There was an interesting story on the front page in the print edition of today's Wall Street Journal with an eye-catching but gratuitously offensive and grossly inaccurate headline: "Maybe Mummy Should Have Laid Off the Salt." We had to respond :

There has been exactly one clinical trial of the effect of low-salt diets on cardiovascular morality and rehospitalization for congestive heart failure. That study confirmed observational studies and showed conclusively that low salt diets produced greater mortality. See the article in Clinical Science, "Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? " It concludes: "The results of the present study show that a normal-sodium diet improves outcome, and sodiumdepletion has detrimental renal and neurohormonal effects with worse clinical outcome...."

So, perhaps the mummy should have used more salt during life -- as well as the salts used in the mummification process.

It's headline writers like this that are responsible for newspapers coming in dead last in terms of consumer confidence .

TheWashington Post just released a story that the U.S. Preventive Services Task Force has concluded that mammograms are unwise for younger women. Post reporter Rob Stein describes the USPSTF as "an influential federal task force" and "the federal panel that sets government policy on prevention."

We could only hope that his description was true. In fact, the USPSTF has been trying to steer the federal government away from "junk science" and towards "evidence-based" health interventions for years. This may be, as Stein sums up, a "radical change" in public health recommendations.

Perhaps now people will pay more attention to what the USPSTF concluded back in 2003 and maintains today: our present policy discouraging salt intake in the general population may be politically-correct, but it is a scientifically-flawed policy. The USPSTF has studied the question and found insufficient evidence to make a general recommendation for the public .

We'd all be better off if the US Prevention Services Task force was, indeed, the influential panel that sets government policy on prevention that the Post postulates.

House speaker Nancy Pelosi (D-CA) unveiled her version of healthcare reform at a highly-orchestrated news conference yesterday. Featured in coverage in the Washington Post was the fact that the event featured 50-pound bags of salt -- used to anchor the background staging for the outdoor event against gusty winds,

six 50-pound bags of salt -- ice-melting salt, to be specific -- placed on the bases of the six U.S. flags on the stage to keep them from toppling over in the wind and marring the event with unwanted visuals and ruinous metaphors.

The Post headlined the speaker's rollout: "Rally has a lot of salt, but little pep."

Who knew salt would get dragged into the healthcare debate?

Matthew Continetti's editorial, "The inevitability myth," in the November 2nd Weekly Standard asks: "Did the Democrats become Calvinists when we weren't looking?" Continetti discusses the Obama/Reid/Pelosi strategy to pass healthcare reform. They argue, he says, that passage is "inevitable" given the overwhelming partisan majorities on both sides of Capitol Hill. He notes "lately they've been talking a lot about predestination" and claim enactment is "foreordained."

Healthcare reform is a discussion for another forum. Some might find the same pattern for other issues like global warming or the electronic bombardment of those living under high-voltage transmission lines. As usual, I see a salt connection.

I was struck by the synergy of the Standard's construct with an observation noted here in the past: how salt reduction activists have been prying into citizen's lives and larders. We had in mind more the "fire and brimstone" Puritans seeking to affix the "Scarlet S" on the nutritionally/politically incorrect than the Puritans' Calvinist forebearers . But it's much the same.

Now that we think of it, the second strand of strategic embrace of predestination/foreordaination as a rhetorical tool would also characterize these salt nannies. While reasonable scientists find evidence of elevated risk for significant portions of the population with a one-size-fits-all salt reduction strategy and others find evidence that human's salt intake is a physiologic appetite not a choice that can be educated or regulated, these New Calvinists gloss over the scientific controversy and want to skip ahead to "implementation," churning up group endorsements to add momentum to their version of "the inevitability myth."

Science, like time, would seem to answer this myth. Over time, population salt intakes are unchanged. Moreover, it may not be due to sinful choices of salty foods nor the perfidy of food manufacturers who (take your choice) either stuff their products with hidden salt or make wild health claims that low-salt products have proven health benefits. Salt intake, the science now suggests, is the direct result of neural signals from the brain controlling an unconscious salt appetite. Some may see intelligent design. We think it's heavenly.

Pointing to recently published evidence that salt intakes are unchanged over decades and in a range above that recommended in the Dietary Guidelines for Americans and may, therefore, reflect physiological signals of need and not consumer behavior, the Salt Institute has renewed its call to abandon numeric targets for Americans' salt consumption.

In formal comments today to the Dietary Guidelines Advisory Committee (pdf 36.38 kB) , Richard L. Hanneman, president of the Salt Institute pointed out that the body's consistent physiological salt appetite has the perverse result of increasing caloric intake instead of curtailing dietary sodium.

The Institute called for further study and for replacing the numeric target in the 2005 Guidelines with a call for "moderation" as contained in Guidelines beginning in 1980 until 2000.

Sometimes when telling the truth isn't "politically correct," messages in the mainstream media receive short shrift. Elitism trumps the views of the "man on the street." We've seen it blatantly in coverage of the salt and health issue. But as Bobby Dylan famously sang "the times they are a-changin.'" Today's Times (London, UK) carried a story dismissing efforts to demonize salt intake ("Is salt really the devil's ingredient? "). No, concludes journalist Peta Bee, quoting the chief dietitian at London's St. Georges Hospital, Dr. Michael Alderman from the Albert Einstein College of Medicine and Dr. Paul Whelton of Loyola University.

While these experts weigh-in saying the scientific evidence against dietary salt has been over-interpreted and anti-salt campaigns overblown, the often missed story is found in the "Comments" that regular readers contribute. They may not be "informed" by the science, but they reflect well-earned experiences that offer practical tempering to elite PC opinion. Consider these:

• "I find it very annoying that I was forces to eat tasteless food throughout my childhood due to my bother's belief that salt is bad." -- Genevieve Wilkins
• "I have often wondered why salt licks were provided for animals. We are animals, aren't we?" -- alan burden
• "I have truly believed for many years that if the government says salt is bad fro us, in time the opposite would prove to be true...how much taxpayers' money is wasted on health propaganda campaigns." -- Nicholas Mayes
• "It's funny - my horse's vet tells me that adding salt to feed isn't a problem....Odd how it's so difference in humans - almost like it's just an excuse for the government to interfere and tell us all how to live our lives, isn't it?" - K Charlton
• "Nanny doesn't always know best." - Chris Palmer
• "Be extremely careful about the anti salt message. I cut out salt on this advice, then moved to a sub tropical country and became seriously ill, with low salt at least one of the causes." - Paul Flynn

There seems to be a bubbling up of resentment about dietary diktats that may make holding the line on the anti-salt message akin to the fall of the Berlin Wall -- its demise could be more sudden and complete than "intelligence" estimates.

A study released on-line this week in The Clinical Journal of the American Society of Nephrology indicates that physiology, not public policy, will determine a human’s daily sodium intake. This research likely represents a important step forward in light of past and current efforts by government agencies and government funded organizations to set progressively restrictive guidelines for salt intake among U.S. citizens.

The study, Can Dietary Sodium Intake be Modified by Public Policy? (David A. McCarron, Joel C. Geerling, Alexandra G. Kazaks, Judith S. Stern), analyzed existing research to determine whether sodium or salt intake follows a pattern consistent with a range set by the brain to protect normal function of organs such the heart and kidney. The analysis is based upon 19,151 subjects studied in 62 previously published surveys and reflects the differing ‘food environments’ of 33 countries. The data reported documents that humans have a habitual sodium intake in the range of 2800 to 4600 mg/day with an average of 3600 mg/day. Currently, the U.S. consumes an average of about 3,500 mg/day.

The Dietary Guidelines Advisory Committee of the U.S. Health and Human Services and the U.S. Department of Agriculture considers 2,300 mg/day sodium to be a healthy maximum almost 20% lower than the minimum intake observed in the 19,000-plus subjects reported in this first-time analysis. In spite of that reality, the Committee is in the midst of a review to determine whether that recommendation should be lowered even further. An Institute of Medicine Committee is also considering a strategy to reduce dietary sodium.

The Committees should heed this study as they consider wasting more time and energy on policies which are unlikely to make American citizens any healthier. Time spent on draconian recommendations on a single ingredient would be better spent encouraging a healthful overall diet rich in fruits, vegetables and whole grains. The Mediterranean diet is high in salt, yet the Mediterranean people are known for excellent cardiovascular health. A healthful overall diet, not a fixation on any single ingredient, is one of the secrets to maintaining good health.

See the Salt Institute's news release (pdf 29.80 kB) .

One of the joys of my commute is the opportunity to listen to stimulating recorded lectures as part of The Teaching Company's Great Courses series. I'm in the middle of part 2 of a course by Steven L. Goldman, Ph.D. on "Great Scientific Ideas That Changed the World."

Lecture 13 on "The birth of Modern Science" discusses the contribution of Francis Bacon, an Elizabethan Renaissance man who developed the modern experimental method. Bacon developed his new method to overcome what he considered the intellectual fallacies of his time which he called "idols" of which there were four: idols of the tribe, idols of the cave, idols of the marketplace and idols of the theater. An idol, in Bacon's terms, was a fascination or fixation without basis in fact and which interferes from acceptance of an accurate understanding of some phenomenon.

Consider how relevant these fallacies are to the current debate on salt and health.

Idols of the tribe are deceptive beliefs inherent in society; they are based on error because they interpret observed relationships through the eyes of (current) orthodox opinion.

Idols of the cave are errors rooted in personal experience and limited by that experience.

Idols of the marketplace are errors rooted in semantics; words conjure up conclusions so the use of improper descriptors induces misunderstanding.

Idols of the theater grow from sophistry, a body of opinion sustained and perpetuated by group acceptance and popularity, but based on false assumptions.

How do Bacon's "idols" relate to the ongoing controversy over salt?

Tribe -- the overwhelming popular majority accept fallacious reasoning that because salt and blood pressure are related and blood pressure and health outcomes are related, that lowering salt will improve health. The evidence shows the contrary.

Cave -- Blood pressure researchers can manipulate subjects' BP by varying salt intake; therefore, they reason that changing BP alone, by any means (and an easy "means" is changing salt intake) will produce better health. There is no evidence to support this conceit.

Marketplace -- It's too bad recently-deceased William Safire didn't address this point. Assertions of "excess dietary sodium" and conclusions that "we eat more salt than we need" are among the several sleights-of-hand employed by salt reduction activists. How do they know better than an individual's neural-hormonal system what is "too much" salt?

Theater -- There are several illustrations, but the easiest to see is the continued preoccupation with endorsement by "expert groups" of the policy recommendation to reduce dietary salt, all the while ignoring the lack of evidence of a health benefit.

We salute Francis Bacon for pioneering a modern scientific method. He would be right at home with his passionate advocacy in today's kerfuffel over dietary salt.

European "food companies guilty of misleading people with health claims" trumpets a headline in the October 2 issue of Medical News Today . The story reports the views of the UK-based activist group Which? quoting the group's chief policy advisor saying of an ongoing review of health claims by the European Food Safety Authority (EFSA):

A huge number of food products claim to have health benefits, but finally we are separating the wheat from the chaff. Incredibly, only a third of health claims looked at by EFSA could be backed up.
Clearly many food companies are exploiting people's interest in improving their health, often over-charging them for alleged health benefits which can't be proved.
On a more positive note, there are foods using proven health claims, so it's vital that industry acts responsibly when making claims, and that the Food Standards Agency ensures the removal of misleading products. Only then can people be confident that the health claims on items they buy are genuine.

Medical News Today reports that EFSA has assessed over 500 claims.
Among the claims supported by Which? and found acceptable by EFSA are claims that reduced sodium foods are healthy. Food companies offering these products are pleased to cooperate to say these foods are healthier for consumers.
Talk about misleading people! EFSA (and Which?) ignore two yawning data gaps that fatally undermine the argument for salt reduction:

1. There is no evidence that there is a net health benefit of reducing dietary salt (pdf 434.26 kB) (in fact, the single controlled trial of the health outcomes (pdf 802.65 kB) of salt reduction found a greater risk among those on low salt diets), and
2. There is no evidence that those who choose low-salt foods (with "healthy" labels) consume lower sodium diets -- the evidence suggests salt appetite is an autonomic physiological response (pdf 517.27 kB) to the body's need for salt.

So, Which?, if food manufacturers are misleading consumers for unsubstantiated claims that their low-salt foods are healthier, you're no better for criticizing them while endorsing the very basis on which their misleading claims are based. As Wikipedia explains, the original idiom about "the pot calling the kettle black " has an alternative, subtler interpretation from a century old poem that extends the critique beyond simple hypocrisy. The poem points out that the actual idiom is "The Pot Bottom Calling The Kettle Bottom Black" drawn from the fact that "the pot is sooty (being placed on a fire), while the kettle is clean and shiny (being placed on coals only), and hence when the pot accuses the kettle of being black, it is the pot’s own sooty reflection that it sees: the pot accuses the kettle of a fault that only the pot has, rather than one that they share." The observation that the root of the problem is that food companies are reflecting back the junk science of groups like EFSA and Which? properly assigns responsibility.
The poem found in "Maxwell's Elementary Grammar" school book, reads:
"Oho!' said the pot to the kettle;
"You are dirty and ugly and black!
Sure no one would think you were metal,
Except when you're given a crack."
"Not so! not so! kettle said to the pot;
"'Tis your own dirty image you see;
For I am so clean -without blemish or blot-
That your blackness is mirrored in me"

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.

William McGurn's op ed in today's Wall Street Journal on "Harry Reid's 'Evil' Moment ," brings to mind the ongoing similar campaign to de-legitimize dissent from the orthodoxy of salt reduction. McGurn recalls the mainstream media outrage when U.S. presidents described the Soviet Union as an "evil empire" and North Korea, Iran and Iraq (at the time), an "axis of evil." More recently, when House Speaker Nancy Pelosi accused those opposing President Obama's health care recommendations as "un-American" and Senate Majority Leader Harry Reid following in her train calling those protesting the "public option" health care proposal "evil mongers," the media have been silent about the characterization.

Indeed, it does seem a bit over the top to use the same rhetoric to describe opponents in a domestic American political debate with the same terms as truly "un-American" regimes that employ (or employed) cruel repression as their modus operandi.

What struck me in the McGurn column, is the parallel tactic being employed by proponents of universal sodium reduction in an attempt to deny the controversy among scientists about the scientific underpinnings offered to support having all Americans eat less salt. When the Royal Society of Chemistry conducted a debate in London several years ago, I laid out the evidence amassed by renowned scientists in peer-reviewed medical journals showing the lack of evidence of a health benefit for reduced-sodium diets; my opponent, Dr. Graham MacGregor, eschewed the science and reminded the audience that I was not a medical doctor and my salary was paid by salt producers. When the president of the International Society of Hypertension used his presidential address to decry the misdirection of anti-sodium proponents in focusing on blood pressure rather than health impacts, the mainstream groups pointed out that the Salt Institute has consulted with this acknowledged expert -- even though the consultancy was unpaid -- as if to say that somehow our seeking after the best quality scientific advice and the doctor's proffering his expertise to those dissenting from a view to which he had repeatedly objected is illegitimate.

Just as Americans should recoil from attempts to intimidate debate on legitimate Congressional debate, so should we be concerned at attempts to delegitimize the public health nutrition debate on sodium and health.