With this provocative title for its March 2007 featured article, the UC-Berkeley Wellness Letter caught our attention, particularly because they mentioned the Salt Institute. Because it may have caught others' attention, these thoughts to correct some misinformation in the article.

MythStatement: "As concern (with salt intake) has faded, people have been eating more salt. Since the early 1980s, U.S. per capita salt intake has risen by about 50%."

Fact: US food salt sales entering the 1980s were a shade over 1 million tons. Today they are 1.586 million tons -- up about 50%, right? But not "per capita." The US population in 1980 was 227 million; today it exceeds 300 million, up over 32%. And that is "sales," not ingested salt. Looking at the baseline data of entrants to clinical trials who are tested for 24-hour urine sodium, there is no evident increase in per capita sodium intake over time.

MythStatement: "Many large observational studies over the years have linked a high sodium intake to high blood pressure and increased deaths from heart attacks and strokes. For example, the Intersalt study looked at 10,000 people in 32 countries and concluded that high salt intake was directly related to hypertension and deaths from stroke." The article then states that pro-salt critics have found methodological problems with Intersalt.

Fact: Intersalt was a great study, though not an intervention trial. The primary hypothesis of the study was that salt intake was directly related to blood pressure. Contrary to the Wellness Letter, the study did not confirm this hypothesis; neither for systolic blood pressure (the primary hypothesis) nor diastolic blood pressure (the secondary hypothesis). There was no relationship. The Salt Institute has always considered Intersalt a high quality study. Salt opponents did too, until the results were announced; after that, they began to find reasons to back away from its findings. As for other "large observational studies ," none have found higher incidence of cardiovascular events nor higher CV mortality on diets with US-levels of salt.

MythStatement: "It's much harder to dismiss the research on the DASH (Dietary Approaches to Stop Hypertension) diet, which consists of fruits, vegetables, and whole grains, plus small servings of meat and dairy. It also provideds a lot of potassium, magnesium, and other minerals that help control blood pressure. DASH comes in two versions -- one with 2,300 milligrams of sodium a day, the other with 1,500. Both diets lower blood pressure in healthy people, but most dramatically in those with hypertension. The lower-sodium version lowers blood pressure even more. "

Fact: Where to start? The Salt Institute has endorsed and strongly promoted the DASH Diet since it was first reported in 1997. It is not properly described in the Wellness Letter. It is high in fruits, vegetables and dairy products and low in meat -- not reduced in dairy as stated. In fact, half the blood pressure benefit is from the dairy. The DASH Diet is also not reduced in sodium at all. A second "DASH" trial was held reducing sodium to 2,300 mg and 1,500 mg. Judge the results for yourself. As the Wellness Letter points out, those with high blood pressure benefit the most. The original trial found they achieved a drop of 11.4 mm/Hg in systolic blood pressure when on the DASH Diet (with no sodium reduction). When DASH Dieters were placed on the 1,500 mg salt-reduced diet, they achieved an 11.5 mmHg SBP reduction. We call that statistical noise. We think it's clear the benefit is conferred by the improved quality of the DASH Diet (11.4 mmHg) and the additional contortions to reduce sodium by 60% produced only an insignificant change (0.1 mmHg). Furthermore, while the nutrients stated are likely to be responsible for erasing the "salt sensitive" blood pressure response, the trials were for foods, not nutrients.

MythStatement: Finland achieved a decrease in deaths from strokes and heart attacks over the past 30 years by reducing dietary salt.

Fact: The US has reduced its rate of reduced cardiovacular events and mortality over this same time span by the same amount without reducing dietary salt (the Wellness Letter even says salt intake in the US has increased).

MythStatement: "Here's what the salt industry advises: There's no ironclad evidence a high salt intake is bad, so don't worry. Eat what you want, and enjoy yourself. Help us make a lot of money out of salt."

Fact: We have no evidence that they're still smoking stuff on the Berkeley campus; this statement could just be a coincidence. The Salt Institute has long supported "moderation" in sodium intake, supporting the US Dietary Guidelines until 2000 when the Guidelines left this safe harbor. It may be that high-salt diets such as in Japan are problematic; experts disagree (see previous blog ), but we are at the polar opposite of hedonists who say "eat what you want." The answer, as we've repeatedly testified, is that we need to improve the overall quality of the diet, particularly improving the mineral density of the diet (more calcium, magnesium and potassium).

MythStatement: "Most people can quickly get used to a lower-sodium diet..."

Fact: Reducing dietary salt is NOT easy. In the DASH Diet, they achieved compliance by providing free food. In the Trials of Hypertension, with heavy hands-on encouragement and coaching of highly-motivated volunteers, salt reduction was reduced by about a third over the three years of the trial. (Note: during that three years, the body adjusted and blood pressures returned to their former levels -- how come the Wellness Letter didn't mention that?)

There are more assumptions and leaps-of-faith, but this gives you an idea of how a supposedly unbiased and expert review can go awry when confronted with the near-religious zeal to cut salt.