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The War on Salt

The problem with the Western diet is not one of deficiency, but one of excess. We get too much of a good thing – too many calories, too much of the wrong kind of fat, and too much salt. As a result obesity, diabetes, and hypertension are growing health problems.

There also does not appear to be an easy solution – voluntary diets founded primarily on will power are notoriously ineffective in the long term. Add to that is the marketplace of misinformation that makes it challenging for the average person to even know where to apply their (largely ineffective) will power.

It can be argued that this is partly a failure, or an unintended consequence, of market forces. Food products that provide cheap calories and are tasty (sweet, fatty, or salty) sell well and provide market incentives to sell such products. Consumers then get spoiled by the cheap abundance of tempting foods, even to the point that our perspective on appropriate portion sizes have been super-sized.

It may be counter argued that there is a market for healthful foods, but it seems that this creates the incentive to claim that food is healthful with marketing gimmicks rather than to make food for which there is good scientific evidence that they improve health.

And so the public is faced with claims that products are “all natural” when this term is not regulated and there is no evidence to support this notion that “natural” by any definition is necessarily healthful. Low fat foods are made palatable by adding sugars, and low sugar foods are kept tasty by adding fat.

All of this has led to the conclusion that systemic fixes are necessary to address what is becoming and increasing public health problem of diet-related diseases. The first round of regulations dealt with transparency – providing the consumer with accurate and complete information on food labels so that they cna make informed choices. If we gauge success by public health outcomes, this strategy has not succeeded.

So governments, who are also increasingly conscious of the cost of health care, are experimenting with other options. New York City has famously declared War on Fat and has passed laws to limit the use of trans fat. Now the Big Apple has added salt to their 10 most wanted list.

According to the New York City Department of Health:

The New York City Health Department is coordinating a nationwide effort to prevent heart attacks and strokes by reducing the amount of salt in packaged and restaurant foods. Americans consume roughly twice the recommended limit of salt each day – causing widespread high blood pressure and placing millions at risk of heart attack and stroke. This is not a matter of choice. Only 11% of the sodium in our diets comes from our own saltshakers; nearly 80% is added to foods before they are sold.

How do these claims hold up to the evidence. I found a reference that states that over 75% of salt intake is from processes food and restaurants – which is close to the 80% figure quoted above.

Do Americans really get twice the recommended salt intake? Here is a comprehensive review of salt intake around the world, suggesting that Americans get close to three times the daily recommended about (which is about 65 mmol/day or 1.5 grams – Americans get about 165 mmol per day).

What about the core claim – that salt intake causes increased risk of hypertension, cardiovascular disease, and stroke? Well, this is a trickier question – as are all epidemiological questions. My review of reviews suggests that there is a growing consensus that increased salt intake does correlate with an increased risk of vascular disease. However, increased salt intake also correlates with obesity, which may be at least partly responsible for this increase.

The more important question, however, is this – does reducing salt intake reduce high blood pressure and/or the risk of vascular disease? Here the answer seems to be a qualified yes. Salt reduction reduces blood pressure, but only a little. However, most of these studies are short term. Longer term studies are still needed. Some reviews claims that salt reduction – with or without a reduction in blood pressure, in hypertensive and normotensive people – reduces cardiovascular risk. Meanwhile, other reviews claim the evidence is inconclusive on long term effects.

Conclusion

As usual, the medical and regulatory communities are tasked with making sense out of chaos – with implementing bottom-line recommendations in the face of inconclusive evidence. While there remains legitimate dissent on the role of salt in vascular health, the current consensus is something like this:

- Most of the world, including Americans and those in industrialized nations, consume more salt than appears to be necessary.

- In the US most of that salt comes from processed or restaurant food (while in other countries, like Japan, most salt intake is added while cooking).

- There is a plausible connection between excess salt intake, hypertension, strokes and heart attacks.

- There is evidence to suggest that reducing overall salt intake will reduce the incidence of these health problems, but the evidence is not yet conclusive and longer term and sub-population data is needed.

Given all this it seems reasonable (from a scientific point of view – and ignoring the role of political ideology) to take steps to reduce the amount of salt in processed and restaurant food, while continuing to study the impact of such measures. But we also have to consider unintended consequences. Part of the reason salt is added to processed food is because it helps preserve it – give it a longer shelf life. People also develop a taste for salty food, and a sudden decrease in salt content may be unsatisfying, leading people to seek out higher salt foods. But these are technical problems that can be addressed.

It should also be noted that salt requirements and tolerance may vary considerably from individual to individual – based upon genetics, and certainly underlying diseases. Therefore recommendations from one’s doctor should supercede any general recommendations for the population.

In any case it seems that the War on Salt has begun. I only hope this is a war we choose to fight with science.


Posted in: Science and Medicine

Leave a Comment (87) ↓

87 thoughts on “The War on Salt

  1. Grinch says:

    Yes, please, more regulation. More, more, more! Sorry, Dr. Novella, but this ‘war’ will be anything but purely scientific.

  2. windriven says:

    Sorry Dr. Novella, gotta go with Grinch on this. Legislation is not miscible in science. Legislators just aren’t wired for it.

    Sweeping aside arguments about the appropriate role of government in the lives of individuals, tick through legislation attempting to regulate aspects of people’s private lives; compare the costs and the outcomes. The so-called war on drugs comes to mind.

    Compare the war on drugs at a cost of perhaps $50 billion per year and the damaged lives of millions (of especially black) young men incarcerated for relatively minor drug offenses against the undeclared war on smoking. Tobacco use has been nearly halved from 1965 levels largely through social pressure driven by PSAs.

    There’s nothing like a good dose of communal self-loathing to curb undesirable personal habits (remember the ‘kissing a smoker is like licking an ashtray ads?).

  3. joep says:

    @windriven

    With regard to Tobacco, PSAs but also steep tax increases. Perhaps it was just the good marketing but I think the cost also plays a role. And let’s not forget accessability either.

  4. JerryM says:

    Smoking and Drugs are very personal choices. You can’t compare that with the salt in our food.
    It’s not more regulation. It’s tighter regulation. Food is well regulated, and a good thing too.

    The amount of salt in most foods is astonishing, and the food corps have added more and more, because it tastes better.

    There are increasing calls on mandatory reduction in salt over here in .nl, because despite promises by the likes of Unilever, voluntary reduction isn’t going anywhere.
    The key is to reduce the salt content very slowly. The argument the food corps make is that if you reduce salt, people will notice, and they’ll go to the competition that doesn’t reduce salt.

    But if you make it mandatory, and set long term targets that can be reached incrementally, people wouldn’t even notice, because you get used to how something tastes.

  5. Dacks says:

    @windriven,
    The analogy with tobacco isn’t very strong. Buying and smoking cigarettes is a purely personal choice, and one that can be avoided without any detriment to health. Eating can not be avoided. If we grant that most people will consume some amount of processed food on a regular basis, then the amount of salt they get is partially up to the manufacturers.

    I think regulating the amount salt in processed foods could have some beneficial effects, and few detrimental effects. It’s a cooking truism that salt added early on in food prep is not tasted as strongly as salt added later. It should be possible to reduce the amount of salt in processing without significantly changing the taste.

  6. Fifi says:

    The food industry is already highly regulated, it’s just about making sure those regulations serve the public good and not simply corporate demands (and the food industry actually respects regulations). Big Food is a massively powerful lobbying group and, like all corporations, their main objective is making money. Government needs to balance out private interests and the public good, they are meant to be the defender of the public interest and not the facilitator of corporate greed. At the moment in the US the government is serving corporate masters, and the same is increasingly true in Canada (where our public health tradition is being quickly dismantled and handed over to corporations).

    Leaving aside traditionally salt-cured foods (such as salt cod, et), salt and sugar in commercially processed foods has less to do with preserving the food and more to do with making basically bland food tasty. Most commercially processed food has less taste than home cooked and fresh food, manufacturers compensate for this by adding salt and sugar. It’s worth noting that the cheaper the processed food (including fast food) the higher they tend to be in salt and sugar. Most processed American food is actually oddly bland – and remarkably saltier and sweeter than in other nations. Really, for one of the wealthiest nations on earth, it’s pretty incredible how

    Implementing nutritional education and lunches in schools would do more to address this problem, as would ensuring access to fresh foods. Educating palates and minds, and ensuring that children get adequate nutrition and understand basic nutrition, is much more useful (of course, that would mean stopping Big Food from selling in schools). This IS a systemic issue in the US, particularly for poorer people (though this is true all over the world, it’s particularly evident in the US). It’s hard to eat well if you don’t have any access to good food – if all that’s sold in your neighborhood is fast food and food-like substances. Particularly if you’re being lied to about the nutritional content of what you’re buying.

    The other integrally associated issue is getting adequate exercise.

  7. kirkmc says:

    You say:

    “In any case it seems that the War on Salt has begun. I only hope this is a war we choose to fight with science.”

    The problem is that, as you point out, the science isn’t really conclusive. So this is the wrong war to start.

  8. Fifi says:

    Dacks – “The analogy with tobacco isn’t very strong. Buying and smoking cigarettes is a purely personal choice, and one that can be avoided without any detriment to health. Eating can not be avoided.”

    Actually it is very strong. Until smoking in public places was regulated, people had no choice about breathing in second hand smoke. (People who never smoked but worked in smoky places continue to die of lung cancer.) It’s only because of regulations prohibiting smoking in public places that people have a choice about breathing in tobacco smoke. Banning smoking in public places also meant that people had to make an effort – more of a choice – to smoke and removed the sort of seductive environmental triggers most of us humans are susceptible to. Big Food spends a lot of money advertising and seducing us, and lying to us about what’s in the products they sell and the health risks (just like Big Tobacco). Big Food has done a lot of research into how to manipulate consumers (product placement in stores, misleading claims on packages, the psychology of desire and how to create it, etc).

  9. Fifi says:

    The War on Drugs isn’t analogous however since drugs are illegal.

  10. Dacks says:

    @Fifi,
    Good point. Limiting smoking in public places certainly affected people’s choice to smoke.

  11. windriven says:

    Let me point out that I used smoking only as an example of the power of non-legislative means of shaping behavior. Don’t ask the analogy to be more than intended.

    The sodium content of packaged foods is there for all to see. Would you like the menu at your neighborhood pasta palace to list the caloric content, sodium, calories from fat? How about vitamin B12? Any idea what that might cost? You think Luigi is going to pay that out of his pocket?

    WTF that you can’t just say no to supersizing? Potato chips? Double starch with a side of grease? Grow up and take responsibility for your actions. Don’t whine that you’re too fat because the government won’t ban inanity. If you’re that weak willed do us all a favor and expire before you breed.

  12. micheleinmichigan says:

    here, here! FiFi, particularly when it comes to school lunches. The amount of processed, salty, sugary food in American lunches is amazing and it trains children’s palates to prefer mushy, salty, sugary food. I pack lunches for my kids (sandwich rolls, fresh fruit, vegy). Of course they complain because the kids who get school lunch are having chicken nuggets and fries, french toast sticks with syrup and hot dogs every day. Often there is not a green vegtable or fresh fruit near the menu.

    Of course, the food service complains. “We offered a tossed salad as an alternate choice to french toast sticks, but the kid’s didn’t choose it.” :)

  13. Fifi says:

    Dacks – Thanks. In Canada, well before indoor smoking in public spaces was banned, there was also a campaign in elementary schools that educated children about the dangers of smoking. As well as campaigns aimed at adults that outline the health risk to their children. This meant that kids started to pressure their parents not to smoke, particularly around them (most people I know smoke outside, even at home, now…that’s anecdotal of course but it does hint at how influential public policies and education can be).

    Educating kids about food, and feeding them good food so they actually know what it tastes like, is a good way to inform and pressure parents into making change. In Quebec – and we’re a hardcore smoking province, it’s a French café culture thing partly – all these measures have had a very significant impact. If people have to make an effort to indulge something – even as pernicious an addiction as tobacco – then they have to think about it and make a choice.

    It’s worth noting that the major culprits vis a vis food are aimed at being “convenient”. Fast food drive-throughs that line the main streets in poor neighborhoods, pre-packaged and pre-prepared foods (TV dinners really), etc. It’s much harder – particularly for poor people – to actually obtain healthy foods. If, on top of it, people don’t know how to cook then the problem is only compounded. Both boys and girls should be taking Home Economics in school, and learning about food, exercise, health and their body. Many countries are now in the process of legislating against advertising food-like products directly to children on TV. Considering that many kids cartoons and TV shows in the US are just advertisements for products, it’s clear that the food industry knows exactly what it’s doing in marketing to children. (Just like tobacco companies that make candy-like cigarettes and soda-pop like alcoholic beverages are intentionally marketing to underage kids.)

  14. windriven says:

    So tell us micheleinmichigan, having said of school lunches “it trains children’s palates to prefer mushy, salty, sugary food,” does that suggest that parents are so disengaged from their children’s schools that they exert no influence over school lunches? Have PTAs been abolished? Have principals walled themselves off?

    Or is it just so much easier to kvetch on blogs and hope that the Great Father in Washington will strike the problem with His magic wand?

  15. cob says:

    I would love to see some of these companies be made accountable for the garbage that gets loaded into their products.

    How about a tax? Foods that contain excessive amounts of harmful ingredients could be subject to a health tax to be paid by the offending company. That tax could be used to help the heath care system deal with the effects of a food industry who has no regard for the general public.

    To me, this is the only way to to make these companies think twice about some of their practices.

  16. weing says:

    “Often there is not a green vegtable or fresh fruit near the menu.”
    What? No ketchup? That’s gross.

    I’ve read that the placement of healthy foods at eye level and unhealthy foods not at eye level will increase healthier choices by children in school. Who is responsible for that? I’m sure the purveyors of unhealthy foods know who to give kickbacks to.

  17. cbarna says:

    This micromanagement of our health is starting to get very intrusive–pretty soon we’ll have the exercise police. The easy solution for reasonable nutritional needs is to avoid processed foods and eat a variety of whole foods. The microwave oven makes preparation of this fairly easy and rapid.

    Salt is hard to control no matter what a regulation might intend. Anyone going to a restaurant with low salt food can always bring their own salt–it is much harder to bring your own fat though. If you ate at a sushi restaurant would they have to somehow leach out the salt in their food.

  18. Jack123 says:

    Do I see libertarians getting angry over nothing just because it involves government regulation?

    Come on, even if it is “the wrong war” because the evidence is not “conclusive” it’s still the a good start!

    Not even the evidence on saturated fats is conclusive. And we are still told to avoid them because it they’re *generally* inferior to monounsaturated fat or other macros — hardly any evidence is conclusive in the nutrition sciences.

  19. Dacks says:

    On school lunches – these programs are closely tied to the USDA commodity programs. In fact, they are more or less the place where we dump our surplus production. School systems are required to take the commodities – things like frozen chicken nuggets – in order to get the supplemental payments to cover low income students. Neither the PTA nor, more importantly, the school lunch providers, have much leeway in this system.

    The question is how do we attack public health issues? If obesity is a public health issue, and if we have fairly substantial evidence that it is related to consumption of high fat, high calorie processed foods ( leaving salt out of the picture at the moment) we might want to limit consumption of these foods.

    We can do this by telling people – hey, those foods are bad for you, but that hasn’t been very effective so far. Other ways to reach this goal might be to restructure farm subsidies towards producing less corn and soybeans and more towards growing a wider variety of crops; or we could put different regulations on the manufacture of processed foods; or we could put more money into school lunch programs so they can buy better food. These are just a few of the options.

    The key to all this is seeing diseases like type 2 diabetes and heart disease as public health issues. We regulate air and water quality because it affects all of us, even the ones who don’t get sick. If we took that approach with these diseases we might improve everyone’s health.

  20. Dacks says:

    Commodity Foods and the Nutritional Quality
    of the National School Lunch Program:

    http://www.frac.org/pdf/commodities08.pdf

  21. Lawrence C. says:

    If anyone would like to know how this is all likely to play out, I’d recommend reading Marion Nestle’s Food Politics. It is an eye-opening and very, very well-researched account of how food, politics and science have clashed and collided over the last half-century.

  22. weing says:

    Once the government started regulating what’s in Coca Cola, it’s been downhill from there.

  23. Scott says:

    I’m honestly torn about this sort of thing. I’d much rather see people provided with information and allowed to make their own decisions, since I’m pretty libertarian at heart. So regulations to require restaurants to disclose nutritional information I have no problem with. If people cared enough to pay attention, they could then choose not to patronize restaurants where the chefs use excessive salt.

    But as Steve points out, providing information hasn’t really worked out very well, since people largely ignore it. (Unhealthy preprocessed food already has the nutritional information, but people still eat it in large quantities.) So what degree of “nanny state” to force people to act healthily is appropriate? Do we *really* want the government in the business of decreeing what amount of salt is appropriate for different dishes? Anybody who says this is an easy question, I’d say hasn’t thought about it.

    How many choices are we willing to take away from people for their own good?

    Also, @cob:

    You can’t realistically blame the companies. Their customers freely choose to buy their products – indeed, they generally refuse to buy the healthy products when available. So yeah, blame the producers for the fact that they produce what their customers have loudly and emphatically demanded. That makes a lot of sense.

    Nor is it credible to consider the tax you mention as really being on the companies. Any such tax will simply be passed directly on to higher prices. The consumer ALWAYS pays the taxes, regardless of how the politicians try to hide it.

  24. Geekoid says:

    windriven – Schol are severly limited in resources, and food costs becme a fctor so they go for the cheapest; which is always fatty salty foods. The PTA’s effort fall of deaf ears, and when the ide of raising taxes to properly feed children comes up it turns into a fire storm of stupidity. Your post reeks of Arrogance if ignorance.

    Speaking of which, it’s pretty ignorant to think tobacco use is driven by just market forces and not regulation. Your libertarianism ideas have been tried, and they failed. Look at what happened 100+ years ago with industry.

  25. windriven says:

    @Jack123

    “Come on, even if it is “the wrong war” because the evidence is not “conclusive” it’s still the a good start!

    How is it ‘still a good start?’

    Not even the evidence on saturated fats is conclusive. And we are still told to avoid them because it they’re *generally* inferior to monounsaturated fat or other macros — hardly any evidence is conclusive in the nutrition sciences.”

    So avoid saturated fats. Is there someone stopping you? Or do you so lack initiative and/or free will that you cannot trust yourself to to take responsibility for what you put in your mouth and need a keeper to do it for you?

  26. Calli Arcale says:

    Dacks:

    I think regulating the amount salt in processed foods could have some beneficial effects, and few detrimental effects. It’s a cooking truism that salt added early on in food prep is not tasted as strongly as salt added later. It should be possible to reduce the amount of salt in processing without significantly changing the taste.

    Thing is, the salt added early on is not usually added for the purpose of flavor. It’s a preservative, and one of the safest and cheapest around. If we replace this salt with another preservative, it is entirely possible that we’ll just run into another problem. Possibly even the same problem. It’d be tough to find a preservative which has no adverse health impacts when eaten in excess.

    I’m not convinced that regulation is the answer to the problem. Banning salt or even limiting the proportion strikes me as oversimplistic, especially since this is only a small part of a much larger problem. It is not the food industry’s fault that poor people can’t afford fresh produce. This has been a problem forever, and it’s basically part of what it means to be poor — you can’t get the things other people can. It’s something we should all strive to correct, but it’s not simple and will never be completely solved. There is no magic answer.

  27. Zoe237 says:

    I thought it was a reasonable article- and I gathered from it that there are very real health risks to excessive salt. But I haven’t read salt research at all either.

    The libertarian argument over whether or not the government should do anything about it is not a scientific one. As a liberal with libertarian leanings (for individual choices, not corporate ones), I would say that it is fine to regulate the amount of fat, salt, sugar in food, within reason. Maybe they should try a surgeon general warning (speaking of which, any thoughts on Regina Benjamin? mainstream media has been criticizing her being overweight @@@).

    As far as I can tell, PTAs don’t have any control over school lunches. I am ITA that the government ought to look at the salt, fat, and sugar in the food that THEY buy and subsidize before regulating what outside corporations do. If NYC school lunches suck, they ought not to be going after McDonald’s.

    My libertarian leanings, however, kick in when I hear people propose that nobody should be allowed to smoke in their own cars or that every child should have home economics.

    Salt and tobacco are also not analogous because it is impossible to have a little bit of nicotine and still be healthy. Salt can be a good thing in moderation. Tobacco also affects others.

    I am going to read Food Politics and the link Dacks gave- thanks!

  28. windriven says:

    @Dacks

    “we might want to limit consumption of these foods.

    Good gracious, where do you find constitutional freedom to do such a thing?

    Doesn’t it make more sense to allow insurance rates to reflect the greater health risks of people with stratospheric triglycerides.

  29. windriven says:

    @Geekoid

    I am not advocating unbridled libertarianism. It doesn’t work, I agree. But neither does a nanny state.

    I for one do not need the law to tell me what I can and cannot eat, when to brush my teeth, what time to go to bed, and so forth.

    And let’s follow your impulse to regulate through to its conclusion. A law gets passed that limits consumption of fat. I choose to eat a triple cheeseburger and get caught. Am I then fined? If I refuse to pay am I jailed?

    And if the schools in your district are too poor to feed your children properly you have only yourself and your neighbors to blame. Schools are funded in most districts by property tax assessments that are approved at the ballot box. Open your wallet and your mind. Insist that your children be taught to high academic standards and insist that the be fed nutritious and flavorful meals. The two are not mutually exclusive.

  30. Dacks says:

    “we might want to limit consumption of these foods.”

    Doesn’t it make more sense to allow insurance rates to reflect the greater health risks of people with stratospheric triglycerides.”

    These two are not mutually exclusive, but I’d put my money on the first (literally) as a more cost effective way to lower health risks caused by obesity, etc. in the population.

  31. SF Mom and Scientist says:

    This is a dilemma. One thing that concerns me is that, if we limit the amount of salt in processed foods, something else will be added to make up for the flavor. And in any case, it is still a processed food.

    Every time we do this as a society (for example, lowering fat content), we seem to end up with a product that is less healthy.

    I often find Michael Pollen annoying, but one thing he said that I agree with is to avoid any food that is labeled as “healthy”. Often, this is a packaged food which has a lot of crap in it that has been manipulated by a clever marketing department.

    Honestly, I’m not sure what the answer is. My family has the resources (money and time) to make fresh food, but I am concerned about the public health issue of how others eat. Although I do feel uncomfortable judging those who don’t have the same resources that we have.

    I guess this wasn’t very helpful. I do see this as a complex issue that has not easy answers.

  32. bameeker says:

    I’ve never really been a huge fan of salt, to the point that a few doctors have told me my sodium is low and that I have to change the way I eat. After starting to eat more processed foods, I was so happy to be in the healthy range last time I had a blood test, but was disappointed that my cholesterol was suddenly high.

    I think, based on this, that another problem is the “one size fits all” mentality. When we discuss decreasing calories, we don’t take the athlete into account, since they can burn significantly more calories than the average person. Similarly, we target food additives like salt for reduction without considering other eating patterns.

    I’m not against lower sodium foods (I love them and I think the problem would be partially solved by reducing sodium content of foods), but I see this as more of a place for education. Why not emphasize the importance of adding up percentages, adding other spices to flavor foods, and shaking a salt cellar only once? Perhaps that will be less successful, but maybe it’s worth a try before we start heavy salt taxes.

  33. windriven says:

    @Dacks

    And what penalty do you propose for those who fail to heal to your command?

  34. Fifi says:

    windriven – “A law gets passed that limits consumption of fat. I choose to eat a triple cheeseburger and get caught. Am I then fined? If I refuse to pay am I jailed?”

    That’s just silly since it’s about regulating industry (cigarette smoking inside is a different matter since you’re exposing other people to the smoke, it’s protecting non-smokers). You’re making the same kinds of silly arguments as General Stubblebine and Rima Laibow at healthfreedom regarding regulating supplements. Regulating industry isn’t creating “a nanny state” it’s regulating industry so they don’t exploit the public. It’s creating a level playing field for citizens so they can actually make choices for themselves and have choices (not on corporate propaganda/advertising but on the facts).

    Btw, you earlier claimed that all people had to do was read the packaging. What you fail to understand is that both smaller food companies and corporations lie on packaging all the time for a variety of reason, just like they try to avoid regulation to increase profit and reduce available information. There have been a lot of stories about this recently, here are a few…

    http://latimesblogs.latimes.com/booster_shots/2009/12/think-that-sheeps-mik-cheese-comes-from-a-sheep-dna-doesnt-lie.html

    http://www.foodnavigator-usa.com/Financial-Industry/Health-food-claims-strongly-misleading-says-CSPI

    http://www.foodproductdesign.com/news/2010/01/many-food-nutritional-values-mislabeled.aspx

  35. EricG says:

    @ fifi

    “Educating kids about food… ”

    this idea seems to get the shaft all too often.

    to all – i presume we are all at least moderately educated, have adequate resources and, as a partial result, “know better.” It would surprise me to find anyone contributing to this post to be a 300+ lb. type II diabetic. the point is, *information* and access to it.

    In regards to windriven’s points, I, personally, don’t want to eat crap, avoid crap, will teach my children to avoid crap and, to anyone who is legitimately interested, effectively preach why it is in your very best interest to avoid crap food.

    Inform the kids, the kids bully the parents (with great enthusiam, I might add) and legislation is obviated. Of course, this presupposes that addressing curriculum is easy and there are funds to to it to begin with (sigh…CA school system).

    Seriously, information and access to it. Watch an episode of the biggest loser where the in-house doctor sits them down and lays the cold hard truth on them for their terrible choices. they had *no idea* how their bodies work, how the food they eat impacts them or how being 526 lbs. necessarily means they are unhealthy. They then turn 180 on a mission to save their own lives. Information can be extremely powerful…isn’t that the foundation of a PSA to begin with?

    as my restaurant owning family member says, “oil without trans fat doesnt fry as well.” she could give a flyin F about nutrition facts and public health – its the almighty dollar that governs her choices. educate a person to avoid her food offerings and she must change or perish.

    taxing food…not quite as clear cut as booze or cigs, I suppose I would be entertained by an attempt.

  36. passionlessDrone says:

    Hello friends –

    This is a complicated problem that has fingers in a lot of areas that don’t have anything to do with science.

    Processed foods are a lot cheaper in dollars and time to table compared to real food. I’ve read in a few places that the percentage of available dollars spent on food has decreased from ~ 30% to ~ 10% for most families in the past few decades; we have more DVRs as a result, but at what other costs?

    How do we convince people to pursue a whole food diet? Or indeed, one that is largely vegetarian? It’s a big, big shift and one without immediately obvious benifits, and obvious costs; and little debbies taste good (well, they used to).

    Some thoughts I had on this might include targeted subsidizations for people making some of the worst food choices by need; i.e., food stamps that make the cost of fresh fruits and vegetables comparable to their processed calorie equivalents.

    I am not entirely averse to the idea of differential insurance, or health care costs for individuals with problems that have direct ties to diet. By way of example, I know a guy who just had a federally funded quadrouple bypass after weighing ~ 350 lbs for the last twenty years. Six months later, he is eating McDonalds for breakfast every morning.

    Anyways, we are doomed.

    - pD

  37. windriven says:

    @Fifi-

    “Btw, you earlier claimed that all people had to do was read the packaging. What you fail to understand is that both smaller food companies and corporations lie on packaging all the time for a variety of reason, just like they try to avoid regulation to increase profit and reduce available information.”

    Cite proof. Then prosecute them to the fullest extent of the law. That does not require new laws, only enforcement of the laws on the books. Why do you suppose that a new law will be somehow better than the old law?

    And BS to your claim that my scenario is silly. There have been all sorts of proposals floated to regulate what people eat. The question of where the line is to be drawn has yet to be decided.

  38. edgar says:

    Or would such regulation just level the playing field? Are we promoting unhealthy foods from he very beginning when we subsidize corn, soybeans, and potatoes?

  39. overshoot says:

    Reduce the salt added by restaurants and packagers? How is this a bad thing? It’s not like we can’t add our own if we want to.

    As for me, I have a chronic potassium deficiency. Easiest (and by far cheapest) solution is to use potassium chloride along with sodium chloride at the table — but this only works if the food isn’t already heavily salted. So I suppose I’m putting my own health ahead of the convenience of others who would rather not be bothered to salt their own food at the table.

    Sorry about that.

  40. Dacks says:

    [This rant is a little off the topic of salt in foods.]

    @windriven.
    You focus entirely on individual choice, without acknowledging the role of government regulation in shaping the way we eat today. The foods available, and the price we pay for them, do not come from some idealized form of the free market. The Farm Bill, USDA, FDA, NSLP (National School Lunch Program), WIC coupons – these government agencies and others determine in large part what we eat.

    What I’m suggesting is that we could modify the policies already in place to benefit the public health, rather than entrenched interests. I’m no number cruncher, but the argument has been made that a significant savings in health care costs would be realized by a lowering of the rate of obesity. And, again, if we could find a way to improve the quality of foods consumed, it would benefit us each individually as well.

  41. bameeker says:

    @overshoot

    I hadn’t thought about that, really. Hopefully whatever ends up happening will benefit you. As someone with another dietary restriction (celiac disease) I understand how food additives can make it really hard to eat conveniently.

    I grew up without really learning to cook with salt because I lived in a very salt conscious (that sounds weird…) household. It’s not so much that I don’t add salt because I can’t be bothered, but I just can’t get it to taste right. Processed food can be way too salty, but some of it is not overwhelming to me.

    An earlier comment said that adding salt early on decreases the taste. I guess I’ll try that.

  42. Scott says:

    As a liberal with libertarian leanings (for individual choices, not corporate ones), I would say that it is fine to regulate the amount of fat, salt, sugar in food, within reason.

    You’re kind of going against your argument here, if I’m understanding you correctly (which I may well be not). This is NOT a question of regulating what corporations can produce, but rather what individuals are allowed to consume. If people wanted low-salt foods and corporations were refusing to produce them, that would be one thing. But the low-salt foods are available, and people aren’t buying them.

    The end result is most emphatically a reduction in consumer choice – and the eliminated choice is the popular one, too, so it would be an impactful reduction. It may or may not be a justifiable reduction (I tend to think not), but let’s at least be honest enough to admit that’s what it is.

  43. Dacks says:

    “If people wanted low-salt foods and corporations were refusing to produce them, that would be one thing. But the low-salt foods are available, and people aren’t buying them.”

    They usually cost more than their saltier counterparts. What if that were reversed – what if it cost more to buy heavily salted foods? Would poor people still choose the less healthy alternative (assuming that high levels of salt is unhealthy)?

  44. Angora Rabbit says:

    Dr. Novella,

    As a relatively new reader of SBM and a professor of nutrition at a major university (gads, you’ve out-ed me!), I want to congratulate you for a concise synthesis of a complex subject. What you say is correct, and you touch on many facets on why it has been challenging to lower sodium intake in the population overall. The environment we evolved in was usually salt-deficient, so it is no surprise that we animals crave salt and will reward saltier foods by consuming more of them. Blame the manufacturers, but also blame the consumers who repeatedly prefer these in blind taste tests. Sadly, the mfcr is only giving consumers what the majority prefer. While not ideal, the record suggests that it is going to take legislation before mfcrs finally reduce salt content in exchange for potentially reduced sales.

    Regarding “evidence,” the evidence in favor of lower hypertension risk in the face of lower salt intake is actually quite good. However, readers need to understand that hypertension is MULTIFACTORIAL. This fact is repeatedly lost in any discussion of nutrition – disease interactions. The media report on the latest “magic bullet,” the clinical intervention fails to find a strong link, and folks whinge that the nutritionists were wrong. The reality is that in a multifactorial disease, there are multiple contributions and assuming that just one change will magically stop the disease is naïve and reflects a lack of understanding of disease progression and pathology. The DASH intervention is a lovely example of how a multi-prong approach (lower salt plus increased calcium plus reduced fat) can pay bigger benefits.

    For salt and hypertension, perhaps the readers are confused because they may not realize that the problem is not just about the sodium, although it is an important leg supporting the table, if I can use an analogy. There are also good data implicating reduced potassium intake (thus affecting Na/K renal exchange), high chloride intake, low calcium intake, and of course the raft of factors affecting atherosclerosis and obesity, which impact cardiac function and secondarily contribute to hypertension. Oh, and alcohol consumption and a lack of exercise.

    And then add in that there are many roads to hypertension. Some folks are salt-sensitive and respond very well to reduced salt intake with lower blood pressure. However, an equally important HT cause is due to genetic alterations in how the body responds to blood pressure (osmolarity) through the angiotensin and aldosterone systems; some of those respond well to ACE inhibitors and not to salt intake alterations. In making recommendations we have to consider the individual, but in tackling the public health problem we have to consider the population as whole (or whole-ish).

    As a semi-aside, I just had my day made. NPR is just reporting (from Bill Dietz at CDC?) that obesity rates in US children have stabilized in the past 10 years (now off to pull the paper out of PubMed). Nice to know that people are starting to listen to the message and are making the small changes that make a difference. It gives me hope.

  45. windriven says:

    @Dacks

    “They usually cost more than their saltier counterparts. What if that were reversed – what if it cost more to buy heavily salted foods?”

    Are you suggesting that food companies want to force salt upon consumers? Companies don’t make salt and fat laden foods because they happen to have extra salt and fat laying around. They are responding to consumer demand. When labeling requirements showing calories, fat, sodium, etc. were mandated, food manufacturers complied. But as far as I can see most people continued to buy Cheesy-Poofs instead of switching to Sun Chips.

    Low salt foods often cost more at retail because the product isn’t moving off the shelves. Companies like Frito Lay take product freshness very seriously and old product gets trashed. Further, and you may not be aware of this, manufacturers actually pay grocery stores and chain pharmacies for shelf space. So they will stock that expensive space with products that move.

  46. Fifi says:

    windriven – “Cite proof.”

    Actually the articles I linked to discuss the studies that have been done (both one recently done by Tufts University and also a fun school project done by kids, the second is quite a fun read and has been all over the place recently because it’s a fun human interest story as well as being revealing). One also discuss the difficulties of enforcement. I’m not advocating more laws (that’s a strawman you’re erecting), I’m merely countering your claim that people can simply read a label and choose for themselves. You clearly think corporations are honest and not trying to manipulate consumers by providing misleading or straight out wrong information.

    Dacks – “They usually cost more than their saltier counterparts. What if that were reversed – what if it cost more to buy heavily salted foods? Would poor people still choose the less healthy alternative (assuming that high levels of salt is unhealthy)?”

    Yes they often would. Poor people often only have access to the crappiest food in their neighborhood and can’t afford to travel great distances. Eating at McDonald’s is often cheaper than making a healthy meal. If both parents work, and in the US the working poor often work more than one job just to stay afloat (that’s two people working 3 or 4 jobs just to survive), it’s hard to also come home and do everything else. Rich people can afford for one parent to stay home, or to go to a good restaurant, or to have one of the working poor clean their house so they can fit in yoga and then pick up gourmet prepared food. The middle class is rapidly disappearing into the working poor in the US, but they do have more options. Food is most definitely a class issue. One only need to look at hunger in impoverished countries and food waste in affluent ones to see how obvious that is.

    Another health issue is commercially produced GMOs (I’m not anti-GMO necessarily, though a recently study has shown that Monstanto’s Roundup Ready GMOs are bad for rat’s health, and most likely human health). Certainly the government shouldn’t be subsidizing GMOs that are damaging to public health (and family farms should be protected from the predatory practices of Monstanto).

    http://science.slashdot.org/story/10/01/13/0328221/Organ-Damage-In-Rats-From-Monsanto-GMO-Corn?from=rss&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Slashdot%2Fslashdot+(Slashdot)
    http://www.biolsci.org/v05p0706.htm

    The prevalence of corn syrup as an ingredient in processed food in the US is very high. Obviously this new information raises a lot of questions. It doesn’t necessarily mean all GMOs are bad or unhealthy but it’s looking like ones designed by Monstanto to work with their chemical fertilizers are.

    There are a variety of solutions and quite a lot of people involved in environmental activism or who are environmentally conscious are working at the grassroots level. Community sponsored agriculture is one (CSAs); yardshares, rooftop gardens and community gardens are others; subsidizing family farms so they can become CSAs instead of subsidizing commercial crops of GMOs owned by Monsanto, etc. Food Inc is a decent enough documentary that talks about some of the issues with the American food system (though Canada and Australia have just as many problems with Monstanto, in Europe the farming traditions have held their own somewhat better but they’ve had much more protection from the predatory practices of Big Food).

    Really though, it’s about education since no one wants their children to be obese and stupid (and no child wants to be obese and stupid). The reality is that a diet of fast and processed food, and a lack of exercise, isn’t only making people obese, it’s also making them stupid. And because some rich and middle class people choose to eat crap too or do so through ignorance or laziness, even though they could afford not to, that’s not just a problem of the poor.

  47. jpspeno says:

    IMO, the war on salt is is as misguided as the war on saturated fat though not nearly as harmful to the health of its victims. In that way, I find it funny that long before Gary Taubes covered the later topic in “Good Calories, Bad Calories”, he wrote “The (Political) Science of Salt” which you can read here:

    http://www.stat.berkeley.edu/users/rice/Stat2/salt.html

  48. Fifi says:

    windriven – “Are you suggesting that food companies want to force salt upon consumers? Companies don’t make salt and fat laden foods because they happen to have extra salt and fat laying around. They are responding to consumer demand.”

    You seem pretty naive about the ways of the world and how industry actually works. Advertising is ALL about creating demand, it’s why it exists and why Big Food make kids cartoons that are advertisements masquerading as entertainment. And, yes, food companies to try to make stuff out of things that are “lying around” (by-products of other things). ALL industry spends a lot of time trying to think up a way to sell by-products. Corn is a fine example of a product the food industry has in excess (due to government subsidies) that the industry keeps finding new uses for.

  49. Fifi says:

    windriven – “Companies like Frito Lay take product freshness very seriously and old product gets trashed. Further, and you may not be aware of this, manufacturers actually pay grocery stores and chain pharmacies for shelf space. So they will stock that expensive space with products that move.”

    Actually it’s the government that mandates “use by” dates, it’s not Frito Lay being all worried about the freshness of their product. And it’s stores that are responsible for yanking old product, it’s not Frito Lay. (Even though a lot of food is still entirely edible after it’s use by date, most big food chains make sure that poor people can’t take it out of dumpsters by pouring bleach and poisons on it. They also thrown out “ugly” or slightly bruised or dented products and produce. It could, of course, be donated to a soup kitchen for immediate use instead of being thrown away. This is what happens in Vancouver, it’s entirely doable.)

    Yes, manufacturers do pay for shelf space so that their product will be in the most advantageous position (this includes having certain products at kiddie eye level). All you’re doing is pointing out how incredibly manipulative Big Food actually is and how deeply they study the psychology of selling and practice the art of manipulation.

  50. Fifi says:

    It’s not like the government is talking about banning salt all together so this whole Corporatist Libertarian stance is idiotic. (Since not all libertarians are corporatists, I think it’s important to note that Windriven is promoting a corporatist Libertarian perspective.) People will still be able to pick up a salt shaker and add more salt to their food if they want to. Or sugar to their fries if they want that special McD’s taste.

  51. arid says:

    Well it looks like I’m sort of posting in the middle of some intense discussion here, but since this entry is about diet I’d like a suggestion. I’m planning on going to medical school, so I am shadowing a family practice physician this week. He sees lots of patients with diabetes, and there is no doubt that individuals could do a lot to improve their health through diet alone.

    What concerns me, however, is that he has recommended to several people over the last few days (and probably many more in the last few years) to read this book called ‘The China Study’, which I had never heard of until a few days ago. I’ve flipped through a copy he gave me, and there are red flags all over the place. According to the book, becoming a vegetarian will drastically reduce your chances for developing myriad chronic diseases. Does anybody in the SBM crowd have any thoughts on this book?

    The physician I am shadowing is a member of a certain fundamentalist Christian denomination that I was brought up in, and most members are vegetarian, so I know there is no convincing him there is anything wrong with the book, but if it’s such a big deal, I wonder why I have heard nothing about this book in my several years of consuming skeptical media.

  52. windriven says:

    @Fifi-

    There have been outcries throughout this blog for more regulation. Strawman, my butt.

    “You clearly think corporations are honest and not trying to manipulate consumers by providing misleading or straight out wrong information.”

    Don’t put words in my mouth. I think any decent company tries to manipulate consumers every chance they get – into buying their products. I do believe that most do it honestly and ethically. And I know for a fact that there are existing laws and an entire federal bureaucracy – the FTC – to enforce those laws.

    You are again, quite wrong. The government may well mandate ‘use by’ dates but those are not the dates that Frito Lay (and I’m sure many others) use to remove stock from shelves. Because Frito Lay does not want you to eat a stale Frito. (For what it is worth, I am in the medical manufacturing business not consumer products. I simply know a regional manager for Frito Lay so I am speaking from certain knowledge)

  53. Val Jones says:

    The Institute of Medicine will be releasing its analysis on this very issue in February, 2010. It will be interesting to see how they summarize the relative “threat” of salt in our diets.

    For me, the key issue is that while a low salt diet can reduce blood pressure, it only seems to do so by a few mmHg. And for people with healthy kidneys and normal blood pressures, it’s unclear to me at this point if even eating 3x the recommended daily amounts of salt has any measurable long or short term deleterious effects.

    The health benefits of weight loss (on HTN) seem much more significant. So as a doctor I’d much rather have my patients focused on losing weight than counting their sodium.

  54. Zoe237 says:

    Me:
    “As a liberal with libertarian leanings (for individual choices, not corporate ones), I would say that it is fine to regulate the amount of fat, salt, sugar in food, within reason.”

    Scott:
    “You’re kind of going against your argument here, if I’m understanding you correctly (which I may well be not). This is NOT a question of regulating what corporations can produce, but rather what individuals are allowed to consume. If people wanted low-salt foods and corporations were refusing to produce them, that would be one thing. But the low-salt foods are available, and people aren’t buying them.”

    I don’t consider it a contradiction. As others have noted it, you can easily put more salt on your food. I think the “free market will regulate itself” people are full of it, that’s all. The NYC law is voluntary. Still, I can see lots of problems with it, and I do believe it is too easy of a solution. There are other more effective ways of encouraging healthy eating and stopping government financial support of corporations. It would be interesting to know if transfats (which really ahve been banned in NYC I think) really are dangerous.

    RE: gmo. I certainly do not believe that gmos are dangerous and think public perception (particularly the EU ban) shows an ignorance of science. However, Monsanto was recently chosen “corporation of the year” by Forbes mag. Their stupid patents of seed and drive to eliminate the small farmer disgusts me. Particularly the legal system’s involvement.

    I’m also not convinced that healthy eating is more expensive. I can feed my family from the dollar menu at Mcd’s for about $12. I can make a big pot of chili, spaghetti, or stew for $5-10 and have it last for several meals. Fresh fruit and veggies are fairly expensive (and this is where our money goes), but frozen is pretty cheap. I do have time to cook though.

  55. Fifi says:

    windriven – You claimed that people could just read the packaging to get information and then make a choice. I showed you that wasn’t the case and presented some articles you clearly didn’t bother to read that gave just a few examples of corporations getting caught lying on their packaging and about what’s in the food they’re selling (or what it actually is), how many calories it is, etc. The issue being discussed was whether people could actually make an informed choice. Clearly they can’t if they’re being lied to by corporations.

    Your going on about regulations was erecting a strawman because regulations have nothing to do with whether or not people can make an informed choice or whether corporations are honest in their packaging and marketing so people can make an informed choice. The fact that you having a friend who sells Frito Lay products and you believe whatever he tells you is pretty irrelevant to the issue of whether corporations have been caught misrepresenting their products (and is evidence of nothing, it’s not even worthy of being anecdotal evidence). Frito Lay is owned by Pepsi, they’re Big Junk Food. It’s pretty funny that you’re so sure they’re ethical, honest and concerned with public health.

    For someone who claims to be a salesman, you’re either incredibly naive about marketing or just being dishonest in an attempt to sell/lobby for industry. You’re clearly more interested in protecting corporate profit than public health, or even looking at the evidence. Like I said, you’re really a Corporatist and not a Libertarian.

  56. windriven says:

    @Fifi-
    You didn’t show me anything. What you showed is that sometimes companies lie. Sometimes politicians lie, sometimes bankers lie. Your ‘proof’ is piffle.

    There are laws and the bureaucracies to enforce them already on the books. If you have proof that a company is lying about the contents of its products, report them to the FTC and/or the FDA. I will be first in line to support you.

    You continue to misrepresent my statements. I am not a salesman, I own several small medical manufacturing companies. And I am not holding out Frito Lay as “ethical, honest and concerned with public health. ” I was simply making the point that they are highly motivated to sell a product that consumers want to buy. THAT IS THEIR FRIGGING JOB. Now they need to do that ethically and legally. I have no reason to believe that they don’t. But I am not suggesting that they are concerned with public health beyond complying with GMPs and legal labeling practices.

    What is it with you and your hatred of businesses? Big Junk Food? That’s the same kind of crap that the Big Pharma nuts spew. It may shock you but most of the people that I know who are business owners or business executives genuinely want to profit by making quality products that people want and need. No one except a few sociopaths work to rip people off.

    “Like I said, you’re really a Corporatist and not a Libertarian.”

    OK, here’s what I say: you exhibit shocking ignorance of business and economics. You apparently live in a dream world where corporations and their executives stay up late dreaming of new ways to poison you or to rip you off. Who the hell do you think makes the ventilators that keep premies breathing? Who makes the computers that connect you with a breadth of information that could only be imagined a couple of generations ago. It must be the Keebler elves.

  57. Fifi says:

    Actually I know lots of people who run ethical businesses. I have nothing against ethical businesses, corporations are a very different beast than a regular business (not that there aren’t smaller businesses that are also unethical). I take issue with sleazy business practices and big corporations trying to control government and trying to get rid of basic public safety regulations or prevent them from being passed. Or when they promote pseudoscience like climate change denialists in the employ of oil companies do. I take issue with corporations trying to pretend they’re people and claiming that corporate lobbying (aka buying politicians) is “freedom of speech”. Or the pretense that government regulations that require manufacturers be honest about their products is impinging upon “freedom of choice” (when in reality corporations are impinging upon freedom of choice by promoting pseudoscience, mislabeling and making false claims for their products, etc). You sound like a healthfreedomUSA apologist for industry, not to mention a defender of pseudoscience.

    Recent events suggest that apparently a lot of CEOs do actually spend their time dreaming up ways to screw people for a buck – the banks, predatory loans and hedge funds are a fine example of this. Ditto the very well documented practices of tobacco companies. Also true of Monsanto. Sure their primary motivation is profit not hurting people but if people get hurt in the process of making profit these people clearly don’t care. I don’t think they’re out to get me – you’re the one who seems to be proposing the government is out to get you, in usual Corporatist style – I just know how marketing works. I don’t believe in fairies (let alone animated elves from commercials), apparently you do if you think corporations are honest and care about people. Your belief in the free market – something even Randians like Greenspan have recanted about – is believing in fairy dust and ideology rather than dealing with reality.

    It’s quite possible to make ventilators for preemies at cost, there’s no need to exploit people in the process. Once again you’re erecting strawmen in trying to pretend that all technological advances are dependent upon corporations and industry (when industry is actually one of the biggest threats to freedom of information on the internet). There’s a very good argument to be made that technology actually advances much more quickly in a non-corporate environment since there’s sharing of information (science certainly does). Industry constantly uses advances made by public science and rarely shares information so it actually effectively slows the progress of technology (as well as misinforming us about new technologies such as GMOs, trying to prevent public science being done that reveals the truth about their products, etc).

  58. windriven says:

    @Fifi-

    “It’s quite possible to make ventilators for preemies at cost, there’s no need to exploit people in the process.”

    I hate to sink to ad hominem attacks. So I’m just going to roll my eyes and let those who read your bizarre and hysterical rantings draw their own conclusions.

    But I must wonder: Do you have any idea how much it costs to bring a product – even one far simpler than a ventilator – to market? Do you have any concept of the risks involved? Why would someone take those risks instead of, say, buying a new sailboat?

    “corporations are a very different beast than a regular business”

    You truly are clueless. In the year 2000 there were about 5,000,000 active corporations in the US with total revenues of about 17.6 TRILLION dollars. (BizStats.com) It sounds like a big number but if you divide that out you’ll find that works out to only about $4000 per corporation. Sure, there are lots of big ones with huge revenues. But there are far more small mom and pop corporations. And there are a fair number that lose money in any given year.

  59. Fifi says:

    Clearly you have no interest in public health or in science, you’re simply here to defend corporate interests and promote an ideology that pretends to be about individual freedom but is really about promoting corporate interests. My interest is in keeping medicine science-based and in the public good, and in promoting reality based thinking and freedom of choice by protecting science-based medicine and access to accurate and scientific information so people can make informed choices.

    I’m not sure what kind of fantasy world you live in where you think that dividing the amount of corporations by the amount of profit is in any way reflects reality. There’s no such thing as a “mom and pop corporation”. There are “mom and pop” small businesses, they’re not corporations.

  60. JMB says:

    I don’t have any specific references, but I remember a lecturer in nephrology that made the point that between 30 and 40% of the population does demonstrate both an increase in blood pressure with higher salt intake, and a decrease in blood pressure with lower salt intake. The majority of people do not demonstrate variations in blood pressure due to salt intake. That subgroup of the population is large enough that larger studies will show a positive correlation between salt intake and hypertension in the population as a whole. If there really is a subgroup of the population that is unaffected by salt intake, then it is unfair to legislate lower salt intake for the entire population. It would be better to come up with an inexpensive test to determine which individuals are succeptible to hypertension due to elevated salt intake. They would then be counseled to limit salt intake.

  61. windriven says:

    @Fifi-
    Oh you’re so right! I’m in the pay of Big Pharma, Big Business, Big Banking, and Big Salty Sugary Food. It provides me with a comfortable life!

    Grow up and take responsibility for yourself. And allow others to do the same. The sodium content of foods is clearly labeled. Read it and use it.

    If a company lies about the sodium content (an impossible thing to conceal), prosecute them to the gates of hell.

    Problem solved by laws already on the books and with a regulatory bureaucracy that is already in place.

    But then what would you do with all your sanctimonious righteous indignation?

  62. micheleinmichigan says:

    # windrivenon 13 Jan 2010 at 11:37 am

    “does that suggest that parents are so disengaged from their children’s schools that they exert no influence over school lunches? Have PTAs been abolished? Have principals walled themselves off?”

    I think Dacks answered that “On school lunches – these programs are closely tied to the USDA commodity programs. In fact, they are more or less the place where we dump our surplus production. School systems are required to take the commodities – things like frozen chicken nuggets – in order to get the supplemental payments to cover low income students. Neither the PTA nor, more importantly, the school lunch providers, have much leeway in this system.”

    The PTA and Principle some power to rework the menu if they are willing to give up the federal funds. In Michigan all schools are facing huge cut backs. Some schools are eliminating the busing, lots of teacher cut back, class size increases. They are not going to risk losing federal lunch money funding. IMO, the change has to come nationally.

    It could be that if I worked really hard and mobilized a bunch of parents we could slightly increase the available healthy choices. It could also be that that movement would give me a reputation in the school as being difficult, thus making it harder for me to easily get the classroom adaptations, speech therapy, speaker systems that my son needs to participate in class each year. So, yup, I guess I’m choosing to whinge about it rather than do something. Of course, this is my second comment in this thread, while it is your (what number?) Maybe you have more time and will take on the task in your school district?

    I pack my kids lunches (oy, the complaints). But some of the kids lunch comes from the “hot lunch program” for low income families. To me it seem obvious, when hearing about any obesity epidemic that the place to start is school lunch and vending machines in school.

    I do think that there is usually ketchup available, though. So really it must all be okay. ;)

  63. Scott says:

    I don’t consider it a contradiction. As others have noted it, you can easily put more salt on your food. I think the “free market will regulate itself” people are full of it, that’s all. The NYC law is voluntary. Still, I can see lots of problems with it, and I do believe it is too easy of a solution. There are other more effective ways of encouraging healthy eating and stopping government financial support of corporations.

    Let me try to clarify my point, as I don’t think it got across well. As I read your post (that I originally quoted), you appeared to be saying “I don’t approve of the government limiting individual choices, but limiting corporate choices is OK, so I don’t have a problem with this sort of regulation because it is a limit on corporate choice, not individual.” If I misunderstood, which is very plausible, clarification of what you did mean would be appreciated.

    But assuming that’s in fact what you meant, my problem with it is that the primary effective restriction is in fact on individuals – they would no longer be permitted to purchase the types of food they have strongly indicated they prefer.

    So long as the production and sale of unhealthy foods is driven by consumers wanting to buy them, as opposed to being driven on the supply side, restricting such production and sale has its principal effect as removing consumer choice.

  64. Fifi says:

    windriven – “Grow up and take responsibility for yourself. And allow others to do the same. The sodium content of foods is clearly labeled. Read it and use it.”

    Oh please, grow up and recognize that being an adult involves being socially responsible and not just acting like a greedy five year old. Once again you’re totally ignoring the fact that corporations lie on their labels, this prevents people from being able to make informed choices. Your unquestioning adherence to an ideological position and rejection of reality (and constant erecting of strawmen) is what is childish. Like the healthfreedom crew, you’re not actually interested in personal freedom and allowing people the needed information to make an informed choice but in unrestricted corporate freedom to exploit and misinform people. Corporations aren’t people, even though they keep trying to argue that they deserve “human rights” (and there’s the pretense that corporate lobbying is freedom of speech).

    I cook my own food so it’s not an issue for me. However, I also recognize that I grew up in a privileged position and had access to education (and food) that not everyone else did. My parents are doctors, I was taught how to look after my health, etc. I have no interest in making people’s choices for them, my interest is in giving people access to the education and information to make their own informed choices, and access to healthy foods so that they have a choice. That’s not a nanny state, that’s true freedom of choice. You’re the one who wants to allow corporations to manipulate people because you have some naive idea that corporations are good and honest. You’re also naively ignoring how marketing and advertising works, how access to food works, etc. Or is it really that you just believe it’s okay to screw over and exploit people for personal or corporate profit? In that case, it’s rather frightening to think that you’re involved in manufacturing medical devices of any kind since clearly you think it’s okay to do anything to make a profit.

  65. edgar says:

    I think I land right smack in the middle of Fifi and Wind. Aside from the corporate end and shelf space and advertising at all that….
    It isn’t free market is it, when potatoes and corn are so heavily subsidized. You think Frito-Lay (and others) don’t have a say in that? It irks me that the US taxpayer is allowing these companies to buy the raw products so cheap, then we pay again in increased health care costs.

    The obesity issue is about personal choice.

    It is also about government policy, workplace policy, the built environment, access to healthy food, shifting the idea of what exercise is…for a start

  66. Fifi says:

    Scott – “they would no longer be permitted to purchase the types of food they have strongly indicated they prefer.”

    This is the fallacy. Poor people buy what they can afford, not what they’d prefer. If you only have access to certain things, those are the only things you can buy.

    Even if someone is affluent enough to have an actual choice and that choice is available where they live, if they’re being lied to by manufacturers via advertising and on packaging then their choice isn’t reality-based or even really a choice (it’s an illusion of choice).

  67. windriven says:

    @edgar-
    Potatoes and corn are heavily subsidized and I suspect that everyone (excepting potato farmers and the companies that buy potatoes in mass quantities) would agree that it should be stopped.

    But I’m tying to grasp your underlying point here. In an earlier post you asked:

    “Are we promoting unhealthy foods from he very beginning when we subsidize corn, soybeans, and potatoes?”

    Corn, potatoes and soybeans are in and of themselves pretty nutritious foods. It isn’t so much the direct subsidy to potato farmers that promotes unhealthy foods as it is the indirect subsidy to, for instance, potato chip makers. Is that more or less what you were getting at?

  68. Fifi says:

    edgar – “It isn’t free market is it, when potatoes and corn are so heavily subsidized. You think Frito-Lay (and others) don’t have a say in that? It irks me that the US taxpayer is allowing these companies to buy the raw products so cheap, then we pay again in increased health care costs.”

    Well said. Corporations already benefit from all kinds of government subsidies, it’s hardly a free market in the US when it comes to food. Corporations spend a great deal of money lobbying government to ensure that the playing field isn’t actually level and that they get to use taxpayer money to create private profit. If we’re going to talk about personal responsibility, then we need to talk about social and corporate responsibility too. At the moment, America really is the best democracy that money can buy (and obviously there’s a huge power differential between an individual and a corporation when one talks about both government influence and the ability to settle something in court).

    edgar – “The obesity issue is about personal choice. It is also about government policy, workplace policy, the built environment, access to healthy food, shifting the idea of what exercise is…for a start”

    I agree. I’m all for personal responsibility and freedom of choice, but freedom of choice means having enough information to make that choice and having access to a real choice. That’s why I’m an advocate of education and access to healthy foods, rather than regulation. That said, there’s a place for regulation as well when it comes to public health. For instance, would windriven argue that lead paint should still be on sale? Or that industry should be allowed to dump toxic waste into rivers because people can choose not to drink water out of their tap?

    And to bring it back to SBM, corporations are some of the biggest promoters of pseudoscience out there and often directly attack SBM and public science. They also often hinder technological and scientific advancement due to promoting pseudoscience, not sharing information and trying to stop advancements or public policies that may interfere with their ability to exploit people or lie about their products.

  69. edgar says:

    Yes, they are healthy foods, or used to be.

    Much of the subsidized corn cannot be eaten off of the ear, it has to be processed first. It no longer resembles what we get at the farm stand.
    And the soybeans are not grown for edemame.
    The potatoes are being grown for their uniformity and sugar/starch content so that they may be better sliced into chips or fries.

    So it isn’t a matter of those foods being healthy and then made unhealthy, in many cases, they are less healthy in their raw state and (in the case of corn) inedible. It is very clear that we are subsidizing the making of junk food itself.

  70. windriven says:

    Unfortunately, ending these subsidies is going to be tough. Science may not be miscible in legislation but money is. Justice and legislation are alike in this country in that you often get exactly as much as you can afford ;-)

  71. Scott says:

    This is the fallacy. Poor people buy what they can afford, not what they’d prefer. If you only have access to certain things, those are the only things you can buy.

    Hardly limited to the poor. There’s a different problem there, but people from all walks of life eat way too much unhealthy food.

    Even if someone is affluent enough to have an actual choice and that choice is available where they live, if they’re being lied to by manufacturers via advertising and on packaging then their choice isn’t reality-based or even really a choice (it’s an illusion of choice).

    Leaving aside the fact that you’re describing the vast majority of Americans (the population of interest when discussing regulation in America) but portraying it as rare, this argument doesn’t by any stretch of the imagination lead to regulation of food contents. False advertising is already illegal, and the FDA has recently been taking action in such cases. (e.g. the Cheerios warning letter) I’ve got no problem with stronger regulation of what may be claimed on packaging and in advertising, but that’s completely different from regulating contents.

    If the problem is people making decisions based on bad information, surely the proper course of action is to correct the bad information, instead of making the decision for them.

  72. lizkat says:

    I do not believe salt is relevant to the current health crisis, which is mostly related to the obesity epidemic. Everything I have read so far on the link between salt and artery disease suggests that most of the research has been correlational and misleading, or short-term. Yes you can increase blood pressure by eating salt. But is there a chronic increase, and does it contribute significantly to artery disease? I don’t think we really know.

    I don’t worry about salt for myself, and won’t unless I hear of good quality evidence showing it really is dangerous. A reasonable amount of salt (with NO additives) can make certain kinds of food taste great. I think millions of Americans have suffered with a taste-free low-salt diet for no reason at all.

    If you want to address the health crisis in a meaningful way, decrease the amount of refined carbohydrates in restaurant and processed food. Refined carbohydrates contribute to the type 2 diabetes epidemic, which is a major cause of artery disease.

    This is the first time I have seen an MD express skepticism regarding the low salt diet craze, and I am very glad to see it. Of course we should use salt (and everything else) moderately. But there is no need to give up, or drastically cut back, something that tastes great, is natural, and has no calories.

  73. edgar says:

    A reasonable amount of salt (with NO additives)

    yeah, but if your goiter gets big enough your BMI increases!

  74. lizkat says:

    How much iodine do we really need? The additives in salt taste really really bad. Not necessarily the iodine, but the other garbage. I had no idea until I tried kosher salt with no additives whatsoever. What an amazing difference.

  75. Zoe237 says:

    “But assuming that’s in fact what you meant, my problem with it is that the primary effective restriction is in fact on individuals – they would no longer be permitted to purchase the types of food they have strongly indicated they prefer.”

    Scott, that’s exactly what I meant, and I understand your disagreement. I don’t see it as taking away choice of the individual because they can add salt to their food. I also don’t see constitutional right (in a manner of speaking) to salty food. Consumers aren’t allowed to buy a lot of things, and corporations aren’t allowed to make a lot of things- there has to be an analysis of benefit and harm there.

    Now if the government tried to ban the importation or ingestion of salt, that would be another thing.

    I can appreciate your side, and maybe it is my own anti-corporate bias (maybe not quite as extreme as Fifi’s). The truth is that salt is not “dangerous” and more and more I’m finding the idea of regulating salt content of food kind of silly, considering the other more pressing nutrition issues out there (like vending machines in school or the AAFP affiliation with COKE!).

  76. Dionigi says:

    @joep
    In the Uk higher taxes have driven smokers into the arms of the criminal underworldm smuggling ciggies is now big business.

  77. Fifi says:

    1 – NYC isn’t trying to ban individuals from eating salt, it’s trying to regulate how much salt is added by people who sell pre-made food. It’s a strawman to try to make out this is about individual freedom. No one will be arrested for adding salt to their meal, there will still be salt shakers on tables. Trying to pretend this is about personal freedom is EXACTLY the same strawman tactic – trying to argue a fantasy rather than the reality of a situation – as used by the likes of General Stubblebine of “healthfreedom” (so his business doesn’t get regulated).

    2 – I’ve been advocating education and access to healthy food as the solution, not regulation. The food supply is already subsidized, it’s a matter of changing it so that public health and access to healthy food is being subsidized and it’s not corporate profit that is being subsidized by taxpayer dollars. Food is already regulated, it’s about making sure those regulations reflect the public good and are enforced. If industry was inherently ethical, there’d be no need to have regulations. Some companies ARE ethical, they have no problem with being regulated since it makes no difference to them. The industries and manufacturers who lobby against regulation the most are those who need to be regulated the most.

    3 – There are ethical companies and businesses, and ethical business people. I’m not anti-business or trade, I’m anti-multinational corporations because I’ve yet to run across one that’s actually ethical (and their unethical practices are well documented). There is no such thing as a “mom and pop” multinational corporation, to propose this is silly and yet again lifting a tactic straight from Stubblebine’s “health freedom” playbook.

    On a voyeuristic note, it’s interesting to see how Corporatists/NeoCons have totally hijacked the Libertarian movement in the US.

  78. manixter says:

    I find it interesting that people vary in their responses to a salty diet. My husband definitely has a greater response to salt than I do, to the point that there are times where I will actually seek out a salty meal (certainly my diet is not high in salt, but I tend to seek out more salt than he does). Perhaps it’s all those kosher jews in my genes– generations of salted meat created a higher salt tolerance (and possibly requirement) in my hunky forebears.

  79. BillyJoe says:

    I find salt destroys the true, often subtle, taste of good food.
    I heap it on bad food though: fish and chips without salt? …get away!

  80. MattHagen says:

    As an frequent marathon runner (20 last year), I find it necessary to take salt supplements in order to stave off cramps due to potassium, sodium and calcium deficiencies. Most of my endurance running friends seem to agree on this point – that they have to seek out extra salt to keep things in balance.

    So the answer seems simple. Any customer who wants a salty meal should have to pop out for a quick 10-miler first. :-)

  81. BillyJoe says:

    MattHagen,

    “As an frequent marathon runner (20 last year), I find it necessary to take salt supplements in order to stave off cramps due to potassium, sodium and calcium deficiencies.”

    This reference disagrees:
    http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Salt?OpenDocument

    “Some people believe that salt has to be replaced during hot weather or strenuous exercise to avoid muscle cramps. This is not correct. What you need to replace is water. The human body can happily survive on just one gram of salt a day, as hormones keep a check on sodium levels and make adjustments for hot weather. A genuine sodium shortage brought on by hot weather or exercise is extremely rare, even among hard-working athletes.

    The muscle cramps that sometimes follow a bout of sweating are due to dehydration, not lack of salt. To prevent cramps, drink plenty of water on hot days and before, during and after exercise. This will also help to even out the water–sodium ratio in the body.”

    My anecdote for what it is worth:
    I have run marathons in the past and presently walk and run in the hills for 4 to 8 hours every weekend. I drink only water and have never suffered from muscle cramp.

  82. yeahsurewhatever says:

    This generation’s war on salt is next generation’s rampant iodine deficiency, resulting in profoundly more births of mentally impaired infants. Unless large numbers of people begin to eat more seafood, but then the waters of the world are already being fished to extinction.

    Someone think of another foodstuff to dope with iodine besides salt. Iodized rice, perhaps?

  83. clgood says:

    Dr. Novella:

    This issue just came back on my radar with a report that Nanny Ortiz in New York wants to outlaw the use of salt in restaurants. Along with this (absurd) news was mention of a new study which apparently shows that our bodies self-regulate sodium levels, meaning that you can’t control them by policy anyway. It certainly seems plausible to me. I’d be curious to know what you and the SBM crowd opine.

    Here are a couple of links I found:

    http://www.healthjockey.com/2009/10/22/research-reveals-interesting-facts-about-salt-intake-by-humans/

    http://www.news-medical.net/news/20091015/New-evidence-indicates-humans-naturally-regulate-their-salt-intake.aspx

    (I’m assuming someone gets pinged about comments, because this thread has been dead for a month.)

    Thanks.

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