Salt Institute technical director Mort Satin explores this issue in the just-released issue of Salt and Health newsletter.

In a paper entitled, “Aldosterone and cardiovascular function: a lifetime of damage,” Dr. John Connell, who is Professor of Endocrinology at the University of Glasgow and Head of the of the Medical Research Council’s Blood Pressure Group, based in the British Heart Foundation’s Cardiovascular Research Centre in Glasgow described how an excess of aldosterone greatly increases the risk of stroke and heart failure, thus explaining the results of several previous research studies that revealed more cardiovascular patients dying on low salt diets than on regular diets.

Professor Connell said:

“Aldosterone is a key cardiovascular hormone. The higher the level of aldosterone in your blood, the more likely it is that you will suffer from high blood pressure, which will increase your risk of suffering a heart attack or a stroke.”

Elevated aldosterone levels mean that throughout life, certain individuals will be more prone to developing high blood pressure, arterial stiffness and cardiovascular disease. Connell’s previous research indicated that aldosterone may be a causal factor in 10% of UK patients with high blood pressure*.

It is difficult to understand why the UK Food Standards Agency, the EU Commission and the Health Canada are all deliberately ignoring this research in their drive to reduce the levels of salt consumed. The mechanistic research work on the malignant role of elevated aldosterone levels upon the cardiovascular system brings far more weight to the salt and health outcomes question than the highly promoted, yet scientifically flawed epidemiological studies on salt and blood pressure.

The human body is an organism governed by biological mechanisms and no amount of bias, hype or imprudent policies will change this.
______
*Connell, J.M.C., Davies, E. 2005. Journal of Endocrinology, 186, 1-20.

Unfortunately, chronic high levels of aldosterone in the blood can have major negative consequences for the cardiovascular system, including to induce myocardial fibrosis, renal damage and stiffening of the arteries.

After its discovery more than 50 years ago, the medical interest in aldosterone has been dramatically renewed because of it’s immense impact on the cardiovascular system. Aldosterone is now considered to be the most important cardiovascular hormone in the human body.

As an integral part of the renin-angiotensin-aldosterone system (RAAS), a key function of aldosterone is to conserve salt (sodium chloride), when an insufficient amount is consumed. The latest research published in Clinical Endocrinology indicates that for most healthy humans, anything less than 6 g/day of salt (2300 mg sodium) will be insufficient to prevent the RAAS system from kicking in. That’s right – anything less than 6 grams of salt a day!

But the Dietary Reference Intakes recommends that an adequate intake of salt is 3.8 g/day of salt – not 6 g/day. In fact, the dietary reference intakes state that 6 g/day of salt is the tolerable upper limit of salt intake. How can one recommendation state one figure for a maximum intake while the scientific research indicates that very same figure is a minimum intake?

Perhaps the answer lies in the paper given at the Institute of Medicine workshop “The Development of DRIs 1994-2004: Lessons Learned and New Challenges” held in Washington September 18-20, 2007 by Dr. Peter Greenwald, Director of Cancer Prevention at the National Cancer Institute of the National Institutes of Health. Dr Greenwald described how most of the figures behind the recommended dietary intakes were based upon expert opinion (the lowest quality evidence) rather than randomized controlled double blind clinical trials (the highest level of evidence).

“Little research of the most useful type (randomized clinical trials) is available, whereas there is an enormous amount of information that is not very meaningful. This needs to be reversed.”

“To underscore the importance of “getting the science right,” we need only turn to a recent article in the New York Times Magazine written by a respected science reporter. It was entitled “Why can’t we trust much of what we hear about diet, health and behavior-related diseases?” (Taubes, 2007). The reporter includes several examples, many in nutrition epidemiology, where there is so much conflicting evidence that people do not believe it. Clearly, we have a serious problem, and we must push for the conduct of definitive studies before we make pronouncements on public health.”

In Europe, the EU Commission, led in large part by the UK and its Food Standards Agency has decided that public policy to reduce salt intake will trump basic human physiology. Charging forward pell-mell, the EU Commission, deliberately ignoring the latest scientific evidence, believes that they could not possibly go wrong on this issue because of the support of medical advocates, who have long ago given up any pretence of scientific objectivity.

The world has seen, time and again, that we ignore the science at our peril and as usual, consumers will end up being the victims.

The EU Commission has set the stage for the largest nutrition experiment ever carried out in history with the half billion citizens of the European Union expected to serve as the guinea pigs. When the compulsion to be seen as a driving force for change grabs policy makers by the throat, there is little left to do but allow that change to take place, regardless of the potentially disastrous consequences.

Not wanting to be perceived as being left out of this salt-reduction policy wave, Canada is set to follow suit – again totally ignoring the science and putting Canadian citizens at an elevated risk. One would think that some caution would be in order, but once again, backed by medical advisors and institutions that have done far more advocacy than homework, the government believes it cannot lose on this issue. Since when does ignoring the science and putting a population at an elevated risk give the Government a free pass?

So here we are, in the early part of 2008, with the drumbeat of scientific evidence piling up that the dietary guideline recommendations for sodium are largely irrelevant for the general population and insufficient to prevent production of elevated levels of aldosterone. For the majority of the people, salt, like water is a self-limiting nutrient. We know that aldosterone, chronically maintained at elevated levels as a result of reduced salt intake, will have major negative consequences on the integrity of our cardiovascular system. Like the mythical lemmings that march inexorably over the cliffs to their watery demise, it appears that the EU and Canada are on a track guided by what they don’t know, rather than by what they know – by urban myth and prejudice rather than science.

It is hoped that the new Committee selected to establish the Dietary Guidelines for 2010 will not feel obliged to make poor quality, knee-jerk decisions based upon subjective opinion and search out the most current scientific data upon which to establish their recommendations. Our health is at stake here.

It turns out that the dietary recommendations from noted medical authorities as well as self-appointed health gurus to drink two or more liters of water per day are totally unsupported by any scientific evidence. Doctors Dan Negoianu and Stanley Goldfarb from the University of Pennsylvania in Philadelphia reviewed all the published clinical studies on the subject and concluded that no data exists for average healthy individuals regarding the amount of water they should consume on a daily basis.

Indeed, it is unclear where this recommendation came from," the University spokesman added.

Their research also debunked the myth that drinking water makes the skin more supple and made it easier to lose weight. "There is simply a lack of evidence in general," they reported in the Journal of the American Society of Nephrology .

Reuters reports that this was not the first time such a conclusion was made since Dr. Heinz Valtin of Dartmouth Medical School found the recommendations to drink that amount of water to be totally lacking in scientific merit.

Because we all have specific individual needs for water, Goldfarb recommended, "If you're thirsty, drink. If you're not thirsty, you needn't drink."

This most recent article highlights the specificity of an individual's metabolic need, a situation paralleled by salt intake. The human body has an ability to excrete 250 times the maximum recommended intake of salt - an amount of salt that is virtually impossible for anyone to consume. In other words, our salt consumption is not limited by our ability to excrete it, but rather by our innate senses - sensory perception and biological feedback mechanisms. Both of these mechanisms are specific for every individual, just as water is.

For this reason, it is the very same folly to apply a "one size fits all" set of policy recommendations to salt consumption as it is for water consumption. Salt consumption is self-limiting and regulated by nature's biology, not by shortsighted dietary recommendations.

This outcome is no great surprise. The American Heart Association (AHA), the American Medical Association (AMA) and the National Heart Lung and Blood Institute (NHLBI) have all deliberately mislead the public by spinning the results of the DASH-Sodium trial to indicate that most of the blood pressure benefits were the result of salt reduction. It is hard to say if this myth-information was the work of specific individuals within these organizations or the organizations themselves. What is critical, however, is that these organizations have not lived up to their responsibilities and barely promoted the importance of the DASH- or Mediterranean-type diet in reducing cardiovascular disease. Instead, they have adopted the magic-bullet, single nutrient approach and almost exclusively promoted salt reduction as the dietary approach to improve cardiovascular health. That is why so few U.S. adults now follow the DASH diet.

It is time that the credibility of these organizations comes under far greater public scrutiny. The recent disasters of hormone replacement therapy and the disasterous strategy to aggressively drive down blood sugar in diabetes patients are clear examples of our medical establishments doing harm with ill-considered policies and information.

The following graph encapsulates the results of the DASH-Sodium trial:

It is immediately apparent that moving from a regular U.S. diet (blue line) to a DASH-type diet (red line) has a far greater impact on blood pressure than lowering salt consumption. On the regular diet, dropping from the current level of sodium consumption to the recommended daily level of 2,300mg Sodium/day dropped the systolic pressure by an average of 2.1 mm Hg (mercury). However, changing from a regular U.S. diet to the DASH diet, without any changes to sodium consumption, reduced the systolic blood pressure by 5.9 mm Hg, almost three times the drop resulting from the sodium reduction! There is no equivalency here. The move to a DASH diet far exceeds the benefits of salt reduction – there is no comparison. This clearly explains why Mediterranean people enjoy an excellent cardiovascular status despite their high salt consumption, as mentioned in a previous article. With a DASH diet, the impact of sodium on the blood pressure of hypertensives is minimal (and is of no significance to normotensive people – the majority in the population). On top of that, the DASH- or Mediterranean-type diet has myriad other health benefits aside from reducing blood pressure.

Yet, the AHA, the AMA and NHLBI always spin the data to place the majority of the benefits on salt reduction first and then the DASH diet, almost as an afterthought. In lock step, the Center for Science in the Public Interest (CSPI) repeats this in much the same manner.

What a pity that people take their advice!

No wonder we see headlines like, “Not many follow anti-hypertension diet” or “Fewer hypertensives adhering to DASH diet” or “Most With High Blood Pressure Do Not Follow Recommended Diet”. AHA, the AMA and NHLBI must all share in this predictable consequence of myth-direction.

In order for us to survive, our circulatory system must have an adequate volume of blood that is under sufficient pressure to supply all our tissues with the nutrients they need and to remove all the toxic byproducts of metabolism. It is a finely tuned balance of water and salt that allows this to happen. Any amount of water or salt that is consumed in excess of our needs is quickly eliminated through our kidneys. However, an equally important issue is ensuring that we have ingested enough water and salt to make up for any losses we experience. This is where the incredible mechanism controlling the thirst for water and the appetite for salt comes in.

This latest publication shows that this multi-factorial system is so robust and includes so many failsafe mechanisms that it continues to fully function even after large sections of its system are shut down. Employing a complex cascade of physiological functions from powerful hormones, such as aldosterone, to pressure sensitive receptors in the brain, this water thirst and salt appetite mechanism moderates our behavior so that we are driven to quickly replenish the volume and ionic balance of our blood, so that it is pressurized sufficiently for our heart to circulate it through our bodies. When fluids and electrolytes are lost, such as with sweating, physical exertion, diarrhea or other circumstances, we immediately get a water thirst signal. So we drink water to make up the loss. After a delay, our salt appetite kicks in to ensure that the ion levels are replaced. If we don’t respond on time to the salt appetite, we die – a situation which was described in an earlier article where a young woman died in a water-holding contest.

It has been repeatedly suggested that policies must be developed to reduce the amount of salt in processed foods. In fact, some countries already have or are in the process of considering policies to effect this. Will these policies be effective? What indication is there that people who are provided with a lower-salt food supply will actually reduce their intake of salt? Based upon this latest publication on salt appetite, individuals faced with foods that are mandated to be low in salt may make up for this in other ways. They may eat considerably more food in order to get more salt or they may simply pick up the salt shaker and add more voluntarily.

The recent publication by Shapiro, Boaz, Matas, Fux, and Shargorodsky as described in a recent article legitimately brings up the question of minimum levels of salt intake. Based upon their data, we can justifiably ask whether the current recommended daily values are prudent. Should the 2,300mg daily upper limit for sodium be reconsidered? Should the Institute of Medicine recommended daily adequate intake of 1,500mg sodium be reconsidered?

Our thirst for water is a basic mechanism we have evolved in our fight for survival. So is our appetite for salt. It is time we realize that the two mechanisms are interdependent and basic to our survival. Any policies promulgated to regulate our consumption of salt must bear this in mind and be based on the most rigorous science. If not, harm will be done.

In an analysis of 219 patients with essential hypertension in the early 1970s, heart attacks and strokes were observed when plasma rennin was elevated. It was concluded that renin may be a risk factor for heart attacks (1). In 1991, Alderman et al reported on the relationship of reduced-salt related high rennin levels with increased myocardial infarction rates (2). This relationship was again confirmed in 1997 (3).

In 58 trials of hypertensive persons, reducing sodium intake to 118 mmol/24 h (urinary sodium excretion) lowered systolic blood pressure (SBP) by 3.9 mm Hg and diastolic blood pressure (DBP) by 1.9 mm Hg. In 56 trials of normotensive persons, reducing sodium intake to 160 mmol/24 h resulted in a reduction of 1.2 mm Hg on SBP and 0.26 mm Hg on DBP. However, another consequence of this drop in sodium consumption was a significant 3.6-fold increase in the levels of plasma renin and a 3.2-fold increase in the level of aldosterone. These increases were proportional to the degree of sodium reduction and were accompanied by a significant decrease in body weight, and an increase in noradrenaline, cholesterol, and low-density lipoprotein cholesterol levels (4).

In his introduction of Dr. Michael H. Alderman as Editor-in-Chief of the American Journal of Hypertension, renowned hypertension researcher, Dr. John Laragh stated that Dr Alderman rightly “questioned the popular wisdom of unselectively advising salt avoidance for all hypertensives, and for all normotensive people, - a popular public health strategy which will surely chronically raise all of their plasma renin values and may have other unintended adverse consequences. (5)”

The primitive Yanomamo Indians of Brazil do not use added salt in their diet. As a consequence, this group provides an opportunity to study the hormonal regulation of sodium metabolism in a culture with a life-long restriction of dietary sodium. Results indicate that urinary excretion of sodium is very low, however, plasma renin activities were elevated when compared to other societies. The findings suggest that the hormonal adjustments to life-long low sodium intakes are similar to those achieved in acute sodium restriction of civilized man. In other words, there is a constant struggle to retain salt through the employment of the renin-angiotensin-aldosterone system, together with all its other consequences. Yanomamo Indians have a life expectancy of 48.5 years.

While there is little doubt that increased plasma rennin and aldosterone have a potential to result in increased myocardial infarction, a recent publication may reveal the mechanism of this action.

Aldosterone might affect arterial stiffening, in both the short and long term. Shapiro, Boaz, Matas, Fux, and Shargorodsky investigated the association between excess aldosterone, reflected by an increased aldosterone-renin ratio (ARR) and pulse wave velocity (PWV) in young healthy adults. In a single-center study, 60 subjects were evaluated for lipid profile, glucose, hs-CRP, renin and aldosterone (6). PWV was performed as a simple noninvasive recording and computer analysis of the two artery sites pressure waveform . The ARR was significantly and positively associated with PWV and had the potential to exhibit the direct effects of aldosterone on the vascular wall. Most significantly, the participants received instructions to consume intermediate levels of sodium proportional to energy intake, corresponding to 2,300 mg/day sodium per 2,100 kcal and to avoid foods notably high in sodium due to processing or foods with salt topically added – in other word to comply with the upper limit DV recommendations of the Institute of Medicine (7). This level of intake resulted in increased aldosterone and increased arterial stiffness.

There are a number of reasonable conclusions that can be derived from the above data. In the first instance, there is a strong possibility that a reduction in salt intake will elicit increased plasma aldosterone-renin output, thereby placing normotensive people at a greater risk for myocardial infarction. It appears likely that the arbitrarily derived IOM upper limit of sodium may not be sufficient to protect the majority of the population from arterial stiffening.

Finally, we must tread very carefully during any consideration of a change in the regulatory status of salt to ensure that we do not do the population more harm than good.

At this point in time, there is no justification to change the GRAS status of salt and there is sufficient information to reconsider increasing the IOM’s DV of salt.

(1) Brunner, H. R., Laragh, J.H., Baer, L., et al, “Essential hypertension: renin and aldosterone, heart attack and stroke,” N Engl J Med, 286, 441-449, (1972).
(2) Alderman, M. H., Madhavan, S., Ooi, W. L., et al, “Association of the renin-sodium profile with the risk of myocardial infarction in patients with hypertension,” N Engl J Med, 324, 1098-1104, (1991).
(3) Alderman, M. H., Ooi, W. L., Cohen, H., et al, “Plasma renin activity: a risk factor for myocardial infarction in hypertensive patients,” Am J Hypertens, 10, 1-8, (1997).
(4) Graudal, N. A.., Galløe, A. M., abd P. Garred, “Effects of Sodium Restriction on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterols, and Triglyceride - A Meta-analysis,” JAMA, 279,1383-1391, (1998).
(5) Laragh,J. H., “Dr. Michael H. Alderman Takes the Helm as Editor-in-Chief of the American Journal of Hypertension, Am J Hypertens 19, 1197–1198, (2006).
(6) Shapiro, Y., Boaz, M., Matas, Z., Fux, A., & M. Shargorodsky, “The association between the renin-angiotensin-aldosterone system and arterial stiffness in young healthy subjects,” Clinical Endocrinology (OnlineAccepted Articles). doi:10.1111/j.1365-2265.2008.03176.x.
(7) Dietary Reference Intakes For Water, Potassium, Sodium, Chloride, and Sulfate, Institute of Medicine of The National Academies, The National Academies Press, Washington, D.C. (2005).

“Don’t Just Do Something, Stand There!”

Legislation on food labeling, recommendations on Daily Values and the Dietary Guidelines are all examples of interventions that would have benefitted from my friend’s advice. About the only thing that everyone can agree upon is that they are all largely ineffective and hold scant benefit for the consumer.

In a recent article entitled, “A Call for Higher Standards of Evidence for Dietary Guidelines,” Am J Prev Med 2008: DOI: 1016/j.amepre.2007.11.017., authors Marantz, Bird and Alderman make the case that with their weak standards of evidence and tendency to focus on individual nutrients, the national dietary guidelines might actually do consumers a lot more harm than good.

As an example, they used the guidelines developed against the consumption of dietary fat, promulgated in the late 1970s. The authors noted that people were inadvertently led into believing that if they limited their fat intake, they could then go ahead and pig out on carbs - a phenomenon which may have contributed to the current epidemic of obesity and overweight in the U.S.

The flaw in reasoning was that no one believed that the guidelines could cause any harm, therefore only the weakest evidentiary support was needed to promulgate them. Indirect evidence, expert opinions and scientific “reasoning” were the main drivers of the guidelines. After all, they were only guidelines – what could be so bad?

In fact, once published, they took on an aura of credibility that far exceeded any scientific justification. Once promulgated and given the blessing of the medical establishment and the government, they were looked upon by the public, by the media and by teachers no differently than if they had been irrefutably proven by the most rigorous scientific experimentation. And government guidelines don't simply affect one or two of us - we are all influenced by government guidelines.

The authors write that in 2000, the Dietary Guideline Advisory Committee reversed an earlier 1995 recommendation to lower fat intake, indicating that it may have been premature and ill-advised. The Committee stated that "an increasing prevalence of obesity in the United States has corresponded roughly with an absolute increase in carbohydrate consumption."

Marantz et al also point to the advice given on salt intake as another example of the unintended consequences of a seemingly innocuous recommendation, noting that any blood pressure benefits may be trumped by the stream of harmful effects on plasma renin, insulin resistance, sympathetic nerve activity, and aldosterone levels. They further point to a recent finding of no difference in total mortality between randomized sodium-intake groups.

The authors final conclusion for a dietary guideline recommendation reminded me of my dear old friend;

“When adequate evidence is not available, the best option may be to issue no guideline.”

It seems a bit odd to be referring to lifestyle improvements for children; after all, don’t children do what they’ve always done?

Wrong!

The lifestyles of children have changed dramatically and most of these changes are not positive for their health. Eating a breakfast bar during the morning bus commute to school is OK but it is not the same as sitting down at the kitchen table, having breakfast and then marching off to school. Playing the Wii game for a few hours a day in front of the widescreen is a lot of fun, but it is not the same as running your heart out chasing a soccer ball. Not the same for a child's mind nor a child's body.

Having a pizza delivered, with double everything and cheese product extruded into the crust might be great to order one night, but unless someone insists that everyone take a 5 km run afterwards, the extra calories have only one unflattering place to go. Do that or something similar a few times a week and you are beginning to talk about some pretty serious caloric and nutrient imbalances.

Maybe referring to children’s lifestyle issues is not such a bad idea, after all.

The recent GMA Industry Health and Wellness Report highlights the goal of reducing obesity rates and encouraging healthy lifestyles for children. Not only do children have to be encouraged to pursue a fully balanced diet as shown in MyPyramid, but they should be taught the simple concept of energy balance and encouraged to do far more aerobic physical activity to keep their weight in check and their metabolic processes toned up.

In a recent paper entitled, “Children's diets: looking at the bigger picture”, Charlotte Musgrove, a nutrition scientist at the British Nutrition Foundation in London states that previously, the main focus was to provide enough energy and nutrients to meet the needs of a growing child. However, today there is a stronger emphasis on making sure that children are having a varied and balanced diet, and an active lifestyle. Of particular interest, is the finding that the message to eat at least five portions of fruit and vegetables a day appears to be gaining ground. Although many children are still not consuming the recommended amount of fruit and vegetables, their intakes have increased over recent years. In 2000, children were on average eating only 2 portions of fruit and vegetables a day. One in five children did not report eating any fruit, and three in five children did not report eating any green leafy vegetables over an average week. Between 2001 and 2004, average intakes of fruit and vegetable portions per day increased slightly, with boys consuming 2.5 portions per day, and girls consuming 2.6. Data from 2005 shows the average number of daily portions of fruit and vegetables eaten was 3.1 (for both boys and girls) and there was an increase in the proportion of children eating five or more portions per day (Health Survey for England 2005). Good news, but still a long way to go.

Together with the balance of nutrients from the rest of the diet, with physical fitness programs to ensure their bodies are kept in tune and a social environment where they can flourish with support and mentoring, our children will thrive in good health.

Slowly, slowly, we are moving away from the single, silver bullet solutions to children’s health problems, because although they seem easy and they have made many rich and famous – they don’t work – they never have. Life is just not that simple. It’s the whole diet as part of the whole lifestyle that will direct us to good health for our children.

Everything should be made as simple as possible, but not simpler - Albert Einstein

Anyone promoting the addition or reduction of any single nutrient as the key solution to children’s diseases is little different from the snake-oil salesmen of days gone by.

The problem is, they sold an awful lot of the stuff.

Drs. Leclercq and Ferro-Luzzi of the WHO Collaborating Centre for Nutrition, at the National Institute of Nutrition in Rome, Italy reported in that males consumed 4400mg sodium per day based upon 24 hr Urinary excretion, equivalent to 11grams of salt per day . It was also observed that the discretionary intake of salt for adults varied from 36% (males) to 39% (females) of the total intake. The discretionary intake alone, of salt in Italy amounts to almost 75% of the total sodium recommended in the US (2300 mg). Since many of the Mediterranean foods are naturally well salted (cheeses, olives, salted fish (cod, anchovies), fish eggs, etc., it is natural to expect that a majority of the discretionary salt is used to improve the palatability of the variety of vegetables that are such a conspicuous and essential part of the diet.

When the DASH-Sodium trial is examined, it is immediately apparent that moving to a DASH-type diet has a far greater impact on blood pressure than lowering salt consumption. Dropping from the current level of sodium consumption to the recommended dietary level dropped the systolic pressure by an average of 2.1 mm Hg. However, simply changing from a regular to the DASH diet, without any changes to sodium consumption, reduced the systolic blood pressure by 5.9 mm Hg, almost three times the drop resulting from the sodium reduction. This clearly explains why Mediterranean people enjoy an excellent cardiovascular status despite their high salt consumption. With a DASH diet, the impact of sodium on the blood pressure of hypertensives is minimal (and of no significance to normotensive people – the majority in the population).

Considering that significantly increased fruit and vegetable consumption is a key element to the DASH/Mediterranean diet models, it is entirely realistic to question whether the current recommended daily intake of sodium (2300mg/day) is realistic, given the Italian example above. Amongst the most important foods are the bitter cruciferous vegetables. While they have so much nutrition to offer, without salt, they are not palatable to adults or children (who are even more sensitive to bitterness). In addition to the benefits of the DASH/Mediterranean diet for cardiovascular disease outcomes, all other health parameters are significantly improved. Based on all the scientific evidence we have available, fruits and vegetables are the cheapest, most readily available, and most beneficial foods we can consume to give a significant degree of protection from the modern health challenges we face. Considering the hierarchy of positive health impacts, maintaining the DASH/Mediterranean diet is far more significant than reducing salt – the one safe condiment that has traditionally made this diet so agreeable.

When the audience, which was composed of professional food scientists, nutritionists, dieticians, epidemiologists and policy makers split into working sessions to consider all that was said, they concluded that the benefits of salt reduction to health outcomes had yet to be proven scientifically and that that a singular focus on salt reduction was not a viable solution. Indeed, the delegates unanimously stated that a more holistic approach was needed to improve overall dietary quality.

Almost as it on cue, within two weeks of the Salt Conference, two peer-reviewed medical journal articles appeared, both demolishing Michael Jacobson’s assertion that “the debate on sodium is over.” In a paper published in the October issue of the European Journal of Epidemiology, prominent Dutch scientist D.E. Grobbee and colleagues in the Rotterdam Study concluded that urinary sodium is not significantly associated with myocardial infarction, stroke, or overall mortality, adding: “The absence of a relationship between salt intake and mortality in our study corroborates the findings from the large Scottish Heart Health Study among almost 12,000 middle-aged subjects with 24-h urine samples.”

Shortly thereafter, in the Journal of Interactive Cardiovascular and Thoracic Surgery, Drs. Jay Walker, Alastair MacKenzie and Joel Dunning of the Department of Cardiothoracic Surgery at James Cook University Hospital, in Middlesbrough, UK reported their in-depth review of all available evidence to determine if restricting dietary salt intake would provide protection from adverse cardiovascular events or mortality. They found it impossible to find a link between salt and heart disease due to a “lack of adequately powered randomized trials or observational studies conducted with sufficient rigor.” Dr Dunning went further – he dismissed the theory that salt can cause strokes and heart attacks as,

...an argument of hope over reason....

Today saw a scathing denunciation of the poor science that has gone into the UK’s public health policies. Dr. Phil Peverley, a GP from Sunderland in Northern England is this year's Magazine Journalists and Designers Association Columnist of the Year. Last year, he won the Press and Periodical Association's columnist of the year award. In his article, “A Very Large Pinch of Salt,” Dr. Peverly criticizes

those doctors and politicians who have for years promoted the nannying theory that we should be forced to eat less salt in our diets. The obvious lack of a correlation between elevated blood pressure and salt intake should have been good enough for them.

Ms Primarolo’s only qualification to spout off on this subject is a six-year pre-MP career as a ‘mature student’, so I would always have regarded her pontifications as profoundly suspect…

However, my remit is a wider one. This is further evidence that it is us, the medical profession, who don’t know what we are talking about. I never fell for the bollocks about salt, but I have been as guilty as the rest of spreading disinformation and inaccurate advice about a whole manner of other medical subjects. It is becoming embarrassing.

Predictably, science eventually finds it way to the surface and in this case, the Argumentum ad Verecundiam is showing signs of collapse in the face of mounting evidence against a link between salt intake and cardiovascular disease.

In the most recent issue of the Journal of Interactive Cardiovascular and Thoracic Surgery, Drs. Jay Walker, Alastair MacKenzie and Joel Dunning of the Department of Cardiothoracic Surgery at James Cook University Hospital, in Middlesbrough, UK carried out an in-depth study of all available evidence to determine if restricting dietary salt intake would provide protection from adverse cardiovascular events or mortality. Using reported search parameters, 462 papers were identified of which 14 papers represented the best evidence on the subject. They concluded that restricting sodium intake to levels below 6 g per day as most international guidelines, such as those of the AHA, the US Dietary Guideline Committee and the Scientific Advisory Committee on Nutrition recommend may reduce blood pressure, but found it impossible to find a link between salt and heart disease due to a "lack of adequately powered randomised trials or observational studies conducted with sufficient rigor."

This information corresponds with the recent publication of the Rotterdam Study by Geleijnse et al, as well as the evaluation of the health outcomes from Finland’s three decade long salt reduction program.

The myth-information about salt and cardiovascular health outcomes has gone on for a long time and misdirected our focus from more practical and effective approaches to achieving good health. It’s time we start devoting our resources to solutions that have scientific merit, such as improving the overall diet through systems and products that encourage greater consumption of fruits, vegetables and low-fat dairy products.

Since this was the first medical study to actually look at a broad-based national salt reduction with health outcomes over a 30 year period, I thought it would be worth comparing with other countries.

This comparison appears in our latest edition of the Salt and Health Newsletter. The Global Cardiovascular Infobase, makes possible a clear comparison of patterns of ischaemic heart disease (IHD) in all countries. As it turns out Finland, the only country to significantly reduce salt consumption, experienced the weakest reduction in Ischemic heart disease over the last 30 years. In fact, Canada, a country where no salt reduction took place, started at the same point as Finland, but ended up with double the heart disease reduction. That certainly doesn't say much about the positive impact of salt reduction, quite the contrary.

To check out the situation with life expectancy, I accessed the International Data Base of the US Census Bureau . Here again Finland, the only country to severely cut its salt intake, ended up with a rather small increase in logevity compared to the other countries.

Based on this Finnish study, we can say with confidence that despite an almost 50% reduction in the consumption of salt in Finland, there are no health benefits attributable to this intervention.

Since this was the first medical study to actually look at a broad-based national salt reduction with health outcomes over a 30 year period, I thought it would be worth comparing with other countries.

This comparison appears in our latest edition of the Salt and Health Newsletter. The Global Cardiovascular Infobase, makes possible a clear comparison of patterns of ischaemic heart disease (IHD) in all countries. As it turns out Finland, the only country to significantly reduce salt consumption, experienced the weakest reduction in Ischemic heart disease over the last 30 years. In fact, Canada, a country where no salt reduction took place, started at the same point as Finland, but ended up with double the heart disease reduction. That certainly doesn't say much about the positive impact of salt reduction, quite the contrary.

To check out the situation with life expectancy, I accessed the International Data Base of the US Census Bureau . Here again Finland, the only country to severely cut its salt intake, ended up with a rather small increase in logevity compared to the other countries.

Based on this Finnish study, we can say with confidence that despite an almost 50% reduction in the consumption of salt in Finland, there are no health benefits attributable to this intervention.