Friday, April 30, 2010

Rant: We Might Not Get Enough Salt? Really?

Tuesday April 27, 2010 USA Today published an article under Today's debate: Your health. It was entitled What can be done to shake Americans' salt habit?. The opposing view, Consumers deserve better, was offered by Morton Satin, Director of the Technical and Regulatory Affairs for the Salt Institute.

My husband pointed out this article to me, probably because he knows it will trigger a rant. I fall for it every time. The links are at the end of this post so you can read the debate for yourself. Hopefully it won't raise your blood pressure or leave you craving a salty snack for comfort. Not that it did that to me, I'm just saying...

Is salt inherently bad?

Let me think about salt for a minute. It contains mainly sodium chloride and is an essential mineral to life. It is a common preservative and has many other practical uses, such as being an ingredient in my favorite skin exfoliator. It was necessary to mix with ice for our homemade ice cream machine when I was a kid. We put it on the pavement if we have an ice storm. It hurts when I get it in a paper cut. It is what I am craving when I eat chips at my favorite Mexican restaurant. It looks pretty in my antique salt shaker. Okay, except for the paper cut part, salt can't be inherently bad.

The key is in the word inherently. No, salt in and of itself is not bad.

So What's the Problem?

Well apparently, as with many other things, Americans are taking in too much sodium. I know, I was shocked too. The article states the recommended maximum intake of sodium is 2,300 milligrams (mg) daily, and Americans are consuming an average of 3,400 mg daily. It also reminds us of the concerns of high blood pressure, heart disease, stroke, kidney problems and associated medical costs. That doesn't seem to be anything new to me, and the distressing part is that we've known all this for a while, but we're still consuming too much sodium, so we're obviously not motivated to change our habits to prevent disease or save money.

More interesting for fueling the debate is the fact that the article pointed out salt use in the food industry is contributing to the obesity crisis. Apparently salt used in specific combinations triggers cravings for not only more of that particular food, but for common, associated beverages. But it seems it's not so much about the salt shaker as it is about processed foods.

The problem is with intake of products with excessive, unnecessary sodium.

Let's say we want to be conscious about how much sodium we're taking in.

To do so, we MUST read labels. Here are a few examples:

  • Can of green beans (generic): 390 mg of sodium in 1/2 cup
  • 10.5 oz can of popular brand of soup: 480 mg of sodium in one serving

Not compelling? Do we think the average person eats 1/2 cup of plain, unsalted green beans? How about the fact that there are 2.5 servings in that one 10.5 oz can of soup? So if you ate the whole can, you'd have eaten 1200 mg of sodium and that's assuming you didn't eat any crackers with it, or a salad with dressing on it (more sodium). (You're thinking sure, I know canned stuff has more sodium in it). How about this?

  • 1/2 cup of lowfat cottage cheese has 450 mg of sodium
  • 1 tbsp of ketchup has 190 mg of sodium

Think about all the ingredients that just went in to what was cooked for dinner last night. Oh, but that's assuming we are cooking! See more ranting below.

More obvious labeling? What is the world coming to?

Part of the uproar is that the FDA is working on requiring nutritional labeling on the front of the package, so it's harder to ignore the label, and perhaps it might draw attention to the label for folks who really do want to know and make more informed decisions. To that I say, let's do it! But then I guess there wouldn't be room for pretty colors, fancy logos and cartoon characters and words like enriched, fat-free, low-fat, no sugar added, sugar-free, low carb, whole wheat, more fiber, etc.

The frenzy starts with the recommendation that the FDA set legal limits for sodium content in foods. To that I say, please don't! I've never seen a situation in any area of life in which a rigid, one-way, blanket approach solved a complex, multi-faceted problem. If we only legally require less sodium in foods, we will still have a problem of twisted labeling and people making bad eating choices. How about an informed, educated and supported consumer who doesn't consume the products that have an outrageous, unnecessary amount of sodium in them?

Now, some random examples from eating out at common places:

  • 1/4 pound hamburger, fast food: 1,152 mg sodium
  • 6 inch turkey sub on white: 1,010 mg sodium
  • bowl of New England clam chowder: 1,110 mg sodium
  • chicken alfredo entree: 2,030 mg sodium
  • 1 extra crispy chicken breast: 1,286 mg sodium
  • 1 bare chicken burrito: 2,330 mg sodium

Opposing View: What Makes Sense

Besides stating that a policy that treats everyone the same is discriminatory because we all react differently, other good points are that hyponatremia is real and serious, and that there is more literature out there than is being considered. I think it's safe to say we would always be served better if a fully balanced diet is promoted, rather than focusing in on a silver bullet approach, no matter what the element.

Opposing View: What I Don't Quite Get

There was concern that we'd be put on a clinical trial unknowingly/unwillingly if sodium was reduced in foods. Maybe we should be questioning the clinical trial we've been on all these years that we've been sodium-loading without common knowledge. And perhaps instead of proposing we spend money on huge clinical trials that show what happens to people when they don't consume so much salt, we could put that money into educating the public on balanced diets and how to make smart choices.

I also must point out that world-wide statistics might show that women take in less sodium than men, but I can tell you that I've personally seen, in America, women that could eat more sodium than men and win hands down. I cannot believe a reduction of all the excess sodium will throw any people that eat sodium-packed processed food, into danger of hyponatremia, regardless of gender.

I'd like to see the studies that show that babies born to women on low-salt diets are low-weight and have lifelong increased salt appetites, and that congestive heart failure patients placed on low-salt diets die or are readmitted more often than those who aren't. I have a lot of questions, such as how large the studies were, where were they conducted, what were the conditions surrounding the subjects, how old were they, were the pregnancies healthy otherwise, how long did we track the life-long salt cravings of the babies, what other co-morbid conditions did the heart patients have, how were the patients monitored, how was food consumption tracked or reported? Things like that.

I'm trying to leave the last paragraph of the opposing view alone, but I just can't. I really need a definition of "Italians". Are we talking about American Italians, or Italian Italians? My daughter married into a lovely Italian family, and I've not seen or heard about any salt extravaganzas. How can a diet of adequate fruits and vegetables also include a larger sodium intake than the American diet?

Lastly, we don't spend enough time promoting the benefits of vegetables (true) and that's THE reason consumption has dropped? How about the fact that we can't buy a head of broccoli for the price of a fast food cheeseburger?

I believe the opposing view gets it right when saying "consumers deserve better treatment", but I don't think the thoughts behind that statement are the same as mine.

What are your thoughts?

USA Today "What can be done to shake Americans' salt habit?"

USA Today "Consumers deserve better"

Related posts:

Food Inc, The Movie Review

The End of Overeating Review


Morton said...

I will not only send you the publications, but I leave it to you whether you wish to apologize for leaving the impression that the publications do not exist. Among the references are:
Leshem, M., 1998. Salt preference in adolescence is predicted by common prenatal
and infantile mineralofluid loss. Physiol. Behav. 63, 699–704.

Shirazki, A., Weintraub, Z., Reich, D., Gershon, E., Leshem,M., 2007. Lowest neonatal
serum sodium predicts sodium intake in low-birthweight children. Am. J.
Physiol. (Reg, Integr. Comp. Physiol.) 292, R1683–R1689.

I also include a link to the latest study commissioned by the German Government on the health benefits of population-wide salt reduction. There were a couple of conclusions that they came to. The first is that there was a possibility that salt reduction in food products may benefit only the portion of the population that is chronically hypertensive, but they had two reservations: the first was the relatively small drop in blood pressure that can be achieved through salt reduction; and the second was their concern for the sustainability of this drop in blood pressure. Because so few studies have been carried out for long periods of time, and because of the refractive nature of our physiology they felt their might be a distinct possibility that this drop would not be sustainable - in other words salt reduction was accompanied by a small drop in blood pressure, but would that blood pressure remained depressed once the body became accustomed to this new low-level of salt intake, or would it eventually creep back up even with the reduced salt. Here is the link to the Executive Summary:

As far as salt consumption is concerned, we have never consumed as low levels as we have in the last 50 years. Do you want me do send you links to the historical records taken from the military rations archives? What I would like from you is a single reference, only one, that shows any clinical trial that justifies the levels of sodium intake set by the IOM, i.e. 1,500 – 2,300 mg sodium per day. There is not a single publication anywhere that justifies these figures. There were simply opinions – not scientific evidence. On the contrary, the average person’s renin-angiotensin-aldosterone system gets activated to recover salt from the urine at 3,000 mg sodium per day – in other words our bodies start to tell us we are running short of salt at a much higher level than the IOM says. (Tell me if you want these references as well.) You can believe in the institutions that recommended hormone replacement therapy for women and the same institutions that swore if we ate any more than one egg a week we would die a horrible death from clogged arteries – I prefer to listen to a higher authority – human physiology.

This is obviously a charged issue and the people responsible for our health have slacked off and taken the easy way out and substituted urban legend for evidence. Read the IOM report. Their strategy is to cut salt incrementally and at each stage they will test to see if there are any unintended consequences. That’s what a trial is!

Morton Satin
Salt Institute

Kelley Moore said...

Mr. Satin, first may I say that I am quite humbled that a person of your stature would take the time to visit my blog and leave a comment.

Secondly, I absolutely would like to apologize for giving you the impression that I was insinuating the studies did not exist. In my blog post I expressed my desire to see the studies because I had several questions. I appreciate all the links you included in your comment relating to the original article statement regarding life-long increased salt appetites in low birth weight babies. It was interesting to read, particularly about the relation to fluid loss, electrolyte imbalance and vomiting. I appreciate the study by the German government. Please feel free to send me the links to the studies for congestive heart failure patients on low salt diets as well, and any others you deem important.

I must admit I cannot get my mind around the statement that we have never consumed as low levels of salt as we have in the last 50 years. Is that referring to adding salt at the table, or cooking with salt? I will be amazed if it includes total intake of sodium across all food sources, including restaurant and grocery items. Perhaps my mind is narrow or I'm just too wrapped up in real life scenarios. I am nearly 45 years old and I can tell you that in the course of my lifetime there has never been such a broad selection of easy access high sodium (fat and sugar) foods, processed items, fast foods, and just flat-out manufactured fake foods. The obesity problem (even in our children) is a visible sign that intake of any food is way too high.

I have obtained a link to the Dietary Reference Intakes for Water, Potassium, Sodium, Chloride and Sulfate. From what I have read so far, it is clearly stated that the research was insufficient to set absolute Upper Intake Levels but rather the Adequate Intake levels and ranges were based on the increased risk of cardiovascular outcomes. I will continue to read and educate myself. Just as a side note, you might find it interesting that I took myself off of hormone therapy quite a while ago and I also eat about 4 egg whites (and one yolk) a day.

Clearly I am not a statistician or a researcher, nor do I claim to have the answers. I am a person who is passionate about information that may be helpful in terms of fitness and eating well. I have seen first hand the devastating effects of cardiovascular disease. I've had my own struggles with unhealthy eating and excessive intake. I live in an area that consistently ranks in the top 5 for being unhealthy and obese. My heart is heavy for those that take every blanket and generalized statement they read as fact, without questioning. How about those who can't read, or who can't afford to even purchase healthy food choices? I am concerned about the health condition of America.

Like you, I don't want to see anyone participate in a clinical trial unknowingly or unwillingly. Your point is well taken, and my blog post reflected my opinion that it's not the answer. But I cannot ignore that we're all already a part of a widespread clinical trial with the insidious increase of sodium, fat and sugar laden commercial foods available to us, whether marketing or science driven, even though we are seeing and cannot deny the consequences of such unhealthy choices. So while salt was the topic of the day, it's just one part of a much larger picture to me.

I really do appreciate your taking time to respond. Thank you for your references, your work and your thought-provoking comment.

SuccessfullySlim said...

There certainly is a lot of information to look at in relation to salt in the diet.

What works for me is to make almost all my own meals, using as few processed and tinned or bottled ingredients as possible, and simply add salt to those foods where I really need it. Like scrambled eggs and spinach for breakfast!