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Salt Fights Back (with Science)

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?

Not your typical supermarket salt, these pink-brown chunks of salt from the Himalayas are as tasty as might be expected with 84 minerals allegedly present.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.

One teaspoon of salt a day is enough, more may kill you - but will trying to reduce salt intake save your life?  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.

Cheezits might fall apart if they had less saltSalt 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.

The disciplined Dr Claude l'Enfant sets a very good example as he  warns the world against rising systolic (heartbeat) over dyastolic (between heartbeats) measurements of blood pressure.  His own levels at 81 are an exemplary 115 over 60, against the new health goal of 120 over 80.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.

French grey sea salt, quite delicious and fortifying at no more than one teaspoon and a half a dayOf 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

The salt solution: like this Salt Institute model, your wife or sweetheart can prepare nourishing food at home and banish salt worries with restrained use of salt to taste - though the use of real sea salt as pictured earlier is the better choice.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…..

2 Responses to “Salt Fights Back (with Science)”

  1. Truthseeker Says:

    Nice comments at the Times at The Hard Sell on Salt – 266 readers’ Comments :

    Has there been a conclusive study done by anyone that shows a clear link between eating more salt and developing high blood pressure? As far as I know, the studies have shown that if you have high blood pressure, reducing salt intake can reduce your blood pressure. I don’t believe that reducing salt intake in people with normal blood pressure will prevent or reduce the risk of these people getting high blood pressure. The link has just not been established.- Anup Vidwans, Wilmington, Delaware.

    I haven’t had a salt shaker on my table for years and never use the stuff in my cooking. There are hundreds of seasonings and spices, both fresh and dried, that enhance taste and won’t kill you. Garlic, basil, parsley and the hot spices like cumin and turmeric actually have proven health benefits.

    Salt in processed foods provokes an unnatural thirst, and that has us drinking more of the high-fructose corn syrup enhanced drinks that agri-business has also thoughtfully provided for us. The extra salt and fluid intake make for abnormal fluid retention in some people. leading to the high blood pressure. That, in turn, provides a lucrative market for Big Pharma to develop more drugs to keep our BPS low.

    It’s easy to advise people to cook from scratch and avoid the big chain supermarkets, but salt is cheap and eating healthy can be expensive. The food industry is just one more way that average American people are in thrall to corporatism. – Karen Garcia, New Patz, NY.

    I think this is a case where we are our own worst enemy. I spent twenty five years in the food service industry as a chef (fifteen as an executive chef) which included three years with General Foods as a product development chef. Twenty years ago at the Culinary Institute of America I was taught that salt is a flavor enhancer, not a flavor. My experience is that the American palate has been corrupted to the point where everything must taste of salt. I use more salt to refill the shakers on the table than I do when cooking in the kitchen. Salt is an acquired taste and we can be weaned from it by simply not adding more to what we eat, especially pre-prepared foods. -John Keglovitz, Austin, Texas.

    The Food Industry…that says it all.

    Fresh ingredients with a pinch of salt for seasoning, that’s all you need.

    Of course industrialized processed Franken-foods need to be cloaked in a salt and chemical blanket to make them palpable. – Don, Madrid.

    – and a lot more. The Times threads are among the most informed, intelligent, civil and constructive on the Web. They are also usually spelled correctly.

  2. cervantes Says:

    The recent book Boone, by Robert Morgan, is wonderfully detailed about Daniel Boone’s family and fellow settlers going through the Appalachians to “Kaintuck” and their myriad confrontations with Indian tribes that realized their own way of life was on the brink. Salt played a critical role in all this with various natural salt licks, and salty springs essential to the new settlers.

    Salt was so vital to health, in the middle of one typically cold Kaintuck winter (still part of Virginia), most of the men of the new settlement of Boones Borough left their families for two weeks to “boil down” salty spring water at a site several days away, and all were captured by the Shawnees. What follows I will not give away, it’s a story worth reading. Of course Boone and fellow settlers were hunters of immense skill and normally salt was supplied via the flesh of the deer and black bears they relentlessly hunted, in fact bear meat was the favorite of most everybody, with bears originally numerous for beyond our present modern experience.

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