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|Salt: Right Question, Wrong Answer|
Richard L. Hanneman, president of the Salt Institute, issued the following response statement to release February 24 of a report on salt by the Center for Science in the Public Interest:
“Mr. Jacobson’s conclusions represent his viewpoint, not science. His report fails the sniff test: it hasn’t been peer reviewed or published.
“That said, however, CSPI’s focus on whether the amount of salt we eat matters to our health is the right question. CSPI, however, has the wrong answer to the question. It’s right to ask whether cutting back salt will save lives. The government has been ducking that question for years, refusing to conduct a randomized clinical trial to provide evidence on this point. We know salt affects blood pressure: for some people cutting back salt lowers blood pressure; for others, it raises blood pressure. We also know reducing salt also adversely affects hormone systems, our nervous systems and our sensitivity to insulin. It is the total effect of these impacts that determines the number of heart attacks. You can’t just assume that projected blood pressure falls will net a health benefit. We need the data from a clinical trial.
“In fact, the only evidence we have is from observational studies. There are no clinical trials at all. And, worldwide, there have been only a dozen observational studies reported. Eleven of the twelve show just the opposite of what Mr. Jacobson is saying. None of these eleven studies shows improved rates of heart attacks or strokes on low salt diets; three, in fact, show just the opposite â low-salt diets have higher risks of heart attacks. The twelfth study just came out and was done in Japan where the 'low salt' group actually consumed more salt than the average American. I haven’t had a chance to study it in detail yet, but its stated conclusions support Mr. Jacobson’s claim. But what about the other eleven studies? Many of the other eleven studies are quite large studies and none of them could find a population benefit in reducing dietary sodium.
“Mr. Jacobson says that diets too high in salt are responsible for 150,000 premature deaths each year in the United States. There is no evidence supporting this claim. In fact, the American Heart Association says 150,000 is exactly the total number of all Americans under age 65 who die of cardiovascular disease every year. Is Mr. Jacobson alleging all of them died from salt? Or is he saying the American Heart Association is wrong?
“This allegation is sophistry, pure and simple. It is based on a hidden assumption to tie together two well-known facts. First, we’ve known for 4,000 years that salt is an important factor in blood pressure, and, persuasive evidence shows that a two-thirds reduction in dietary salt will reduce average blood pressures by a few millimeters of pressure. And, second, we’ve known for much of the last century that populations with lower average blood pressure, even a few millimeters, have lower incidence of heart attacks and strokes. But that doesn’t mean that reducing dietary salt would lower the incidence of heart attacks. Perhaps it would. But perhaps other known cardiovascular factors such as the impacts of lowering dietary salt on the kidney hormone renin or on insulin sensitivity or on sympathetic nervous system response will cancel out the blood pressure effect. That is a question that deserves a clinical trial and that clinical trial has never been done.
“Let’s look at the evidence. It’s easy to make bombastic charges. Where’s the beef? We invite Mr. Jacobson to join with us in demanding the government conduct a randomized controlled trial of the cardiovascular outcomes of sodium reduction.”
Citations for the twelve studies are provided on the Salt Institute website at www.saltinstitute.org/healthrisk.html. For further background, see www.saltinstitute.org/28.html.
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