It was personally deeply disappointing to read the publication today by my respected, esteemed, even revered think tank, the American Enterprise Instittute (AEI) of a superficial review of the salt and health controversy. Research assistant Sara Wexler properly concluded that FDA regulation of salt was a blind alley, but, instead, she urged "low-sodium campaigners (to) focus their efforts on consumer demand."

This was "think tank lite" at its worst. Both the facts and the analysis were flawed. In fact, the entire article was written to address the wrong problem altogether. This is a worthy subject for a serious AEI analysis, but this wasn't a serious AEI analysis in the proud tradition dating back to Murray Weidenbaum and Chris DeMuth. A sad day.

Where to begin? Let's start with a few facts.

Wexler states the Salt Instittute (and Grocery Manufacturers Association) "have called for voluntary sodium reductions instead of federal regulation." I'll let GMA speak for themselves. The Salt Institute feels that patients should follow their doctors' advice on dietary sodium, but we strongly oppose a general recommendation for sodium reduction. Wexler continues, accurately, to report that the Salt Institute, GMA and the International Food Information Council have concluded that the medical evidence shows "the direct impact of sodium reductin on human health is still unclear." True. That's why we oppose it. Why would we think a "voluntary" program to undertake a major, unjustified health intervention would be appropriate? We don't.

Wexler conflates "blood pressure" and "health risks" regarding dietary sodium. Experts agree salt is related to blood pressure and, indeed, as reported, research at the University of Indiana shows that in a strong majority of people', their blood pressure is unchanged on a low-salt diet while a significant minority actually increase their blood pressure and more has the "desired" fall. But experts do NOT agree that evidence shows that reducing dietary salt actually improves health. In fact, most of the health outcomes studies find no benefit at all and several have found possible risks when people cut back salt. That said, Wexler correctly reports the Salt Institute's support for improving overall dietary quality to improve risks.

Wexler points out there is "confusion" on the issue, but she states that "(t)he biggest problem for industry groups seems to be the lack of adequate demonstrative studies." That's just wrong. First of all, the problem isn't an "industry" problem, it's a "health" problem. The prospect of imposing billions of dollars of additonal cost on American food consumers is not the issue here (though legitimate), the question is whether evidence shows that the proposed major re-engineering of the American food supply has any scientific justification and whether the intended benefit will be sacrificed to unintended consequences. The "confusion" isn't with the evidence. The confusion is caused by those who persist on ignoring the evidence of a lack of a health benefit and suggesting that the "industry" should fund the research to document the government's policy. As an aside, HHS has stonewalled release of key data at every step and fought an attempt by the Salt Institute and the US Chamber of Commerce to force transparency in the process.

Wexler implies FDA's regulation awaits a determination of "(w)hether or not sodium can be linked to high blood pressure." We certainly hope not. And all Americans should hope that FDA should not consider regulations in this area until it can show that 1) reducing salt will improve health and 2) regulating the amount of sodium in individual foods will reduce overall dietary sodium intakes sufficient to achieve a health benefit. Neither has been shown. That's why the US Preventive Services Task Force has concluded there is a lack of evidence for a general salt reduction recommendation.

Wexler seems to consider salt to be just another nutrient, like fat, carbs and sugars, ignoring the fact that it is an essential nutrient necessary for life. As such, the body has redundant systems to ensure an appetite for salt, as discussed as recently as this month's Experimental Physiology and discussed in our blog by both Mort and me . What this suggests is that "consumer demand" will never be the answer.

We won't get the right answer until we start asking the right question: Will a low-sodium diet improve health? We may need to go no further. HHS should fund the controlled trial of this question that will answer this serious question.

Wexler's once-over-lightly piece is fluff. We expected more from AEI.