Is It Time to End the “War on Salt”?

Photo: DaGoaty

The assault on dietary salt has been growing, and salt sales have been trending slightly downward. Is this a good fight?

According to Scientific American, perhaps not:

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.

(HT: Eric Jones)

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  1. Graham says:

    The Nature News take on the meta-analysis is much more balanced:

    Essentially, the authors concluded that reducing salt does indeed lower blood pressure, which would suggest that lowering salt is good for heart disease. However, they were unable to show a relationship between reducing salt intake and lowering heart disease. But this doesn’t mean there is no relationship. It just means more research would need to be done to demonstrate it.

    Science with human subjects is hard.

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    • Neil (SM) says:

      It seems too much research is done with the premise of “lets keep researching until we can prove x,” rather than “lets determine if x or y is true.”

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    • anomdebus says:

      If this were a merely academic discussion, then you are completely on point. However, as it is, there are serious pushes to regulate salt content with no proven relationship between intake and health effects. Since there is also some evidence that too low salt intake can impact health, forcing a low salt diet isn’t necessarily a matter where it would at worse do no harm.

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      • Graham says:

        On that point, I agree. I’ve been fascinated watching how the press covers this story, as it seems journalists don’t know how to report on inconclusive results. But inconclusive results do mean that it would be crazy to start regulating salt as has been proposed, just as it would be crazy for someone with hypertension to start eating an all-bacon diet.

        But since my last comment, I’ve actually gone back to read the paper. Assuming the analysis was correct — I am not a biologist or an MD, so I’m not qualified to judge — then even the relationship between salt and blood pressure is tenuous.

        Given the attention this issue has gotten, it would seem funding should be available for a new larger study to start answering these questions.

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  2. Tom Megginson says:

    I blogged about this 2 years ago:

    My issue with the “war on salt” is that it takes a real public health issue and destroys all credibility for the cause by overstating the dangers. An average, healthy person is not in deadly danger for occasional pizza, pickles, or chips. The real issue is the mass quantities of hidden sodium in processed foods that people at risk of high blood pressure, hypertension or heart disease consume without thinking.

    As a social marketing cause, the anti-salt people make the same mistake as the “War on Drugs” when it implies that smoking a joint will destroy your life. It goes against common sense and experience, and it only hurts the argument when it’s made for the dangers of harder drugs.

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  3. oliver street says:

    Hidden due to low comment rating. Click here to see.

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    • TonyDanzaPervo says:

      This comment makes little sense. There is already a multiplicitive effect between asbestos exposure and cigarette smoking. Smoking, combined with prolonged asbestos exposure, can increase the chance of lung cancer by up to 70 times. Chemicals in tobacco smoke can paralyze cilia movement used to extract particulate from the lung and airways, and the lungs are forced to defend against asbestos fibres, which cannot be broken down by the body, but against tar and particulate from smoking as well.

      As for salt, I believe earlier studies maybe looked past the fact that the obesity rate and number of people with heart disease from a sedentary lifestyle and comsumption of fast food and processed pre-packaged meals which have been a norm in North American life in recent history maybe have more to do with heart disease than salt intake as a single culprit. Salt is a scapegoat for a host of other problems that contribute to heart disease through the lifestyle (or lack there of) in North American households.

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    • Neil (SM) says:

      Cigarettes are the least common denominator in second-hand smoke. The threat of has been greatly overstated to the point of even prohibiting it in some outside areas where exhaust and other fumes are the elephant and cigarette fumes are the mouse of danger to others.

      First-hand smoke, on the other hand, is clearly more damaging to the smoker than all of the above.

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  4. LNS says:

    I agree this research brings into question the paradigm of attacking a public health problem like high blood pressure with a simplistic, overarching recommendation that will by definition be too broad to apply to many patients. Especially in rising health challenges like obesity, diabetes, high blood pressure, etc, the path from correlation to causation is much murkier than the more easily recognized health hazards of tobacco, on which many public health campaigns have been modelled. However, in the medical community it has been understood that some patients are salt-responders, and others are not. Factors of genetics and other demographic traits can help winnow down this population, as can a simple blood test seeing how a patients BP respond to salt intake. Thus, before we end a war- we might be better off starting a counterinsurgency targetted to those patients most likely to benefit from the decreased salt intervention. This is the downside of meta analyses- sometimes the proper subgroups that would benefit from a dietary modification are lost in the data.

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  5. Jonathan Bagley says:

    There are now efforts to portray salt as an addictive drug. See today’s UK Daily Mail.

    Well, why not? Pseudo science worked with passive smoking and, in the UK, the same people have moved on to alcohol and so called “junk food”. Anti this, anti that, anti the idea that somewhere, somebody is enjoying life without fresh air and exercise. All cheeks of the same anti arse.

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  6. Clifton Griffin says:

    I for one am glad everyone has avoided the “grain of salt” pun (except for possibly me, just now).

    If history teaches us anything, it’s that there is rarely a final word on any nutrition issue. Hence the endless ping pong of eggs are bad for you, eggs are good for you, eggs are bad for you, eggs are good for you, ad infinitum.

    As with many things, it seems the safest course is usually “everything in moderation”.

    This years poison may be next year’s fountain of youth. If anything, it’s a pretty darn good reason to not go changing laws all willy nilly. (I’m looking at you NYC)

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  7. Tadpoles says:

    It’s never made sense to me since sodium is so easily excreted in the urine that any increase in salt intake just leads to an almost immediate increase in salt in the urine, so any rise in blood pressure would be very transient.

    The only thing i’ve ever been able to find that seems like a link between salt and the CVD stuff is that possibly some people, after eating salt, have a genetic component that decreases the release of normally blood pressure lowering chemicals.

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  8. James says:

    Oddly enough, a new study* reported in the last few days finds that there is a connection. For myself, I just think food tastes better when I can taste something besides the salt.

    “Sodium and Potassium Intake and Mortality Among US Adults: Prospective Data From…”, Yang et al., Arch Intern Med.2011; 171: 1183-1191. Unfortunately it’s behind a paywall.

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    • RC says:

      That study establishes a link between high sodium/low potassium and heart disease compared to low sodium/high potassium then goes to mention that processed diets provide combination 1 and low processed diets provide combination 2. It does not provide a comparison to a low processed combo 1 or a high processed combo 2, so we do not know if the link is to processed foods and low fruits/vegetables or to the sodium.

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