Guessing and Advising

In 1972, when the National Institutes of Health introduced the National High Blood Pressure Education Program to help prevent hypertension, no meaningful experiments had yet been done. The best evidence on the connection between salt and hypertension came from two pieces of research. One was the observation that populations that ate little salt had virtually no hypertension. But those populations didn’t eat a lot of things — sugar, for instance — and any one of those could have been the causal factor. The second was a strain of “salt-sensitive” rats that reliably developed hypertension on a high-salt diet. The catch was that “high salt” to these rats was 60 times more than what the average American consumes.

Still, the program was founded to help prevent hypertension, and prevention programs require preventive measures to recommend. Eating less salt seemed to be the only available option at the time, short of losing weight. Although researchers quietly acknowledged that the data were “inconclusive and contradictory” or “inconsistent and contradictory” — two quotes from the cardiologist Jeremiah Stamler, a leading proponent of the eat-less-salt campaign, in 1967 and 1981 — publicly, the link between salt and blood pressure was upgraded from hypothesis to fact.

In the years since, the N.I.H. has spent enormous sums of money on studies to test the hypothesis, and those studies have singularly failed to make the evidence any more conclusive. Instead, the organizations advocating salt restriction today — the U.S.D.A., the Institute of Medicine, the C.D.C. and the N.I.H. — all essentially rely on the results from a 30-day trial of salt, the 2001 DASH-Sodium study. It suggested that eating significantly less salt would modestly lower blood pressure; it said nothing about whether this would reduce hypertension, prevent heart disease or lengthen life.

http://www.nytimes.com/2012/06/03/opinion/sunday/we-only-think-we-know-the-truth-about-salt.html?_r=1&pagewanted=all

So who pays for the damage if the government says "eating less salt with help you live longer", but in fact, eating less salt raises the liklihood that you perish early? 

You do. 

Which is why the government should constrain itself from offering dietary advice until the science is rock solid, confirmed by interventions studies, and well publicized and critiqued. 

Kresser: Salt 2

The results of the Intersalt Study did not indicate any clear pattern between the level of salt intake and blood pressure in those countries studied. (23) And when average life expectancy is plotted against the countries’ average salt intake, the trend shows that higher salt consumption is actually correlated with longer life expectancy. While this correlation does not imply causation, it is interesting to note the compatibility of a high salt diet with a long life expectancy.

http://chriskresser.com/shaking-up-the-salt-myth-the-human-need-for-salt

You eat whole foods, and add some salt here and there, you will be hard pressed to eat "too much" salt, and if you do, your healthy kidneys will easily flush the extra.  Best way to get into trouble with your kidneys is by becoming diabetic.  The cascade of nasty that accompanies uncontrolled blood sugars is causing renal failure on a large scale - that's why you see so many dialysis centers all over the place.

Best way to heal a kidney damaged by diabetes or metabolic syndrome?  Carb restriction.  Even the ADA recommends that for weight loss for up to a year (after that, I suppose you are supposed to go back to the high carb diet that almost killed you the first time).

Kresser: Salt Is Good/Bad?

Most of what we read and hear about salt these days is telling us that salt consumption needs to be reduced, and it has even been referred to as “the single most harmful substance in the food supply”. (4)

However, until recently, salt had maintained an extremely high level of value for thousands of years of human history. As Mark Kurlansky explains in his book, A World History of Salt, “salt is so common, so easy to obtain, and so inexpensive that we have forgotten that from the beginning of civilization until about 100 years ago, salt was one of the most sought-after commodities in human history.” (5) So how did we develop this insatiable taste for salt, and why is it that we now fear salt as being dangerous for health? And furthermore, what role does salt truly play in our health and wellbeing?

http://chriskresser.com/shaking-up-the-salt-myth-history-of-salt

This is part one of three by Chris Kresser, read on and learn.

If there's any better indictment of the current state of science and health than the government's recommendations on fat and grains, it's the absurd recommendations on salt.  "The best health care system in the world" - which it is, measured by how well it fixes broken people and keeps sick people alive - and the basic science of human metabolism and wellness is still wandering in the darkness of NIH and Department of Agriculture led weird science. 

The strangest part of all?  Everyone knew better.  As far back as the late 70s, my father (a pediatrician) told me that triglycerides were a more important measure of heart health than was cholesterol, and that salt restriction was only useful if you already had high blood pressure.  These things were not secret.  How could a system "unlearn" so much in such a short period of time? 

Low-Salt Diets May Raise Risk of Heart Disease

Cutting back on salt may not be as beneficial for your heart as once thought, a new study suggests.
While a diet low in salt reduces blood pressure, it increases the levels of cholesterol, fat and hormones in the blood that are known to increase the risk of heart disease, the study found.
Overall, the good and bad consequences of a low-salt diet may cancel each other out, so the diet has relatively little effect on the development of disease, said study researcher Dr. Niels Graudal, of Copenhagen University Hospital in Denmark.
http://www.livescience.com/16959-salt-diet-heart-health.html?utm_content=LiveScience&utm_source=@LiveScience&utm_medium=twitter

So if lower blood pressure equates to lower risk of CVD, and lower salt levels decrease blood pressure, then how could it be that low salt diets don't lower risk of CVD?

In short, high blood pressure is a symptom of a high carbohydrate diet.  It results when the body retains sodium due to excessive insulin levels.  So, the key factor isn't how much salt you eat, it's how much your body retains.  Even though treating the symptoms of the illness - metabolic syndrome - somewhat results in decreasing risk of CVD, lowering salt or medically lowering blood pressure is still only treating a symptom.  In this way, low salt diets and BP meds are just like statins and just like gout medications.

Eat meat, vegetables, nuts and seeds, little fruit or starch, and no sugar/wheat.

Low Salt Is Low Science and Low Smart

Or as Fat Head The Movie creator Tom Naughton put it, So if your blood pressure is 130/90, cutting back on salt might reduce that to 128/89 or so. Whoopie.
http://www.fathead-movie.com/index.php/2011/11/10/odds-ends-2/

I know I've posted several references to the low salt hocus pocus, and one can start to believe, once they've waded through same, that everyone else is on to the idea also, but incredibly, virtually no one is.

A bit more from Tom's post:
Since so many experts are pushing low-salt diets in spite their negligible effect on blood pressure, I’ll bet those other effects are fabulous.
People on lower-sodium diets had an average 2.5% increase in cholesterol and a 7% increase in bad blood fats called triglycerides compared to people who were eating more than 3,450 milligrams of sodium — an amount that’s close to what the CDC says the average American eats every day.

Dude, pass the salt!  And by the way - make some of that salt iodized salt because our non-paleo diets don't include enough fish eyes to keep us up to snuff on that iodine stuff.

Salt - Good?

http://www.medpagetoday.com/Cardiology/Prevention/27426

The cardiovascular benefits of salt restriction remain unproven on the basis of currently available evidence, authors of a systematic review concluded.
The accumulation of clinical-trial data on 6,500 participants failed to produce a statistically significant outcome for hypertensive or normotensive individuals with respect to overall mortality or cardiovascular morbidity.
Moreover, salt restriction was associated with an increased mortality risk in patients with congestive heart failure (CHF), according to a report in the Cochrane Database of Systematic Reviews.
"There is still insufficient power to exclude clinically important effects of reduced dietary salt on mortality or cardiovascular morbidity in normotensive or hypertensive populations," Rod S. Taylor, PhD, of Peninsula College of Medicine and Dentistry in Exeter, England, and co-authors wrote in conclusion.
"Further randomized clinical trial evidence is needed to confirm whether restriction of sodium is harmful for people with heart failure. Our estimates of benefits from dietary salt restriction are consistent with the predicted small effects on clinical events attributable to the small blood pressure reduction achieved."

The War On Salt was mis-guided and thankfully, you can take comfort that you can eat salt without fear of injury - if you like it.

BTW - have some iodized salt at least weekly, for most of our modern diets, devoid of fish eyeballs, we don't get enough iodine to support healthy thyroid function.

Finding the Real Killer

Salt War
What if you are a "public health authority" and you are passionate about helping people live longer and better.  You get used to the idea that your job means wielding a clumsy club - for example, you know some percentage of people will die every year from adverse reactions to vaccination, but you believe many more will be saved.  Therefore, you can live with the requirement that people can't send their kids to public schools unless they've been vaccinated.

If you are a parent however, the calculus comes out a bit differently.  Other parents can "protect" their kids if they feel the need to, but you may think that the risk of vaccination exceeds the risk of infection by, for example, measles, mumps or rubella.  You don't care about the odds - you just don't want to be the parent who loses a kid due to an un-needed vaccination, and you believe that for a healthy, well fed kid, most infectious diseases have a relatively low risk of mortality.

What's the point of describing this situation?  The point is to illustrate that the playing field looks differently depending on where you sit.  The link above describes the salt wars - the ongoing battle amongst health professionals and their critics about whether or not salt will make you sick.  Here's the short version of the answer:  if you don't have high blood pressure, salt will not make you sick.  If you have high blood pressure, cutting back on salt will help - but for most with high blood pressure, salt restriction only helps a little (if you want to cure your high blood pressure, try carb restriction - works very well for most folks, because most high blood pressure is a result of excess carb intake and hyper insulinemia.  Once your normalize your BP, you can enjoy your salty food with a clear conscience).

Why's that a big deal?  Because those passionate health professionals have done some interesting math.  If you reduce a population's salt intake enough, you can get an average reduction of that population's blood pressure equal to a percent, or maybe a little more.  If you make some assumptions and do some complicated math, you can predict that the aforementioned salt restriction will reduce heart attacks and strokes by some percent, thus saving lives.  Thus, the passionate health professionals are pushing for restrictive legislation to reduce salt intake (Say What?).

You may or many not have a problem with that course of action depending upon your sense of what the limits of government should be.  I have a significant problem with it, however, because it the government can dictate what you eat based on the flimsy science supporting the case for salt restriction, they can make you do anything they want to.  Nevermind the bizarre logic that allows them to take aim on salt but allow cigarette smoking, alcohol consumption, selling gatorade like drinks as a health food, and driving in cars.

I mean if you want to save a bunch of lives, get rid of automobiles and don't let anyone make or sell booze, for crying out loud.

Of course, that's the point - they know they can't get away with taking your car to save your life because we'd all rather be dead than to lose our cars - or booze for that matter.  But they think they can bamboozle you with shady salt science and save some random folks from an untimely death.  At least they mean well.

Read the articles linked above.  Read this gem by Gary Taubes which examines the topic in even greater depth.  Consider that there's evidence that salt restriction may kill as many folks as it saves.

Then ask yourself:  What should the standard of scientific proof be before government may impinge upon your liberty "for your own good"?

I obviously do not think that standard has been met for salt.  Do you?

Say What?

Last week, discussing the Federal Trade Commission's call for slashing the sodium content of food marketed to children, I noted that the scientific case for population-wide reductions in salt consumption is pretty shaky. A new study in The Journal of the American Medical Association reinforces that point. The researchers, led by Jan Staessen, a professor of medicine at the University of Leuven in Belgium, tracked 3,681 middle-aged Europeans for an average of eight years, measuring their daily sodium intake through urine collected at the beginning and the end of the study. None of the subjects had high blood pressure or cardiovascular disease at the outset. But over the course of the study, those who consumed less salt were more likely to die of heart disease: There were 50 such deaths in the lowest third, compared to 24 in the middle third and 10 in the highest third. The subjects who consumed more salt did have slightly higher blood pressure, but they were no more likely to develop hypertension. "If the goal is to prevent hypertension" by reducing sodium consumption, Staessen told The New York Times, "this study shows it does not work."
http://reason.com/blog/2011/05/05/could-eating-less-salt-be-dead

This is the next boondoggle from "public health authorities."  What are public health authorities?  Folks who's job it is to think of ways that they can use the coercive power of the government to enforce their will upon you for your own good.  These people need pets and children, vice jobs in the government. 

As regards salt, there's little doubt that coercive government interference in salt intakes will not help most of us live longer or better; the science on the topic is at best unclear, and if anything, the science shows that salt does not cause disease, though it can exacerbate disease in those that already have given themselves high blood pressure.  Shaky science didn't stop the saturated fat fiasco, so I don't expect that it will stop the salt nazis either.

Michael Alderman, who edits the American Journal of Hypertension, also worries that sharply reducing sodium intake, while good advice for people with high blood pressure, could raise the risk of cardiovascular disease in the rest of the population, perhaps by increasing insulin resistance. His own research has generated  results similar to Staessen's. "Diet is a complicated business," he told the Times. "There are going to be unintended consequences."

This is why the standards for government intervention as regards diet should be very, very high.  A government bureaucrat with good intentions and half baked science should not have the power to dictate anything to anyone, nor to issue dietary guidelines that government agencies are bound by.