteen were consistent in finding a health benefit for lower-salt consuming populations, perhaps we would have a strong argument that we should do a controlled trial of salt reduction to confirm that the postulated benefits would be realized. Recent trials of hormone-replacement therapy, calcium supplementation and low-fat diets have failed to confirm benefits suggested by observational studies of these questions even though the hypotheses were eminently plausible. Not only is there no controlled trial of the health outcomes of salt reduction, but all thirteen observational studies that have been reported turn out to be consistent in their findings -- but consistently find that there is no health benefit of reducing dietary salt. Four of the thirteen studies, including the Scottish Heart Health Study, have shown that low-salt consuming populations, in fact, showed a higher risk of adverse cardiovascular outcomes. The current, March edition of the American Journal of Medicine, for example, contains the latest of these studies. That research, by the current president of the International Society of Hypertension, documents that those on low-sodium diets have a 37% greater cardiovascular mortality.
So I agree with the commentary that "The current debate about the levels at which the UK's food regulator has set its salt reduction targets misses the point about how healthier eating habits can be achieved." "Healthier eating" will not be achieved by reducing dietary salt. We believe that the "healthier eating habits" should be based on the Dietary Approaches to Stop Hypertension (DASH Diet) with greater emphasis on consumption of fruits, vegetables and dairy products and which is salt-neutral. Let's not let the "details" of the scientific underpinning for the entire enterprise be lost in the discussion to the detriment of both consumers' understanding and, more importantly, improving consumers' health.
We know salt masks bitter flavors. The reason for the bitter taste of the salt debate is the lack of a crucial, missing ingredient -- mixing in a generous portion of health outcomes data. For more, see http://www.saltinstitute.org/28.html.
