The Salt Debate - far more salacious than salubrious
The last few weeks have demonstrated a world-wide coordinated campaign to promote the reduction of salt in the diet, most likely timed to culminate with Salt Awareness Week an international media blitz sponsored by World Action on Salt and Health. The goal of this coordinated effort is to convince the media and the public that there is solid scientific evidence behind the assumption that a population-wide reduction in dietary salt intake will result in significant health improvements for all – this does not appear to be the case and it is likely because there is insufficient evidence that this coordinated extravaganza was undertaken.
The issue is consumed by conflicts of interest. Every salt-reduction advocate accuses the Salt Institute of muddying the waters with their industry 'lobby', while, at the same time, members of the World Action on Salt and Health try to pass themselves off as being objective and, as a consequence, trustworthy.
Somewhere between 60 - 80% of all papers recommending salt reduction have been authored by members of WASH – which is an activist, advocacy group committed to salt reduction. Yet, none of these authors have ever admitted to any conflict of interest. The chief proponent of salt reduction at the CDC as well as the Chairperson of the Electrolyte subgroup of the US Dietary Guideline Advisory Committee are also listed members of WASH. Motives are not a justification for conflict of interest. It does not matter if someone has a lofty passion to save the world. The moment individuals become committed to a particular point of view, they have lost their objectivity have a conflict of interest. The fact that all WASH authors have refused to admit their conflict of interest when it comes to the impact of salt on health is a clear indication of the quality of their interpretation of the evidence. Their views have to be considered with the same degree of skepticism as those of the Salt Institute – in fact even more skepticism, because they refuse to fess up to their conflict of interest.
One look at their Salt Awareness Week is all that's necessary to prove the notion that WASH is an activist advocacy group. They are little different in their approach than other activist groups such as CPSI (Center for Science in the Public Interest). For example, on the WASH website, http://www.worldactiononsalt.com/health/Salt_and_health/asthma.htm , they continue to mention problems with salt and asthma long after the University of Nottingham dispelled such a notion with their large study. For a long time, before the Nottingham study was completed WASH referred to it as a definitive study. Now that the results did not conform to WASH's expectation, they pretend it doesn't exist - just like they pretend all the other evidence that conflicts with their salt reduction agenda is flawed or does not exist.
The only meta-analyses of all the evidence written by authors with no possible conflicts of interest whatsoever, (the 2003 Cochrane Collaboration review and the 2009 German government IQWIG review) have both concluded that there was not sufficient evidence from medical trails to warrant a population-wide reduction in salt consumption. In addition, in a recent, highly controlled, randomized clinical trial in Italy on congestive heart failure, patients demonstrated that those individuals who were placed on a low salt diet died or were readmitted to hospital in much greater numbers than those who were kept on a regular salt diet. In other words, a low salt diet held much greater risks.
A review of all countries in the WHO Cardiovascular Infobase (which anyone can openly access) indicates that Finland, the only country to have reduced salt significantly, performed the worst of all developed countries in reduction of cardiovascular death rates, over the last 30 years, despite their reduction in salt intake.
A legitimate randomized clinical trial is what is required. Such a trial is the greatest fear of the salt reduction advocates for they know the outcome is unlikely to support their case - which is why they insist on activist tactics to get their way, without the support of a legitimate scientific trial.
The FDA is correct in demonstrating caution here. They did this once before. The FDA delayed the approval of thalidomide use in pregnant women while many other countries rushed ahead with it before all the clinical data was in. This cautionary delay resulted in sparing unspeakable tragedy to the US public. This same course of prudence and vigilance has to be followed here. Britain, Australia and Canada are pursuing salt reduction programs aggressively and we should await the results of their initiatives before doing anything in the USA. Once the data on actual reductions in salt consumptions (reproducible 24 hr Urinary Na) and the resultant impact (cardiovascular metrics to reflect the benefit in salt reduction), we can decide on a path of action. By the way, which metrics are those countries putting into place to measure the impact of population-wide salt reduction? None that I have seen. Typical activist technique – promote a policy, but never check if that policy actually works – this is politics not public health.
Posted by Morton Satin 01 February 2010 | 18h44
Please fill in the box below to tell us why you feel the post breaks our rules. When you are finished, click on "Send" so that it can be reviewed by a moderator.
The Salt Debate - far more salacious than salubrious
The last few weeks have demonstrated a world-wide coordinated campaign to promote the reduction of salt in the diet, most likely timed to culminate with Salt Awareness Week an international media blitz sponsored by World Action on Salt and Health. The goal of this coordinated effort is to convince the media and the public that there is solid scientific evidence behind the assumption that a population-wide reduction in dietary salt intake will result in significant health improvements for all – this does not appear to be the case and it is likely because there is insufficient evidence that this coordinated extravaganza was undertaken.
The issue is consumed by conflicts of interest. Every salt-reduction advocate accuses the Salt Institute of muddying the waters with their industry 'lobby', while, at the same time, members of the World Action on Salt and Health try to pass themselves off as being objective and, as a consequence, trustworthy.
Somewhere between 60 - 80% of all papers recommending salt reduction have been authored by members of WASH – which is an activist, advocacy group committed to salt reduction. Yet, none of these authors have ever admitted to any conflict of interest. The chief proponent of salt reduction at the CDC as well as the Chairperson of the Electrolyte subgroup of the US Dietary Guideline Advisory Committee are also listed members of WASH. Motives are not a justification for conflict of interest. It does not matter if someone has a lofty passion to save the world. The moment individuals become committed to a particular point of view, they have lost their objectivity have a conflict of interest. The fact that all WASH authors have refused to admit their conflict of interest when it comes to the impact of salt on health is a clear indication of the quality of their interpretation of the evidence. Their views have to be considered with the same degree of skepticism as those of the Salt Institute – in fact even more skepticism, because they refuse to fess up to their conflict of interest.
One look at their Salt Awareness Week is all that's necessary to prove the notion that WASH is an activist advocacy group. They are little different in their approach than other activist groups such as CPSI (Center for Science in the Public Interest). For example, on the WASH website, http://www.worldactiononsalt.com/health/Salt_and_health/asthma.htm , they continue to mention problems with salt and asthma long after the University of Nottingham dispelled such a notion with their large study. For a long time, before the Nottingham study was completed WASH referred to it as a definitive study. Now that the results did not conform to WASH's expectation, they pretend it doesn't exist - just like they pretend all the other evidence that conflicts with their salt reduction agenda is flawed or does not exist.
The only meta-analyses of all the evidence written by authors with no possible conflicts of interest whatsoever, (the 2003 Cochrane Collaboration review and the 2009 German government IQWIG review) have both concluded that there was not sufficient evidence from medical trails to warrant a population-wide reduction in salt consumption. In addition, in a recent, highly controlled, randomized clinical trial in Italy on congestive heart failure, patients demonstrated that those individuals who were placed on a low salt diet died or were readmitted to hospital in much greater numbers than those who were kept on a regular salt diet. In other words, a low salt diet held much greater risks.
A review of all countries in the WHO Cardiovascular Infobase (which anyone can openly access) indicates that Finland, the only country to have reduced salt significantly, performed the worst of all developed countries in reduction of cardiovascular death rates, over the last 30 years, despite their reduction in salt intake.
A legitimate randomized clinical trial is what is required. Such a trial is the greatest fear of the salt reduction advocates for they know the outcome is unlikely to support their case - which is why they insist on activist tactics to get their way, without the support of a legitimate scientific trial.
The FDA is correct in demonstrating caution here. They did this once before. The FDA delayed the approval of thalidomide use in pregnant women while many other countries rushed ahead with it before all the clinical data was in. This cautionary delay resulted in sparing unspeakable tragedy to the US public. This same course of prudence and vigilance has to be followed here. Britain, Australia and Canada are pursuing salt reduction programs aggressively and we should await the results of their initiatives before doing anything in the USA. Once the data on actual reductions in salt consumptions (reproducible 24 hr Urinary Na) and the resultant impact (cardiovascular metrics to reflect the benefit in salt reduction), we can decide on a path of action. By the way, which metrics are those countries putting into place to measure the impact of population-wide salt reduction? None that I have seen. Typical activist technique – promote a policy, but never check if that policy actually works – this is politics not public health.
Posted by Morton Satin
01 February 2010 | 18h44