Slow Food Fast

I started this blog last spring more or less just to test out blogging lightheartedly about food. However, I have just read Bon Appetit‘s appalling “Health Wise” column from the May issue, “The Saline Solution” by John Hastings.

I do actually love to cook and eat well, and that’s my main purpose for this blog, but seeing this kind of blithely irresponsible “health” advice on salt makes my blood boil (not appetizing). Worse, it starts dragging me back to my work roots and up on my soapbox (also not appetizing, though kind of fun), because I trained as a biochemist and worked for several years as a science journalist. I worked for the National Heart, Lung, and Blood Institute at NIH at the time some of the bigger studies Hastings refers to were first being published. It was my job to know about them and write about them in plain (and preferably short) English for Congress and the public. To do it I talked to national experts, interviewed the leaders of the National High Blood Pressure Education Program, and combed through a century’s worth of research on salt and high blood pressure.

But you don’t have to be a scientist to find this stuff out. Descriptions of the studies AND their updates AND the reasoning behind the basic public health guidelines calling for Americans to watch their salt AND how to do it without eating a restricted diet of cardboard and baby cereal are all easily available from the NHLBI web site or the American Heart Association.

Hastings, a former editor of Prevention and health column contributor to O, the Oprah Magazine, is someone you’d expect to be reasonably accurate in reporting health research findings. But here he gets the science on salt and high blood pressure just about as backwards and upside down as he possibly can.

Worse yet, he does it in a strangely breezy, cheerleading tone that’s really hard to believe.

Hastings’ argument goes something like this:

…here’s a little secret: salt isn’t a problem. If that sounds crazy, it’s because the public health message about salt causing high blood pressure has been very, very effective, and it’s backed by reams of scientific research…Upon this, nearly everyone agrees. The controversy arises when you ask experts about the connection between salt intake and high blood pressure…All of this is fantastic news for those of us who are already cooking with high-quality meats and farmers’-market produce…

Did you follow all that? Probably you felt like you did for the few seconds you were reading it, but look again and you start to pick out the self-contradictions–“If it sounds crazy” that salt isn’t a problem, “it’s because the public health message that salt causes high blood pressure… is backed by reams of scientific research.”

Well, yes it is. The way Hastings phrases it, you’re supposed to think that was a bad thing, that health research in general and carefully designed tests of the effects of diet on cardiovascular health in particular are part of some kind of unnamed conspiracy against the public’s right to eat every bit of salt it can get.  Personally, I’d rather that broad public health messages were backed by reams of scientific research rather than by some diet guru or brand-name chef’s nutritional fantasy that will help sell his next book or tv program, or–more realistically–by corporate marketing and pressure campaigns from big pharma and big agro. Of course, it’s less profitable if people simply eat less salt–and less processed food–and never develop hypertension in the first place than if they eat salt like it’s going out of style and call it gourmet, and then have to make up for their diet by taking hypertension pills…hmm. Food, Inc., anyone?

“Upon this nearly everyone agrees”, but somehow there’s still a great controversy over it? Really? No. Not really.

The vast majority of salt researchers look at the bulk of the study results and conclude–repeatedly, for decades now–that salt is, in fact, a direct and modifiable risk factor for hypertension (high blood pressure). Which is both a disease in its own right and a leading risk factor for heart disease, stroke, and chronic kidney disease. Combine that with the fact that the average current salt intake is about twice what the consensus guidelines recommend and that more than half the adult population in the U.S. is crossing the line into overweight and obesity–and…well, yes.

Salt IS actually a health problem for most people. Gee.

The Bon Appetit article is a jumble of self-contradictions and serious misinterpretations of the findings from two older salt research studies, one of which has since been revised,  plus a cherry-picking recent review that comes to a different conclusion about salt than most of the other reviews of the same data on diet and health. That one comes from the lab of Mickey Alderman, an otherwise eminent researcher who just happens to be a long-time, much-trumpeted advisor and consultant for the Salt Institute.

Hastings  doesn’t indicate that he interviewed the man or even recognized his name on the journal article, but he should have. Anytime somebody in the media wants to come up with the magical–and really, really popular–conclusion that lots of salt, any day, any time, anywhere, please add more, is perfectly harmless and even good for you, they go to Mickey Alderman because they can paint him as a lone hero against the Food Police (the typical name they give the National Institutes of Health and the American Heart Association in such cases). Because what Alderman will say–with precision, but with disregard for the bigger public health picture–is that high salt intake isn’t directly proven to cause death from cardiovascular disease.

And it isn’t. It can’t be proven directly in a well-controlled diet study large enough to reach statistical significance, because that would require thousands of participants to follow a carefully prepared diet throughout their entire lifetimes, with no deviations for dates, wedding receptions, pizza parties, etc., and it would take 50-75 years to collect the majority of the data. You’d literally have to wait until most of the participants died before you could make a public health recommendation about salt. And the cost of doing that study “right” would run into the billions. It would bankrupt the federal science budget. And maybe a few other budgets as well.

That’s why the NHLBI and the AHA have sponsored studies that look at signs of developing cardiovascular illness–heart attacks, stroke, phlebitis, high blood pressure, kidney disease–rather than death. When you look at these ailments, you find that dietary salt actually matters quite a bit–contrary to what Hastings thought he understood from the studies he mentions.

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