You've all heard about one-armed economists (on the one hand.....on the other hand....). So it's hardly news that economists do not agree with a basic premise of Obamacare, namely, that "prevention" will save money. We did a blog post back in June when Time magazine featured the issue. Proponents responded last week when the New York Academy of Medicine released its Compendium of Proven Community-based Prevention Programs .

New York City has, of course, been waging war on salt in the city for a couple years now, so it's ironic that salt reduction is a glaring omission in the prevention policy recommendations.

The Mediterranean diet (pdf 592.83 kB) is unlike any other because it's a way to eat for maintaining weight loss. The basics are fresh fruits, vegetables, legumes, pasta products. The anchor of the diet is olive oil and the often ignored nutrient is salt which is olive oil's alter ego. Salt is a main ingredient in making the staples of the Mediteranean Diet such as olives, prosciutto, and boiling pasta. Without salt the diet would not be palatable. So take this article to heart and then take someone out to lunch or dinner. As they say in Italy: "Buon appetito!"

Irving Kristol died yesterday, one of the great political thinkers of the last half of the 20th century. Among his sage observations was this from 1972:

"All bad poetry springs from genuine feeling," wrote Oscar Wilde, and I would like to suggest that the same can be said for bad politics. . . .
It seems to me that the politics of liberal reform, in recent years, shows many of the same characteristics as amateur poetry. It has been more concerned with the kind of symbolic action that gratifies the passions of the reformer rather than with the efficacy of the reforms themselves. Indeed, the outstanding characteristic of what we call "the New Politics" is precisely its insistence on the overwhelming importance of revealing, in the public realm, one's intense feelings—we must "care," we must "be concerned," we must be "committed." Unsurprisingly, this goes along with an immense indifference to consequences, to positive results or the lack thereof.

The insight about American politics has endured through the intervening years. It might usefully be extended beyond politics to policy.

Consider public health nutrition. The "I feel your pain" approach is to pretend that each and every nutrition-related ailment can be "cured" or its onset prevented by modifying one's diet.

Hubris. Overreach. We CAN improve our diets. Certainly. We can improve health outcomes with dietary interventions. Certainly. But the simplistic single-nutrient focus and, worse, the notion of "good" and "bad" foods trumping the science clearly showing it's diets and not individual foods that are important, have taken us down the wrong road.

We need to get back to the science and retreat from amateur poetry, symbolic politics and posturing on nutrition advocacy -- like the simple-minded calls for salt reduction in the absence of evidence of any health benefit and, even, any proven sustainable change in population sodium intakes within the normal range (what renowned Swedish researcher Bjorn Folkow termed the "hygienic safety range" for sodium, 2,300 - 4,600 or even 5,750 mg/day sodium -- the US consumes a world-average 3,500 mg/day).

Genuine feelings of wanting to help solve problems in public health nutrition cannot remain symbolic gestures, they must recognize human physiology and be rooted in science, not compassionate nannyism.

Rob Sharp, writing online for Independent.ie, asks, "Are you a cowering, diet-obsessed wreck, meticulously measuring your carbs and counting out individual grains of salt granules on to your plate?" He then offers hope--a book by professors Stanley Feldman and Vincent Marks who attack media scare tactics and so-called scientific wisdom, including misconceptions about salt. In his article Are scare stories bad for our health? he addresses the misguided scare tactics on salt:

Eating salt is not bad for us

Many scientists, think that too much salt can cause everything from heart attacks to strokes and kidney disease. Feldman and Marks believe the risks are overblown. This is because of our reliance, they say, on antiquated medical research in which patients were treated for high blood pressure with a lowered salt intake (before drugs were available).

"This seldom worked," they write. "Nevertheless, the myth has persisted." When results of 11 of the most scientifically credible studies of the effects of salt in the diet were analysed by the internationally recognised Cochrane Collaboration, the effect of salt on blood pressure was found to be negligible.

Salt is an essential food and without it we would die. Sweating is impossible without it, and strenuous exercise by those with depleted levels of salt can lead to overheating and death.

Just look at the Japanese, say the professors. They have double the European salt intake, yet have a longer life expectancy and less problem with blood pressure. "Lots of salt is nowhere near as bad as we are led to believe by campaigning groups," says Marks.

We might add that it is not just the Japanese that have high salt diets and positive health outcomes. It is widely known and accepted that the Mediterranean diet is high in salt, yet the Mediterranean people have the world's best cardiovascular health. The diet is so healthy that the National Heart, Lung and Blood Institute (NHLBI) used it as a model in their famous DASH Study (Dietary Approaches to Stop Hypertension). The study confirmed that the Mediterranean/DASH diet was healthier than the typical American diet and effectively reduced blood pressure (BP).

In fact, we can take this one step further. Because a diet rich in vegetables is key to good health and because vegetables are much more flavorful with added salt, a healthy diet is much more easily realized by using salt, rather than trying to reduce it. As a mom, I spent years luring my children to eat their vegetables by adding salt and butter and, if necessary, ranch dressing. Hint for getting a finicky, rambunctious three year old boy to eat broccoli: Call the broccoli "trees", the salt "rain" and the ranch dressing a "river". Desperate times call for desperate measures! No damage done. He's a healthy 21 year-old now and has never referred to broccoli as trees in public, but he does like vegetables.

Message for the day: Scare stories might be bad for your health.

Rob Sharp, writing online for Independent.ie, asks, "Are you a cowering, diet-obsessed wreck, meticulously measuring your carbs and counting out individual grains of salt granules on to your plate?" He then offers hope--a book by professors Stanley Feldman and Vincent Marks who attack media scare tactics and so-called scientific wisdom, including misconceptions about salt.

Eating salt is not bad for us

Many scientists, think that too much salt can cause everything from heart attacks to strokes and kidney disease. Feldman and Marks believe the risks are overblown. This is because of our reliance, they say, on antiquated medical research in which patients were treated for high blood pressure with a lowered salt intake (before drugs were available).

"This seldom worked," they write. "Nevertheless, the myth has persisted." When results of 11 of the most scientifically credible studies of the effects of salt in the diet were analysed by the internationally recognised Cochrane Collaboration, the effect of salt on blood pressure was found to be negligible.

Salt is an essential food and without it we would die. Sweating is impossible without it, and strenuous exercise by those with depleted levels of salt can lead to overheating and death.

Just look at the Japanese, say the professors. They have double the European salt intake, yet have a longer life expectancy and less problem with blood pressure. "Lots of salt is nowhere near as bad as we are led to believe by campaigning groups," says Marks.

We might add that it is not just the Japanese that have high salt diets and positive health outcomes. It is widely known and accepted that the Mediterranean diet is high in salt, yet the Mediterranean people have the world's best cardiovascular health. The diet is so healthy that the National Heart, Lung and Blood Institute (NHLBI) used it as a model in their famous DASH Study (Dietary Approaches to Stop Hypertension). The study confirmed that the Mediterranean/DASH diet was healthier than the typical American diet and effectively reduced blood pressure (BP).

In fact, we can take this one step further. Because a diet rich in vegetables is key to good health and because vegetables are much more flavorful with added salt, a healthy diet is much more easily realized by using salt, rather than trying to reduce it. As a mom, I spent years luring my children to eat their vegetables by adding salt and butter and, if necessary, ranch dressing. Hint for getting a finicky, rambunctious three year old boy to eat broccoli: Call the broccoli "trees", the salt "rain" and the ranch dressing a "river". Desperate times call for desperate measures! No damage done. He's a healthy 21 year-old now and has never referred to broccoli as trees in public, but he does like vegetables.

Message for the day: Scare stories might be bad for your health.