The Salt Game Continues

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The USDA, FDA and others still say salt is bad.  The CDC just came out and said otherwise.  Search this blog and see where I have been all over this issue before.  Well, here is a small piece in the WSJ that explains the controversy some more:

We were told the science was settled. Yet new research suggests that salt is not nearly as dangerous as the government medical establishment has been proclaiming for many decades—and a low-salt diet may itself be risky. Other than how to season tonight’s dinner, perhaps there’s a lesson here about politics and the scientific method.

The USDA, Food and Drug Administration and other regulators have long instructed eaters to consume no more sodium than 2,300 milligrams a day, or about a teaspoon, well below the U.S. average of 3,400 mgs. The limits are said to reduce the risks of high blood pressure, cardiovascular disease and stroke.

But several related papers in this week’s New England Journal of Medicine undermine these recommendations, and one even speculates that the official targets pose health hazards. In one of the most complete treatments of the subject to date, researchers followed more than 100,000 people world-wide for three and a half years. They found that those who consumed fewer than 3,000 mgs had a 27% higher risk of death or a serious medical event like a heart attack.

The findings are associations, not definitive clinical proof (to the extent there is such a thing). But they add to a growing literature arguing that the evidence that sodium is harmful is weak or nonexistent, including a report last year out of the Institute of Medicine.

If the war on salt was wrongly declared, that may be because diet is inevitably an elusive and ambiguous field given the complexity of human biology. What we know about the body evolves over time. Many theories of food and health are no more than superstition, so any nutrition advice that is more specific than moderation and more vegetables ought to be taken with a grain of—well, you know.

Yet the latest USDA food pyramid, which was updated as recently as 2011, clings to simplistic low-salt pseudo-science. The FDA is pressuring food manufacturers and restaurants to remove salt from their recipes and menus, while the public health lobby is still urging the agency to go further and regulate NaCl as if it were a poison.

The larger point is that no scientific enterprise is static, and political claims that some line of inquiry is over and “settled” are usually good indications that real debate and uncertainty are aboil. In medicine in particular, the illusion that science can provide some objective answer that applies to everyone—how much salt to eat, how and how often to screen for cancer, even whom to treat with cholesterol-lowering drugs, and so on—is a special danger.

Government regulation often can lock in bad advice and practices and never changes as quickly as the evidence evolves. So be glad the salt debate continues.

Now my two cents.  Maybe it isn’t the salt. Maybe it is the process food that it comes with?  You know, the crappy convenience or supermarket food that comes with over 20 ingredients and full of simple carbs?  Maybe, the researchers could open their eyes to that.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “The Salt Game Continues

  1. Kurt
    September 4, 2014 at 3:06 pm

    I wish you would put this to bed. I’ve seen plenty of people who go into florrid heart failure, retain fluid and get into beaucoup trouble with salt. If they are one of that kind, they need to stay away from it. I’ve seen one person who had “side effects” from “every” anti-hypertesive tried but achieved 120/80 when she chucked the salt. It CAN cause trouble period. Those that can get away with it, aren’t going to be showing up in the office anyways!

    • T Newberry
      September 5, 2014 at 12:44 pm

      I doubt it. According to the CDC only about 11% of sodium intake comes from the salt shaker – a little less than the amount that naturally occurs in food. The rest comes from packaged and restaurant food – and NOT primarily in the form of salt. Avoiding salt won’t change much. Besides, it CAN cause trouble for SOME people. So EVERYONE needs to avoid it?

  2. T Newberry
    September 3, 2014 at 9:11 am

    Hear, hear Doug! It is interesting that in the part of the article you quoted they only use the word sodium twice. They use the word “salt” five times (plus NaCl once). According to Subway’s website, here are the forms of sodium they use in the Sweet Onion Chicken Teriyaki sandwich:

    Salt
    Sodium Acid Pyrophosphate
    Disodium Inosonate
    Disodium Guanylate
    Sodium Propionate
    Sodium Bicarbonate
    Calcium Disodium
    Sodium Benzoate
    Sodium Phosphates

    This is typical of the way food is engineered today. Even if sodium is a problem, it sure doesn’t look like it’s the salt.

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