Science Guardian

Times exposes industry’s ploys to keep America salt-smitten

The cure: home cooking, sea salt, 2/3 tsp daily

But are the salt police scientifically correct?

A knockout piece about salt today (Sun May 30 2010) on the ever more investigative New York Times’ front page – The Hard Sell on Salt by Michael Moss – showing how intensely the salt industry is fighting to keep plenty of salt in the American diet, despite its proven depredations in the form of high blood pressure, heart attack and stroke.

Their solution: people can eat less, period.

That might be what they indeed have to do, since most (80%) of the salt Americans swallow is added to processed foods:

“Salt is a pretty amazing compound,” Alton Brown, a Food Network star, gushes in a Cargill video called Salt 101. “So make sure you have plenty of salt in your kitchen at all times.”

The campaign by Cargill, which both produces and uses salt, promotes salt as “life enhancing” and suggests sprinkling it on foods as varied as chocolate cookies, fresh fruit, ice cream and even coffee. “You might be surprised,” Mr. Brown says, “by what foods are enhanced by its briny kiss.”

By all appearances, this is a moment of reckoning for salt. High blood pressure is rising among adults and children. Government health experts estimate that deep cuts in salt consumption could save 150,000 lives a year.

Since processed foods account for most of the salt in the American diet, national health officials, Mayor Michael R. Bloomberg of New York and Michelle Obama are urging food companies to greatly reduce their use of salt. Last month, the Institute of Medicine went further, urging the government to force companies to do so.

But the industry is working overtly and behind the scenes to fend off these attacks, using a shifting set of tactics that have defeated similar efforts for 30 years, records and interviews show. Industry insiders call the strategy “delay and divert” and say companies have a powerful incentive to fight back: they crave salt as a low-cost way to create tastes and textures. Doing without it risks losing customers, and replacing it with more expensive ingredients risks losing profits.

Scientific prescription: 2/3rds teaspoon daily if at risk

The science of salt is simple enough. The body needs a balance between potassium and sodium, with more potassium than sodium. The current balance for too many people is more sodium than potassium, mostly in the form of sodium chloride, common salt.

Normal intake should be around one teaspoon (2 grams) of salt, give or take half a teaspoon. But for thirty years the typical American has been using more, sometimes up to ten times that amount, mostly unwittingly. Currently the average adult figure is 3.5 grams daily, just about the world wide average according to the industry Salt Institute’s quite informative page Food, Salt and Health.

The Institute of Medicine recommends a teaspoon and a half as optimal. The CDC says 145 million US adults (69 per cent) are now oversensitive to salt – those with high blood pressure, African-Americans and everyone older than 40 – who typically use 3.4 grams daily. Only 1 in 10 restrict themselves to 2/3rds of a teaspoon of salt a day, 1.5 grams, which is what they should do to avoid heart attacks and strokes.

Unfortunately, with the taste and texture of so much manufactured food heavily dependent on its added salt all this will be hard to reverse as long as American tastes lean toward the appalling rubbish – sorry, nutritionally low caliber snacks – many are used to enjoying.

The power that salt holds over processed foods can be seen in an American snack icon, the Cheez-It.

At the company’s laboratories in Battle Creek, Mich., a Kellogg vice president and food scientist, John Kepplinger, ticked off the ways salt makes its little square cracker work.

Salt sprinkled on top gives the tongue a quick buzz. More salt in the cheese adds crunch. Still more in the dough blocks the tang that develops during fermentation. In all, a generous cup of Cheez-Its delivers one-third of the daily amount of sodium recommended for most Americans.

As a demonstration, Kellogg prepared some of its biggest sellers with most of the salt removed. The Cheez-It fell apart in surprising ways. The golden yellow hue faded. The crackers became sticky when chewed, and the mash packed onto the teeth. The taste was not merely bland but medicinal.

“I really get the bitter on that,” the company’s spokeswoman, J. Adaire Putnam, said with a wince as she watched Mr. Kepplinger struggle to swallow.

They moved on to Corn Flakes. Without salt the cereal tasted metallic. The Eggo waffles evoked stale straw. The butter flavor in the Keebler Light Buttery Crackers, which have no actual butter, simply disappeared.

“Salt really changes the way that your tongue will taste the product,” Mr. Kepplinger said. “You make one little change and something that was a complementary flavor now starts to stand out and become objectionable.”

Moving the goalposts

High blood pressure is an increasing concern worldwide and more recently the level of blood pressure considered healthy was lowered. As Jane Brody wrote last September, in Too Much Salt Takes a Blood-Pressure Toll ,

Once, the prevailing medical opinion was that lowering an elevated blood pressure was hazardous because it would deprive a person’s vital organs of an adequate blood supply. But a few pioneering medical researchers thought otherwise and eventually showed that lowering high blood pressure could prevent heart attacks, heart failure, strokes and kidney disease — and save lives.

Even then, it was long thought that the only important indicator was diastolic pressure — the bottom number, representing the pressure in arteries between heartbeats. Further studies showed that the larger top number, systolic pressure, representing arterial pressure when the heart beats, was also medically important.

And as the various studies reached fruition, it became apparent that the long-accepted numbers for desirable blood pressure were too high to protect long-term health.

Now the upper limit of normal blood pressure is listed as 120 over 80; anyone with a pressure of 140 over 90 or higher is considered hypertensive. Those with pressures in between are considered prehypertensive and should take steps to bring blood pressure down or, at least, prevent it from rising more.

The change mirrors what happened with serum cholesterol, for which “normal” was once listed as 240 milligrams per deciliter of blood and is now less than 200 to prevent heart disease caused by clogged arteries.

It was also long thought that blood pressure naturally rises with age. Indeed, the Framingham Heart Study showed that when 65-year-old people whose blood pressure was below 140 over 90 were followed for 20 years, about 90 percent of them became hypertensive because their arteries narrowed and stiffened with age, causing blood to push harder against artery walls.

But in many societies where obesity is rare, activity levels are high and salt intake is low, blood pressure remains low throughout life. This is the best clue we have for the lifestyle changes needed to prevent illness and premature death caused by hypertension.

Back to home cooking

The simple solution to all this is to prepare properly nourishing and tasty real food at home, such as potassium rich fruit and vegetables, added to buffalo or other lean meat, fish and chicken prepared from scratch, organic if possible. Walking a few miles a day helps too.

Dr. Claude Lenfant, who served as director of the National Heart, Lung and Blood Institute, is now 81 and has a blood pressure of 115 over 60, a level rarely found among older Americans not taking medication for hypertension. His secret: a normal body weight, four or more miles of walking daily, and no salt used to prepare his meals, most of which are made from scratch at home.

In an interview, Dr. Lenfant, who now lives in Vancouver, Wash., said the problem of hypertension was rising all around the world and added that by 2020 the number of people with uncontrolled hypertension was projected to rise 65 percent. One reason is that doctors today are more likely to diagnose the problem, so it is reported more often in population surveys. “But I’m much more concerned about the fact that so much high blood pressure is not controlled,” he said, and called “therapeutic inertia” an important reason.

It is not enough for doctors to write a prescription and tell patients to return for a check-up in six months, he said. Rather, a working partnership between health care professionals and patients is needed to encourage people to monitor their pressure, adopt protective habits and continue to take medication that effectively lowers pressure.

Of course, many people nowadays do not know how to cook even a boiled egg, so this may not be feasible without forced retraining.

But if you do this, you won’t have any problem with salt. We have this on the best authority (the live in critic at SG HQ). But there are many more details in the Times article which should be pored over, if the whole situation is to be fully understood.

The picture it draws of the endless wriggling of the industry to get out of its plain duty to reduce salt in its food processing is marvelous to watch.

Back in the 1980s, some companies began offering low-sodium products, but few sold well. Surveys by the Center for Science in the Public Interest have found little change in salt levels in processed foods.

Sugar and fat had overtaken salt as the major concern in processed foods by the 1990s, fueling the “healthy” foods market. When the F.D.A. pressured companies to reduce salt in those products, the industry said that doing so would ruin the taste of the foods already low in sugar and fat. The government backed off.

“We were trying to balance the public health need with what we understood to be the public acceptability,” said William K. Hubbard, a top agency official at the time who now advises an industry-supported advocacy group. “Common sense tells you if you take it down too low and people don’t buy, you have not done something good.”

Science provides a loophole

But are they wrong? When the scientific studies are sifted, it does seem that reducing salt intake does not reliably improve health even as it reduces blood pressure – the latter effect established since 2001 (Study: Reducing salt really does lower blood pressure).

As one of the few science reporters who takes official pronouncements with a pinch of salt, John Tierney, pointed out in the Times in February, there is plenty of room for skepticism here, however doubtful the motivations of industry might be in promoting it. In When It Comes to Salt, No Rights or Wrongs. Yet. he was able to note the following:

Suppose, as some experts advise, that the new national dietary guidelines due this spring will lower the recommended level of salt. Suppose further that public health officials in New York and Washington succeed in forcing food companies to use less salt. What would be the effect?

A) More than 44,000 deaths would be prevented annually (as estimated recently in The New England Journal of Medicine).

B) About 150,000 deaths per year would be prevented annually (as estimated by the New York City Department of Health and Mental Hygiene).

C) Hundreds of millions of people would be subjected to an experiment with unpredictable and possibly adverse effects (as argued recently in The Journal of the American Medical Association).

D) Not much one way or the other.

E) Americans would get even fatter than they are today.

Don’t worry, there’s no wrong answer, at least not yet. That’s the beauty of the salt debate: there’s so little reliable evidence that you can imagine just about any outcome. For all the talk about the growing menace of sodium in packaged foods, experts aren’t even sure that Americans today are eating more salt than they used to…….

In other words, if you do get people to try to reduce salt intake, they may not succeed. But worse, while it may reduce blood pressure, this may involve other consequences which are not necessarily so beneficial.

The salt solution

But even if people could be induced to eat less salt, would they end up better off? The estimates about all the lives to be saved are just extrapolations based on the presumed benefits of lower blood pressure.

(Tierney again:) If you track how many strokes and heart attacks are suffered by people on low-salt diets, the results aren’t nearly as neat or encouraging, as noted recently in JAMA (Reducing Dietary Sodium : The Case for Caution by Michael H. Alderman, MD – JAMA. 2010;303(5):448-449) by Michael H. Alderman, a hypertension expert at Albert Einstein College of Medicine. A low-salt diet was associated with better clinical outcomes in only 5 of the 11 studies he considered; in the rest, the people on the low-salt diet fared either the same or worse.

As the JAMA abstract puts it:

Authoritative recommendations, sometimes sanctioned by government, routinely call for reduced dietary sodium. However, when the strength of evidence is made explicit, it is generally acknowledged to be opinion or common “practice.”1 Advocates contend that the recommendation is justified because sodium restriction has been convincingly proven to lower blood pressure and that this will surely prevent stroke and myocardial infarction. Skeptics argue that modification of this single surrogate end point does not guarantee a health benefit as measured by morbidity or mortality. Instead, they note that salt restriction capable of reducing blood pressure also unfavorably affects other cardiovascular disease surrogates.

Diet is a complicated factor involving a multitude of interrelating nutrients. Genetic, behavioral, and environmental factors determine wide interindividual variation in sodium intake compatible with good health (end abstract).

Tierney continues:

“When you reduce salt,” Dr. Alderman said, “you reduce blood pressure, but there can also be other adverse and unintended consequences. As more data have accumulated, it’s less and less supportive of the case for salt reduction, but the advocates seem more determined than ever to change policy.

Before changing public policy, Dr. Alderman and Dr. McCarron suggest trying something new: a rigorous test of the low-salt diet in a randomized clinical trial. That proposal is rejected by the salt reformers as too time-consuming and expensive. But when you contemplate the potential costs of another public health debacle like the anti-fat campaign, a clinical trial can start to look cheap.”

So all in all, it seems that all the wise really need do is simply avoid processed foods for this and other nutritional reasons, stay with home cooking and add sea salt to taste.

This may involve unintended consequences of a benign nature, of course, such as stowing the Blackberry and switching off the screen and actually talking to the spouse and kids.

ADDENDUM: :

To heck with the food police! Here’s a mildly amusing Time piece on America’s most outrageously non PC burger:

Hold the Bun by Joel Stein on the KC Bunless Burger

My first bite of KFC’s Double Down made me question why I ever used bread for sandwiches. By replacing the bun with two fried chicken breasts and putting bacon, cheese and glorified Thousand Island dressing in between, this culinary invention made me feel, for perhaps the first time in my sandwich-eating life, completely free — my fingers greasy, my mouth a mess, my testosterone pumping like Henry VIII eating a turkey leg and demanding a new wife to behead. It inspired me to plan a whole diet of breadless sandwiches: a hamburger that consists of two meat patties and an inner layer of condiments; a BLT that packs lettuce and tomato between crisscrossed pieces of bacon; a pastrami sandwich that entails my just shoving pastrami in my mouth…..

Tests at Mt Sinai counter current theory

Civility breaks out among surprised Beethoven experts

Would that HIV?AIDS, cancer and other fields of scientific inquiry could learn that lesson

James Barron in the New York Times today (May 29 Saturday) in Beethoven May Not Have Died of Lead Poisoning, After All reveals that Andrew C. Todd, a lead poisoning expert at Mt Sinai hospital on the Upper East Side of Manhattan, has tested two skull fragments from Beethoven’s grave and found that the larger piece had only 13 micrograms of lead per gram, about average for a man of 56.

So although the smaller piece had more lead (48 micrograms) Todd appears to have toppled the long standing paradigm that his death in 1827 was due to lead poisoning, or at least called it into question.

Beethoven’s miserable ill health at the close of his life and the considerable pain he recorded in his letters (added to by the doctors who poured hot oil into his ears and drained fluid from his abdomen) were put down to lead poisoning after the lead content of his hair (click this link for technical discussion) and skull was found to be well above normal in tests thirteen and five years ago, at up to one hundred times the levels of modern urban man.

Scientists began speculating about what really killed Ludwig van Beethoven almost as soon as he was buried in 1827. He had complained of a “wretched existence,” with a long list of symptoms: abdominal pain, digestive trouble, colic, chronic bronchitis, foul body odors and extremely bad breath. And of course there was the hearing problem.

Thirteen years ago scientists, including one who had investigated whether Napoleon died of arsenic poisoning and whether the paint on the Shroud of Turin dated to the time of Jesus, tested strands of Beethoven’s hair and ruled out syphilis as the cause of death. Unexpectedly, they found signs of acute exposure to lead.,

Five years ago tests on different strands of Beethoven’s hair and a tiny piece of his skull again pointed to lead. That, Beethoven scholars said, could have explained his infamous temper and his occasional memory slips. Some figured he had drunk too much cheap wine that was sweetened — in the custom of the 19th century — with lead to hide the bitterness.

But last week a lead-poisoning expert at Mount Sinai School of Medicine in New York tested the same piece of Beethoven’s skull that had been examined in 2005, along with another, larger, fragment. The researcher, Dr. Andrew C. Todd, said that over all he had found no more lead than in the average person’s skull.

The hair was obtained from Ira F. Brilliant, a real estate magnate who bought it for $7300 in 1994 at Sotheby’s in London, and the two skull fragments from Dr Meredith were among those originally taken home by a friend of Beethoven’s when his body was exhumed from a Vienna cemetery in 1863, and kept in his bedroom.

As Russell Martin’s book Beethoven’s Hair : An Extraordinary Historical Odyssey and a Scientific Mystery Solved suggested in 2000, lead seemed a likely culprit for the ill health that wracked the supremely gifted composer in his tortured last years, which were so very different from his youth as a charming and sociable man.

Meek concession by ruling dogmatists

After all, there were plenty of other reasons to suppose that the composer suffered from lead poisoning, since the plum wine he drank to excess (a treat suggested by his doctors) was sweetened in the 18th Century with lead, and the pencils Beethoven uindoubtedly chewed on contained lead, which also filled the china and the plumbing of the time. His symptoms of irritability, lassitude, headaches and muscular weakness fitted the hypothesis.

So it is quite surprising and even heart warming to find (judging from the article) that the scientists and scholars who had adopted this attractive theory are being surprisingly gracious in conceding its debunking from this one test of one fragment. Todd’s methods, like those conducted earlier by Dr William J. Walsh of Illinois, whose tests at the Argonne National Laboratory in Illinois, involved “multiple measurements with X-ray fluorescence”.

Walsh now notes that Todd has only tested skull fragments and not the hair samples, but “agrees with the notion that Beethoven’s exposure to lead was a short term problem that came toward the end of his life.”

Whatever happened to the famous tendency of scientists like all academics to cling like barnacles to current theory and fight any revision to the death? William R. Meredith, the Beethoven scholar who carried the skull fragments from California to Mt Sinai, is surprised by the findings but amiably concedes it is “back to the drawing board” for all those concerned with why Beethoven died.

Perhaps it is the influence of James Barron, the Times reporter, which accounts for the geniality of the discussion. Or perhaps he discreetly omitted the more combative comments made to him in researching the event. Certainly one can ask why the one large skull fragment reading is so decisive when the smaller one contained four times as much lead, and when the skull bone grows much more slowly than hair and naturally will not register high doses of lead that quickly.

Where we really need an antidote to poison in science

Is James Barron’s style is just so elegant that the scientists were influenced into civility, where they might otherwise have burst out with more indignant objections? If so, we would suggest to the Times editors that Barron might be assigned to look into the notoriously unsustainable paradigm in HIV/AIDS, the belief engendered by Robert Gallo, Anthony Fauci, Luc Montagnier and David Baltimore that HIV has anything to do with AIDS.

Perhaps his soothing manners might tone down the defensive alarm of defenders of this faith like the notoriously ungracious John Moore of Cornell, and the sinister Dr. Mark Wainberg, director of the McGill University Aids Centre in Montreal and a Toronto AIDS conference organizer, both enthusiasts for jailing if not hanging those who publicly question their fond funding paradigm.

Both these men have instigated poison pen letters to university administrations and other employers of those who ask awkward questions about HIV/AIDS lore, seeking to have them ejected from their positions for not believing HIV is the cause of AIDS, in one case at least resulting in the victim failing to gain tenure at her university, after writing one of the best argued and most realistic books on the topic.

The excessive zeal with which the defenders of HIV/AIDS and its indefensible paradigm rush to suppress its questioning could do with public exposure in the Times. That a scientific belief needs shoring up by personal attacks on its skeptics is a very telling indication of its weak intellectual foundation, and the current certainty that the vast funding now attached to it is being poured down a very large rat hole.

The antics of HIV believers in trying to pin responsibility for many African AIDS deaths on Peter Duesberg and to undermine his position at Berkeley have reached morally disgusting levels in recent months, and we will post on them shortly.

All those who believe in good science in the public interest can only dream that the civility and open minds of Beethoven scholars and the scientists who are helping them out could somehow be transferred to HIV/AIDS, cancer research and other areas where the internal politics of the science is so corrupted and rife with self serving, anti scientific nastiness.