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Salt Medical Necessity Avoid Overuse Reduce Heart Disease Hypertensi

1403 -
1403 -    ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS 19 0000.
140502 -
140504 -  ..
1406 -
1407 -
1408 - Progress
1409 -
140901 - Research salt issue finds...
140902 -
140903 - Follow up ref SDS 19 D58G.
140904 -
140905 - While driving to the airport last year, Ross asked about effects of
140906 - excessive salt, reported on 101130 0400. ref SDS 30 YP6M
140922 -  ..
140923 - Today, Reuters published an article on this issue...
140924 -
140925 -    Special Report: A pinch of doubt over salt
140926 -
140927 -              http://news.yahoo.com/special-report-pinch-doubt-over-salt-130624186.html
140928 -
140929 -    By Kate Kelland, Health and Science Correspondent
140931 -         ..
140932 -    1.  LONDON (Reuters) - In Britain it started with Sid, the "giant
140933 -        slug with a message", who slicked his way onto television
140934 -        screens back in 2004 as part of a government health campaign
140935 -        to warn people about the dangers of consuming too much salt.
140936 -        "Stay away from fast cars, loose women and SALT!" he screamed.
140938 -         ..
140939 -    2.  Sid's message -- that liberal sprinklings of sodium, the main
140940 -        component of salt, don't only kill slugs but humans too -- has
140941 -        now become conventional wisdom worldwide. High salt intake is
140942 -        linked to high blood pressure, or hypertension, a key risk
140943 -        factor for strokes, heart attacks and other cardiovascular
140944 -        diseases. Together those rank as the world's number one
140945 -        killers. The World Health Organization (WHO) puts cutting salt
140946 -        intake alongside quitting smoking as one of the top 10 "best
140947 -        buys" in public health.
140948 -
140949 -    3.  "Blood pressure is the biggest cause of death in the world
140950 -        ...and salt is the most important thing that puts it up,"
140951 -        says Graham MacGregor, a professor of cardiovascular medicine
140952 -        at the London-based Wolfson Institute of Preventive Medicine
140953 -        and chairman of the influential World Action on Salt and
140954 -        Health lobby group (WASH). "Cutting back on salt gives a
140955 -        direct beneficial effect on the biggest cause of death in the
140956 -        world. That's why it's so important."
140958 -  ..
140959 - Reducing salt in diet to lower blood pressure begs the threshold
140960 - question of whether blood pressure is currently too high for good
140961 - health?
140963 -  ..
140964 - Patient history in case study on 101010, shows blood pressure and
140965 - heart rate do not present health risk for coronary artery disease
140966 - (CAD), and in recent months show very strong coronary pulmonary
140967 - system, ref SDS 29 TI4J, based on published guidelines for good health
140968 - listed on 100305 1000. ref SDS 26 2R4O
140970 -  ..
140971 - Weight is a patient controllable factor that affects both blood
140972 - pressure and cholesterol.  Doctor Sandhu noted in a meeting at the VA
140973 - on 110803 that progress reducing weight toward 165 will help reduce
140974 - LDL cholesterol toward < 70 even though simvastatin has done all it
140975 - can to lower cholesterol, and it is still higher than ideal, based on
140976 - evolving standards, reported on 110803 1400. ref SDS 32 NQ38
140978 -  ..
140979 - Special Report on salt continues...
140980 -
140981 -    4.  Or is it? Recent scientific papers suggest the basis for a
140982 -        global crackdown on salt is not what you'd call rock solid.
140983 -        Two 2011 studies indicate that the evidence is inconclusive,
140984 -        or that reducing salt may even be harmful.
140985 -
140986 -    5.  "There's a view that salt is the root cause of all high blood
140987 -        pressure worldwide and some people religiously hold on to
140988 -        that belief," said Tony Heagerty, head of the cardiovascular
140989 -        research group at Britain's Manchester University and a
140990 -        formerpresident of the International Society of Hypertension.
140991 -        "But the evidence for that is actually pretty flimsy."
140993 -         ..
140994 -    6.  It's a debate that has flared over the past few months, with
140995 -        each side harnessing a legion of experts in hypertension, heart
140996 -        disease, nutrition and scientific analysis. The salt industry
140997 -        has, naturally, jumped on studies that question the
140998 -        conventional wisdom, and at least one food manufacturer has
140999 -        started to add salt back to some of its processed foods.  At
141000 -        times the row has become personal. Trapped in the middle are
141001 -        consumers, who may worry they have become unsuspecting guinea
141002 -        pigs in a grand global experiment.
141003 -
141004 -    7.  "The two sides are totally polarized and there's no agreement or consensus on
141005 -        what the answer is," says Peter Sherratt of the UK Salt Association. Any new
141006 -        scientific paper which supports the anti-salt position is lauded as proof
141007 -        saltconsumption is dangerous, but any piece of evidence or science showing
141008 -        salt is beneficial, or reducing it dangerous, is criticized as
141009 -        unrepresentative, he said.
141011 -         ..
141012 -    8.  The debate has big implications for business. Salt for food use accounts for
141013 -        only a fraction of the 250 million tonnes of annual global production.
141014 -        Lookingat the United States alone, 1.5 million tonnes of so-called human
141015 -        nutrition salt was sold in 2009 with a value of more than $321 million.
141017 -         ..
141018 -    9.  But the U.S. snack foods industry -- a key consumer of salt which includes
141019 -        major companies like Pepsico's Frito-Lay and Kraft's Nabisco -- has a
141020 -        combinedannual revenue of $27 billion, according to analysis by company
141021 -        profile builder Hoover's. Then there's the business of selling drugs to treat
141022 -        high blood pressure. Worldwide sales of anti-hypertensives were around $35
141023 -        billion in 2009, according to research by Deutsche Bank.
141025 -         ..
141026 -   10.  Heagarty disclosed that 15 years ago, his department accepted 2,000 pounds
141027 -        ($3,200 at today's rates) from the U.S.- based industry lobby, the Salt
141028 -        Institute, but said he has no current financial conflict of interest.
141030 -         ..
141031 -   11.  WORTH THE SALT?
141032 -
141033 -        Salt has been taxed, monopolized, treasured and fought over for thousands of
141034 -        years. Today's scientists are waging a modern-day salt war.
141036 -         ..
141037 -   12.  In the 1970s, American researchers experimenting on rats found very high
141038 -        dosesof salt raised blood pressure. Some of the most-cited evidence on salt
141039 -        and health came in a 1988 international study called InterSalt, which
141040 -        surveyedmore than 10,000 men and women in scores of populations across the
141041 -        world. The study included four remote tribes in Brazil, Kenya and New Guinea
141042 -        whose people had the lowest salt intake and were also found to have the
141043 -        lowestblood pressure and very few, if any, cases of hypertension. Although
141044 -        these findings were disputed by parties including the Salt Institute, it
141045 -        wasn't long before a scientific consensus emerged that too much salt is bad
141046 -        for you.
141048 -         ..
141049 -   13.  A 2005 study in the PubMed journal found almost 1 billion people around the
141050 -        world have high blood pressure, which makes the heart work too hard, hardens
141051 -        the walls of the arteries and can cause other problems such as heart failure,
141052 -        kidney disease, and blindness. Cardiovascular diseases are the leading cause
141053 -        of death globally, claiming 17.1 million lives a year. A substantial number
141054 -        ofthese deaths are put down to smoking, which raises the risk of
141055 -        hypertension,strokes and heart attacks.
141057 -         ..
141058 -   14.  In the past few years, governments have begun to act. Under its
141059 -        health-promoting mayor Michael Bloomberg, New York City pledged in 2010 to
141060 -        coordinate a U.S.-wide effort to cut salt in restaurant and packaged foods by
141061 -        25 percent. National sodium reduction strategies have been adopted across
141062 -        Europe and in Australia, China and India.
141064 -         ..
141065 -   15.  Scores of health authorities around the world advise that we should aim to
141066 -        reduce our salt intake from the roughly 9 to 12 grams a day we eat now down
141067 -        toaround 6 grams - about a teaspoonful a day. Since around 75 percent of all
141068 -        the salt we consume comes from packaged and processed food, rather than from
141069 -        what we sprinkle on top of it, food manufacturers have been in the firing
141070 -        line.
141072 -         ..
141073 -   16.  Under pressure from health authorities and the WHO, the food industry --
141074 -        whichstands accused of using salt to boost the flavor, shelf-life and profit
141075 -        of what would otherwise be bland ingredients -- has taken action. Big brands
141076 -        like Heinz, Kellogg's, Nestle, Pepsico, General Mills and others have been
141077 -        steadily reducing sodium levels in their foods.
141079 -         ..
141080 -   17.  According to Susan Jebb, a nutrition adviser to the UK government, Britain is
141081 -        leading the way, forcing foodmakers to make some "impressive" reductions
141082 -        including a 30 percent reduction in salt in bread, about a 50 percent cut in
141083 -        branded breakfast cereals and around 25 percent in pasta sauces.
141085 -         ..
141086 -   18.  Among the health-conscious at least, a salt-shaker on the dining table is
141087 -        becoming almost as frowned on as an ashtray.
141089 -         ..
141090 -   19.  NOT CRYSTAL CLEAR
141091 -
141092 -        But the findings that policy-makers have accepted as settled are not as
141093 -        clear-cut among scientists. A study in July by the much-respected Cochrane
141094 -        Library, which conducts meta-analyses of scientific data by grouping together
141095 -        the best studies on a subject and pooling the results, found no evidence that
141096 -        reducing salt intake cuts the risk of developing heart disease or dying
141097 -        beforeyour time.
141099 -         ..
141100 -   20.  In that study Rod Taylor, a professor of health services research at Exeter
141101 -        University, analyzed seven randomized controlled trials covering more than
141102 -        6,500 people and found that although cutting down did appear to lead to slight
141103 -        reductions in blood pressure, this did not translate into lower risk of heart
141104 -        disease or premature death.
141106 -         ..
141107 -   21.  In one group of people -- those with pre-existing heart conditions --
141108 -        reducingsalt was actually associated with an increase in the likelihood of
141109 -        premature death.
141111 -         ..
141112 -   22.  Taylor said he did not receive payment from, or have links to, the salt
141113 -        industry. His study was funded by a grant from the UK government's National
141114 -        Institute for Health Research.
141116 -         ..
141117 -   23.  Taylor's study came hot on the heels of another, by Belgian scientists, which
141118 -        was published in the Journal of the American Medical Association (JAMA). That
141119 -        found people who ate lots of salt were no more likely to get high blood
141120 -        pressure, and were statistically less likely to die of heart disease, than
141121 -        those with low salt intake.
141123 -         ..
141124 -   24.  The researchers used data from two different studies, involving a total of
141125 -        around 3,700 Europeans whose salt consumption was measured through urine
141126 -        samples. The scientists divided the participants into three groups with low,
141127 -        medium and high intake: those with the lowest salt intake had the highest
141128 -        rateof death from heart disease - at 4 percent. People who ate the most salt
141129 -        had the lowest death rate from heart disease, at less than 1 percent.
141130 -
141131 -   25.  "One should be very careful in advocating generalized reduction in sodium
141132 -        intake in the population at large. There might be some benefits, but there
141133 -        might also be some adverse effects," says Jan Staessen, head of hypertension
141134 -        studies at the University of Leuven and the lead investigator on the Belgian
141135 -        study. "You have to ask, should public health policies be based on something
141136 -        which is still being debated? I don't think so."
141138 -         ..
141139 -   26.  Staessen told Reuters he had no financial conflicts of interest. His work was
141140 -        funded largely by grants from the European Union and European national
141141 -        governments.
141143 -         ..
141144 -   27.  WHO SAYS A TEASPOONFUL WILL DO?
141145 -
141146 -        Such studies are re-drawing the battle lines around salt. Foodmakers are
141147 -        starting to fight back against the low-salters. Campbell's is now putting
141148 -        more salt back into all 31 of its Select Harvest soups after consumers voted
141149 -        with their taste buds and stopped buying the reduced-salt version.
141150 -
141151 -   28.  "One size doesn't fit all," says Juli Mandel Sloves, Campbell's senior
141152 -        managerfor nutrition and wellness communications. "And what this research
141153 -        debate shows is exactly that. You can't make a recommendation based on the
141154 -        needs of only one part of the population. It's really important that we offer
141155 -        a variety of choices."
141157 -         ..
141158 -   29.  Other major food industry groups and manufacturers approached by Reuters,
141159 -        including Kellogg's and Pepsico, as well as the U.S. Grocery Manufacturers'
141160 -        Association, either declined to be interviewed or sent statements reiterating
141161 -        their commitment to reducing sodium levels in their foods, in line with
141162 -        government dietary recommendations.
141164 -         ..
141165 -   30.  But the powerful U.S. National Restaurant Association is questioning the
141166 -        accepted wisdom. "The science is very clear in showing that reducing sodium
141167 -        reduces blood pressure. There's no question about that. The controversy is
141168 -        around reducing cardiovascular disease and ... basically the risk of death.
141169 -        That's where the evidence is completely weak," says Joy Dubost, the NRA's
141170 -        Director of Nutrition and Healthy Living. In other words, cutting back on
141171 -        saltdoes reduce blood pressure, but it may not reduce the risk of dying early.
141173 -         ..
141174 -   31.  Michael Alderman, a blood pressure expert at Albert Einstein College of
141175 -        Medicine in the United States and editor of the American Journal of
141176 -        Hypertension, believes there's a sense that some scientists -- and most
141177 -        policymakers -- may have moved too early to target salt as the cause of the
141178 -        problem. "If we're doing something so dramatic to the diets of whole
141179 -        populations, there should be no argument. The evidence should be
141180 -        overwhelming,but it's not overwhelming at all," he said.
141182 -         ..
141183 -   32.  Of around a dozen scientists interviewed by Reuters for this story, about
141184 -        halfshared this point of view; but since they included salt-reduction
141185 -        campaigners and salt industry representatives, that is not necessarily an
141186 -        indicator of the balance of opinions across the scientific community.
141188 -         ..
141189 -   33.  Alderman argues that in addition to changing blood pressure, cutting sodium
141190 -        can cause other physiological changes such as increased resistance to insulin
141191 -        -- which can set the stage for diabetes and increase the risk of death from
141192 -        heart disease. Too little sodium can also increase sympathetic nerve activity
141193 -        which raises the risk of heart attacks, and boost the secretion of
141194 -        aldosterone, a hormone produced by the adrenal gland that is bad for the
141195 -        cardiovascular system.
141196 -
141197 -   34.  "What we have -- like almost all interventions in health and medicine -- is
141198 -        something that produces a multitude of different effects," said Alderman, who
141199 -        disclosed having taken one $750 payment more than a decade ago from the Salt
141200 -        Institute, but who said he has since had no financial help from the industry.
141201 -        Besides Alderman and Heagerty, none of the other academic scientists
141202 -        interviewed for this article have disclosed financial interests.
141204 -         ..
141205 -   35.  In a letter to the British government seen by Reuters, the UK's Salt
141206 -        Association -- which along with the Salt Institute has a vested interest in
141207 -        defending the salt industry -- cites the Cochrane and JAMA papers and demands
141208 -        an urgent review of the salt reduction strategy. It goes as far as to say:
141209 -        "People may actually be dying as a result of poorly founded advice."
141211 -         ..
141212 -   36.  IS SALT THE NEW TOBACCO?
141213 -
141214 -        That kind of talk exasperates the Wolfson Institute's
141215 -        MacGregor, one of the most vocal advocates of salt reduction
141216 -        anywhere.  Along with Franco Cappuccio, head of the WHO's
141217 -        collaborating center for nutrition at Warwick University
141218 -        andSimon Capewell, a professor of clinical epidemiology at
141219 -        Liverpool University, McGregor argues that salt -- most of it
141220 -        hidden in processed and packaged foods -- is a huge problem.
141222 -         ..
141223 -   37.  It's perhaps an indication of his conviction that MacGregor
141224 -        equates the argument about salt to past rows over tobacco, even
141225 -        though unlike tobacco, salt is a fundamental nutritional
141226 -        requirement for humans to survive.
141228 -         ..
141229 -   38.  "We're in exactly the same position as we were with tobacco 20
141230 -        or 30 years ago when people were still arguing about whether
141231 -        tobacco caused lung cancer or heart disease," MacGregor says.
141232 -        "It obviously did, there was no doubt about it-- and the only
141233 -        people arguing were people who had commercial interest."
141235 -         ..
141236 -   39.  WASH and its UK counterpart CASH (Consensus Action on Salt and
141237 -        Health), which is also chaired by MacGregor, are funded by
141238 -        donations from individuals and charities.
141240 -         ..
141241 -   40.  Cappuccio and Capewell point to scores of scientific analyses
141242 -        to make their point.  A 2007 study predicted that reducing salt
141243 -        intake around the world by 15 percent could prevent almost 9
141244 -        million deaths by 2015.  Another study published in March 2010
141245 -        found that cutting salt intake by 10 percent in the United
141246 -        States could prevent hundreds of thousands of heart attacks and
141247 -        strokesover decades and save the government $32 billion in
141248 -        health care costs.
141250 -         ..
141251 -   41.  In a recent British Medical Journal commentary, Capewell and
141252 -        Cappuccio cautioned: "Denial and procrastination will be costly
141253 -        in terms of both avoidable illness and expenses."
141255 -         ..
141256 -   42.  When confronted with the two most recent scientific studies
141257 -        suggesting the contrary, MacGregor dismissed them as flawed or
141258 -        paradoxical. "There is absolutely no evidence of any harm from
141259 -        reducing salt intake.  Absolutely none," he said.
141261 -         ..
141262 -   43.  In the case of the Cochrane review, MacGregor set about
141263 -        re-crunching the numbers and swiftly published a fresh analysis
141264 -        of the data in a rival medical journal, The Lancet, which drew
141265 -        the opposite conclusion.
141267 -         ..
141268 -   44.  Taylor responded by saying MacGregor had taken two of the sets
141269 -        of data in the study -- one from people with normal blood
141270 -        pressure and one from people with hypertension - and grouped
141271 -        them together.  This, he said, is like comparing apples and
141272 -        oranges, and breaks a central tenet of statistical analysis.
141274 -         ..
141275 -   45.  Manchester University's Tony Heagerty has a wry observation of
141276 -        this to-and-fro: "If you torture data long enough it will give
141277 -        you the answer you want."
141279 -         ..
141280 -   46.  ONE BIG EXPERIMENT
141281 -
141282 -        Much of the argument barely touches on the data -- descending
141283 -        instead into personal attacks and accusations of conflicts of
141284 -        interest.  Scientists on both sides talk of being taunted by
141285 -        their rivals.  Both Cappuccio, who advocates less salt, and
141286 -        Staessen, the hypertension expert who has found risks in salt
141287 -        reduction, say they have been victimized or intimidated after
141288 -        publishing papers in scientific journals.
141290 -         ..
141291 -   47.  Salt-reduction advocate MacGregor points at one of his main
141292 -        opponents across the Atlantic, Morton Satin, director of
141293 -        science and research at the U.S.-based Salt Institute, who says
141294 -        reducing salt across whole populations may do more harm than
141295 -        good. "Imagine he's wrong," MacGregor said. "That would mean
141296 -        he's responsible for millions of strokes worldwide. When he
141297 -        goes to sleep tonight, he might like to think about that."
141299 -         ..
141300 -   48.  Satin hits back that the whole situation has left science
141301 -        behind. "Passions overtake an objective view of science... and
141302 -        we can have an entire society being led to believe something
141303 -        that doesn't stack up."
141305 -         ..
141306 -   49.  There is one thing the two sides appear to agree on: the matter
141307 -        could be settled by a large-scale -- 20,000 to 30,000 people --
141308 -        randomized clinical trial with half allocated to a high and
141309 -        half to a low salt diet.  To be done properly, the main
141310 -        protagonists agree, such a trial would need to run for several
141311 -        years. The huge numbers are needed so that all other possible
141312 -        factors -- weight, age, fitness, quality of diet, and medical
141313 -        conditions -- are roughly equal in both groups.
141315 -         ..
141316 -   50.  But salt-reduction advocates MacGregor and Cappuccio say such a
141317 -        trial would be prohibitively expensive, unnecessary, and may
141318 -        even be unethical.  Again they draw comparisons with smoking.
141319 -        Since, in their view, the harms of salt are indisputable,
141320 -        asking people to be kept on a high salt diet for the purposes
141321 -        of a medical experiment would be equivalent to forcing people
141322 -        to smoke.
141324 -         ..
141325 -   51.  Alderman is enraged by such suggestions. "Any medical ethicist
141326 -        would say that before you impose changes you have to make sure
141327 -        they are safe and beneficial.  If the science is uncertain,
141328 -        then how can it be unethical to do the right studies to answer
141329 -        the scientific questions?  If you're asking 300 million
141330 -        Americans and I don't know how many millions of other people
141331 -        around the world to change their diet so dramatically, you
141332 -        ought to have overwhelming evidence that it's a good idea and
141333 -        it's safe."
141335 -         ..
141336 -   52.  Until the row is settled, people's salt intake will probably be
141337 -        guided by personal taste.
141338 -
141339 -   53.  (Edited by Simon Robinson, Michael Williams and Sara Ledwith)
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