Salt and Freedom Gang Together

Fairfax looks forward to the good old days, when the government chose what we ate…

The Sydney Morning Herald’s Melissa Davey really doesn’t like salt, writing in Tuesday’s paper:

DIET and exercise campaigns are so ineffective at preventing heart disease that they should be abandoned and replaced with strict regulation of salt levels in food combined with wider medication use, a study has found.

She’s not much of a fan of individual freedom either, letting this clanger go without bothering to quote a single voice on the opposing side:

Heavy-handed food industry regulation by the government combined with more aggressive prescribing of heart drugs would be cheaper and save more lives than lifestyle counselling, she said, because most people found it hard to sustain exercise and diet programs long term.

And here she is again on Saturday:

It seems so simple. If we eat less salt, sugar and fat and start moving more, the lifestyle diseases that plague us – such as heart disease and diabetes – will begin to disappear.

The message is loud and clear, yet when it comes to the decisions we make every day about what to put in our mouths and shopping trolleys, it seems not to be getting through.

The solution? Why, more intervention in peoples’ lives by the caring classes, of course. Her Twitter feed is hardly a bastion of libertarianism either, though she’s got the company line down pat when it comes to her paper’s crashing circulation numbers.

The likes of Davey may pine for the day when the government just writes our shopping lists for us mere citizens who are too damn fool to do it ourselves (good comrades being allowed an extra ration of caviar, surely). But surely anyone who calls themselves a “health reporter” should be aware that the facts on salt are not as cut-and-dried as public health academics might have us believe:

For decades, policy makers have tried and failed to get Americans to eat less salt. In April 2010 the Institute of Medicine urged the U.S. Food and Drug Administration to regulate the amount of salt that food manufacturers put into products; New York City Mayor Michael Bloomberg has already convinced 16 companies to do so voluntarily. But if the U.S. does conquer salt, what will we gain? Bland french fries, for sure. But a healthy nation? Not necessarily.

This week a meta-analysis of seven studies involving a total of 6,250 subjects in the American Journal of Hypertension found no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure. In May European researchers publishing in the Journal of the American Medical Association reported that the less sodium that study subjects excreted in their urine—an excellent measure of prior consumption—the greater their risk was of dying from heart disease. These findings call into question the common wisdom that excess salt is bad for you, but the evidence linking salt to heart disease has always been tenuous …

Scientific tools have become much more precise since then, but the correlation between salt intake and poor health has remained tenuous. Intersalt, a large study published in 1988, compared sodium intake with blood pressure in subjects from 52 international research centers and found no relationship between sodium intake and the prevalence of hypertension. In fact, the population that ate the most salt, about 14 grams a day, had a lower median blood pressure than the population that ate the least, about 7.2 grams a day. In 2004 the Cochrane Collaboration, an international, independent, not-for-profit health care research organization funded in part by the U.S. Department of Health and Human Services, published a review of 11 salt-reduction trials. Over the long-term, low-salt diets, compared to normal diets, decreased systolic blood pressure (the top number in the blood pressure ratio) in healthy people by 1.1 millimeters of mercury (mmHg) and diastolic blood pressure (the bottom number) by 0.6 mmHg. That is like going from 120/80 to 119/79. The review concluded that “intensive interventions, unsuited to primary care or population prevention programs, provide only minimal reductions in blood pressure during long-term trials.” A 2003 Cochrane review of 57 shorter-term trials similarly concluded that “there is little evidence for long-term benefit from reducing salt intake.”

Studies that have explored the direct relationship between salt and heart disease have not fared much better. Among them, a 2006 American Journal of Medicine study compared the reported daily sodium intakes of 78 million Americans to their risk of dying from heart disease over the course of 14 years. It found that the more sodium people ate, the less likely they were to die from heart disease. And a 2007 study published in the European Journal of Epidemiology followed 1,500 older people for five years and found no association between urinary sodium levels and the risk of coronary vascular disease or death. For every study that suggests that salt is unhealthy, another does not.

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