SaltSensibility

"Reactionary." That's the word that best captures the loud defense of the status quo in science. And, as the old saw goes about courtroom strategy for lawyers: If you have the law, argue the law; if you have the facts, argue the facts; if you have neither the law nor the facts argue at the top of your lungs. Perhaps the humor offers an insight into why institutional defenders of the status quo in medical science have turned up the volume in condemning high quality new science that challenges the conclusions of their earlier, often lower quality conclusions.

One of the best new blogs I've read in months examines this phenomenon in two posts this weekend. Junkfoodscience.com, in "Say it isn't so - Part 1" looks at the Women's Antioxidant Cardiovascular Study (WACS), noting:

It is predictable. A flurry of press releases and articles appear everytime a major study is released that debunks “pop science” — what everyone “knows” to be true — and threatens the research or agendas of special interests. These stories attempt to confuse us, spin the science, or restate the beliefs more emphatically. Many times, they even claim to have new research supporting their position, when they don’t!

Registered Nurse Sandy Szwarc, RN, BSN, CCP, pointed out that WACS

followed nearly 16 other major clinical trials released earlier — including the Heart Outcomes Prevention Evaluation (HOPE), Atherosclerosis Folic Acid Supplementation Trial (ASFAST), and the Norwegian Vitamin Trial (NORVIT) — all firmly demonstrating no benefit of folic acid or vitamin supplementation in heart disease, and that lowering homocysteine levels does not translate to real-life reductions in heart disease. And more importantly, has no effect on the most important end point of all: death.

As a Medscape review noted, the clinically measureable evidence is overwhelmingly consistent.

Immediately, the institutional status quo leaped into action, papering the media with the contrary story, to wit (from Reuters):

Folic acid can cut heart attack risk: experts

Can taking folic acid supplements reduce the risk of heart disease and stroke? British researchers believe it can. After analyzing evidence from earlier studies, a team of scientists in Britain said on Friday there is enough research that shows folic acid lowers levels of the amino acid homocysteine and reduces the odds of cardiovacular [sic] disease.

Now, I"m not going to wander from the confines of salt and health to comment on the benefits of folic acid supplementation; there are plenty of experts to thrash that out. What seems worth mentioning, however, is the tactic of the defenders to deflect serious consideration of the WACS and the other 16 studies. And you can read in more detail on Junkfoodscience.com. Szwarc describes how David Wald, a colleague of Malcolm Law, well known for his low-quality "meta-analyses" of the blood pressure effects of salt restriction, for context, launched a high-volume attack on the mounting number of clinical trials using older, lower-order observational studies he had done reaching the contrary conclusion (his news release implied the studies were new and of superior quality).

In today's "Part two," Szwarc turns her attention to the same phenomenon in the current debate over obesity. Anyone who challenges the orthodoxy that obesity is the root cause for virtually all nutrition related medical conditions has a hard time having their voice heard. Again, it's not a primary issue for our focus, but the process of defending the status quo is frighteningly consistent. As she explains:

Nothing compares to the all-out, massive, well-organized efforts to preserve the “obesity crisis” that began last year after senior research scientists inside the CDC’s National Center for Health Statistics exposed the war on obesity — begun by their own director of the CDC, Julie Gerberding, and Secretary of Health and Human Services, Tommy Thompson — as a grossly exaggerated and fabricated scare campaign.

She continues:

the study, looking for correlations between weight and premature death that had been created to lay the foundation for billions of dollars in government and industry “obesity” initiatives, and popular with an enormous throng of marketing and political interests all using the “obesity crisis,” had been derived from poor data and had flagrant methodological flaws. How bad was it? It didn’t even account for aging, the single biggest risk factor for death, in its computer model!

But, back to the story of tactics used to defend the status quo. Szwarc explains:

Within hours of the release of this potentially devastating study in the Journal of the American Medical Association, special interests — notably, doctors from Harvard School of Public Health, along with the American Cancer Society, American Heart Association and the CDC — quickly rallied press conferences and media releases to deny and spin the findings and attempt to discredit them in the minds of the credulous public. They made noises about it failing to consider smoking, of reversing causality and attributing higher deaths among thin due to the fact they are sick or old, and of not considering the long-term effects of obesity. These spin doctors assumed, correctly, that the media would simply repeat their assertions and not a single reporter would go to the actual study to realize they were nonsense.

Flegal and her associates had analyzed the data in a myriad of ways and had accounted for smoking, chronic diseases and preexisting health problems, involuntary weight loss, and long-term obesity ... and each time the results were the same.

Reporters who’d read the journals where this controversy had been raging could have learned that the “obesity is deadly” studies done by researchers from Harvard, the American Cancer Society and CDC that were being so vehemently defended, had looked at self-reported data from select groups of people that weren’t representative of the population and had excluded nearly 90 percent of the deaths in their analyses to get the results they wanted. Among other such studies, you’ll find all sorts of other shenanigans.

Let's not blame the media entirely. As much as we should hope reporters would ask the tough questions and look critically at the evidence itself and not just accept what one side of an issue says it means, the real -- and largely hidden -- story here is the enormous lengths that defenders of the status quo have gone to dredge up lower quality studies or those focused on only one portion of a broad problem to emphasize their argument. And the volume! Turn down the hyperbole. Let's discuss science and get that right; then we can turn our attention to getting the policy right to build on that science.

The same process has been playing out in the salt and health issue. Investigative journalist Gary Taubes won the top award from the National Association of Science Writers for his article "The (Political) Science of Salt" appearing in the prestigious magazine Science.

We all need to pay attention to these tactics. Thanks, Ms. Szwarc.

Posted by Dick Hanneman at 12:19 PM | Permalink

Almost on cue and in response to the Business Week story this week, the November 17 issue of Science magazine reports that the underlying premise of the "wild fix" to "salt the seas" was a "False Alarm: Atlantic Conveyor Belt Hasn't Slowed Down After All." It turns out that the cooling of the Gulf Stream -- and consequent deposition of its salt-dense contents further to the southwest rather than between Norway and Greenland -- was just another blip on nature's uneven and imperfectly understood cycle. The concern had been that with the warmer Gulf Stream failing to go as far north, that Europe would suffer a disastrous Ice Age (all caused by global warming).

Many scientists had doubted the theory and it certainly throws cold brine on hopes raised by Business Week that a new market for salt would be to dump shiploads of salt into the North Atlantic. Oh, well...

Posted by Dick Hanneman at 12:16 PM | Permalink

Ray Keating, chief economist for the Small Business and Entrepreneurship Council just posted a Thanksgiving-themed opinion column of this title.

Personally, I tend to think of pumpkin pies for Thankgiving. Perhaps that's why the piece caught my eye. It's worth a read. Keating makes the point that there are "seemingly countless individuals and businesses that must coordinate their efforts to make sure pie lovers are happy on Thanksgiving." He simply reviews the recipe for a cherry pie and the production processes that produce the "shortening, flour, salt, sugar, margarine or butter and, of course, cherries." (full disclosure: Keating cites the Salt Institute for his information on salt).

Keating references Adam Smith's "invisible hand" to explain how myriad self-interests combine to produce a public good. I was reminded, even more, of R.W. Grant's classic, The Incredible Bread Machine, which has just been re-published (see the online reviews at Amazon.com).

Enjoy your pie, whatever ingredients you use (mine will be pumpkin!) -- you'll surely be using salt. And be thankful for the competive marketplace that has produced such abundance at historic bargain-basement prices -- whether of pies, of salt or of any of a million items in daily commerce.

Posted by Dick Hanneman at 03:49 PM | Permalink

Now here's a virtually limitless NEW market for salt: Adam Aston in this week's Business Week identifies five "wild fixes for a warming planet." Number 5 is

SALTING THE SEAS

Scientists worry that freshwater from melting Arctic ice and Greenland's glaciers will dilute and disrupt the Gulf Stream as it loops through the North Atlantic. In the past, when this conveyor belt of warm water has stalled, Northern Europe was sent into a mini-Ice Age. To keep the current flowing, Robinson suggests that tanker loads of mineral salt could be dumped into the sea at key points along the Gulf Stream. Since saltier, denser water sinks, staggered deliveries of salt could jolt the cycle and keep the current going. Risks: Altering ocean chemistry on this scale could have catastrophic effects on sea life. Will we have a choice, though? "I'm as dubious about geo-engineering as anyone else," says Robinson. "But the fact is, with climate change we're already doing it."

We've got the salt and the ships. Who'd have thought we could make money by taking salt OUT of the ocean and then putting it back in? It's like WPA, digging holes and filling them back up -- for a good cause!

Posted by Dick Hanneman at 11:55 PM | Permalink

Most American historians with any sensitivity to the strategic significance of salt will recognize that Saltville, VA, in the far southwestern corner of the Old Dominion, was the scene for two major battles as the Confederacy fought to protect its sole source of this crucial mineral and the Union tried to tighten its economic blockade.

Retired Virginia Tech chemistry professor Jim Glanville has done more than any person to restore the luster of Saltville's rich heritage, including a steady publicity effort. His latest media foray appeared in today's Richmond Times-Dispatch, entitled "A similar tale predates Pocahontas" in which Glanville tells the story of an early Indian "chieftainess" who married a European (acually, one of two recorded).

As Virginia prepares to celebrate the 400th anniversary of the arrival of the Jamestown settlers in 1607, Glanville recounts the documented vist -- a full 40 years earlier -- of 15 Spanish conquistidores who sacked the fortified Indian village erected at Saltville to obtain salt from the saline springs there. The Spanish boasted of burning 50 huts and killling 1,000 defenders, though Glanville considers this hyperbole. In any case, the "first battle of Saltville" was 290 years before the Civil War clash.

Posted by Dick Hanneman at 10:12 AM | Permalink

A news analysis, with this title, by Denise Grady published in yesterday's New York Times should be required reading by the nation's public health nutrition community. Grady points to public health campaigns that "have drilled that message into the national psyche." Her example: angioplasties and coronary stents. She could have been talking about salt. She continues:

Ideally, treatments, operations and diagnostic procedures should be thoroughly tested before they come into routine use. Bu that is not always the case. ...

Some treatments -- like opening a closed artery -- appeal so strongly to common sense that it becomes irrestible to go ahead and use them without waiting for scientific proof that they are effective. ...

As the treatments start to catch on, people assume they must work, and it becomes difficult or impossible to study them in the most definitive way -- by comparing treated patients with an untreated control group. If most people think a therapy works, who wants to be the control? Doctors may balk at controlled studies, too, calling it unethical to withhold the treatment from patients in the control group.

Grady recognizes that her example is just that, a single instance of a widespread phenomenon of pseudo medical advice lacking "gold standard" testing through randomized trials to prove improved health outcomes -- just as is the case now with encouragement to reduce dietary salt.

And today's news that FDA has (once again) approved silicone breast implants suggests that FDA understands the need to revisit arguments based on Chicken Little pseudo-science. Responding before controlled studies confirm the problem can compound the ultimate solution by creating controversy as medical experts learn the earlier "fix" is wrong, but the public has already been indoctrinated on the basis of the premature "solution."

Grady reminds us:

Medical history is strewn with well-intended treatments that rose and then fell when someone finally had the backbone to test them, and the scientific method trumped what doctors thought they knew.

Hormone treatment after menopause, which works for symptoms like hot flashes, was widely believed to prevent heart disease and urinary incontinence. But carefully done studies in recent years have shown that hormones can actually make those conditions worse.

Stomach ulcers were once attributed to emotional stress and too much stomach acid, and were treated with surgery, acid-blocking drugs and patronizing advice to calm down. Then, in the 1980s, two doctors who were initially ridiculed for proposing an outlandish theory proved that most ulcers are caused by bacteria and can be cured with antibiotics.

For decades, women with early-stage breast cancer were told that mastectomies offered them the best chance of survival. But in 1985, a large nationwide study showed that for many, a lumpectomy combined with radiation worked just as well.

“As a nation, we’re not doing ourselves any favors by going after the next new thing without doing the studies,” said Dr. James N. Weinstein, chairman of orthopedic surgery at Dartmouth and a researcher at its Center for the Evaluative Clinical Sciences, which studies how well various medical and surgical procedures work.

When established treatments turn out to be useless, or worse, harmful, Dr. Weinstein said, “everybody’s going to lose trust in the system.”

With regard to salt, the FDA and NHLBI may have succeeded in brainwashing the public, but, ultimately, science will prevail. Government pronouncements don't change physiology. The essence of the scientific method is that current "knowledge" is bombarded with new facts and new analytical methods as they are developed and, guess what, the old orthodoxies are often overturned or modified.

What we need to sort out the controversy among medical experts regarding dietary sodium is a controlled trial of the health outcomes of various levels of dietary sodium. We need to know if lowering the average population sodium intake will save lives or put our population at higher risk of heart attacks and cardiovascular mortality as the latest studies have found.

Posted by Dick Hanneman at 06:14 PM | Permalink

Looking for a Christmas gift that's perfect for a young person who you'd like to know about salt? Consider The Story of Salt by Mark Kurlansky with wonderful illustrations by S.D. Schindler. It's a digestable version of Kurlansky's Salt: A World History. (No, we get no royalties; this is an unsolicited testimonial). Says the School Library Journal:

"Kurlansky uses salt as the lens through which to present a new perspective on history. [T]he author mixes science, history, and personal anecdotes, resulting in a fascinating look at this amazing substance. Schindler’s humorously detailed pen-and-ink drawings with colorful washes enliven the narrative and help to convey the wealth of information in the text. A lively and well-researched title, with exemplary art."

Posted by Dick Hanneman at 05:21 PM | Permalink

In the salt business, there is seldom any question as to what a Dome is. High pressure on embedded salt deposits in the earth's crust causes the salt to flow up plastiically, often with a bulging top. The characteristic, rounded water-tower-shape formation, resulted in the name salt domes, particularly in the Golf Coast area. So it was with a bit of surprise that I read of the massive salt dome in UK's Ribble Valley, rural Lancashire's country escape. Of course, Lancashire is Northwest England's home of Liverpool and Manchester, so having access to a country retreat is a great benefit to all those working in that heavy industrial environment - but the headline read, Massive salt dome to keep roads safe. Was this a new source of deicing salt?

No, not, nyet!

The article described a marvelous new structure designed to house the salt required to keep the winter roads of Ribble Valley and the surrounding area open throughout the winter season. County councillor Tony Martin, cabinet member for sustainable development correctly characterized the benefits of winter salting by stating,

Nobody realises until it's not done one day.

The word Dome originally meant house in is the English language. It came from the Latin domus, which itself was traced back to the Greek domos and Sanskrit dama. In Italian, the word duomo came to mean house of God, and since all Italian cathedrals had cupolas, the word dome attached itself to that bit on top.

Posted by Mort Satin at 09:38 AM | Permalink

Tunnel vision is described as the loss of peripheral vision resulting in a constricted circular tunnel-like field of vision. This week has seen a rash of newspaper articles on salt and hypertension in children that precisely reflects that idea. Stemming from the work of MacGregor and He of St. George's University of London and published in the November issue of Hypertension, a number of journalists have parroted the view that reducing salt intake is the single most important path to the future health of all people. Their research, found that a significant reduction of salt intake in children will bring down their systolic and diastolic blood pressures by as much as 1 millimeter of mercury each.

Dr. MacGregor has long espoused salt reduction as the silver bullet for hypertension and has published a number of books: The salt-free diet book; The Low-salt Diet Book; and Salt, Diet and Health: Neptune's Poisoned Chalice, on this issue. Like other researchers focused on reduction of salt consumption as the one answer to hypertension, he believes that research results contrary to his own are tainted by industry or the international salt conspiracy. Since the drop in blood pressure in this study was found to be small, the authors rationalized it by speculating that if it was extended into adulthood, it would have major public health implications in preventing cardiovascular disease in the future. Speculation comes easy to those with committed views, however, as Samuel Johnson once said, “When speculation has done its worst, two and two still make four.”

No one doubts the lifelong health benefits of eating more fruits and vegetables as recommended in the government’s 5 a Day program or following the principles of the DASH diet for those concerned with hypertension. Rather than extolling the virtues of consuming more fruits and vegetables as the most effective and enduring path to improved health and reduced hypertension for people of all ages – MacGregor and company cannot get away from their singular focus on salt – a constricted, tunnel-like point of view. Could it be because a small amount of salt makes bitter vegetables so much more palatable for everyone, particularly youngsters and would result in far greater benefits (see, And Now For Something Completely Different...)? That might contradict everything they stand for.

And herein lies the problem. Scientists who are committed to a single idea can be very damaging. Francis Bacon, the father of modern science insisted that knowledge had to derive from dispassionate scientific experimentation, rather than the musings and speculations of philosophers. Zealots committed to a single idea are, almost by definition, incapable of objective science – neither in the design of proper experiments nor in the interpretation of results. The danger is that they parade around under the mantle of science and will never recognize their own bias. We see this everywhere – advocacy groups proclaiming to pursue science in the public’s interests, yet subjectively pick and choose selective bits and pieces of data to serve the objects of their advocacy. Believing in science means practicing science and that means being objective. It leaves no room for individuals committed to a single idea and any information or advice that they develop must be treated with the intellectual reserve and caution it deserves - particularly when it come to the health of our children. Journalists should understand this before they serve as a vehicle for the dissemination of myth-information.

Posted by Mort Satin at 02:01 PM | Permalink

Never we're John Donne's words more appropriate than in today's global village. Operating in an international environment can only benefit from broad-based relationships and a knowledge of what is going on around the world. Louis Pasteur, whose public health achievements I've described in two textbooks once said, "Chance favors the prepared mind." In keeping with that precept, the Salt Institute has maintained a close relationship with The Salt Science Research Foundation (SSRF) in Japan, exchanging technical information and new developments, whenever possible. On October 16, Mr. Hitoshi Kusume, President of the Salt Science Research Foundation, and Mr. Kiyoshi Kawabata, Associate General Manager, visited the Salt Institute and had an excellent meeting with Dick Hanneman who assisted them with visits to other venues in North America.

While on a private visit to Japan, I took the opportunity to return the visit and dropped by the SSRF offices in Tokyo where I was kindly received by Mr. Kawabata and the Managing Director, Dr. Tsutomu Ikeda.

The SSRF has significant funding from the Japanese government and is able to sponsor a significant amout of truly cutting edge research in a variety of salt-related areas. Among the projects we had an opportunity to discuss were genetic analysis being carried out on a range of hypertension and salt-sensitivity areas, as well as salt tolerance/acclimatization and taste response research using the latest DNA microarray analysis methods. Whenever possible, we will continue to share and exchange knowlege with colleagues in the salt sector on both sides of the Atalantic and Pacific to everyone's mutual benefit.

Posted by Mort Satin at 10:10 AM | Permalink

The accession of Congressional Democrats, Daniel Ortega's Sandinistas and Margaret Chan are big news this week.

Speaker Pelosi, and likely-Majority Leader Reid promise to push the U.S. government in an undefined "new direction" and the patience of incoming Democratic committee chairs will test civility in Washington. Only a dramatic gesture from President Bush such as replacing Sec. of Defense Don Rumsfeld (with former US Sen. Sam Nunn) and/or accepting V-P Dick Cheney's resignation (to be replaced by Colin Powell) can preserve the President's ability to set the agenda effectively for the last two years of his term. As the phone company Verizon advertises: "Can you hear me now?" The election underscores the importance of listening in our democratic government.

In Nicaragua, it's probably "head for the exits" time as Daniel Ortega returns as president with a plurality in a multi-candidate field. When the Sandinistas ran the country from 1979-1990, according to the International Monetary Fund, per capita income in the country fell by two-thirds.

Dr. Margaret Chan won nomination as the new Director General of the World Health Organization, the first woman and first Chinese national to hold the post. She had been in charge of public health in Hong Kong. Passed over, appropriately, was Finland's Pekka Pushka, who spearheaded WHO's unfortunate foray into publlic health nutrition with its Global Strategy embodied in Report 916.

Posted by Dick Hanneman at 10:18 AM | Permalink

I love this story in Burt Prelutsky's Townhall column today of the above title. We can all agree that our public health authorities, as well as our personal doctors, should avoid harming us with their interventions "on our behalf." But that really is setting the bar too low, isn't it?

I'm reminded of the furor a decade ago when the first studies began appearing examining whether reduced-salt diets actually delivered the improved health outcomes long forecast based on blood pressure models. They didn't. The first study, in fact, in 1995, found in a New York City medical practice, that diagnosed hypertensive patients who consumed low-salt diets actually had a 430% greater incidence of a heart attack than those on regular levels of salt intake. Of course the study had flaws, but it was what it was; and what it was was a wake-up call for The Establishment to re-examine its advocacy of reducing dietary sodium/salt. The National Heart, Lung and Blood Institute leaped into action, commissioning both internal and external research on the subject and produced consistent results: their research, they proclaimed, demonstrated that there was no elevated risk of reducing dietary sodium. Unstated, their research also clearly showed that there was no benefit of the reduced-salt diets. No matter. Their advocacy persisted, despite subsequent studies showing risk in the U.S. and Scottish populations. Still, today, one hears low-salt advocates claiming that while not everyone could conceivably benefit by reducing dietary salt, "at least no one could be harmed." We are unpersuaded and have called for a controlled trial of the health outcomes of low-salt diets, but, in the meantime, shouldn't we be a bit more concerned about the lack of efficacy? As Prelutsky says:

The first principle of the Hippocratic Oath, which all physicians are sworn to abide by, is: Do no harm. I don’t want to be regarded as a nitpicker, but, as standards go, I’d say that’s a pretty measly one.

Do no harm?! For crying out loud, Boy Scouts at least have to be prepared. Soldiers are expected to be all they can be, and while I think we’d all agree that’s pretty vague as to specifics, the basic tone suggests that courage and self-sacrifice could well be part of the job description.

And although I don’t know it for a fact, logic would dictate that being a member of the 4-H Club would at the very least require feeding the chickens, slopping the pigs, and washing one’s hands before sitting down at the breakfast table.

I mean, what if something that inconsequential was the first principle of other occupations? What if accountants had to be admonished not to round off numbers to the nearest zero, and bus drivers were told to really knuckle down and not run into any lampposts? How would you like it if chefs graduating from culinary academies were handed their diplomas, their puffy white caps, and a friendly piece of advice from the dean along the lines of “Remember, arsenic is not a condiment”?

How about barbers? Would it put your mind to rest if you discovered that the first principle in their handbook was a reminder that they’re not matadors, and it’s not recommended that they take home a bagful of ears at the end of the day?

This is not to say that we should all stand around and ridicule physicians simply because the Mafia apparently has slightly higher expectations of its members than the AMA has. While we can all agree that the doctors’ motto leaves something to be desired, things could be a lot worse. Take criminal defense attorneys. Please, as Henny Youngman used to say.

Posted by Dick Hanneman at 06:00 PM | Permalink

The Public Health Advocacy Institute (PHAI) held its annual meeting last weekend in Boston and, according to the Chicago Tribune,, agreed to "increase threats of litigation (against) food companies to improve the fare they offer. The group did not name the companies targeted with "tobacco-style litigation" seeking "huge fines" against (the) corporations."

Less adulatory is the description of the group by the consumer watchdog group ActivistCash.com. Says the group's website, PHAI

is a lawsuit lounge where food cops and trial lawyers swap strategies to litigate away consumers' food choices. Located in Boston with a board composed of faculty members from the Northeastern University School of Law and Tufts University School of Medicine, PHAI's goal is to attack food makers through lawsuits. Along the way, it is creating the next huge payday for trial lawyers, who are trying to demonize popular foods by using their template for attacking tobacco.

Self-interested or not, the threat is the latest in a barrage of charges that the food industry is trying to undermine the health of its customers. A nummber of reporters are in obvious sympathy. We'll see how the general public responds.

Posted by Dick Hanneman at 03:49 PM | Permalink

Is the "silly season" of US elections spilling over into anti-salt advocacy? Latest news release: longstanding anti-salt zealots in Finland assert that salt is responsible for the burst in global obesity.

In an article in Progress in Cardiovascular Diseases , Drs. Heikki Karppanen and Eero Mervaala assert that their study "refutes the frequently repeated claims that a comprehensive salt reduction would not produce any overall health benefits, or would even increase diseases and shorten the life span."

The Salt Institute has made the argument frequently (and, apparently, someone is listening!) that observational studies of health outcomes fail to identify population health benefits at levels common in the North American diet -- and advocating a controlled trial of reduced salt diets to determine whether they decrease heart attacks and cardiovascular mortality.

We still think that's the right question, but this claim that low-salt diets "would be a powerful means against obesity" is just over the top. Of course, if we made foods so unpalatable as to stop people from eating as much (as has been done with less-than-happy results in geriatric institutions) we might be able to link salt and body mass, but to assert that

The increased intake of salt, through induction of thirst with increased intake of high-energy beverages has obviously remarkably contributed to the increase of obesity in the United States.

with no evidence adduced to support the allegation is irresponsible.

The authors specifically cited Salt Institute statistics of U.S. salt sales saying that salt intake had increased "more than 50%" over a recent 15 year period. In response, I wrote Dr. Karppanen:

Your concern with increased salt intakes is obviously misplaced. While salt intakes in the U.S. have increased in the past 15 years, they track population increases. The U.S. population is 300 million today. We've added 50 million in population in those years. I know population growth is something a bit foreign to your part of the world, but we've experienced a lot of immigration and natural population growth. Even so, our latest figures show food salt sales growth up 41%, not "over 50%" and while greater than the population growth, this does not account for US food salt which is exported in US processed foods, salt used in food processing and wastage. The better metric, as I'm sure you agree, is 24-hour urines and those in study after study show that baseline salt intakes per capita are unchanging generation after generation.

Of course, correlation is not causation, but to correlate salt intake with the rise in obesity ignores evidence that those on higher salt diets are actually leaner than other Americans. Just as obviously, the longest-lived national population in the world, the Japanese, have much higher salt intakes than Americans. Your "obvious" correlation of salt intake and thirst and obesity makes interesting headlines, but sorry science.

The Finns claim salt reduction is responsible for increasing the life span of their compatriots by 7-8 years over the past one-third century. Let's keep in mind, Romans lived to an average age of 28. The Yanomamo people of the Brazilian jungles who are touted as low-salt-consuming models for our diet live only into their 30s. A century ago, Americans lived only 48 years on average while a century later we live 77 years on average. If Finland's medical and nutrition improvements parallel Americans, 7-8 years additional longevity over the past 30 years is just average, nothing to crow about -- nor to try to assign causation when none can be adduced from ecologic data.

Unfortunately, while preposterous charges amongst American politicians will likely abate after November 7th, there is no apparent reprieve from the anti-salt crowd.

Posted by Dick Hanneman at 01:01 PM | Permalink