Tuesday, April 20, 2010

"It is a true saying that a man must eat a peck of salt with his friend before he knows him." Miguel de Cervantes, 'Don Quixote'

Today, a red flag went up when I read this on the HHS web site: using $15M in stimulus funds "NYC will also work to set policies and create environments that reduce consumption of sugar-sweetened beverages and overly salted foods". Additionally, the FDA is considering regulating the amount of salt that can be added to processed foods like canned foods, cereal, and cheese, as well as the amount used in restaurants. I'm a registered dietitian and health and nutrition is my passion - logically I would support this. "So," you ask, "why the red flag?"

Well I'm also a self-proclaimed "foodie." And I like salt. A lot. Don't get me wrong - I'm aware of what happens when you eat too much of it (e.g. high blood pressure combined with obesity may lead to heart attacks, strokes, etc.) and I'm actually very salt-sensitive (I still blame Panera's soup for my "water-weight" gain during pregnancy). But since discovering Kosher and sea salt I've become a better cook, not to mention the umami factor in soy sauce. Salt is a flavor enhancer; food with salt just tastes better.

So it rubs me the wrong way when someone who doesn't know me wants to decide how much salt I can consume. And who decides what is "overly salted"? I'm in great health; I work out, eat a variety of foods and actually have very low blood pressure. Shouldn't I be exempt from salt restrictions? Shouldn't I be able to make that decision for myself, knowing the state of my health? And even if I was in poor health but my dying wish was to eat salty french fries, shouldn't I have that right? I recall, while working in a nursing home as a dietetic intern, the bland, tasteless, low sodium food that was served to residents who had deteriorating health conditions. Food is a simple pleasure and these folks, when faced with death, couldn't even enjoy that - it was out of their control. The food was beyond uninspiring.

Admittedly, I don't eat a lot of processed foods and that is really where these policies will have an impact. I am not going to preach about the demerits of processed and fast foods - I think people should have access to whatever food is available. I think we are lucky to have foods of convenience and so many choices (with salt and without). My job, as an RD, is to provide science-based education about nutrition and let people make their own choices accordingly. Interestingly, there is some doubt that the science backs up such policies. Dr. Michael Alderman was quoted in a recent Heartwire article as having some doubts that limiting sodium intake is the magic fix to the high blood pressure issues facing the U.S.:

"My stance is based on what I see of the science of the issue," he told heartwire. He argues that although there is no doubt that reducing sodium intake reduces blood pressure, salt also has a myriad of other biological effects. The clinical-trial evidence that reducing salt actually affects hard outcomes such as heart attacks and strokes "is all over the place; the whole thing is kind of a mess," he says. "Advocates of salt reduction believe the only thing that matters is the BP effect, but skeptics like me say, 'Wow, that's a stretch.' "

He maintains that a US policy to slash sodium intake at the population level would be "an experiment" and that there is no way of knowing whether it would be beneficial or indeed harmful: "There are many very committed, well-meaning, and zealous partisans for people's health who say, 'Let's go ahead and try it, let's get everyone to lower their sodium intake. We can't be sure what's going to happen—we don't have any direct evidence—but we are so firmly convinced that the BP effect will rule all that we will go ahead and do this,' " he continues. "This strikes me as kind of rash and is based on a firm belief in something that hasn't been proven.

"In folks with a diet like that in the US, there are some studies that show an inverse association—less salt, more heart attacks—so the data are conflicting, and it's a problem," he states. He was involved in some of the analyses he refers to, however, and they have attracted some criticism with regard to methodology.

The article continues to say the Finland has reduced incidents of stroke and heart attack through policies limiting salt. And while I have no doubt that consuming less salt could be beneficial for many Americans, the looming question is: do we need someone else to make that decision for us? And, if a decrease in salt is mandated, what's next? Where do we draw the line?

"With all thine offerings thou shalt offer salt."
Moses, Leviticus

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