This past summer, DrRich wrote a post on the utter arrogance of the public health experts who are urging the FDA – and international bodies of busybodies – to mandate a policy of strict sodium restriction across the globe.
DrRich attempted to show how such a broad-based salt restriction at this juncture is ill-advised for three reasons. First, the conclusion that a population-wide salt restriction would actually do any good is not based on any actual prospective studies, but on a contrived extrapolation of observational data. Second, there is some evidence that a salt restriction would be harmful to at least a substantial minority of people, even if the overall effect on the population turns out to be positive. And third, there is good reason to believe that the degree of sodium restriction which is being recommended by the public health experts is below the level which is dictated by human physiology.
Perhaps salt restriction for the entire population will turn out to be a good idea. But perhaps not. So in his previous post, DrRich was advocating a prospective, randomized controlled trial to test this proposition before just going ahead and inflicting it upon hundreds of millions of Americans.
And now, as it happens, in recent weeks new studies have been published which question the safety of salt restriction for the whole population. In fact, five studies have been published just this year suggesting that salt restriction might be unsafe.
The latest, published this week 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.
And, of course, the public health experts are recommending sodium intakes far below the 4000 mg threshold. They recommend (and urge world governments to enforce) sodium restrictions of 1500 mg per day for the people they consider to be at high risk (which amounts to about half of us), and restrictions of 2300 mg per day for the rest of us.
This kind of restriction would place everyone on an unenviable portion of the J curve, according to this new study, and would risk exposing all of us to an excess of cardiovascular disease.
The public health experts, of course, will not take this slander lying down, and accordingly have been quick to respond. Interestingly, their response sounds a lot like the response of the global warming experts whenever someone has the audacity to introduce new evidence that questions some of their conclusions.
Heartwire quotes Dr Graham MacGregor of London’s Wolfson Institute of Preventive Medicine (and a major sodium restriction guru) as saying, “[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 insists that the need for global sodium restriction (like global warming) is 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 apparently, new data need not apply. It is neither being sought, nor will it be accepted.
Other experts have pointed out that these new studies urging caution on restricting salt were not the kind of prospective, randomized controlled trials that are so valued in medicine, so their results should not be taken too seriously.
DrRich might be more inclined to agree with this admonition if the studies that suggest we ought to employ severe, widespread salt restrictions were randomized, controlled trials. But they, also, are not.
What we have is two sets of very confusing 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.
We have already seen the harm that can be done when we allow public health experts to launch major population-wide dietary changes, without 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 adequately study its likely results.
Of course, the whole thrust of our new healthcare system is to allow the experts to practice medicine on the whole population. So urging caution or even a certain amount of circumspection on this newly-empowered expert class is destined to be a futile exercise.