It appears that we finally have something that we can agree upon with the Center for Science in the Public Interest (CSPI) . According to a recent article prepared by Merrill Goozner of the at CSPI, and repeated by Marion Nestle in her blog , nearly half the new 2010 Dietary Guidelines Advisory Committee's 13 members have taken funding from the food and pharmaceutical industries. Of common interest is the Chairperson of the Committee, Dr. Linda van Horn, professor of preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago. We are not aware of any conflict of interest involving research funding, however, during the first public meeting of the DGAC, Dr. van Horn recalled an experiment that she had done as a graduate student, which she stated proved without doubt that children who were fed reduced salt diets ended up abhorring the typical salt levels in many foods. Thus, she revealed the personal bias she brings with her as she assumes the chair of a committee tasked with the 'objective' evaluation of all the data on salt and health to be used as a base for future recommendations.
It is interesting to note that CSPI, Marion Nestle, and the preponderance of professionals in the medical community choose to define conflict of interest almost exclusively in terms of funding received from outside (particularly industry) sources. What they seem to totally ignore is the overwhelming bias resulting from personal ego, and a lifelong investment in a particular point of view on a subject. Such an all-consuming passion usually results in a conflict of interest greater than any motivated by research funding. Clinical researchers who have promoted a particular theory for decades are very unlikely to change their minds easily. Many brazenly belong to advocacy groups that publicly espouse their positions. How can they be expected to objectively evaluate data that may make decades of their investment worthless? Yet, there they are - fully prejudiced by preconceived positions - and placed in a position of public trust to make objective evaluations.
Thus, we have one of the greatest hypocrisies in modern medicine - biased researchers sanctimoniously pointing their fingers at the 'conflicts of interest' of others.
Physician, heal thyself.
As we pointed out in an earlier article, the chairman of the sub-committee for Fluid and Electrolytes for the 2010 Guidelines is Larry Appel. Dr. Appel is one of the world's most outspoken anti-salt advocates and is listed as a member of World Action on Salt and Health (WASH) , an advocacy group whose singular aim is: "to achieve a reduction in dietary salt intake around the world." In their justification for salt reduction , WASH focuses almost exclusively on hypertension to the virtual exclusion of all other risk factors and biomarkers responsible for overall health outcomes. They systematically ignore all data (including the Cochrane review and its latest reissue - ) as well as the most recent evidence that demonstrates the net negative health outcomes from reduced salt diets. How any member of such an advocacy group could possibly be selected (much less lead) what is supposed to be an objective advisory group is quite astonishing and black mark on the Institute of Medicine as well as our National Academy of Sciences under which it operates. It is not as if the IOM were unaware of this conflict of interest. They simply choose to ignore it, confident in the belief that they can pass anything off as legitimate science.
And why not? When has the medical establishment ever been called out, no matter how egregious their behavior or advice has been? How many people marched on the IOM or the AMA offices to protest the countless deaths resulting from the hormone replacement therapy fiasco. When it comes to medicine, people suffer silently - and the establishment gets a free pass.
Such hypocrisy does not bode well for the future of objective medical science in this country.
Recently, the Department of Health and Human Services launched their first Physical Activity Guidelines for Americans . This was in direct response to the national obesity epidemic whose effects can be seen everywhere. The U.S. Centers for Disease Control have stated that adult obesity rates doubled since 1980, from 15 percent to 30 percent while childhood obesity has almost tripled during the same time period, from 6.5 percent to 16.3 percent.
While it is great that these new guidelines are here, it is fair to ask why it took so long for them to be published. The answer to that is clear. The responsibility for carrying out physical activity is almost entirely in the hands of individuals. If individuals don't make the effort to do physical exercise, then there is no one to blame but themselves. This is, of course, much more related to adults than children. For children, it is both the home and school environment that is largely responsible for the amount of exercise they do.
Because of the great degree of personal responsibility associated with physical exercise, there has been little attention paid to this issue on the part of consumer advocacy groups, whose political capital is largely the result of finding businesses and large institutions to blame for problems. With reference to the obesity epidemic, consumer advocacy groups invariably blame the food industry for producing high fat, empty calorie foods, and, to a lesser extent, they blame the government for not regulating the industry. It is a very rare occurrence when a consumer advocacy group calls on consumers to bear their share of the responsibility for managing their lifestyle and matching their food consumption with energy expenditure through physical activity.
Thus, while the Physical Activity Guidelines for Americans has just been published, the Dietary Guidelines for Americans is in the process of preparation of its sixth iteration since 1980.
It is strange that it is only since the first iteration of the Dietary Guidelines for Americans that we have experienced the obesity epidemic. This does not say much about the effectiveness of the Dietary Guidelines and the people or institutions that have developed them. Considering what has happened to our physical condition in the last quarter century, one wonders if Americans would have been better off without the Dietary Guidelines. Is it possible that this could have been corrected if the Physical Activity Guidelines were issued at the same time? Not likely.
As much as the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) assure us that the Dietary Guidelines are evidence-based, they are about the worst example of this that anyone might choose. The Dietary Guidelines are predominantly based upon opinion - the absolutely lowest level of evidence in the hierarchy of acceptable evidence. In fact, some of the evidence upon which the Guidelines are based is so subjective, there have been complaints that certain of the Guidelines should never have been issued. Unfortunately, there are certain segments of our society that have an burning desire to provide guidance, no matter how ill-advised.
If you consider both the Dietary and Physical Activity Guidelines, you will see that they don't really relate to one another. (It is interesting to note that the Physical Activity Guidelines are issued by the HHS alone, while the Dietary Guidelines are issued jointly by HHS and USDA - are there some issues at play here?) While food products carry labels that indicate the energy content (calories) of each serving, it is almost impossible for consumers to easily translate this into the amount of physical activity required to expend the energy taken. People who watch their weight and exercise regularly are an exception. They have a good idea of what extra energy will have to be burned off in order to make up for extra food consumption. If they treat themselves to a few extra chocolate chip cookies, then they put in the effort to jog for an extra half hour in order to burn the calories off.
Instead of putting calories on the food label, why don't they put the physical activity equivalent on, so that people will have an idea of what they have to do to get rid of that additional intake. That is the sort of thing that will link the Dietary and Physical Activity Guidelines together - calories by themselves simply don't convey the energy input/output message to consumers.
Getting consumers to relate their diet to physical activity and energy expenditure is not rocket science. It does, however, require a sensitivity to the needs and awareness of consumers rather than a focus on political expediency and a compulsion to give advice by a medical establishment that has still to learn what food and nutrition are all about.
Britain's Food Standards Agency (FSA) has a target to reduce average salt intakes across the population to 6g per day by 2010. It selected its targets, it says, on surveys from 2000-2001 claiming British men consume 11 g/salt/day and women, 8.1 gpd. The agency announced July 22nd the publication of a survey of Britons' urinary sodium -- the "gold standard" measure for salt intake, "which shows the UK's average daily salt consumption has fallen from 9.5g to 8.6g since 2000." FSA termed the results "an encouraging decline in salt levels," but conceded its pace would fail to achieve the 6 gpd target in 2010 so it unveiled a consultation to "make its voluntary 2010 salt reduction targets, for 85 categories of food, stricter, and set more challenging 2012 targets, for 80 categories of food."
The publication behind the news release tells a different story .
Entitled "An assessment of dietary sodium levels among adults (aged 19-64) in the UK general population in 2008, based on analysis of dietary sodium in 24 hour urine samples," the methodology explains the care taken to secure accurate samples and analysis. So, we can be pretty sure that the 2008 number is sound. The study actually didn't find 8.6 grams, but rather 8.728 grams; it is expressed as 148 mmol Na (a millimole of sodium being equal to 23 milligrams; this assumes, as they mistakenly do, that all the sodium comes from salt, which it doesn't -- no matter). So they misled on the achievement, but still, reduction from 9.5 grams salt (161 mmol Na) would be an impressive achievement. Indeed, FSA continues to boast that it "is encouraged that action to reduce the average amount of salt we are eating on a daily basis is clearly having a positive impact." This, of course is not the proper metric: salt reduction isn't an end it itself. The "positive impact" would be reduced incidence of heart attacks or better than projected cardiovascular mortality -- no matter, here.
The deception arises in the 9.5 gram (16 mmol) "starting point" which turns out to be a phone survey, not a carefully controlled collection of 24-hour urine samples with quality analysis (as was done in 2008).
Fortunately, we have another exceptionally well-done survey of a representative British population. And from a good deal more vantage point so we can see just how much improvement has been recorded. Its size is nearly comparable, 754 in the 2008 survey and 598 in the Intersalt Study published in the British Medical Journal, July 30, 1988. Intersalt sampled three British populations, carefully collected 24-hour urine samples and had them analyzed in a single laboratory. The results? One population had 149.9 mmol; one 150 mmol; and the third, 151.8 mmol. A far cry from the FSA's claimed 2000-01 starting point of 161 mmol. Instead of a 13 mmol reduction to 148 mmol, over the past 20 years Briton's have changed their salt intake virtually not at all (2 mmol, probably within the margin of error).
All evidence suggests that sodium/salt intakes are largely unchanged in most populations over the past century. The high-salt consuming Finns and Japanese claim signficant reductions, but it does lead one to wonder if the "starting points" are valid in those cases.
So, when FSA makes these bold pronouncements of their "progress" in reducing cardiovascular disease in the UK by cutting salt intake, take it with a grain of salt. Ask whether beating up food manufacturers about reducing salt in their foods is really working. Is a 1.3% reduction over twenty years (even if true) worth the effort? Even using the much-lower "real" starting point, the current pace would have Britons' achieving a 6 gpd target not in 2010, but a bit further down the road -- in 2205 if the current trend can be sustained. That is, another 197 years, not two, before reaching the target of 100 mmol (6 gpd of salt). They admit they're behind schedule, but that may just be classical British understatement, right?
Let's be honest in interpreting the data. FSA has made NO PROGRESS despite the enormous pain it has inflicted on British food manufacturers and diverting resources to supporting "Sid, the Slug" has postponed real progress in improving Britons' health. No wonder FSA prefers to make up number about salt intake than face the proper challenge of improving public health.
The UK Food Standards Agency (FSA) conducts mini surveys amongst consumers on a quarterly basis in order to monitor changes in consumer attitudes towards food related issues. The latest survey was just published and there were some interesting surprises.
Despite a costly public relations campaign demonizing salt, including many television ads, which named and shamed manufacturers for the salt content in their foods, the latest mini survey revealed that consumer concerns over salt has dropped dramatically. In fact, consumer concens with salt are at their lowest level since December 2003 - years before the FSA began its aggressive anti-salt campaigns, including "Sid the Slug " and "Your Food is Full of It ."
Bravo to the British consumer. It is a fitting tribute to the quote, "You can fool some of the people…."
