This is Chapter 10 of my book-in-progress, “Open Wide And Say Moo! – The Good Citizen’s Guide to Right Thoughts And Right Actions Under Obamacare.” Comments are fervently sought; you can leave them here.
You can read my rationale for undertaking this project, and thus opening myself up to the possibility of public failure, humiliation, derision, disapprobation, and unwanted scrutiny, here.
And here is the up-to-date archive for all the chapters that have been posted so far.
Update – September 1, 2012
Open Wide and Say Moo! is now revised and published!
Now available in the audiobook version!
Experts are critically important in modern society. Over the past 500 years, human knowledge has expanded well beyond the point where any one individual can understand all of it. So Western civilization requires experts – people who have a deep understanding of some circumscribed area of knowledge – simply in order to function.
But experts are humans, and they turn out to be subject to all the foibles of human nature. For instance, their thinking tends to be insular and parochial (since their expertise is, by definition, confined to a small area of knowledge); they tend to be secretive and jealous (since their special knowledge is what distinguishes them from lesser individuals); and they tend to stifle ideas that are new and different (since new ideas often threaten their positions of expertise).
So, the benefits provided by experts come with a fair load of baggage. But considering everything, most of us would say that the cost-benefit calculation of living in a modern society, and therefore being dependent upon experts, in general has been positive.
Still, during the past half millennium of our “enlightenment,” there have been discrete times and places where our reliance on experts has been a net negative. These intervals, almost always, have occurred at times when selected experts are backed by the full force and might of some sovereign authority, such that the experts’ word becomes law.
The herd medicine we will see under Obamacare promises to be such a time.
Scientific progress works like this: A new theory is advanced to explain some phenomenon, usually thought up by a whippersnapper of one variety or another. The entrenched experts, whose career, reputation, social status, income, and sexual fulfillment are based on the old theory, find the new theory to be absurdly wrong (or in some cases heretical), and probably dangerous. Since preserving the “truth” is the highest calling of all, the established experts engage in every device they can muster (from “controlling” the peer-review process to burning heretics at the stake) to see that the truth (as they define it) prevails, and that the young upstarts are put down.
To the uninitiated – and certainly to the upstart whippersnappers – this process seems most primitive and unkind. But actually it is quite useful and practical, and in the long term is very beneficial to mankind. It is a process that allows us to enjoy the benefits of relying on experts, while also allowing for human knowledge to progress beyond the “comfort zone” of those experts, albeit at a purposefully slow and stately pace.
To understand the genius of such a system, we first need to understand that most of the new theories thought up by whippersnappers are, in fact, garbage. In order to break through the imposing barriers of bias constructed by the entrenched experts, the novices have to believe deeply in what they are espousing, and their new theory, ultimately, has to actually offer some substantial improvement over the currently accepted one. The whippersnapper, if very lucky, finally prevails, thus becoming the foundation of a new generation of experts – and the process begins all over again. Hence, science progresses. This process is geared toward the gradual discovery of truth, and not toward the nurturing and vindication of whippersnappers. And eventually, truth always does prevail – and often it does so within just a few generations.
In the short term, of course, this process can look very messy and unfair. It is certainly subject to great bias. In fact, we take pains to set up the accepted experts with lots of grant money, prestige, titles, &c. precisely to make sure they’ll develop bias and exercise it, and do everything they can to preserve the status quo. We do this because when the paradigm actually shifts, we want it to shift because the merits of the new paradigm are sufficient to overcome all that useful bias – and not because of a whim. This process keeps science – and society – on an even keel, and keeps it from being whipsawed this way and that.
And so, while the upstarts will always disagree, it is overall a system that is quite sound.
This time-tested process breaks down when a powerful outside influence – say, a religion or a government – firmly takes a side in the scientific debate, and uses its inherent authority – that is, the authority to administer excommunication, inquisition, incarceration or execution – to sanction the actions of one particular set of experts.
When a group of experts are entrenched within the power structure of a Central Authority, the process of advancing human knowledge becomes corrupted. The opinions (that is, the bias) of the selected experts invariably becomes “settled science,” and no further evidence to the contrary is admissible – no matter how dedicated the dissenters, or how sound their arguments might be. And the upstarts are not suppressed any longer by mere peer pressure and propriety, but rather, by whatever threats of legal violence the Central Authority decides to bring to bear.
Furthermore, acting upon those settled expert opinions now becomes a matter of immediate importance for the Central Authority; time is always of the essence, and any obstructions to those necessary actions must be cleared away by whatever means are necessary.
Galileo famously ran into the problem of settled science, as espoused by experts favored by the chief Authority of the day. The experts sanctioned by the Church did not rely on mathematics, but upon Scripture. And Pope Urban VII (who, prior to his investiture had been a friend to Galileo, and had encouraged his efforts), simply could not afford to let Galileo get away with espousing a system that would call Scripture into question. So, even though the Pope apparently understood that Galileo was right, Galileo had to suffer.
The global warming experts provide another example. It seems apparent that most of the world’s governments, including ours, find that the bias of the global warming experts very nicely aligns with the historical bias of governments, which is to say, accruing ever more power over the endeavors of the people. These experts insist that global warming is real; that it is man-made; that it requires immediate action; and that controlling it fully justifies whatever means are necessary. And so governments have thrown in – body and soul – with this side of the debate, to the extent that “global warming” has now become largely sacrosanct. Man-made global warming is officially deemed to be “settled science,” and is beyond reasonable question. No new scientific evidence to the contrary is admissible. Competing viewpoints are, in fact, heretical.
As we enter into a new era of healthcare, where medical decisions will be taken out of the hands of imperfect physicians and entrusted to panels of federally-sanctioned (and thus pretty much infallible) experts, we ought to keep in mind the problems we might create by removing selected experts from the (admittedly imperfect) give and take of scientific discourse, and awarding them with the full backing of the Central Authority.
In the next few chapters we will have a look at some of the damage that is likely to occur under the new expert panels that are being established under Obamacare. But the tyranny that occurs when selected medical experts are backed by the Central Authority is a problem that has existed for decades, well before anyone ever heard of Obamacare. Obamacare merely institutionalizes, systematizes, and streamlines the process.
To get a flavor of what’s likely in store for us, let’s have a brief look at three examples of the travesties that have been (or are being) perpetrated upon the public by government-sanctioned healthcare experts, even before Obamacare kicks in.
The Central Authority is quite exercised at the moment over the obesity crisis they perceive – a crisis which we in the herd have brought upon ourselves through our sloth and gluttony, to the great inconvenience of our enlightened leadership. What the Central Authority fails to note (publicly at least) is their own central role in creating the obesity problem. They did it with their war on dietary fat.
An association between dietary fats and coronary artery disease was first noted in the 1950s. In 1957, the American Heart Association (AHA) published its first, tentative recommendations for limiting the consumption of saturated fat. The recommendations were pointedly aimed only at people who had a strong genetic predisposition to heart attacks or strokes, or who already had heart disease. An accompanying editorial by Herbert Pollack, in the August, 1957 issue of Circulation, specifically warned against the widespread application of any policy restricting saturated fat:
“Altering the dietary habits of a large population group is fraught with a great many dangers. Our knowledge of nutrition is not sufficient at this time to anticipate what ultimate results would happen if the public were encouraged to alter radically their basic dietary patterns.”
The AHA’s recommendations regarding saturated fats received sparse attention for nearly 20 years. Then in 1977 our government, having won the war against hunger, turned its attention to the opposite problem (where it remains to this day). At that time, during another notably Progressive administration, the Senate’s Select Committee on Nutrition and Human Needs, chaired by George McGovern, nationalized the question of avoiding dietary fat. After holding a series of hearings on the relationship between fat consumption to heart disease, the Committee published the first “Dietary Goals in the United States,” advising all Americans to cut back on all fat consumption. With this report, the US government for the first time officially endorsed a particular type of diet – a low-fat diet – for everyone.
The Committee took this stance (on behalf of the Central Authority) despite warnings that were raised at the time by several nutritional scientists, who pointed out that the data establishing a causative role of animal fats in coronary artery disease was circumstantial at best, and further, noted that even if saturated fats turned out to be “bad,” there were plenty of other fats that were healthy, and which Americans should take pains to consume. But the official experts who were advising the Committee strongly objected to any such warnings, and insisted that the science on the matter was sufficiently settled to justify universal dietary guidelines for the whole population. Furthermore, they said, trying to educate the bovine masses on the differences between good fats and bad fats (assuming there was such a thing as good fats) would obviously be impossible. The public was too dim for such subtleties. The Senate Committee followed their experts, because experts know the answer. Accordingly, Committee opted for the far-simpler “fat is bad” message that you can sell even to gun-toting Bible-thumpers.
The anti-fat movement got its next big push in 1983, when the Framingham study published a landmark paper tagging obesity as an important risk factor for cardiac disease. This new evidence allowed the experts to reason thusly: If the people are getting fat, it must be because they are eating too much fat. It is therefore plain that that low-fat diets will prevent heart disease both directly (as they had already decreed in 1977), and now, indirectly (by preventing obesity).
Accordingly, in 1984 the NIH assembled by a group of scientists and experts which subsequently issued a Consensus Statement entitled “Lowering Blood Cholesterol to Prevent Heart Disease.” This document was an all-out, government-sanctioned, expert-led attack on dietary fat. Again, several of the scientists the NIH had invited to the conference argued that there was a lack of convincing evidence demonstrating that low-fat diets would be healthful. But the true experts, seeing an epidemic of heart disease which must surely be due to fatty diets, carried the day, and the Consensus Statement was voted into publication.
Shortly thereafter the AHA also endorsed this Consensus Statement. Finally, everything was in place for a major campaign across the land for low-fat diets for everyone.
The great low-fat diet era was ignited. Prestigious medical organizations spurred a campaign of public service announcements and media blitzes promoting the need to avoid fats in the diet. Influential magazines (that is, magazines read by women) began a prolonged onslaught of low-fat diet tips, articles, and human interest stories emphasizing the deadly nature of dietary fat. The food industry, which was at first very skeptical (just like the banks were when subprime mortgages were initially foisted upon them by government policy), finally jumped in with both feet (again, like the banks). A massive new product line of low-fat and no-fat snack foods was invented. These, of course, were just packed with carbohydrates, and also with the supposedly “healthy,” man-made trans fats (more on this in a moment). This tsunami of change in America’s processed foods has been referred to as the “Snackwell phenomenon.” And, as if to put an exclamation point on the utter goodness of it all, the AHA, tapping into a lucrative new revenue source, began officially certifying these low-fat, high-carb products (including items such as Frosted Flakes and Pop-Tarts) as being “Heart Healthy.”
Americans, however, are filled with the milk of human nature. So they largely ignored the ubiquitous pleas to abandon their burgers, pizza and tacos in favor of broiled, skinless, sauceless, saltless chicken breasts and broccoli. But they did begin scarfing up all those the new-age low-fat snack foods in massive quantities, having been assured that, as long as the snacks contained no fat, they could eat as much as they wanted.
There are a few physiological facts about dietary carbohydrates that the experts chose to largely ignore during the low-fat era. First, the body greedily converts dietary carbohydrates into massive stores of adipose tissue, so indeed you can readily become fat by eating carbs. Second, gorging on the refined carbohydrates found in these new “healthy snacks” causes big spikes in insulin levels (insulin being a key factor in converting excess carbohydrates to fat). When the insulin levels suddenly drop a couple of hours later, that drop produces insatiable hunger. So, two or three hours after enjoying a fat-free Pop-Tart or a Snackwell cupcake, one finds oneself desperately ripping through the cupboards to find another carbohydrate fix. By thus inducing a continuous-snacking mode, the new high-carb snack foods increased the overall caloric intake of many of the people who began eating this stuff, far beyond the additional calories listed on their labels. Third, diets high in refined carbohydrates increase triglyceride levels, reduce HDL cholesterol (“good” cholesterol) levels, and in general create lipid profiles that are likely quite damaging to the arteries.
So, while few people actually stuck to a strict low-fat, controlled-calorie diet (and to this day we still don’t know whether doing so is actually a particularly good idea), many more people became addicted to the AHA-endorsed refined carbohydrates that were officially associated with low-fat diets, and as a result, they became obese.
It has only been in the past ten years or so that the low-fat dogma has begun to moderate, largely thanks to the (now mercifully faded) low-carb craze that struck at that time. We now hear somewhat more reasonable advice about good fats and bad fats, and good carbs and bad carbs. But much of the damage has been done. The damage occurred because public health experts made a conscious decision to change Americans’ dietary habits, despite clear warnings that the evidence for doing so was shaky at best. At least partly because of the major push for low-fat diets, we Americans are fatter and less healthy today than we used to be.
The Central Authority’s low-fat diet policy amounted to a massive public health experiment, with the research subjects being us. Our government and our expert-led medical organizations have yet to apologize for subjecting all of us to this travesty.
In the 1980s, coincident and associated with the adoption of the low-fat diet policy, experts also saw to it that the “deadly” saturated fats in processed foods were replaced with the completely benign, inert, man-made variety of fats known as trans fats.
Almost all the trans fats we find in our in food is man made. Trans fats come from an industrial process that partially hydrogenates unsaturated vegetable oils. The process of partial hydrogenation solidifies liquid vegetable oils, and makes them stable for long periods of time. (Liquid vegetable oils go rancid relatively quickly, and are not suitable for processed foods with a long shelf life.)
For many decades trans fats in American diets were largely limited to the use of Criso, a shortening used for baking. Trans fats did not replace saturated fats in processed foods, for the most part, until the 1980s. It happened in the 1980s, of course, because of experts.
When the Central Authority declared its holy war on fats in 1984, an organization of food experts and food activists dedicated to stamping out saturated fats – the Center for Science in the Public Interest (CSPI) – took that as a signal to launch a major (and apparently well-funded) campaign to coerce the food industry to abandon saturated fats in all processed foods, in favor of trans fats. Trans fats, the CSPI experts declared, were entirely harmless, and by insisting on using deadly saturated fats instead of trans fats, the food industry was killing us all. The food industry largely capitulated to the CSPI’s campaign in 1987, and rapidly moved almost entirely to using trans fats.
The actual safety of trans fats in humans, however, was questionable even then. Indeed, because certain scientists were attempting to call experts’ attention to data suggesting that trans fats are actually quite harmful to vascular health, in 1988 experts at the CSPI felt compelled to write a major defense of trans fats in an article called “The Truth About Trans.” This article strongly defended trans fats as being completely safe for humans, despite growing warnings to the contrary. The CSPI widely distributed this article to experts and decisionmakers (such as legislators), and for a year or two the organization seemed very satisfied with itself.
Unfortunately clinical data continued to accumulate showing that trans fats, far from being benign, likely caused more vascular damage than saturated fats. By 1993 the CSPI could no longer ignore this mounting evidence, and did a complete about-face. It launched an indignant campaign demanding that the food industry remove these deadly trans fats from all food products. Their turnaround was artful. It was accompanied by a whitewash of the CSPI’s very recent history relative to trans fats (i.e., that they were largely responsible for the widespread use of trans fats in the first place). A sympathetic press (sympathetic because the CSPI was, as always, attacking evil corporations for killing Americans in the name of profit) let them get away with their revisionism.
We can give the CSPI experts credit for being willing to shift course so soon after their seminal victory. But we should also note that they displayed stereotypical expert behavior during this episode. In 1987 they insisted they had the right answer, despite warnings from scientists who had credible evidence that their “answer” was wrong. And, once the experts at the CSPI reversed course in 1993, they never again acknowledged their pivotal role in having trans fats placed in our food supply, nor did they express any remorse for it. Likely, they never felt any remorse. Rather, they almost certainly believed they were successful both times – when they wanted trans fats placed into the food supply, and again when they wanted them removed. For experts, process (and not content) is the important thing. And the process worked well on both ends of the trans fats episode.
This orientation toward process is very convenient for experts. When the content of their endeavors turns out to be a horrible mistake, they simply re-orient their processes and move on as if the mistake had never happened. To outsiders it appears that when you are an expert, history always began 10 minutes ago. But to the experts, their history is simply a parade of one success followed by another.
The misbegotten experiments that health experts foisted upon all of us by pushing low-fat diets on us, and by demanding that trans fats be used in processed foods, cost billions of dollars, needlessly transformed large swatches of American industry, and likely produced significant harm to the citizenry. Far from being chastened, however, the experts are determined to continue inflicting us with their expertise, to the great benefit of us all.
Accordingly, without missing a beat, these same experts have now launched yet another experiment that recruits each of us within the herd as unwitting research subjects. And once again, it is an experiment that has a realistic chance of producing serious harm (despite the experts’ assurances that the science is settled and that only good can come of it). I speak, of course, of the new dietary guidelines regarding sodium.
Those new guidelines have been promulgated on the basis of these established “facts:” Sodium is bad. We all get too much of it. And if we restricted our salt intake to a much lower amount than we are likely getting today, we will all become healthier and live longer. Relying on this received wisdom, the new guidelines call for us to cut back to 2300 mg of sodium per day – unless we are 51 or older, or African-American, or hypertensive (and the majority of Americans fall into one of these three categories), in which case we are to restrict our sodium to 1500 mg per day.
For anyone who strays from eating only fresh fruits and vegetables, this kind of restriction is likely to prove a challenge. A nice bowl of dry cereal, for instance, even before you add milk, may give you up to 1000 mg of sodium.
Some Americans might consider such severe restrictions to be merely a statement of an ideal, as if the Central Authority were saying, “It sure would be nice if you could keep your sodium intake down to these levels. It might do you some good. So please do the best you can.” But this is not at all how the Central Authority is viewing the matter.
The experts over at the Institute of Medicine, for instance, recently published (in conjunction with the new Guidelines) its “Strategies To Reduce Sodium Intake In the US.” Noting that public health experts have tried in vain for decades to get Americans to cut back on salt, the IOM says the time for persuasion and education has passed. The great unwashed are proved to be recalcitrant, yet again, to reason and science. It’s time to take the gloves off. So the IOM calls for the US government (specifically, the FDA) to use its regulatory firepower to enforce – once and for all – the kind of sodium restriction that the public welfare demands.
Specifically, the IOM calls for the FDA to reclassify “salt” from a food ingredient categorized as GRAS (“generally regarded as safe,” i.e., items which have been used for millennia in food preparation without regulatory oversight, such as pepper, parsley, or vinegar, and which are accepted as being harmless), to a “food additive” (i.e., a substance which is certifiably harmful, and for which strict, enforceable rules must be promulgated regarding its use). Re-classifying salt as a food additive will give the FDA the authority it needs to enforce its usage (as with any other regulated substance) in the food processing industry, in restaurants, and even, one must assume, in the home. With this new designation, the FDA (and other government agencies) will be able to deploy whatever regulatory and enforcement muscle they must, in order to assure that the Guidelines for sodium are at last realized.
This is serious stuff. The Central Authority seems dedicated, as never before, to actually implementing a significant sodium restriction for all of us within the teeming masses. All, of course, for our own good.
You might think, if you have not been paying attention, that in order for experts to insist on such a severe across-the-board sodium restriction, the scientific data to support this action must be pretty airtight. But if you have been paying attention, you will not be surprised to hear that the actual advisability of restricting dietary sodium across the entire population is anything but settled. In fact, it remains very controversial among scientists.
There are at least three outstanding questions regarding the advisability of a universal salt restriction. Until these questions are addressed, the implementation of a generalized and severe sodium restriction across the population would seem, to any objective observer, to be quite ill-advised (and, of course, incredibly arrogant).
1) Does Sodium Restriction Really Do Any Good?
Books have been written addressing just this one question. Here I will simply summarize the problem.
The question hinges on the relationship of salt intake to blood pressure – that is, does higher salt intake cause the blood pressure to increase? This turns out to be a difficult question to answer with any scientific precision. The studies are difficult to conduct, and difficult to interpret. Accurately measuring sodium intake in any sizable population of patients is nearly impossible; and even measuring blood pressure (which varies tremendously from minute to minute, depending on activity, stress, and many other factors) in a reproducible way within a population of patients is extremely difficult.
Scores of studies have been conducted to try to address this question. And one can assemble from these a large group of studies which will show that salt intake correlates nicely with blood pressure. On the other hand, one can also assemble from these a large group of studies that shows it does not. And for decades, the salt vs. blood pressure question has been divided into two camps, each of which have major conflicts of interest*, and each of which invariably point to only those studies that tend to support their point of view.
* In one camp are the National Heart, Lung, and Blood Institute, the National High Blood Pressure Education Program, the Institute of Medicine, and academic experts on hypertension whose careers have been based on funding from these organizations, and whose reputations and academic standing rely on sodium intake being a major determinant of blood pressure and health. In the other camp are the Salt Institute, the big manufacturers of processed foods, and sundry academic experts on hypertension whose careers have enjoyed funding from these sources. Take your pick.
My own reading of the medical literature suggests that the population itself is divided into (at least) two types of people with regard to sodium and blood pressure: “salt sensitive” people, in whom sodium intake significantly influences blood pressure; and “salt insensitive” people, in whom it does not. Most folks appear to fall into the latter category. So, if we really wanted to use salt intake as a tool for controlling the populations’ blood pressure, it might be a good idea to recommend salt restrictions for “salt sensitive” individuals, but not for the majority. But it is inconvenient and impractical to determine people’s salt sensitivity, and besides, doing so would go against the principles of herd medicine. So the experts, in their wisdom, appear to have determined that the best way to restrict sodium in the people who are salt sensitive is to restrict it in everybody.
To see just how deeply politics is involved in the salt controversy, I highly recommend an article called “The (Political) Science of Salt,” by Gary Taubes, which appeared in 1998 in Science, and which outlines the incredible machinations that have been employed by the various interested parties in interpreting some of the complex studies that have attempted to correlate salt intake with blood pressure.
Our imaginary objective observer can only conclude that, at the very least, this is not a settled question.
But even if it were a settled question, and sodium intake did indeed correlate nicely with blood pressure across the whole population (and even legitimate herd medicine would require this minimum criterion before enforcing a universal sodium restriction), the degree of blood pressure reduction predicted by even the most vociferous sodium-restriction-enthusiasts, even employing drastic sodium restrictions, seems trivial. Most experts predict an average reduction in blood pressure of only 1-2 mmHg. The experts defend their universal salt restriction by arguing that this tiny reduction in blood pressure, on a worldwide basis, would save over 100,000 lives per year. But this argument is (scientifically speaking) hogwash. Such estimates are merely calculations made from strings of assumptions piled upon assumptions, and have little or no bearing on reality.
The fact is that we just don’t know what effect it would have on the population’s health to significantly restrict salt intake in everybody. We don’t know the magnitude of blood pressure reduction it would achieve, or the improvement in clinical outcomes that would follow such blood pressure reduction.
We could find out if we really wanted to – by doing a large, randomized clinical trial to test the hypothesis. But the experts have determined that such a randomized trial is not necessary because the science is settled, and besides, time is of the essence. (Astute readers will have noticed that when you are an expert, the science is always settled, and time is always of the essence.)
Our health experts would rather conduct a non-randomized experiment that enrolls every living American as an unwitting research subject. Then, in a couple of decades (reminiscent of the low-fat diet “experiment”), maybe we could figure out how it all worked out.
2) Does Sodium Restriction Cause Harm?
Here is a question that the health experts, who have revealed to us that salt restriction is an unalloyed good, really object to. For it questions their infallible pronouncements. It is, indeed, criticism. So they tend to get downright nasty when anyone brings it up.
But, as it happens, it is a legitimate question.
Sodium is extremely critical for any living creature. For any living cell to function normally, it must exist in an environment that contains, within a narrow range, just the right concentration of sodium. Consequently, living beings have evolved a complex series of mechanisms to assure an adequate sodium concentration under any and all circumstances. So, if animals are made to survive on a severely sodium-restricted diet, these homeostatic mechanisms are called into play to restrict the loss of sodium from the body. The stimulation of these sodium-retaining mechanisms can have many secondary effects.
In states of sodium depletion, tissues are more susceptible to injury from ischemia (lack of oxygen), a condition seen in heart attacks and strokes. Kidney damage caused by many types of medication will occur much more readily in states of sodium depletion. The way the kidneys handle various drugs is also altered when sodium intake is reduced, leading to potentially harmful changes in the blood concentrations of certain medications. The renin-aldosterone system is activated under salt restriction, which can have several adverse effects. (In fact, a major therapy for several medical conditions, such as heart failure and – ironically – hypertension, centers around suppressing the renin-aldosterone system.) Adrenaline levels and LDL cholesterol are increased when sodium is restricted. And at least one study, disturbingly, has correlated sodium restriction with an increase in cardiovascular mortality.
Calling attention to these kinds of findings just makes the sodium-restriction experts angry, and they usually respond by pointing out that so-and-so got a grant from the Salt Institute. (As noted, there are conflicts of interest on both sides of this fight.)
In 2011 alone, five new studies were published which question the safety of salt restriction for the whole population. One in particular, published in December 2011 in the Journal of the American Medical Association, suggests that when you compare cardiovascular events (such as heart attack and stroke) to sodium intake, the incidence of those events follows a “J” curve. That is, cardiovascular events are lowest at an “optimal” level of sodium intake. But if sodium intake goes above that optimal level – or if it goes below it – the incidence of cardiovascular events increases.
According to this study, the “optimal” level of daily sodium intake is 4000 – 5999 mg of sodium per day. Cardiac outcomes worsen for those with sodium intakes above or below those values.
As we have already noted, health experts are insisting on sodium intakes far below the 4000 mg threshold. Their recommendations would place everyone on an unenviable portion of the J curve, and (if this new study has any merit) would risk exposing all of us to an excess of cardiovascular disease.
Whenever a study appears that calls into question the advisability of a universal sodium restriction, the experts are quick to respond. In response to the “J curve” study, Heartwire (an online newsource for cardiologists) elicited the following response from Dr Graham MacGregor of London’s Wolfson Institute of Preventive Medicine (and a major sodium restriction guru): “[These new studies] are a minor irritation that causes us a bit of aggravation, and we have to talk to journalists about it, because they are not interested in news saying salt is dangerous.” MacGregor went on to insist that the need for a global sodium restriction remains a settled issue: “What [these irritating investigators] fail to understand is that the FDA is not asking for evidence about why salt should be reduced, they are asking how it should be reduced.” So new data is not needed, nor will it be heeded. It is all a settled matter.
At the end of the day, we have conflicting sets of observational data that can be interpreted to say different things. It may be true that a severe population-wide salt restriction would be a huge boon to mankind. But it may also be true that it would harm more people than it would help – or that it would harm and help about the same number, so the overall results would be the same.
The fact is, we just don’t know.
3) Is It Even Possible To Change Sodium Intake By Public Policy?
As we have noted, maintaining the proper sodium concentration in tissues is critical to life, so living creatures have evolved a complexity of mechanisms to assure that the concentration of sodium in the body remains within the proper range.
Among these mechanisms, it now appears, is an inherent “sodium appetite” enjoyed by all humans and all animals, an in-born mechanism that determines how much sodium an individual will ingest each day to help keep just the right sodium “set-point.” This sodium set-point is maintained by a complex neural network that is still being sorted out, involving several regions within the central nervous system, as well as inputs from the peripheral tissues. The bottom line is that one’s own physiology naturally regulates one’s sodium intake to satisfy the body’s needs.
Furthermore, studies of sodium intake across a wide array of human populations, living under a wide variety of conditions and dietary constraints, also show that the range of salt consumption humans take in to achieve their set-point is remarkably universal, and is maintained within a fairly narrow range. That is, not only do humans consume the proper amount of sodium as determined by the body’s needs, but across the diversity of humanity that “automatic” sodium intake is maintained within a remarkably fixed range. (Sodium intake moves within that range to maintain the body’s proper sodium set-point.)
As it happens, the lower limit of that universal, naturally occurring, “optimal” range of sodium intake is roughly 2300 mg/day.
By pure coincidence, this natural lower limit, determined by our physiology, is the same as the the upper limit our Central Authority would have many Americans consume. (The rest of the Americans will be consuming only up to 1500 mg/day, which is far below the natural lower limit.)
In other words, by decree, our government would have every American consume an amount of sodium that is below the optimal range (or at best, barely touching the optimal range), as determined by actual human physiology. Almost by definition, anyone living under the recommended guidelines would likely be unable to maintain proper sodium concentrations through sodium intake alone, and would need to recruit the secondary, sodium-retaining, potentially-harmful physiological mechanisms (such as the renin-aldosterone system) to keep sodium concentrations at an adequate level.
Furthermore, it seems to me that if we have a deep physiological need to satisfy our “sodium appetite,” and if the only food we can get will be (by the Central Authority’s decree) low-salt, then the only way we can satisfy our sodium appetite will be by eating more of it. In other words, an enforced policy of sodium restriction seems likely to worsen our obesity epidemic.
It is apparent that even if a universally-applied policy of significant sodium restriction was proved to be safe and effective, it may not be possible to make people comply with such a restriction. This kind of restriction will be fighting our inherent “sodium appetite” that has been forged through millions of years of evolution. This kind of restriction would appear to fly in the face of our human physiology.
We need salt, dear readers, we truly do. The only reason the Founders did not include an additional paragraph in the Second Amendment (to the effect that, “A palatable diet being necessary to the health and well-being of a free People, the right of the People to bear salt shall not be infringed,”) is that it never occurred to them that any government, anywhere, would ever attempt to restrict such an inherent physiological necessity.
Of course, anyone who has observed the Central Authority at work – as it attempts to implement policies that require fundamental changes in human nature, or that require the repeal of the basic laws of economics – should not be surprised at the notion that our Progressive leaders would also try to repeal human physiology.
We have already seen the harm that can be done when we allow public health experts to launch major, population-wide dietary changes, before adequately studying what their effects will be. Especially given the increasing evidence of the harms that might be done by it, we are nuts if we allow the arrogant expert class to enforce a salt restriction program on all of us, before we have completely studied its likely results.
A major thrust of our new healthcare system is to implement herd medicine. Fundamentally this means empowering the experts to practice medicine, from a distance, upon the whole population. Urging caution or even a certain amount of circumspection on this newly-empowered expert class, as it begins exercising its much-sought and hard-won right to dictate American healthcare on a collective basis, is destined to be a futile exercise.
The health experts hold the high ground. For they are experts in a system that, if it worships anything, worships experts. They are the ones with the answers. Woe unto anyone who would stand in their way!
They are the ones who will give directives to doctors on the front line, and direction to the sundry health-related agencies of enforcement wielded by the Central Authority. Once they have formed an expert opinion the issue is settled, and it immediately becomes time – backed by the power of the Cenral Authority – to sweep aside any opposition, and implement the process.
As long as the process itself is successful, actual results visited upon members of the herd are not that important. Therefore, as far as the experts are concerned, their implementation of low fat diets was successful. Their incorporation of trans fats into our food supply was successful. With these fresh triumphs under their belt the experts have been validated, and they move confidently ahead to implement their new sodium restriction policy.
Armed with their infallible answers, they know only one word (a word we have heard before, and one that is being adopted again as a call to arms): “Forward!” If the herd suffers because of it, the experts will pretend not to notice.
For the herd will always be there, and the experts can always try again.