High Intensity Sweeteners - Practical Guidelines
Brenntag
Excess salt can cause hypertension, heart disease, death. That’s the scientific consensus behind public health campaigns to reduce consumption of sodium chloride in the diet. But not everyone reads the science as conclusive, and when it comes to minerals that are essential to human life, the voice of caution must not be drowned out.
Concern over the impact of too much salt weighs heavy on governments, pushing them towards costly public health campaigns. Around the world, salt awareness-raising from the top down is being met by bottom-up action from food manufacturers, who are deeply engrossed in reformulation to reduce the salt in their products.
Bit-by-bit, excess salt is being squeezed out by a combination of education and choice-editing.
But not everyone is convinced salt is all that bad.
Whoa, hang on. That’s a bit of a bombshell. Surely we know this by now? Just last week scientists said 3 grams less salt a day would save 92,000 deaths a year – and $24 billion in health care costs.
Indeed they did. But in the other corner is the salt industry – EU Salt, and the US Salt Institute. They don’t see consensus in the science on salt, as some studies have not found cause for alarm. Rather, regular assessment of intervention outcomes is needed, and a close eye on emerging evidence.
Pah. The salt lobby. Those guys make a living out of pushing sodium chloride, right? Their pockets are lined with the stuff. Remember big tobacco used to tell people that smoking was good for their health?
Sure, it’s important to remember who is behind every message, and what their vested interests could be. History tells us messages can be twisted for personal gain.
But it’s also important to remember that, unlike tobacco, the optimal amount of salt for health is not zero. Humans need some salt to survive. The sodium balances our water and pH levels, and ensures transmission of nerve impulses; chloride helps fight infection, helps digestion and the absorption of potassium, and helps carry carbon dioxide to the lungs.
Salt is not a black and white issue, nor is science always squeaky clean and irrefutable; and some people who work for big companies are actually good guys who would rather you didn’t die prematurely.
It’s not just salt producers who are wary of the demonisation of salt, either. Last week FoodNavigator received feedback from a respected journalist colleague who reached the conclusion, after wading through 140 studies on salt (more than I have, I’ll admit), that the evidence for harm caused by excess salt is not irrefutable.
He believes scientists are caught up in the tide of bidding farewell to salt, and losing all objectivity on the subject, he believes.
Ellie Krieger, dietician and best-selling author, suggests in her So Easy book that people might want to add salt to low-salt foods to improve the taste – although she says the final level would still be below what the food industry would have added, she reckons.
So where do we go from here?
Humans have always eaten salt; it’s the earliest form of food preservation, and without it many billions would have starved or perished from eating rotten meat.
But we do eat more salt today than ever before.
This week is Salt Awareness week. Raising awareness of the current science is a good thing. It’s devilishly difficult to make processed and packaged foods without adding salt, but efforts to reduce levels on the basis of current science are to be lauded too.
Another goal should be to raise awareness of where there is a lack of consensus. There's no need for the pro- and anti-salt lobbies to be at loggerheads.
Jess Halliday is editor of award-winning website FoodNavigator.com. Over the past twelve years she has worked in print, broadcast and online media in both Europe and the United States.
13 comments (Comments are now closed)
Salt is not salt
What people eat is Sodium Chloride, which IS bad for the body, as is refined sugar.
But real unrefined SALT, like the one from the Himalaya with proven 84 elements, is in fact the stuff the body needs.
There are many reports that it actually LOWERS blood pressure, because the body gets all the 84 elements it needs and not just 2 (and take the others from our organism to puffer Sodium and Chloride).
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Posted by Hans Ludwig
08 February 2010 | 12h42
Facts and wild opinions
I find Margaret Wilde’s comments rather instructive. She states that facts rather than opinions are necessary and immediately follows with her own biased opinion of the Salt Institute’s material All this without ever providing a single example or ‘fact’ to back up her assertion. Her entire intervention should be re-read so that readers can see the sort of 'facts' driving this issue.
Any population-wide intervention such as salt-reduction is a very serious matter. You cannot trifle with an entire population’s diet unless everyone agrees that no harm can be done. This is not the case here. The population-wide response to salt reduction is heterogeneous with about 30% of the population (salt-sensitive hypertensives) showing a very small decrease in blood pressure of 2-6mm Hg; another 20-25% of the population show a small RISE in blood pressure and the remaining 50% showing no blood pressure response. So, such an intervention will be an exercise in discrimination. Margaret and anyone else can get the peer-reviewed references describing this phenomenon on the Salt Institute’s website.
It has been repeatedly demonstrated that reductions in salt intakes stimulate the renin-angiotensin-aldosterone system. This increased RAAS activity can cause a cascade of morbidity effects which some authors believe may explain the observed higher incidence of mortality in heart failure patients placed in lower salt diets. Again all these peer-reviewed references can be found on the Salt Institute website.
Since Margaret likes facts, here are a few:
1) The CDC data shows that our cardiovascular disease death rates have plummeted in the last 30 years, without any reduction in salt intake.
2) The world’s most productive and longest lived populations are those that consume the most salt (e.g. Japan, Switzerland, etc.).
3) The world’s lowest salt consumers have the lowest life expectancy (Yanomamo, Xingu, etc.).
4) Residents of the Mediterranean have excellent cardiovascular figures, yet consume very high salt levels (anchovies, olives, capers, salt cod, parmesan, feta, etc.)
Few will dispute that eating a balanced diet, replete with salads and vegetables will go much further in improving overall public health than population-wide salt reduction.
Pursuing an unsubstantiated silver bullet approach to public health is facile and irresponsible and it will be the unsuspecting public that will reap the unintended consequences.
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Posted by Morton Satin
04 February 2010 | 15h03
PS to Dr. Kenney (and Bobbie Hennessy)
As a post script to my comments, I wish to throw down a gauntlet to Dr.
Kenney: Without addressing the fact that no PhD worth his salt (sorry) should have such a closed mind ["The scientific evidence linking added salt to hypertension and more cardiovascular disease is overwhelming. I am sure I have read far more articles than this 'respected journalist'...and can tell you anyone who claims that added salt is not a major killer is the one who is not being objective."], and ignoring your uncalled-for personal slam at Gary Taubes, I'd like to know which and how many studies on sodium and health you've read. I lost count of the ones I've read at more than 140. So far, the results (not the conclusions, which all-too-often conflict 180° with actual results -- again, look at DASH II) fail to show any indisputable connection between salt intake in healthy people and increased risk for disease. The data simply aren't there. I am not paid by any salt lobby; I'm a "lowly" ABD and RD, as well as nutrition journalist who did 4 years bench science in a trace minerals lab. But as such, I look at evidence, not emotion. As my father, a multi-degreed physicist and NASA retiree used to say, any true scientist will refrain from making a definitive statement, that even when asked his/her name, will respond, "According to the data we currently have..."
Perhaps you would like to rephrase your position to be more in line with someone who has respect for the evidence basis of true science.
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Posted by David Feder
02 February 2010 | 17h32
Added salt is harmful to those who are sensitive to salt.
Neither 'consensus' nor 'objectivity' should be the aim. It is facts that are necessary, rather than opinions. The Salt Institute's material I have read over the years is certainly biassed and because of commercial interests cannot be accorded equal credence to that of the so-called anti-salt lobby.
Nonetheless the anti-salt lobby is also selective in its material, viz: it fails to explain that salt sensitivity linked with intake of added salt is a major cause of obesity, nor that scores of prescribed drugs cause sodium and water retention and salt sensitivity leading to morbid obesity and a host of co-morbidities. Some of the anti-salt lobby even shame their claims to be scientists by explaining away children's weight loss from salt reduction as weight lost by being less thirsty and drinking fewer fizzy, calorie-laden drinks, when they assuredly know that this is a perversion of the truth, which is that the weight lost is from fluid loss, not calorie reduction. Obese pet dogs and rabbits will lose weight when their owners cease to feed them salty food and surely no-one is going to claim that their weight loss is because they are drinking fewer bottles of fizzy pop!
If people were told the truth about the causes of obesity and that the safe, sure, fast way to reduce excess weight is to avoid unnecessary prescription drugs, give up dieting and instead cut down on salt and salty food, then improvement in health would be swift indeed.
If you are overweight, lose weight by eating less salt! - Go on! - Try it! - You will feel so much better!
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Posted by Margaret Wilde
02 February 2010 | 17h23
It's about time!
Way to go, Jess! It's about time someone with journalistic integrity and curiosity stepped to the fore to address the fact that the science on salt is not only far from conclusive, but unfortunately and seriously agendized. I have but two critiques: First, you open your article with a scientifically false statement, presenting as fact and foregone something that is far from either. Second, it isn't just the salt industry crying in the wilderness for people to study the issue with greater care: Some of us (former) bench scientists are simply outraged at the astounding lack of ethics displayed by a considerable percentage of the anti-salt movement. (And a look at how intertwined members of AMA, CSPI, WASH, NIH and others are with the non-objective power behind salt demonization would shock any investigative journalist.) The anti-salt lobby has gone through Herculean efforts to both deny voice to any opposing view and to bend and outright manipulate facts -- something easily proven by reading the actual studies. I urge you to compare the results of the oft-cited DASH II with its conclusions. The blatant disregard for its own findings makes for a sterling example of the utter politicization of the science on sodium and health.
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Posted by David Feder
01 February 2010 | 22h15
Interest saving lives has little to do with science
The reason we are concerned with conflict of interest is because it may affect the way we do science and the way we interpret results. If Mrs. Wall would take the trouble to Google my name, she will see that I have spent my career in the food industry and in the developing world in the service of consumers. I was responsible for the first introduction of folic acid into foods in 1977, a full decade before it was made mandatory. I also introduced the first high natural fiber breads in North America in the early '70s that became the pattern for all similar products since. I left senior management in the food industry to join FAO in Rome to devote the rest of my career to developing countries. The passion to be part of the solution continues today - but I admit to a conflict of interest here - I wish many others would so that we can all join in demanding a large scale trial that would settle the question once and for all, rather than hide behind subjective opinions - no matter how lofty - rather than legitimate evidence. Consumers deserve more.
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Posted by Morton Satin
01 February 2010 | 19h07
Interested in saving lives - really a conflict?
What a strange comment from Mort Satin, who, as has been noted, is paid by the salt industry.
Surely it's not that odd that most of the papers exploring the role of salt in health are written by doctors who are trying to treat people suffering from the diseases caused by salt? It's the fact that they have seen the results of salt on our health that makes them want to lend their support to organisations such as WASH. The fact that they're doing themselves out of a job if they succeed in preventing people from developing CVD, cancer, osteoporosis, kidney stones etc etc to me suggests the exact opposite of a conflict of interest!
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Posted by Mrs Wall
01 February 2010 | 18h37
Salt Debates Conflicts of Interest
Meslissa, my real name is Morton Satin and I am the Technical Director of the Salt Institute. But, surely, you believe that if I was actually trying to hide something I would use a pseudonym.
I did not know that commentators were in a habit of publishing their affiliations - indeed there is no room on the Comment form to do so - which is presumably why you did not give yours - which is...? In any event, I am pleased that you did not take any exception to the content of my comments.
I readily admit to a conflict of interest, which is why I specifically pointed to the two meta-analyses that appeared to be written by individuals with no conflicts that I could determine.
WASH is an activist advocacy group - one look at their Salt Awareness Week is all that's necessary to prove this notion. They are little different in their approach than other activist groups such as CPSI (Center for Science in the Public Interest). For example, on the WASH website, http://www.worldactiononsalt.com/health/Salt_and_health/asthma.htm , they continue to mention problems with salt and asthma long after the University of Nottingham dispelled such a notion with their large study. For a long time, before the Nottingham study was completed WASH referred to it as a definitive study. Now that the results did not conform to WASH's expectation, they pretend it doesn't exist - just like they pretend all the other evidence that conflicts with their salt reduction agenda is flawed or does not exist. What a sorry state of affairs for the consumer.
Morton Satin
Technical Director
Salt Institute
Alexandria, VA
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Posted by Morton Satin
01 February 2010 | 18h30
Salt Debate Conflicts of Interest
In all fairness, it should be noted above that Morton Satin (two comments above) is the Director of Technical and and Regulatory Affairs at the Salt Institute. This fact was not mentioned in his post.
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Posted by Melissa Smith
01 February 2010 | 17h35
A choice
Given a choice I'll go for the extra blood pressure pleasure. Have done it for 85 years.
Cut salt, give botulism a chance! It's a more effective killer.
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Posted by hart oldenburg
01 February 2010 | 16h23
The Salt Debate - far more salacious than salubrious
The last few weeks have demonstrated a world-wide coordinated campaign to promote the reduction of salt in the diet, most likely timed to culminate with Salt Awareness Week an international media blitz sponsored by World Action on Salt and Health. The goal of this coordinated effort is to convince the media and the public that there is solid scientific evidence behind the assumption that a population-wide reduction in dietary salt intake will result in significant health improvements for all – this does not appear to be the case and it is likely because there is insufficient evidence that this coordinated extravaganza was undertaken.
The issue is consumed by conflicts of interest. Every salt-reduction advocate accuses the Salt Institute of muddying the waters with their industry 'lobby', while, at the same time, members of the World Action on Salt and Health try to pass themselves off as being objective and, as a consequence, trustworthy. In fact, James Kenny's comment is representative of this type of ‘objectivity’ - he admits to being committed to the benefits of salt reduction and even takes time in his comment to promote his 'course."
Somewhere between 60 - 80% of all papers recommending salt reduction have been authored by members of WASH – which is an activist, advocacy group committed to salt reduction. Yet, none of these authors have ever admitted to any conflict of interest. The chief proponent of salt reduction at the CDC as well as the Chairperson of the Electrolyte subgroup of the US Dietary Guideline Advisory Committee are also listed members of WASH. Motives are not a justification for conflict of interest. It does not matter if someone has a lofty passion to save the world. The moment individuals become committed to a particular point of view, they have lost their objectivity have a conflict of interest. The fact that all WASH authors have refused to admit their conflict of interest when it comes to the impact of salt on health is a clear indication of the quality of their interpretation of the evidence. Their views have to be considered with the same degree of skepticism as those of the Salt Institute – in fact even more skepticism, because they refuse to fess up to their conflict of interest.
The only meta-analyses of all the evidence written by authors with no possible conflicts of interest whatsoever, (the 2003 Cochrane Collaboration review and the 2009 German government IQWIG review) have both concluded that there was not sufficient evidence from medical trails to warrant a population-wide reduction in salt consumption. In addition, in a recent, highly controlled, randomized clinical trial in Italy on congestive heart failure, patients demonstrated that those individuals who were placed on a low salt diet died or were readmitted to hospital in much greater numbers than those who were kept on a regular salt diet. In other words, a low salt diet held much greater risks.
A review of all countries in the WHO Cardiovascular Infobase (which anyone can openly access) indicates that Finland, the only country to have reduced salt significantly, performed the worst of all developed countries in reduction of cardiovascular death rates, over the last 30 years, despite their reduction in salt intake.
A legitimate randomized clinical trial is what is required. Such a trial is the greatest fear of the salt reduction advocates for they know the outcome is unlikely to support their case - which is why they insist on activist tactics to get their way, without the support of a legitimate scientific trial.
The FDA is correct in demonstrating caution here. They did this once before. The FDA delayed the approval of thalidomide use in pregnant women while many other countries rushed ahead with it before all the clinical data was in. This cautionary delay resulted in sparing unspeakable tragedy to the US public. This same course of prudence and vigilance has to be followed here. Britain, Australia and Canada are pursuing salt reduction programs aggressively and we should await the results of their initiatives before doing anything in the USA. Once the data on actual reductions in salt consumptions (reproducible 24 hr Urinary Na) and the resultant impact (cardiovascular metrics to reflect the benefit in salt reduction), we can decide on a path of action. By the way, which metrics are those countries putting into place to measure the impact of population-wide salt reduction? None that I have seen. Typical activist technique – promote a policy, but never check if that policy actually works – this is politics not public health.
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Posted by Morton Satin
01 February 2010 | 15h42
Salt Toxicity
The scientific evidence linking added salt to hypertension and more cardiovascular disease is overwhelming. I am sure I have read far more articles than this "respected journalist" (let me guess Gary Taubes, perhaps?) and can tell you anyone who claims that added salt is not a major killer is the one who is not being objective. Go to foodandhealth.com and click on "CPE" and read my continuing education course for RDs on Hypertension and Salt Toxicity. If you have anyone who offers you a different opinion I'd be happy to tell you why the evidence proves them wrong beyond a reasonable doubt. BTW - May CPE course has been online for many years and have been frustrated for many years by the failure of journalists to realize they were being hoodwinked by the Salt Institute and commercial food industry so it is nice to see the case against added or second hand salt finally being made in the media. Even the CDC and AHA are now telling people to limit salt to less than 1500mg sodium per day. About time.
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Posted by James J. Kenney,PhD, RD, FACN
01 February 2010 | 14h22
The Evidence Is Already There Gentlemen
Anyone who has followed the DASH Study, which came out in the early 90's, but did not start showing up in doctors office until after 2000 can see the RESULTS of this incredible study. So, is there REALLY any doubt about this issue; or is it only a matter of money! It's excess we are going after, not salt in and of itself.
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Posted by Bobbie Hennessy
01 February 2010 | 14h12
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