Another URL for Salt Sensibility blog

We've moved again. Follow us at http://www.saltinstitute.org/News-events-media/Salt-Sensibility.

Jump to SaltSensibility, the Salt Institute's blog

I'm amazed. I've stopped posting to this blog and switched to one hosted on the Salt Institute website -- about 20 months ago. Yet I still get visits here. If you want to find us, go to http://www.saltinstitute.org/rss/saltsensibility/. We also have a variety of other factual blogs that you may wish to subscribe to at http://www.saltinstitute.org/rss/subscribe-rss.html.

Frugal Baby Tips: Miscellaneous_: Salt!

Frugal Baby Tips: Miscellaneous_: Salt!

Salt Sensibility has a new home

Salt Sensibility has become the harbinger of a series of RSS feeds now hosted on the Salt Institute's webserver. Salt Institute members are encouraged to enroll in Salt Institute NewsCentral which is a newsreader pre-loaded with more than two dozen feeds with information from the Salt Institute, including the Salt Sensibility blog. If you are not a member of the Salt Institute, you can also download the pre-loaded series of Salt Institute blogs at NewsCentral or you can choose to subscribe to any of interest in your own newsreader. To continue your subscription to Salt Sensibility, simply paste the new URL into your newsreader: http://www.saltinstitute.org/rss/saltsensibility/atom.xml. I apologize for the inconvenience and only hope that for those with wide ranging interests in salt you will find this means of keeping informed of breaking news, new calendar items and much more to be well worth the trouble of this extra step.

Overturning political correctness in medicine

Yesterday and today, many of the nation’s leading scientists and experts on women’s health met at the National Institutes of Health (NIH) in Bethesda, MD to celebrate the legacy and probe the findings and future directions of the Women's Health Initiativve, the largest and most comprehensive study of postmenopausal women’s health ever conducted in the United States. And not only the largest, the WHI is aguably the most far-reaching in terms of documenting flaws in our understanding of accepted medical "knowledge" on everything from the effects of a low-fat diet and calcium/vitamin D supplements to the dangers of hormone replacement therapy. In all these cases, WHI reseachers have turned on their head logical hypotheses supported by at least some observational studies. We now know that low-fat diets don't make much difference, nor do calcium/vitamin D supplements, and that hormone replacement therapy creates an increased risk of breast cancer and that, overall, risks from use of the hormones outweighed the benefits. “The WHI has replaced conventional wisdom about women's health issues with evidence-based research findings, and reminded us that there aren't always simple, universal answers to complex questions,” said Elias A. Zerhouni, M.D., director of the NIH, announcing the celebration. Hopefully, NHLBI director Elizabeth G. Nabel, M.D., who also spoke to the gathering, recognized the application of Dr. Zerhouni's comments to the salt and health research funded by her agency. Several days earlier, yet another study of a massive federal nutrition and health database found risks of low-salt diets outweigh any health benefit. NIH has more on WHI on its website.

March is National Chronic Fatigue Syndrome Awareness Month

Many people refuse to accept that "chronic fatigue" is more than not getting enough sleep or an affectation of the lazy. They're wrong. Chronic fatigue syndrome is not only real; it can be cured. The super-active daughter of friends in Arlington, VA, went from normal, energetic roller-blading teen at Labor Day to wheelchair-bound, dog-tired by January and further regressed in the ensuing months such that she was forced to drop out of high school and, by June, was sleeping about 23 hours a day, rising only to eat and visit the bathroom. Her parents took her to doctors at Walter Reed Army Hospital (her dad being a general stationed at Ft. Myer) and they ran her through every test they could over more than half a year; they were stumped. When they finally told the father they suspected Chronic Fatigue Syndrome, they made it sound like it was the leftover category, perhaps not even real, but an explanation when none other could be found. As my friend the father lamented the latest bad news, I found a silver lining. Months earlier, in reviewing the medical literature for all articles pertaining to salt, natch, I had run across highly successful experimental therapy for Chronic Fatigue Syndrome at the Johns Hopkins University in Baltimore, only 40 miles away. The therapy was to place the CFS patient on a high salt diet. The Hopkins doctor: Peter Rowe. Long story short, the doctors at Walter Reed talked with Dr. Rowe and referred the daughter for him to treat. By September, the high salt diet had reclaimed a life and restored a spirit. The daughter had recovered sufficiently to return to high school. Steadily improving, by March, she and my daughter were able to hop over The Pond for Spring Break in England. She returned to her former, active lifestyle and was elected president of her senior class. CFS is real. And for CFS sufferers, one therapeutic option with demonstrated effectiveness is a high salt diet. Don't self-medicate, but if you or someone you love suspects CFS, be aware of this treatment option.

Science journals delivering "political science"

If you've agreed with several posts on this blog expressing concern about manipulating science, you'll likely enjoy Michael Fumento's column "Science journals delivering 'political science'" today at townhall.com. Don't miss the comment "The (Political) Science of Salt" at the end.

Snow on the roads? There oughta be a law

It's no secret: while most folks see a snowstorm as white -- and an inconvenience if not a threat to their driving safety -- those of us in the salt industry, like ski operators, see the same snowstorm as green -- a natural phenomenon that increases our market (for deicing salt and lift tickets). A "good winter" from a salt 'n ski perspective means lots of snow leading to musings about why we can't have more of that white stuff. I respond that if technology made it possible to control the weather, the first result would be the natural "there oughta be a law" call to ban snowfall, at least on highways. But, of course, we can't control the weather, can we? Not to fear, your tax dollars are at work. The Utne Reader reports a Defense Technology International story that "the US Air Force is developing technology that would actually allow it to control the weather. Military scientists have been experimenting with plasma technology that would 'reconfigure the ionosphere' for military purposes. The idea is to sneak up on enemy fighters and change the atmosphere to prevent them from receiving satellite signals." Now, THAT's climate change!

Calcium and health outcomes

Today's New England Journal of Medicine reports the second major health outcomes study in a week from the massive Women's Health Initiative, exploding another cherished axiom of nutrition, this one about dietary calcium. Higher intakes of calcium, the study concluded, do not protect against hip fractures, although consuming more calcium does increase bone mineral density slightly (unexamined in the study is the imporant contribution calcium likely plays in blood pressure regulation). No doubt these results, like those last week finding that low-fat diets do not improve health outcomes, will rekindle debates among nutritionists and the medical establishment. Good. No matter how we have all felt about the wisdom of eating less fat or drinking more milk, a couple other "health outcomes" seem worth mentioning.

• First, these studies offer a great and humbling reminder that our confident embrace of logical explanations for population data demands that population health advisories should be based on randomized trials, not observational studies. They should reinforce our insistence on true evidence-based public health nutrition recommendations.
• Second, randomized health outcomes trials are possible. Many have argued that the importance of the health threat targeted for dietary therapy is so compellingly urgent that waiting for health outcomes trials -- expensive and long-term to be sure -- would be unethical. How ethical is it to tell the population to reconfigure its diet to obtain health benefits that are supported only by population studies whose conclusions are extrapolated into headlines claiming improved health outcomes? Without health outcomes trials examining the validity of the assumptions underlying these extrapolations, the dietary recommendation becomes a house of cards. Let's not gamble with cardsharps.

The salt connection, I hope, is obvious here. Logically, since salt is related to blood pressure and blood pressure is related to the incidence of cardiovascular events, some countries like the U.S. and the U.K. have embraced universal sodium reduction. The theory is clean and neat. But the argument is without evidentiary support. The only health outcomes data today are observational (and those data are only about a decade old, produced long after nutrition know-it-alls confidently concluded that lowering population salt intakes would improve public health). The health outcomes data we do have today shows no improvement in heart attack rate or increased morbidity/mortality for those on lower-sodium diets. In fact, 30% of the studies have identified an increased risk while none have identified a population benefit.

Before 2000, the U.S. Dietary Guideline suggested consuming salt or sodium in moderation. Reasonable advice, if somewhat ambiguous; it matched the ambiguity of the evidence. More recent Guidelines have been more strident even as the observational health outcomes studies accumulated and consistently showed no benefit. We should go back to the pre-2000 Guidelines until we can conduct a controlled trial of the health outcomes of reducing population sodium intake levels.

Diet foods: do they lead to healthier diets?

Today's Food Navigator reports: "Obesity rocketing despite record diet food spending." The headline is for Europe, but describes the U.S. as well. The headline betrays what may prove to be a critical, but erroneous assumption: that people who eat "diet food" have healthier diets, or lower-calorie diets. That linkage has yet to be tested. For years dietitians have lectured on the fact that there are no "healthy" or "unhealthy" foods, only "healthy" or "unhealthy" diets. But "diet foods" sell, so until we have convincing medical evidence, the public goes on buying them, thinking that they're buying better health. As Peter, Paul and Mary sang in "Where Have All the Flowers Gone?": "When will they ever learn?

When the facts contravene conventional wisdom, go with the anecdotes?

I loved this quote from Gina Kolata's news analysis column in today's New York Times entitled "Maybe You're Not What You Eat":

"Whatever is happening to evidence-based treatment?" Dr. Arthur Yeager, a retired dentist in Edison, N.J., wrote in an e-mail message. "When the facts contravene conventional wisdom, go with the anecdotes?"

The furious reaction to last week's JAMA report that low-fat diets don't lead to improved health outcomes reminds me of the current level of civility in Congressional discourse. "Partisan" anti-fat researchers opine in outrage reminiscent of Howard Dean. The situation reminds me of the hysterical rejection of the 1995 study in the American Heart Association's journal Hypertension showing that hypertensive patients classified as "low-sodium" consumers had vastly higher risk of heart attacks. Critics flayed the methodology, yet all eight subsequent studies of health outcomes in populations with salt intakes typical of those in the U.S. have confirmed either no health benefit or an increased risk of lower salt intakes and the author subsequently was elected president of the American Society of Hypertension and, more recently, elected president of the International Society of Hypertension, a post he currently holds. Hopefully, our next Dietary Guidelines Advisory Committee will not ignore this powerful new evidence -- our only controlled trial of the health outcomes of low-fat diets -- in favor of mindless regurgitation of politically-correct policy pronouncements, as they greeted the new evidence on salt. Thank you Dr. Yeager (and Ms. Kolata) for spotlighting our options: follow the evidence or the "experts." We need to insist on evidence-based public health nutrition policies, not the anecdotally-consistent Guidelines being so loudly defended.

Free trade "protects" niche salt market

The NAM's blog headlines "Margarita Lovers, Rejoice" and their story reports agreement by Mexico to allow bulk imports of tequila into the U.S., concluding: "Searchin' for my lost shaker of salt..." The mararita-rim market may not be pivotal to the salt industry, but we appreciate the business. Hooray for free trade!

Snow's coming (finally)

Winter started out right in the DC area in December, but disappeared entirely in January. It's back, forecasters tell us. Appropriately, this morning's Washington Post has a story on the job of weather forecasters. As with the advance of freedom in the world and the resilence of the U.S. economy's growth despite 9/11, Katrina and oil prices, an important and underappreciated story is the significantly improved performance of road weather information systems (RWIS). These aren't the forecasters in the Post story, but rather the data systems that tell roadway maintainers the pavement temperature so they know when to put down salt. For more on road weather, check out the Salt Institute website.

Low-fat diets lose luster (low-salt too!)

The front pages have been crowded with this story, blogged earlier here, and now the editorial writers are beginning to grasp the breadth of impact -- it goes WAY beyond fat. As USA Today reminds us:

Not long ago, it was generally estimated that 400,000 Americans a year die from obesity. Oops. A new study last year by the Centers for Disease Control and Prevention (CDC) found that obesity accounts for only 26,000 deaths, and that a few extra pounds might add to longevity.

"Similarly, hormone replacement therapy was once thought to protect postmenopausal women against heart attack or stroke. Subsequent studies say it doesn't.

"Yesterday's conventional wisdom is today's myth. No wonder so many are skeptical about whether any study can be believed.

"The latest surprising finding is that low-fat diets don't reduce the rate of heart disease, stroke, breast cancer or colorectal cancer, or even result in greater weight loss. That's the conclusion of a government-sponsored study published Wednesday in the Journal of the American Medical Association. It followed nearly 50,000 overweight, postmenopausal women for an average of eight years.

...

"The low-fat study only means that there's no magic bullet, which leaves an obvious if unpleasant fact: Good health comes from a balanced diet, frequent exercise and avoiding obvious risks. Family history and genes count for a lot also, regardless of diet."

It's not that all of "yesterday's conventional wisdom is today's myth." Only when the conventional wisdom isn't based on sufficiently-rigorous thinking or evidence. Here, as in the salt case, we have a very plausible theory (hypothesis) and a bunch of obvservational studies, though far from consensus the fat studies seemed less controversial than those for salt. What we lacked was a randomized trial. Now we have it. NOW we're prepared to act on the evidence or, in the case of fat, perhaps not act. This study may have cost $415 million, but if we learn the harsh lesson about prejudging before we conduct a controlled trial of the health outcomes of the proposed intervention, it will be money very well spent.

Dominoes: fat, salt

Until yesterday, everyone "knew" that low-fat diets were the cornerstone of a healthy diet. Publication in the Journal of the American Medical Association of results of an 8-year, $415 million study of nearly 50,000 American women found that what everyone "knew" was dead wrong. There was no health benefit among the almost 20,000 women on low-fat diets. They had the same incidence of breast cancer, colorectal cancer, heart disease and stroke as the 29,000 women who ate regular diets. Experts on every side of the issue agree the study is conclusive due to its size and quality ... and $400+ million pricetag. Expensive study? You bet. Worthwhile investment? Priceless. Not only have we spent billions of dollars researching low-fat diets, but food manufacturers have invested additional billions re-engineering the foods we eat. Americans have not only paid premium prices for specially-concocted low-fat foods and kept low-fat cookbook publishers in business for the past quarter-century, but consumers anguished over their inability to strip even more fat out of their daily diets. No more. This was a front-page, above-the-fold story in every newspaper in the country (e.g. The Washington Post - "Low-fat diet's benefits rejected" - and NY Times - "Low-fat diet does not cut health risks, study finds"). The New York Times editorialized: "The results clearly surprised the investigators and may sound the death knell for the belief that reducing the percentage of total fat in the diet is important for health." While this is clearly the diet-related news story of our new millennium, most discussions have omitted mention of three additional key lessons we should be learning:

• First, medical science is evolutionary. What we "know" today is subject to further investigation and revision as we learn more. It is a process of creative destruction. We need to be prepared to "move on" when the evidence demonstrates the error of our ways.
• Second, we can save time, expense, anguish -- and people's health -- if we are a bit more patient and humble about the confidence we place in the results of medical studies. All studies are not of the same quality. This was a high quality randomized controlled trial -- the "gold standard." A well-done randomized trial of health outcomes should be required before our officials begin the drumbeat -- and trigger billions of dollars of expenditures -- for a massive dietary change. To re-state an earlier post on this blog: this is why we should insist on true evidence-based public health decision-making. Evidence-based decisions follow a rigorous process defined by the world-renowned Cochrane Collaboration.
• Third, we should require the same kind of controlled trial of the health outcomes of advice to restrict dietary salt as we now have to restrict dietary fat. There are only ten observational studies of the health outcomes of reducing salt in a U.S.-like population. We need to ask the outcomes question: does eating less salt reduce heart attacks or extend life? We need a controlled trial of this question even though it may cost $100 million or more. As in the case of low-fat diet advocacy, the government is spending multi-fold that amount and compliant food manufacturers are investing huge amounts trying to reduce salt intakes when, in truth, we have no evidence that it will make a difference. In fact, the observational studies show that in populations with salt intakes like the U.S., there is no health benefit and may even be a risk in low-salt diets (see our website discussion).

It is hard to exaggerate the importance of this JAMA study. And it's impossible to ignore the validity of the Salt Institute's observation that pursuing a policy of universal sodium reduction without a randomized health outcomes study is sheer folly.

Brit anti-salt ad campaign admits to ad standard violations

The UK's Advertising Standards Authority has chastised the government's Food Standards agency for misleading anti-salt statements breaching standards of social responsibility, substantiation and truthfulness. FSA was also forced to recant its statement that snacks were unhealthy. It is refreshing to see recognition of the obvious fact that government bureaucrats can have every bit as much bias as "private" interests. All parties to public health strategic discussions should insist on fair statement of the evidence. There is room for disagreement whether, for example, messages should be directed to the entire public or to sensitive individuals or sub-groups, but there is no place for abusing the data -- or the public trust.

Replication: "the ultimate test of truth in science"

So says Dr. Donald Kennedy, the editor of America's foremost scientific journal, Science, in an article in yesterday's New York Times about a Congressional briefing on the intersection of science and public policy. Right on! Replication is the key. If scientists cannot replicate a study because its design is not divulged or if their replicated protocol does not produce the same results, then science has failed. That's why the federal Data Quality Act establishes replication as one of the key criteria for determining whether a study meets the high standards that we should require in using science to support public policy. That is a key issue before the 4th U.S. Circuit Court of Appeals when it convenes in Richmond tomorrow to receive oral argument in Salt Institute v. Leavitt, the first challenge reaching a federal appeals court seeking to define how the Data Quality Act will be interpreted. The issue here is that the National Heart, Lung and Blood Institute has been characterizing results of studies it pays for without allowing qualified experts access to enough data to be able to judge whether the statements are true or not. Kennedy is quoted saying "Peer review isnot a process that guarantees truth. If it were, no one would ever repeat experiments. Replication is the ultimate test of truth in science."

Iodized salt boosts brainpower

The Economist recently ran a story on "Diet and the unborn child" emphasizing the importance of omega-3 fatty acids in fetal development. Absolutely valid. Missing, however, was any mention of the importance of iodine in the diet of expectant mothers. If The Economist's story is correct that omega-3 can raise children's IQ by 3 points, that's great -- and about one fourth the estimated 13 IQ points that proper iodine nutrition confers. Eat that iodized salt. For more, see the Salt Institute webpage on Iodized Salt.

New? DASH Diet??

Talk about misbranding! In 1997, the federal National Heart, Lung and Blood Institute (NHLBI)-sponsored Dietary Approaches to Stop Hypertension (DASH) study found that -- holding salt intake at a constant level -- blood pressure could be improved significantly by adding fruit, vegetables and dairy products to the American diet. Hypertensives subjects dropped their systolic BP by 11.4 mmHg -- impressive. Those interested in improving dietary quality and lowering cardiovascular risk -- including the Salt Institute -- rejoiced and called for the DASH Diet to be the guiding principle for the new year 2000 Dietary Guidelines for Americans. It took a bit longer, but the 2005 edition of the Guidelines, in fact, explicitly endorsed the "DASH Diet." So far, so good. But in the last nine years, those with their own nutrition agendas have tried to hijack the "DASH Diet" by asserting that the DASH Diet is now fruits, vegetables and dairy products AND salt-restricted or, in current headlines, fruits, vegetables and dairy products AND carbohydrate-restricted and protein-enhanced. Well, folks, there is no such thing as a South Beach DASH Diet. The DASH Diet offers an exciting possibility that correcting nutritional (mineral) deficiencies in the American diet can confer health benefits, but it has nothing to do with dietary salt, dietary carbs or dietary protein. Unfortunately, NHLBI, rather than defend its original findings, has been playing along with the misbranding of these later studies. FDA should call "halt" on its sister agency; this misbranding is akin to "bait-and-switch." For more on how this plays out for dietary salt, see the Salt and Health or Salt for Human Nutrition pages on the Salt Institute website.

Tao of the Dow

The salt industry shares with other engines of the economy the role of adding value to our common enterprise -- our products, jobs/wages, and the taxes we pay (there, that validates a salt connection for these thoughts). This past week, the Dow Industrial Average reached 11,000 for the first time since 9/11. It has risen from 8,601 since May 2003 when the Bush Administration's tax cuts became effective. Since May 2003, then, the growing value of equities reflected in the Dow has added $5 trillion in shareholder value. The increase in shareholder value is equivalent to all federal spending in the same period, by my calculations; I haven't seen any commentary to that effect. If my numbers are right, they illustrate a larger point beyond the value of low tax rates: federal spending is the "tail" of the economy's "dog." It is the private sector that adds value to our common enterprise. Swings in the health of the private sector have consequence far beyond the allocation of $2 trillion a year in federal spending (about half of it for just three programs: Medicare, Medicaid and Social Security).

The Challenge of Winter Roadway Operations

Shameless plug: the Salt Institute's new Salt and Highway Deicing newsletter is now available online, discussing the important differences betweeen "winter maintenance" and "winter operations." You can subscribe for future issues of this free newsletter.

Is science hopelessly politicized?

Reasononline’s science correspondent Ronald Bailey’s Jan. 6 post revisits the issue of objectivity/politicization in science, asking: “Has science become politicized? A better question might be: When has it ever not been?” He sees no way out of the current situation where funding sources – both industry and government – seem to bias “scientific” conclusions. He continues:

“Surveys of studies show that scientific reports sponsored by drug companies generally find the supporting company's drugs to be safe and efficacious, whereas independent studies often do not. Interestingly, studies supported by the $132 billion in federal research and development expenditures rarely occasion such scrutiny. Perhaps that's because they are generally above reproach. But it is also true that most academic research is funded by government agencies and it will not help a scientist's career to bite the federal hand that feeds him and his postdocs. I also suspect that most agency funded research generally finds that what the agency guesses is a problem turns out to be a problem.

“In a liberal secular society in which traditional sources of authority—the Church and the State—have eroded, science stands the ultimate arbiter of truth. So, both the right and the left loudly seek to claim that scientific findings justify their political goals. “Not surprisingly, when a scientific finding doesn't support their policies or programs, both sides suspect that it has been "politicized." In this case, "politicized" means disagrees with what we good people want. Naturally to prevent politicization, both Republicans and Democrats have sought to legislate scientific objectivity.”

Bailey then concludes.

“What these efforts to legislate scientific objectivity really point up is that science, as the chief arbiter of truth in our society, will remain unavoidably enmeshed in politics. The government official who ordered the ban on DDT despite the scientific evidence for its safety, William Ruckelshaus, the first administrator of the EPA, brought admirable clarity to the issue. In 1979, Ruckelshaus wrote to Allan Grant, president of American Farm Bureau Federation president, stating, "Decisions by the government involving the use of toxic substances are political with a small 'p.' The ultimate judgment remains political." What was true for the EPA in 1972, is even more true for federal agencies today. The science wars are here to stay.”

Who’s to say Bailey’s wrong? I hope we never entirely replace our healthy skepticism with a crusty cynicism that forecloses a healthier outcome for our polity. As I blogged earlier, the objective criteria of good science termed “evidence-based medicine” by scientists united in the Cochrane Collaboration seem, to me at least, to offer hope. The concept is that the rules of the game are set out before the evidence itself is assessed – sort of like an election where we agree to accept the outcome because we know the process itself has integrity (or at least it does in Baghdad if not Broward).

Mere Magazines

Still catching up from the holidays. A Dec. 30 commentary in the Wall Street Journal made much the same point in the Vioxx debate as raised earlier in this blog: even our most prestigious medical journals are "mere magazines." Thomas Stossel, the American Cancer Society Professor at Harvard Medical School, decried MSM coverage of Merck's Vioxx situation, stating the media conclusion: "Medical academics are saints -- devoted selflessly to patient care -- and corporate people are sinners, morally blinded by greed." Stossel obviously disagrees: "But having worked in academic medicine for over 35 years and consulted for companies, this Manichean duality is inconsistent with my experience and a woeful distortion of reality. In a Sept. 8 article in the New England Journal of Medicine, I reported that no systematic evidence exists that corporate sponsorship of academic research contributes to misconduct, bias, public mistrust or poor research quality." Stossel urges medical journals to "stick to their core business of facilitating imperfect communication between researchers. Leave drug and device monitoring to the FDA -- and theology to theologians." Picking up on the last point, it is disturbing how anti-scientific (theological) have become the calls to restrict dietary salt against accumulating evidence that the intervention just doesn't deliver health benefits for the general population. The anti-science has a theological tenor -- faith in the absence of evidence. In this case, it's worse -- faith in the face of evidence to the contrary. As in the case of the all-knowing Wizard of Oz, we're advised: "Pay no attention to the man behind the curtain." We need truth-tellers like Dr. Stossel...and Dorothy.

Thoughts on congestion

I've just received the Fall 2005 issue of Access, the newsletter of the University of California Transportation Center. This edition isn't yet online. I was struck by a couple factoids in the article "What We've Learned About Highway Congestion." From the Cal-Berkeley PeMS database, researchers have determined that maximum highway capacity is achieved at about 60 mph, up sharply from the 40-45 mph estimated earlier. Research also shows that only 21% of congestion is due to "excess demand" -- too many vehicles for the design of the roadway; the other 79% of congestion is due to operational failings such as weather, traffic crashes or failure to provide metered ramp access to freeways. This, of course, underlines the priority that should be given to investing in highway operations -- like snow & ice control. Another tidbit: high-occupancy vehicle (HOV) restriction does encourage carpooling, but otherwise it acts perversely to increase congestion. "Analysis of Bay Area data suggests that the effeect of teh combined penalties is larger than the positive carpooling effect. Thus, the likely net result of HOV restrictions in the Bay Area is worsening congestion." Kinda sounds like the situation we face in salt restriction, ostensibly to improve health and reduce heart attacks. Good theory, but the "net result" may be a worsening of public health (see other posts in this blog).

Blood pressure key: overcoming mineral deficiencies

Reiterating a point the Salt Institute has raised for years, this December 14 post by NewsTarget.com explains the growing medical view that mineral deficiencies are responsible for high blood pressure more than "excess" dietary salt. We can't vouch for all the quotes, but the sentiment is mightily appreciated. Our reading of the DASH Study is that correcting deficiencies of calcium, magnesium and potassium in the diet largely eliminates "salt sensitivity" with regard to blood pressure.

Sea salt is not a good source of dietary iodine

As one navigates cyberspace learning about salt, sometimes misunderstandings, through repetition, seem to endow erroneous claims with an unwarranted credibility. Take the case of iodine in sea salt. One blog I recently visited pointed towards the Saltworks Inc. website reference guide to gourmet salt. Interesting site, but one error on the site -- typical of a number of other cyber-discussions -- needs to be flagged. The site says "Natural sea salt is a healthy replacement for ordinary table salt." Nothing wrong with that. Sea salt, properly washed, is every bit as healthy as evaporated table salt. The context, however, introduces a misunderstanding. Immediately before, the text discusses the importance of dietary iodine, noting that iodized salt is a valued delivery vehicle for iodine-deficient populations, but adding, correctly, that diets with sufficient seafood will get enough iodine. It is in this context, then, that the text claims that sea salt is a safe alternative to vacuum pan evaporated salt. While "safe" and "healthy," sea salt is NOT a good source of dietary iodine. It would seem natural that it might be, since it comes from the sea, but, in fact, sea salt has only minute amounts of iodine and is NOT a safe alternative for those on iodine-deficient diets who are seeking to improve their health (and that of their unborn child in the case of expectant mothers) by boosting their iodine intakes using salt as the carrier. For more on the benefits of iodized salt, see the Salt Institute website, http://www.saltinstitute.org/37.html.

Salt: Its role in preventing global warming

If "Meridional Overturning Circulation" isn't a familiar term, perhaps the more popular concept of the "conveyor belt" describing how the Gulf Stream heats the North Atlantic (and keeps Europe from entering a new ice age) is more familiar. A series in this week's Philadelphia Inquirer examines the crucial role of the Gulf Stream with regard to global warming. While many understand the importance of oceanic circulation, Inquirer staff writer Anthony R. Wood reminds readers: "A critical ingredient in the recipe for climate change is one of the most prosaic and plentiful substances on the planet: salt." He points out that understanding the "subtle but important " differences in the relative densities of salt water and fresh water is "the key to keeping the conveyor belt in motion." The warm Gulf Stream consists of more highly saline water evaporated by the hot sun in the tropics and it eventually sinks below the less dense arctic water in its path. If the salt sinks sooner, the prevailing west winds that transfer the warmth of the Gulf Stream to Europe will have less warmth to transfer and Europe will revert to temperatures more associated with its northerly lattitude. If "global warming" melts the Greenland ice pack, releasing more fresh water, it can affect the rate of salt sinking, perhaps changing the geography of the Gulf Stream itself ... and triggering dramatic cooling in Europe. Whether or not global warming is a short- or long-term phenomenon, experts still debate, but there's no debate that salt plays a crucial role.

Scientific fraud and public health lunacy

Two articles in recent days in New York City newspapers caught my eye. On Dec. 16, the New York Post ran an op ed by Dr. Elizabeth Whelan, president of the American Council on Science and Health entitled "A Year of Public Health Lunacy." She laments how public health advocates "seem to put politics before science," citing Iowa's ban on the preservative thimerosal in vaccines or banning soft drinks from schools to combat obesity (both regular and diet soft drinks). She notes the fall of the Harvard School of Public Health which has recently embraced junk science on at least a couple issues. Then, today's New York Times story "Global Trend: More Science, More Fraud" highlights research shennanigans in South Korea. The Times story cautions: "To be sure, most scientists resist pressures to cut corners and adhere to the canons of science, honoring the truth above all else. But surveys shuggest that there are powerful undercurrents of misbehavior and, in some cases, outright fakery. Just as we need strong and authoritative science so help us sort out issues like the healthfulness of dietary salt, science is under an attack that threatens its credibility. Preserving this credibility is of paramount importance, given the proclivity of both corporate marketers and "public interest" advocates, including those embedded in the federal bureaucracy, to cloak their policy preference in claims they are "evidence-based." It matters not whether the motivation is to increase market share for a product, raise funds by sounding a public alarm or protecting or advancing a professional reputation for advancing the frontiers of medical knowledge. Insidious "insider" manipulation of data and/or their interpretation risks depriving society of any authoritative source. As in other areas where sophistication outstrips morality, we must "go back to basics." In this case, that means to strip away the pretense of "science" and looking at the fundamentals such as study design and standards of interpretation. Everyone says theirs is "high quality" science, of course, even high schoolers' science projects. Fortunately, we can go back to basics by reviewing what it means to embrace "evidence-based" public health policy. Our Dietary Guidelines claimed to be evidence-based, but didn't hew to the definitive standard crafted by the Cochrane Collaboration. As governments slip into politicized health care policy, inviting scientists to explain their findings against the outcomes-based scientific method pioineered by the Cochrane Collaboration offers the most promising way to re-establish the credibility we need for science-based public health policy. Using its rigorous methods, the Cochrane Collaboration offers its views on "advice to reduce dietary salt for prevention of cardiovascular disease," specifically: "There was not enough information to assess the effect of these changes in salt intake (a reduction) on health or deaths." Let's move away from scientific fraud and the public health lunacy that follows in its wake and insist on true evidence-based public health policies.

The cost of Christmas

I couldn't resist. This isn't salt-related at all unless you stretch and say that everyone "worth their salt" gives gifts during the Christmas season. For years, PNC Bank has been calculating the cost of providing the "partridge in a pear tree" and other gifts of the "Twelve Days of Christmas" and if you're ready for a short break from shopping, partying and family get-togethers, I hope you'll enjoy their Christmas Price Index.

Consumers ignorant of first functional food: salt

Marketers would have us believe that the self-selecting online community is composed of above average intelligence information sponges, perhaps suffering info overload, but certainly well informed. A recent poll suggests otherwise. Last week, A.C. Nielsen reported results of an online survey of 21,261 “regular Internet users” conducted earlier this year asking about their views on functional foods. Not too surprisingly, pollsters found consumers skeptical of food manufacturers’ health claims for foods. I’m sure they’d also be skeptical about carrots and broccoli, much less foods engineered or fortified to provide additional health benefits. U.S. consumers, incidentally, were far more accepting of enhanced foods than Europeans or the global sample. But can we believe the pollsters? A look at the poll details suggests they may be wrong. The survey asked whether consumers used functional foods. The first “functional food,” many know, is salt fortified with potassium iodide or potassium iodate. American salt producers began adding iodine to salt in the 1920s in the U.S. and Switzerland to prevent goiters and mental retardation. Salt iodization has been promoted heavily since then; it was UNICEF’s top children’s health initiative in the 1990s. Iodizing salt is the public health community’s preferred choice because it is very inexpensive and iodine-fortifying salt changes neither the taste nor food properties of the salt. Unless they read the label on the container, consumers cannot know whether the salt is iodized or not – except in those countries which require ALL table salt to be iodized (e.g. Canada). In the U.S., 70% of table salt is iodized – that percentage has been stable for several generations. That means more than two out of three “round cans” purchased are iodized and it follows, since salt is consumed, on average, in a relatively narrow range, that about seven in ten consumers are using iodized salt. U.S. consumers told pollsters, however, that only 3 in 10 were using iodized salt, 30% – a somewhat lower percentage than globally (33%). Almost more shockingly, when the U.S. and Canada were combined, only 24% reported using iodized salt – despite the fact that all Canadian table salt is iodized. Since the Salt Institute collects comprehensive market statistics, the certain conclusion is respondents knowledge is the exact reverse of the dictum that “the customer is always right.” It's quite discouraging that there are 70% who claim not to be using iodized salt when actually 70% Americans and virtually all Canadians DO use iodized salt. What is more discouraging is that these erring respondents go on to prove just how clueless they are. Asked about why they chose plain salt over iodized salt, 35% doubted that iodine-fortified salt was any healthier (obviously none were endocrinologists! Iodized salt is the consensus public health solution for iodine deficiency). An additional 17% said they didn’t like the taste of iodized salt (fact: the iodine has no taste whatsoever); 6% said the fortified salt is too expensive (fact: it’s sold at retail for exactly the same price as plain salt); 5% said it wasn’t available where they shop (check this out yourself: iodized salt is always available even if plain salt isn’t) and, finally, 1% complained of poor quality (I won’t even dignify that with an answer). Bottom line: consumers mistakenly think they’re not using iodized salt and provide nonsensical reasons for their fallacious opinions. Why? Could the answer be as simple as the likelihood that “regular Internet users” aren’t as well-informed as previously thought? In mid-19th century U.S. politics, the "American Party" was nicknamed the "Know Nothings." They had nothing on Americans in the Nielsen Poll. For more on iodized salt, see http://www.saltinstitute.org/37.html.

Vioxx lessons for salt controversy

Everyone's afternoon's headlines report a mistrial in the Merck Vioxx case. A few days ago, the New York Times and the Wall Street Journal reported complaints by the New England Journal of Medicine that Merck had withheld health outcomes data on the NEJM-published Vioxx trial. NEJM editors expressed outrage that adverse cardiovascular events (heart attacks, strkes and deaths) were excluded from the Merck analysis. The editors said they were concerned that not reporting the adverse health outcomes and selectively reporting the study results "made certain calculations and conclusions in the article incorrect." Serious charges with serious consequences. Money wasted. Lives lost. Opportunities for better health alternatives ignored. Important story. OK, you can read all that somewhere else. What in the world does that have to do with salt? It turns out that this same journal, these same editors, earlier published another important study where the data were incomplete and the resulting highly-heralded "calculations and conclusions in the article (were) incorrect." Two differences, however. First, the NEJM has not insisted that the authors fill in the blanks and publish the missing data. And, second, the reason may be that in the Merck Vioxx case, the allegations fingered a money-loving corporation while the research in the other case was funded by a federal agency with motives presumed as pure as those puffy white crystals falling from our winter skies. The earlier study is the DASH-Sodium trial and the failure to voluntarily publish enough data to enable objective outside observers to verify (or "replicate," the relevant standard in the applicable federal Data Quality Act) has led the Salt Institute and the U.S. Chamber of Commerce to challenge withholding the relevant data. That case is in federal appeals court and will be heard on February 2nd. To repeat: Money wasted. Lives lost. Opportunities for better health alternatives ignored. Important story. Whether the funding agency is a private corporation or a public agency, we need transparency to ensure that motive, means and opportunity to abuse science don't criminally sacrifice our opportunties to promote improved public health.

Preventing heart attacks

Most readers probably heard about the death this past week of former South Carolina Gov. Carroll Campbell, an exemplary political leader. The same day Gov. Campbell died of a heart attack, I received an invitation to attend an awards ceremony on Dec. 14 sponsored by the New York Academy of Medicine and Greater New York Hospital Association honoring Dr. John H. Laragh, Director of the Cardiovascular Center, New York-Presbyterian Hospital Weill Cornell Medical Center. Dr. Laragh is revered for his pioneering leadership in preventing heart attacks. Dr. Laragh also founded and led the American Society of Hypertension for years and oversees the editorial quality of The American Journal of Hypertension. Many Americans were introduced to his achievements through a cover story in Time magazine nearly 31 years ago, January 13, 1975. Despite our great advances in many areas of medical science, when it comes to preventing heart attacks, the promises of Dr. Laragh’s early research have been realized only inconsistently because “politically correct” decisions have misdirected our attention. Disclaimer: I’ve known and respected Dr. Laragh for nearly 20 years and am pleased and proud to have been able to include an affidavit from him supporting the Salt Institute’s petition to the National Heart, Lung and Blood Institute seeking correction of NHLBI’s improper characterization of the DASH-Sodium Study, which decision has been through a regulatory and now judicial process and will be argued before the U.S. 4th Circuit Court of Appeals in Richmond, VA on February 2, 2006. At the awards ceremony honoring Dr. Laragh next week, he will deliver a lecture on “The Laragh Blood Pressure Equation: BP = (body salt) x (plasma renin).” The message is as important as when he enunciated its principles more than 30 years ago: hormonal factors are crucial to understanding hypertension and the importance of focusing on heart attack risk, not blood pressure alone. I’ve extracted key, relevant quotes from the Time cover story, below, that make it clear that today’s controversies over whether it is a good idea to reduce dietary salt to lower the risk of heart attacks, reflect a turning-away from the sage insights Dr. Laragh contributed long years ago. It's a great story... and a cautionary tale of progress in preventing heart attacks that was undone by an unsophisticated, non-scientific, but "politically correct" assault on salt. Hypertension – Conquering the Quiet Killer” “Much of the credit for this successful treatment belongs to a perky professor of medicine named John Henry Laragh. Best known for untangling the hormonal relationships that control blood pressure, Laragh, 50, pioneered in the treatment of high blood pressure by founding the nation’s first hypertension center, at Manhattan’s Columbia Presbyterian Medical Center, in 1971.” … He had just announced his move to Cornell Medical Center. “Laragh’s move comes at an appropriate time. Medicine is better equipped than it has ever been to handle hypertension. Yet the disease remains perhaps the most neglected of health problems. Many physicians, in fact, still believe that moderately elevated blood pressure need not be treated. Laragh is determined to change all that. ‘Hypertension does not have to be the single leading factor in disability and deaths in the U.S. today,’ he insists. ‘We have the means to control it. What we have to do is use them. We’re ready for an all-out attack.’ “That attack has been a long time coming, for high blood pressure has been an enemy of men throughout recorded history. A Chinese medical text, dating back to 2,600 B.C. noted that a diet high in salt (now know to affect blood pressure) could cause changes in pulse and complexion.” … Since (1929 with the invention of the means to measure blood pressure, doctors) have become considerably more sophisticated about both blood pressure and its effects on the body.” … “To Laragh, the explanation is obvious. ‘Salt is the hydraulic agent of life,’ he explains. ‘It is salt that hold the water in humans, causes welling and a high fluid volume.’ This means an increased blood pressure.’ … “Until the end of World War II, doctors treated hypertensives, if they treated them at all, mainly by diet. Patients with high blood pressure were told to take off weight and lower their salt intakes. … Laragh, a cardiologist by training, “looked elsewhere in the circulatory system, and in 1955 he made an important discovery: he learned that increases in the blood levels of potassium can stimulate the production of aldosterone, an adrenal hormone that raises blood pressure by causing the kidneys to retain salt. “In the years that followed, Laragh made even more spectacular findings, which like so many other achievements in science, were serendipitous. Doctors had been aware of the role of aldosterone for some time. But they had been puzzled by the part played by renin, a kidney hormone produced in response to a drop in blood pressure. Laragh solved the puzzle. In 1958, he and his colleagues began treating a man with malignant hypertension, a rare form of the disease that is characterized by the kidney damage and usually kills its victims within a year. Tests showed that the man was, to their surprise, producing far more than the normal amount of aldosterone. This finding led to another series of tests that proved even more revealing. They showed that high aldosterone was probably due to increased secretion of renin.” … This discovery won Laragh a share of the Stouffer Prize in 1969 and “explained the hormonal controls of blood pressure for the first time. They also permitted the development of a renin profile – a computer-aided analysis of the patient’s hormonal output.” … “Laragh’s finding also cleared up another of the mysteries surrounding hypertension. Many hypertensives dismiss the seriousness of their conditions by citing the case of a relative who lived to be 80 despite a blood pressure that nearly popped the mercury out of the doctor’s sphygmomanometer. Laragh’s work indicates that these exceptions, which seemingly violate the rule that high blood pressure is dangerous, were probably low-renin hypertensives. Patients with this condition are less likely to suffer strokes and heart attacks than high-renin types.” The article also credits Dr. Laragh with discovering that “The Pill” with its estrogen-like ingredients, stimulated renin system and induced HBP and noted, in 1975, that the government was launching the “MRFIT” study, “designed to prevent heart attacks.” Interestingly, government analyses of this government-funded database have not identified that those on low-salt diets achieve any reduction in cardiovascular events or live longer. For more, see the Salt Institute website, http://www.saltinstitute.org/28.html and http://www.saltinstitute.org/healthrisk.html. For information on the Laragh award, contact the New York Academy of Medicine at http://www.nyam.org/events/?id=108@click=

Winter's snowy start

The Chicago Tribune reports the Windy City is off to its snowiest start in 27 years. Commute times in normally-excellent-snowfighting Chicago lengthened from one hour to five hours. Preparation and training are the keys to executing good winter operations. In Illinois, a study by Global Insight, commissioned by the Salt Institute earlier this year, found that failing to clear roadways costs $350 million every day, including $220 million in lost wages and nearly $100 million in lost retail sales. At Christmas-time, the lost sales could be even higher! The Salt Institute website has more information on winter safety and mobility.

Washington wake-up call

Winter's here. No matter your politics, the Washington Post got this story right. The DC metro area was blanketed with 3-5 inches of snow and salt trucks were hard at work. Although local forecasters didn't call it just right, winter's first snow is a wake-up call that snowfighting, often the largest public works expenditure of snowbelt governments, is off to a strong start. For more information, see our website at http://www.saltinstitute.org/30.html.

Scientists sequence genome of salt-resistant bacteria

For millenia, until the dawn of refrigeration a century ago, foods were salted for preservation because massive dosage of salt will kill bacteria. A blog December 3rd, reports that, using funding from the U.S. Department of Agriculture (USDA) and National Science Foundation, researchers have now sequenced the genome of a bacterium from a Spanish solar saltworks that has adapted and exchanged genes with another organism to survive. USDA has an extensive research program to develop salt-resistent crops suitable for harsh desert horticulture like the U.S. Southwest and western Australia.

Snowfighting a late arrival in Asia

Every year we're flooded with calls from areas of the U.S. where winter ice storms inflict unexpected carnage and paralysis by overwhelming unprepared public works agencies. But at least that's the exception in North America. It's one area where Asia is still catching up as this report from Seoul reminds.

Salt's a bargain

Last week, Democrats in the U.S. Senate garnered only 34 votes in favor of punitive measures against alleged excess profits by oil companies. In his Dec. 4th column, commentator George Will observed that gasoline prices have declined from $3.07 to $2.15 (in the DC area, they are lower than that and still declining). Will compared gas prices with the $185.60 that he calculates consumers pay for a gallon of Starbucks espresso. As much as we’d agree that many consider gas and coffee as staples, the real bargain is salt. Table salt is about 30 cents a pound and less-pure highway salt only 2 cents a pound.

DASH for Thanksgiving

As we gather our family today for Thanksgiving (ten of us together this year, spanning four generations), we have much to be thankful for. TV network sports have been touting “Feast Week” football and basketball and today’s Thanksgiving meal will probably have most of us leaving the table the same way the turkey arrives – stuffed. Certainly on Thanksgiving, few will be following the DASH eating plan advocated by both the Salt Institute and the Dietary Guidelines for Americans. The DASH Diet is high in fruits, vegetables and dairy products (and, by implication, low on turkey, stuffing, mashed potatoes and gravy). While the American Council for Science and Health has used the “traditional” Thanksgiving meal to illustrate the dose-determines-toxicity arguments about carcinogens in our foods, so far I haven’t seen a Thanksgiving DASH Diet. That’s something to be thankful for, anyway. The DASH Diet gained immediate national prominence in 1997 when it demonstrated that, holding salt constant, enormous blood pressure lowering could be achieved – fully as much as taking any single medication. The most responsive group were people who already had hypertension (>140 mmHg systolic blood pressure, the “top number” thought to be the most accurate predictor of the risk of cardiovascular events). This group averaged an 11.4 mmHg SBP reduction. Some complained that the common-sense DASH Diet, consistent with diets advocated for years to reduce the risk of cancer and other maladies, didn’t also include evidence showing the “politically correct” results for low-salt diets, or the Mediterranean diet or other favored interventions. With all the favorable publicity around the DASH Diet, others wanted to get on board. So new studies were launched to “improve” the DASH Diet. First came the anti-salt folks. They produced a version of the DASH Diet that also cut salt by 60% and found, voila!, that the hypertensives in their study reduced their average SBP by 11.5 mmHg. They proclaimed that “everyone” would benefit by reducing dietary salt even though this unachievable salt reduction contributed, at best, marginally to the blood pressure benefit (after all, the DASH Diet produced 11.4 mmHg lowering so we’re going to attempt a massive salt reduction to get that additional 0.1 mmHg instead of putting our energies into boosting consumption of fruits, vegetables and dairy products?). Earlier this month came a second round: “DASH Diets” that were also “improved” by making them Atkins/South Beach-like “low carb DASH Diets” and “DASH Diets” with added amounts of monosaturated fats like the Mediterranean diet or high in protein. If this keeps up, the dilution factor will soon destroy the strong effort of the 2005 Dietary Guidelines for Americans to encourage eating the original DASH Diet. That would be nothing to be thankful for. Let's make sure our Thanksgiving plates have some green and yellow veggies and include a glass of milk with our fruit pie for dessert.

Cellini salt cellar makes Most Wanted List

To the right is the famed $55 million gold, ebony and enamel salt cellar created by the noted Renaissance master Benvenuto Cellini. In May 2003, a thief broke into the Kunsthistorisches Museum in Vienna, Austria and made off with this masterpiece of salt art. Last Tuesday, the FBI named the stolen Cellini salt cellar 5th among the top 10 art crimes in history. For more on salt history see the Salt Institute website.

HOW we lose weight (and lower blood pressure) really matters

Last month, the Journal of the American Medical Association published an issue that featured the revelation that gastric bypass (bariatric or stomach stapling) surgery raises the risk of early death “considerably higher than previously suggested.” Those who had their stomachs stapled were promised lower risk of health problems and longer lives because their obesity equated to more adverse health outcomes. Public health campaigns have bombarded us all with the strong message that excess weight is unhealthy. Excess weight is unhealthy. So why didn’t this dramatic surgery that consistently reduces obesity work out as planned? The research addresses the broader question: does everyone who loses weight lower their risks of the adverse outcomes associated with obesity? Or, put another way: does it matter how someone reduces weight or just that they reduce excess weight? But that’s not the question I want to answer. You’ll have to read JAMA for that answer. What I wanted to point out is the strong parallel here with another recommended intervention which, its advocates promise, will reduce health risks, improve health and extend lives. That intervention isn’t bariatric surgery; it’s salt reduction. Consumers are bombarded with public heath messages telling them that cutting back salt will save their lives. Is that true or is it more like stomach stapling? Consider the parallels. A gastric bypass will result in the patient eating less and losing weight. Salt reduction, for a significant minority of the population, will reduce blood pressure. Obesity is strongly correlated with adverse health problems and increased mortality. Elevated blood pressure, likewise, is correlated with increased risk of heart attacks and strokes. The simplistic answers of bariatric surgery or salt reduction rest on the assumption that it makes no difference how a person loses weight or lowers high blood pressure – Just do it! The JAMA papers suggest that this isn’t true for obesity. A dozen papers examining salt intakes and comparing them to health outcomes reach the same conclusion: it matters a great deal how blood pressure is lowered. Salt restricted diets do not reduce adverse health outcomes; in fact, some of the studies show elevated risks, just as the JAMA papers find for stomach stapling. Read more about salt and health on the Salt Institute website.

Salt saves lives on winter roads

“If a car slips on ice, intelligent (roadway) systems could not only inform other drivers but send a notice through the receivers alongside the highways to road crews that salt or sand is needed. Such systems could even be programmed to stop cars before an accident occurs — without driver involvement.” So says GreatestJournal! in a blog post today. That’s true and there’s other good news as well. There are tremendous highway safety benefits inherent in new Intelligent Transportation Systems. Road Weather Information Systems today send road maintenance professionals data on roadway surface conditions from embedded sensors so that salt trucks can deliver their lifesaving service when snow and ice threaten safe driving conditions. More information can be found on the Salt Institute’s website.

Sorting out salt and health issues

Today's Tech Central Station has a great article by author John Luik entitled "A Grain of Salt" that summarizes the ongoing salt and health controversy admirably. Luik points out: "That's why across the board salt reductions such as the MRC and CSPI call for make no scientific sense. Instead, the science, taken in its entirety, suggests that population-wide dietary salt reductions do not improve health outcomes, such as the number of strokes, heart attacks or the risk of premature mortality. In fact for some groups they actually increase certain risks. For example, analysis of the MRFIT (Multiple Risk Factor Intervention Trial), which followed the lives and deaths of 12,866 American males for an average of 12 years, found there were no health benefits from low-sodium diets." It's worth a read. Unfortunately, today's news also includes the assertion that cutting back salt would cut health care costs in Britain by £6 billion, based on assumed reduced incidence of cardiovascular events. In an online response, I pointed out that "Anyone can build a model and project an outcome (£6bn a year), but the model depends on the assumptions of its creators and NHS’ model reflects is the triumph of hope over the realities of the scientific data." I further observed: "Reducing dietary salt is promoted to reduce blood pressure on the assumption that however blood pressure is reduced will lower the risk profile for heart attacks and cardiovascular deaths. That’s where the “savings” NHS projects originate. But there are no data confirming this hope. In fact, only a dozen studies have examined the health outcomes of people on lower sodium diets and they show, if anything, that there is a HIGHER RISK of heart attacks. How can that be? When salt is reduced, the body compensates with other metabolic changes: insulin resistance is increased, sympathetic nervous system activity increases and, most of all, the body secretes vastly more renin, a hormone produced in the kidney that has been shown by the president of the International Society of Hypertension to cause four times more heart attacks."

Fall Colors: Art on the Net

Many artists use salt as their expressive medium. Take, for example, the "Salt Queen," Italian artist (and Long Island dweller) Bettina Werner, Seattle sculptress Pam Gazale, or Jörg Lenzlinger from Switzerland. But this new seasonal artwork is au natural, after a fashion.

Qualified health claims quagmire

Twice in the past two weeks, the Food and Drug Administration has shown why it may have the second toughest and important job in America (after the job of parenting, of course). On November 2, FDA announced its ruling that "there is no credible evidence to support qualified health claims about calcium and breast cancer or calcium and prostate cancer. " Then this week, on November 9, the agency ruled that "there is very limited credible evidence for qualified health claims for tomatoes and/or tomato sauce, and prostate cancer." In short, FDA is denying qualified health claims, not describing them as its rules seemed to promise. Pity the FDA! On the one hand, the public expects approval of life-saving medicines double-quick and food labels that inform but don't mislead consumers. On the other, the courts have ruled against FDA's efforts to prevent food manufacturers from making certain claims about the healthfulness of their products -- "commercial free speech." FDA sought a way to navigate between the Scylla of unrestrained commercial hype and the Charybdis of suffocating hyper-regulation. After the courts invalidated as too restrictive its "health claims" rules for foods with nutrients where "significant scientific agreement" supports a relationship to a "disease or condition," FDA came up with a scheme of "qualified health claims" that manufacturers could make based on FDA's determination about the amount of evidence supporting the claim. So, worst case for a manufacturer, a food would have the right to claim a diet/disease relationship and also be required to carry an FDA warning that there is no evidence to support the claim. With these two decisions, however, FDA seems to have lost its nerve and reverted to denying claims. Rather than require ketchup manufacturers who want to say their product prevents prostate cancer to affix a warning that the scientific evidence for such a claim is very weak, or make sellers of dairy products warn consumers that medical scholars dispute their claims that their high-calcium product cuts the risk of breast cancer or prostate cancer, FDA is denying the claims entirely (or, in the case of tomato products, largely). Preserving the integrity of health claims is virtually a no-win situation. This blog is salt-related. How does this tie in? FDA has yet to consider or approve a health claim that low-salt foods reduce the risk of heart attacks and strokes, though lots of ink is spilled alleging that case. Such a claim about salt and heart attacks, according to my review of the evidence, would have to be judged entirely lacking in scientific support. What is clearly justified in science is the conclusion that "salt is an essential nutrient." Scientific, yes, but politically-incorrect.

Measuring kosher salt

What is it they say about great minds? This morning's Washington Post addresses a topic close to my post last evening -- measuring quantities of table salt. In this case, Robert L. Wolke, professor emeritus of chemistry at the University of Pittsburgh, discusses how to adjust recipe amounts of salt when using the two types of kosher salt available (hint: use 1.5 times as much Morton Kosher Salt and twice as much Diamond Crystal Kosher Salt). And, says Wolke, don't bother using sea salt in cooking; if you use it, add it at the table.

How many jelly beans are in the glass jar?

You've all seen contests where people are asked to guess how many jelly beans are in a glass jar. Amaze your friends with this alternative: Pour a 26 oz. "round can" of salt into a jar and ask your friends to guess how many salt crystals are in the jar. Ever wonder how much a single crystal of table salt weighs? The Salt Institute hadn't given that question a thought until this just-received request arrived. Thanks to Lead Research Chemist Lorrie Ann Fisher of Morton Salt, the world now knows (but your friends may not) that the average weight of a single crystal of table salt is 0.16 milligrams. Thus, a typical 26 oz. "round can" of table salt would contain over four and a half million salt crystals (4,606,800 give or take). Now you know! Bargain? What other crystals can you buy at 10 million for a buck? Put another way, that means the FDA's "Daily Reference Value" (FDA food labels do NOT provide a "daily recommended value") for sodium is more than 37,000 crystals of table salt.

Get a fact-checker!

The nutrition nannies at the gratuitously-self-named Center for Science in the Public Interest are at it again. Denied in court, they today petitioned the FDA to declare that salt should forfeit its "Generally Recognized As Safe" status and that food manufacturers should use less of it in the foods they make. The petition doesn't pass the sniff test. It badly needed a fact-checker. I opened the petition randomly and didnt' have to read beyond the first paragraph to find an error. There were plenty more. But worse, CSPI persists in trying to foist off extrapolations and projections in the place of data. They allege salt is killing 150,000 people a year (nearly four times the number that die in traffic crashes and 75 times more than the number of Americans killed in Iraq since Sadaam's fall). The huge number is a statistical construction based on blood pressure only and ignores the fact that lowering dietary salt has other impacts -- No, not just that the food tastes bad. The other impacts of lowering dietary salt are that it triggers the production of the kidney hormone renin, it activates the sympathetic nervous system and it increases insulin resistance, a key risk factor for diabetes. What we need to look at is the NET EFFECT of lowering dietary sodium. Will it make people healthier or not? If so, then we should address the very real problems of implementing such a change with food manufacturers and try to convince the public to forego their salt. But in the absence of evidence of harm, why expend all these resources? In fact, the evidence shows no benefit and some studies even show people on low-sodium diets suffer more heart attacks and die more often -- not a figure you'll find in the CSPI petition. See the Salt Institute's compilation of the medical studies. For reference: the CSPI petition.

National Journal Blogroll notices Salt Sensibility

Today's National Journal Blogroll features a story about how manufacturers are initiating blogs and mentioning this blog.

Prioritize highway operations, not construction

With extraordinary federal spending requirements for such emergencies as the several devastating hurricanes and the war on terror, Congressional conservatives are trying to constrain discretionary federal spending. This includes rolling back spending authority under the federal highway program alleging “pork” excesses. Congress brought the "pork barrel" charge on itself by directing funding for a massive number of earmarked projects in key Congressional districts. And the SAFETEA-LU law is massive, more than $286 billion over five years – lots of room for hiding spending. As former Illinois Senator Everett Dirksen used to say, “A billion here, a billion there, and pretty soon you're talking about real money.” So balanced budget advocates are lining up with anti-highway environmentalists who complain that highway builders are trying to “pave over America.” While waste is certain (and certain in virtually all federal spending programs), we should be keeping a few facts in mind. We’ve added relatively few lane-miles of highways over the past quarter century while we’ve increased highway usage several orders of magnitude. And, while $286 billion is an enormous amount of money to invest in highways, the Federal Highway Administration says it would take yet another $100 billion -- $374 billion or so over five years – just to maintain the operations of our highways at the same level of safety and congestion. Even spending $286 billion, they calculate, will result in increased congestion because of growing demands of highway users. Most motorists already think congestion is a problem and don't want to see it grow worse. Add in another fact: getting money to build highways is a political winner. Newspaper photos at groundbreakings and ribbon-cuttings and new roads has been a winner since before the days of George Washington. But that doesn't mean a construction priority is the best way to invest our highway dollars. The key point in all this is that we are focused on the wrong problem. Sure, we may need more highways, but we need to be spending a lot more time and attention – and probably dollars – on highway operations, not just construction and maintenance. Credit President Bill Clinton’s DOT and particularly Gloria Jeff, now directing the MI DOT, for orienting the FHWA towards operations. The federal momentum has been maintained by President Bush’s FHWA Office of Operations (http://ops.fhwa.dot.gov). This is the right idea. Let’s measure how well we are doing in moving people and goods safely and reliably from Point A to Point B and if we’ve exhausted our technologies in improving traffic flow, then determine what additional capacity we need to be constructing. These roads are being paid for by highway user fees (the “gas tax”), but highway users are more interested in service levels than in pouring concrete. Yet, in one state DOT after another, it is far easier to get the Legislature to lay out funding to match federal dollars to build new or wider roads and much harder to get authorizations for technologies and programs – like using salt to keep winter roadways safe and passable – that ensure motorists are getting the highest possible service from the roads we’ve already built. It's time we reversed these priorities and implemented an "operations priority."

Inches and miles

In a play on "give 'em an inch and they'll take a mile," this week's media brought news that the level of the Great Salt Lake in Utah is four and a half feet below its historic average. At 4,195.5 feet elevation, the lake covers 1,000 square miles. At its normal level (4,200') the lake is 70% larger, 1,700 square miles. Doing the math, 54" of elevation increases the lake by 700 square miles, so in this case an inch equals about 13 (square) miles. Salt crystals are grown at the point saline water reaches saturation, about 26% salt. A smaller lake, of course, contains the same amount of salt, so with lower lake levels, the salt concentration has increased to the advantage of salt production. But it was only a decade ago that rising levels of the Great Salt Lake threatened rail and highway arteries, flooded saltworks and prompted the state to install two massive pumps to protect against the rising lake levels. Mother Nature has her rhythms.

DASH for health

Today's Washington Post carries a reminder that the DASH Diet, high in fruits, vegetables and dairy products, provides vital potassium to blunt salt-sensitive hypertension. True, as far as it goes. The DASH Diet, released in 1997, promotes a food consumption pattern, although it does clearly make the most striking changes in overcoming mineral deficiencies. Those under-consumed minerals include not only potassium, but also calcium and magnesium. There is strong medical consensus that these essential nutrients are under-consumed in today's diet. The focus here is on blood pressure. When the DASH Diet was announced, the Salt Institute endorsed it strongly, since it focuses properly on enhanced mineral intake; it does not reduce dietary sodium/salt. For example, hypertensive subjects in the DASH Study population reduced their systolic blood pressure (SBP, the top number) by an impressive 11.4 mmHg. In a later study that also featured cutting salt by 60% (it was, after all, only a 30-day study), hypertensive patients on the DASH Diet with this drastically-reduced salt intake reduced their SBP by 11.5 mmHg. Salt restriction in 6 of the 8 subgroups reported (important because the sample represented particularly a salt-sensitive universe) no significant differences of blood pressure even when salt was reduced by more than half for those on the DASH Diet. We should all keep in mind that blood pressure is only one of several relevant health impacts. The key is to understand the net health outcome of any dietary change. As outlined on the Salt Institute website (http://www.saltinstitute.org/28.html), the limited studies on health outcomes of salt-reduced diets show no health benefit because other systems in the body are adversely affected by salt reduction (e.g. insulin resistance, plasma renin activity). So, eat those fruits and veggies -- and dairy products (dairy contributed more than half the blood pressure-lowering effect) -- but don't get too hung up on what our prehistoric ancestors ate. After all, they didn't live long enough to worry about blood pressure.

Consumers confused about health claims

A new FDA report says consumers are confused about the "health claims" made on food labels. FDA's been trying to balance "free speech" for food manufacturers against the problems of misleading advertising. Health claims used to be based on "significant scientific agreement." The courts have held this unfairly restricts free speech. For salt, the only approved health claim is for "sodium and hypertension." FDA's proposal of "qualified health claims" is designed to meet this judicial mandate, but this new report shows FDA still has work to do. For salt, the health claim that I think most justified is "eat salt or die" or something along that line but less dramatic. Salt is a necessary nutrient. All but one of the studies of health outcomes of salt intake -- studies that relate health outcomes like heart attacks or deaths to the amount of salt people eat -- have confirmed that low-salt diets either don't deliver any health benefits or are actually more risky. See http://www.saltinstitute.org/28.html. Unsurprisingly, the public is confused about health claims on food labels. Unfortunately, this will likely lead consumers to devalue nutrition/health advice on food labels much as they currently dismiss the 42 nutrition/health messages in the Dietary Guidelines.

Here we go

Has anyone seen any research on a question that seems it MUST have been studied? While human societies have been consuming the same amount of salt per person for more than a century, advocates of reducing dietary sodium suggest substituting low-salt products for their regular-salt counterparts can be an important strategy to reduce overall salt intakes. But is it so? Has anyone seen any research showing that individuals who choose low-sodium diets consume less total salt? I raised this question in a letter to the British Food Standards Agency a week ago; no answer yet from them. How about someone else?