Disease Proof : Disease Proof : Health & Nutrition News & Commentary : Dr. Joel Fuhrman

On Wednesday, January 20th, about a week after NYC Mayor Bloomberg proposed his controversial salt reduction initiative, evidence was presented in the New England Journal of Medicine that salt reduction truly can save lives.

Using mathematical models, the authors were able to make estimates of cardiovascular disease rates based on a population-wide 3 g decrease in salt consumption (1200 mg sodium). 

By their projections, a 3 g salt reduction would result in 60,000 fewer cases of coronary heart disease, 32,000 fewer strokes, and 54,000 fewer heart attacks each year. This is comparable to the cardiovascular benefit from smoking cessation efforts.   These estimates don’t even take into account the beneficial effects on other diseases related to salt excess, like osteoporosis, kidney disease, and stomach cancer.

Health care costs were predicted to decrease by $10 billion to $24 billion, making this type of intervention much more cost-effective than medicating people who have hypertension. With health care reform at the forefront of American politics, this study highlights the value of prevention in bringing down costs. Since about 80% of salt in the diet is already in the food when it is purchased, this intervention must occur at a national policy level rather than a personal responsibility level – hopefully, these data will not be ignored by policymakers.

A 1200 mg decrease in sodium consumption would represent a 34.3% drop in sodium consumption of average Americans, somewhat more ambitious than the 25% reduction proposed by Mayor Bloomberg. But based on the above figures even a 25% reduction is likely to bring cardiovascular benefits.

References:

Bibbins-Domingo K et al. Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease. NEJM. Published at www.nejm.org January 20, 2010 (10.1056/NEJMoa0907355)

Appel LJ and Anderson CAM. Compelling Evidence for Public Health Action to Reduce Salt Intake. Published at www.nejm.org January 20, 2010 (10.1056/NEJMe0910352)

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First New York City banned trans fat, then required chain restaurants to post calorie counts, then warned about weight gain from sugary sodas, and now it’s taking on salt.

Mayor Bloomberg has called for a nation-wide initiative to reduce sodium content of packaged and restaurant food by 25% over the next five years. The program would be voluntary for the food manufacturers and restaurant chains.

Of course, cutting sodium by 50% would be even better, but this is a respectable first step.   A reduction in sodium intake by 50%, according to a recent meta-analysis, is estimated to reduce the rate of stroke by 23% and cardiovascular disease by 17%.¹

A similar voluntary salt reduction program has been in action in the U.K. since 2003, and has so far has managed to reduce the average salt consumption consumption from 9.5g (approx. 3,800 mg sodium) to 8.6g (approx. 3,400 mg sodium). This year, the U.K. has set more challenging salt reduction goals for 2012.

Salt is dangerous - I have always warned people about excess salt consumption - here are some facts:

• The human diet, for millions of years, did not contain any added salt – only the sodium present in natural foods. This equates to less than 1000 mg of sodium per day. 

• Today, according to the CDC, Americans typically consume 3500 mg of sodium per day.

• Excess salt contributes to hypertension, kidney disease, heart disease, osteoporosis, stroke, hemorrhagic stroke, ulcers, and stomach cancer.²

• Americans have a 90% lifetime probability of having high blood pressure

• 80% of sodium in the American diet comes from processed and restaurant foods. As NYC health commissioner Dr. Thomas Farley said, “Most of the salt we consume is in the food when we buy it.”  The Center for Science in the Public Interest has found several chain restaurant meals that contain over 6,000 mg of sodium!

• And finally, sea salt is not healthier than table salt – all salt comes from the sea, and it doesn’t matter if it’s pink or gray or white, it’s still about 98% sodium chloride. It’s salt, and it’s dangerous. 

Many people interpret public health policies such as these as the “food police” telling us what we can and cannot eat. I see it as the opposite – progress in consumer freedom. By putting a limit on the amount of salt in foods that can be sold to us, we now have the choice. We, not the corporations that sell food to us, are in control of our salt intake. We are able to purchase packaged food and eat at restaurants without consuming dangerous levels of sodium. For those who prefer to ignore the risks of high sodium intake, no one is outlawing salt shakers.

Even more troubling, others see this as an ‘insignificant’ issue compared to health care reform, the economy, unemployment, etc...

Our health and quality of life are insignificant? Heart disease, stroke, kidney disease – insignificant? I don’t think so. People who die from diseases of nutritional ignorance are not around to worry about the economy.

But won’t cutting salt make the foods bland? First, the program plans to reduce salt gradually so that foods will not appear to be bland. And actually, excess salt deadens the sense of taste - if you cut down your salt intake, your taste buds will adjust over time, becoming more sensitive to salt. By avoiding salty foods, you regain your ability to detect and enjoy the subtle flavors in natural foods.

What do you think about this new push in New York City to improve people’s diets? I think it is great.

References:

1. Strazzullo P et al. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies BMJ 2009;339:b4567 ; http://www.diseaseproof.com/archives/osteoporosis-sodium-acidbase-balance-and-bone-health.html

2. Tsugane S, Sasazuki S. Diet and the risk of gastric cancer. Gastric Cancer 2007;10(2):75-83

http://www.nytimes.com/2010/01/11/business/11salt.html

http://www.cnn.com/2010/HEALTH/01/11/new.york.salt/index.html

http://www.nypost.com/p/news/opinion/opedcolumnists/as_salt_on_science_t5MDuh3FqtTWpMS5bs282J 

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A Glass of thick, yellow human fat, marbled with blood vessels, is NY's latest weapon to fight obesity. "Are You Pouring on the Pounds?" targets the billions of hidden calories which Americans consume each year in sodas and other sugary drinks. It is scheduled to run throughout the New York subway system for 3 months. It's a good thing too because Americans do pour a lot of the fat-promoting fizz, drinking 15 billion gallons of it each year.

New York health officials say the images used in the campaign are intended to be "ugly" and are designed to give people a jolt. Mayor Bloomberg's administration has also forced cafes, restaurants and fast-food outlets to post calorie content information on menus, deployed fruit vendors to poor neighborhoods and given corner shops incentives to sell fresh fruit and vegetables.

Finally a local government is doing something worthwhile, relating nutrition to health . No matter what they do, it can't be shocking enough. Unless you have worked in hospitals yourself, seeing children with cancer and men and women with lost limbs due to diabetes or stroked out and undergoing futile revival attempts while their families are sobbing and screaming in the waiting room, you most likely have separated yourself from the human suffering eating American junk food can cause.

Then when you consider that bad childhood diets create adult cancers, and childhood cancers and even newborn heart defects are primarily related to the pregnant mother's poor diet, you get even more frustrated with our society's self-deception that consuming and feeding junk food and fast food is not criminal.

If I were Attorney General or the Health Commissioner of New York City, I would advertise the fact that junk food kills people. And, I would do something to make nutrient-rich natural foods, like greens, beans and seeds available and affordable to the needy. I would prevent food stamps from being used for junk. I would make Disease Proof Your Child required reading for all government officials.

Just imagine if white flour, sugar and corn syrup were completely out of the American dietary landscape. What would American children eat?

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