Okay everybody, take a valium.
We have heard a lot about Finland today. We have heard no less than four salt reduction advocates state that the recent publication of results from Finland indicates that, because of their 30 year salt production program, they have been able to decrease their rate of cardiovascular disease and increase their life expectancy.
For the record you must all know that the Salt Institute loves the Finland publication by Karpannen and Mervaala. We love it for two reasons; it describes for the first time a country that has actually reduced its salt consumption significantly over a 30 year period, and; it is one of the very few occasions that actual health outcomes rather than proxy risk factors were used as a measure of impact.
Before I go any further, I would like you to take out your pencils and mark this down: the Global Cardiovascular Infobase. Look it up in Google; it is a WHO collaborating center that contains the global database for cardiovascular disease going back more than 30 years. Because of the availability of this database there is no excuse for not comparing the impact of salt reduction on cardiovascular disease in Finland, with the impact of maintaining salt at the same levels in other countries. Indeed, it is surprising that the authors Karpannen and Mervaala did not do so at the time of their publication.
We have done this and according to the data, all of Finland’s neighboring countries that did not reduce salt consumption, as well as United States and Canada, have done far better than Finland in all the cardiovascular health outcomes measurement during the same 30-year time. If anything, the Finland study shows that reducing salt actually worsens the cardiovascular health outcomes.
You will find this review of data on the Salt Institute website as the Summer edition of our Salt and Health newsletter - better yet, check out the figures yourselves on the Global Cardiovascular Infobase and if you see one point out of place in our analysis write us and call us liars. However. if you find that we are correct, you can call up the four salt reduction advocates you’ve heard refer to the Finland study today and tell them whatever you want – and if you’re not sure what to say call me and I’ll help you out.
We have heard much today about the low blood pressure of the Yanomamo Indians of Brazil. There is no age-related rise in blood pressure among the Yanomamo because there is not much of a rise in age. The Yanomamo Indians have a life expectancy of 48 ½ years! Why we compare our society here to one that reaches puberty at the age of six and experiences their midlife crisis at the age of 17 is beyond me! Yanomamo Indians, indeed.
Can you reduce salt in cheese? Maybe, but for more than 350 years Parmesano Reggiano has been made by immersing the cheese rounds in a saturated salt bath (some of which have been in continual operation for more than 100 years - you can see beautiful 5 inch wide salt crystals sitting on the bottom of these baths). The final salt content of this cheese is 2% and you would lose your argument at the World Trade Organization if you insisted that it be below that level, since the Sanitary and Phytosanitary Agreement requires the strictest scientific scrutiny for such a justification. The data that we have heard here today justifying the need for salt reduction doesn't come close to that standard. For goodness sake, the TOPS data on mortality and salt reduction presented here today as fact, has a P-value of 0.3. How statistically significant is that?
You call this science?
Of course Roquefort, Gorgonzola, Brie and Camembert cheeses cannot be satisfactorily made without the current levels of salt. You might convince some people to lower salt, but you cannot convince the Penicillium mold to do so. They need the current levels of salt to grow - something that any microbiologist worth his salt should appreciate!
Pomerleau et al from the London School of Tropical Hygiene have attributed the burden of disease across Europe to the degree of access to fresh fruit and vegetables. In Italy, data shows that there is an average consumption of 11 g of salt per day, yet they have had amongst the best cardiovascular health data in the world. Olives, bacalla (salt cod), anchovies, capers and botarga (salt-cured tuna roe) are all part of the diet, yet voluntary salt addition is approximately 40% of the salt intake! Why is that?
It is because you can't eat all those healthy vegetables without salt. Indeed, you have to question whether 2,300 mg sodium per day will be sufficient to get people to eat all those excellent vegetables we want them to in a balanced diet.
By the way Dr. Appel, you indicated that you felt there was no problem with iodine, yet the NHANES data clearly shows a dramatic drop in urinary iodine over the last 30 years. Perhaps you ought to check this out with CDC before you answer this question in future, or you can read my article in the November 2006 edition of Food Technology.
When asked what works in lowering sodium, Dr. Appel struggled for an answer. In the end he referred to the UK example. Well, in the UK, they removed the salt shakers from school lunch rooms. The Guardian newspaper reported that students no longer ate their vegetables at school, but waited until they got home to consume their vegetables because there, salt was allowed. The fact is you cannot eat all those healthy cruciferous vegetables without salt.
We have heard earlier today reference to bacon. Food safety is not the only function of salt in bacon. Protein solubility is moderated by salt and that results in textual and surface appearance changes. Fried bacon tastes good because the Maillard reaction products produced after frying bacon make it so - but some of those reaction products are bitter, so salt mitigates that bitterness. You have to trust the judgment of the food industry who have a close relationship with their clients to make the call regarding a product’s acceptability to the consumer. After all, they have the most to lose if their products are not acceptable.
Finally, to refer to the UK, that paragon of great food, as a model to follow, is rather strange. People in the UK will eat anything, as long as it's "good value". Not so here.
A friend of mine was international director of quality control for Kentucky Fried Chicken. A number of years ago, he told me that the worst problem he had around the world was in the UK. Quality control was worse there than in most developing countries. And it was for one reason - because people will eat anything there, so let's think twice about using them as an example.
And as far as the Foods Standards Agency in the UK is concerned, their predecessor agency was responsible for delaying the implementation of milk pasteurization for more than 40 years after it was made mandatory the US. In fact, it was the British medical establishment that was responsible for this. Scotland did not make pasteurization mandatory until 1983 - the last country in the Western World to do so. So let's think twice about using the UK as our guiding light.
When it comes to a knowledge of the food industry and their relationship to the consumer, the salt reduction advocates we have heard today cannot say that they have "been there, done that." It's time we stopped listening to misleading pontifications and start getting down to considering the quality of the science.
Lives are at stake here. Thank you.
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