We live in interesting times. As you can imagine, the last week was a very busy one filled with numerous television, newspaper and radio interviews. After the IOM press conference to release their report on "Strategies to Reduce Sodium Intake," a key message that we felt was necessary to get out, was the admission on the part of the lead author that the Committee studying the matter never considered the science behind the salt and health issue - but only the strategies required to reduce salt in foods. This was a rather strange admission, since the major part of the IOM Committee consisted of epidemiologists and physicians rather than industry professionals who actually had some knowledge about food formulation. The centerpiece of the IOM 'Strategy' was the recommendation for the FDA to start regulating the salt contents of processed foods and foods prepared in restaurants and foodservice establishments. This would be a dramatic reconsideration of what is an essential nutrient and the oldest and most ubiquitous food ingredient known to humankind. One would expect that a move of this magnitude would be based upon a substantial body of uncontested scientific evidence, but that is very far from the case.

One of the interviewers from a Los Angeles radio station asked me how I might dare to challenge the medical authorities on this matter. I thought it best to ask him for a clarification. Was he referring to the medical authorities that recommended hormone replacement therapy for women and 30 years later admitted that such a strategy had disastrous consequences for women? Or was it the medical authorities that emphatically stated that the consumption of any more than one egg a week would lead to a very ugly and early death from cholesterol-blocked arteries - only to completely recant this advice 20 years later? Or perhaps he was referring to the medical authorities that decreed that frequent PSA measurements were the answer to prostate cancer, only to come out with their most recent recommendations that perhaps it's best not to do PSA tests at all because they can be misleading? Precisely which medical authorities was he referring to? The interviewer admitted that he got the message and dropped the question.

During the course of the actual press conference, I pointed out to the senior author that the impact of salt on health has been reviewed on a number of occasions over the years with mixed results. The latest meta-review of the evidence was commissioned by the German Ministry of Health just last year and concluded that population-wide salt reduction was not justified from a public health point of view. Indeed, it would have been wise for the US to do the same before going ahead with strategies to reduce sodium. Because of the controversial nature in which the evidence has been interpreted, I went on to ask if the international trade implications of salt regulation in food was ever considered in the deliberations of the IOM ‘Strategies’ Committee. The lead author appeared stunned at this question and admitted that the question of trade never entered into their deliberations.

In establishing the Sanitary and Phytosanitary Agreement (SPS) on trade, the United States was one of the leading countries to insist that unjustified measures could not be used to limit trade between countries. Countries would not be able to ban products for public health or safety issues unless it was proven beyond doubt that these measures were fully justified on a sound, scientific basis. For example, because Italians and Greeks have excellent cardiovascular health, exporters of many traditional high salt foods from these countries may find full justification under the World Trade Organization SPS Agreement to declare the regulation of salt in food as a non-tariff barrier to trade and launch an action against the US at the WTO. Since the US has never carried out a large-scale trial on the overall health impacts of salt reduction, and since the sum of evidence remains controversial, the WTO is likely to consider such a complaint valid.

As I said, we live in interesting times.