Although the authors attempt to make it clear that the negative consequences of iodine fortification of foods would only occur at high levels of fortification and would never be the result of using iodized salt, they do not unequivocally state that, for all intents and purposes, whole formulated food products would never be iodized at levels that would impact the color, flavor or functionality of those foods.

If whole, formulated foods will never be iodized to those levels which can impact on the quality of the food, then the whole issue becomes moot and should not be confused with the use of iodized salt in food products.

Iodized salt can be used in formulating all food products without any fear of reducing quality.

Perhaps it would have been useful for the authors to have made that simple statement of fact.

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.
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*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.

In order to quell the bad publicity regarding the quality of his country’s coastal waters, then President Fujimori wished to demonstrate to his citizens that the press reports were exaggerated. He boldly posed for public television cameras eating some locally-prepared ceviche. Within 12 hours, he came down with cholera confirming that pathogens are a biological, rather than a political phenomenon. That cholera outbreak eventually killed 3,500 people.

Fortunately, doctors quickly turned to effective and inexpensive oral rehydration therapy with clean water and salt. If not, the death toll would have been much greater.

Cholera is characterized by prolonged episodes of diarrhea and it is critical to ensure that lost fluids and salts are fully replaced. Common table salt (sodium chloride) is the key electrolyte that has to be replenished along with water.

Now some officials worry that climate change could bring the scourge back to Peru and are making doubly certain to make the population aware of the need to keep themselves fully hydrated and electrolyte-balanced, proving once again that salt is an essential element of life and good health.

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.