No bitter battle over salt science

Related tags Salt Sodium chloride

Excess salt can cause hypertension, heart disease, death. That’s the scientific consensus behind public health campaigns to reduce consumption of sodium chloride in the diet. But not everyone reads the science as conclusive, and when it comes to minerals that are essential to human life, the voice of caution must not be drowned out.

Concern over the impact of too much salt weighs heavy on governments, pushing them towards costly public health campaigns. Around the world, salt awareness-raising from the top down is being met by bottom-up action from food manufacturers, who are deeply engrossed in reformulation to reduce the salt in their products.

Bit-by-bit, excess salt is being squeezed out by a combination of education and choice-editing.

But not everyone is convinced salt is all that bad.

Whoa, hang on. That’s a bit of a bombshell. Surely we know this by now? Just last week scientists said 3 grams less salt a day would save 92,000 deaths a year – and $24 billion in health care costs.

Indeed they did. But in the other corner is the salt industry – EU Salt, and the US Salt Institute. They don’t see consensus in the science on salt, as some studies have not found cause for alarm. Rather, regular assessment of intervention outcomes is needed, and a close eye on emerging evidence.

Pah. The salt lobby. Those guys make a living out of pushing sodium chloride, right? Their pockets are lined with the stuff. Remember big tobacco used to tell people that smoking was good for their health?

Sure, it’s important to remember who is behind every message, and what their vested interests could be. History tells us messages can be twisted for personal gain.

But it’s also important to remember that, unlike tobacco, the optimal amount of salt for health is not zero. Humans need some salt to survive. The sodium balances our water and pH levels, and ensures transmission of nerve impulses; chloride helps fight infection, helps digestion and the absorption of potassium, and helps carry carbon dioxide to the lungs.

Salt is not a black and white issue, nor is science always squeaky clean and irrefutable; and some people who work for big companies are actually good guys who would rather you didn’t die prematurely.

It’s not just salt producers who are wary of the demonisation of salt, either. Last week FoodNavigator received feedback from a respected journalist colleague who reached the conclusion, after wading through 140 studies on salt (more than I have, I’ll admit), that the evidence for harm caused by excess salt is not irrefutable.

He believes scientists are caught up in the tide of bidding farewell to salt, and losing all objectivity on the subject, he believes.

Ellie Krieger, dietician and best-selling author, suggests in her So Easy​ book that people might want to add salt to low-salt foods to improve the taste – although she says the final level would still be below what the food industry would have added, she reckons.

So where do we go from here?

Humans have always eaten salt; it’s the earliest form of food preservation, and without it many billions would have starved or perished from eating rotten meat.

But we do eat more salt today than ever before.

This week is Salt Awareness week. Raising awareness of the current science is a good thing. It’s devilishly difficult to make processed and packaged foods without adding salt, but efforts to reduce levels on the basis of current science are to be lauded too.

Another goal should be to raise awareness of where there is a lack of consensus. There's no need for the pro- and anti-salt lobbies to be at loggerheads.

Jess Halliday is editor of award-winning website Over the past twelve years she has worked in print, broadcast and online media in both Europe and the United States.

Related topics Ingredients Editor's Choice

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1 comment

The Salt Debate - far more salacious than salubrious

Posted by Morton Satin,

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, , 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.

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