Public Health

Can a New York Bureaucrat Put the Whole Country on a Low-Salt Diet?

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Having taken on smoking, trans fats, and calories, New York City Health Commissioner Thomas Frieden is poised for an assault on salt. He wants packaged food producers and restaurant chains to cut the salt content of their products by 25 percent during the next five years and another 25 percent in the five years after that. "If there's not progress in a few years," he warns, "we'll have to consider other options, like legislation."

Since salt is linked to dangerously high blood pressure in only a small subset of the population, Frieden's proposal is the very model of a modern "public health" intervention. It disregards individual preferences and goes over the heads of consumers, treating the population as a collective. To its credit, The New York Times, toward the end of its story about what Frieden ambitiously calls his "national salt-reduction initiative," notes that not everyone thinks it's a good idea:

Beyond the technical hurdles, Dr. Frieden might encounter resistance on scientific grounds. Some medical researchers question whether a mass reduction in sodium is the best way to spend public-health resources when losing weight and quitting cigarettes would do more for the country's heart health.

Genetics dictate that different people have different reactions to sodium. Some people are more sensitive to high levels of salt. For others, low levels of sodium can be unhealthy.

But public health officials say there is a strong consensus that salt leads to higher rates of heart attacks and strokes.

That consensus alarms Dr. Michael Alderman, editor in chief of the American Journal of Hypertension, who thinks more clinical studies need to be done.

In a 2002 review of the research, Alderman, a past president of the American Society of Hypertension, concluded that "existing evidence provides no support for the highly unlikely proposition that a single dietary sodium intake is an appropriate or desirable goal for the entire population." Despite the weakness of the evidence, Alderman noted, the dogma of less salt is still "preached with a fervour usually associated with religious zealotry."

I noted the controversy over low-salt prescriptions in my 2003 Reason story about the Center for Science in the Public Interest, which has been railing against the "deadly white powder," a.k.a. "The Forgotten Killer," since the 1970s. In 2005 CSPI filed a lawsuit aimed at forcing the FDA to stop considering salt an ingredient "generally recognized as safe."

[Thanks to Tricky Vic for the tip.]