FDA

FDA Salt Guidance Could Kill More People Than It Saves

Treat people as individuals not just as members of an undifferentiated public health herd

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SaltWikimedia
Wikimedia

The Food and Drug Administration issued proposed guidance in June to the food industry aiming to reduce the amount of sodium in many prepared foods. In its draft guidance, the agency stated:

Average sodium intake in the U.S. is approximately 3,400 mg/day. The draft short-term (two-year) and long-term (10-year) voluntary targets for industry are intended to help the American public gradually reduce sodium intake to 2,300 milligrams (mg) per day, a level recommended by leading experts and the overwhelming body of scientific evidence. The targets are also intended to complement many existing efforts by food manufacturers, restaurants, and food service operations to reduce sodium in foods.

The FDA further asserted:

CDC has compiled a number of key studies, which continue to support the benefits of sodium reduction in lowering blood pressure. In some of these studies, researchers have estimated lowering U.S. sodium intake by about 40 percent over the next decade could save 500,000 lives and nearly $100 billion in healthcare costs.

So, the science of salt is settled, right? Actually, no. The FDA asked for public comments on its draft guidelines and it evidently received sufficient pushback that it extended the deadline for comments until December 2, 2016. As I reported earlier more and more studies are calling into question that idea that reducing salt consumption at the population level will actually result in net health benefits. For example, the New England Journal of Medicine published a study in August 2014 finding that people who consume less 1,500 milligrams of sodium (about 3/4ths of a teaspoon of salt) are more likely to die than people who eat between 3,000 to 6,000 milligrams of sodium per day (1.5 and 3 teaspoons of salt).

The free-market think tank, the Competitive Enterprise Institute has submitted comments that show that the FDA's confident claim that reducing salt consumption by Americans will save lives is at best, a hope, and at worst, tragically wrong. The CEI comments to the FDA nicely summarizes the relevant scientific studies. Here is the nub of the issue:

Reduced sodium consumption affects different individuals in different ways. Only an estimated 17 to 25 percent of the population is "salt sensitive"—they experience higher blood pressure with increased dietary sodium—while 75 percent are considered salt resistant and will experience no change in blood pressure with altered dietary sodium. However, an estimated 11 to 16 percent of the population are inverse salt sensitive, which means reduced dietary sodium can increase their blood pressure. With this heterogeneity in response to salt, trying to force a population-wide reduction in sodium availability in order to reduce incidences of hypertension would be ineffective at best and counterproductive at worst.

Among other evidence, CEI cites a 2014 metanalysis in the American Journal of Hypertension of more than two dozen sodium studies which concluded that risk of death appeared to be lowest among individuals consuming between 2,565mg and 4,796 mg of sodium a day with higher rates of death in the upper and lower range. The FDA itself notes that average daily consumption - 3,400 mg - is right in the middle of that range.

CEI correctly argues:

For a minority of the population, reducing dietary sodium can be an effective means of lowering cardiovascular and hypertension risk. But identifying for whom sodium restriction may be beneficial and by how much is something that individuals and their doctors must determine. For the general population, sodium reduction is, by no means, a silver bullet to reducing hypertension and has the potential to increase risks for a large portion of the population.

Treat people as individuals not just as members of an undifferentiated public health herd. Let's hope that the FDA will heed this advice and withdraw its misguided draft guidance.

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68 responses to “FDA Salt Guidance Could Kill More People Than It Saves

  1. I’ve been saying this for years. I honestly wonder if they already know this.

  2. I’m one of the lucky ones. Low blood pressure no matter how much salt I eat.

    I also happen to like salt.

    1. The lucky large majority of the population.

      I’ve noticed that several people I know with some degree of hypertension don’t like salt very much. I wonder if that holds at all in general.

      I’m really glad I’m not salt sensitive. A low salt diet sounds absolutely awful.

      1. A low salt diet sounds absolutely awful.

        It’s not so bad. Especially if your palate reads the average diet as too salty to begin with.

        What would be horrific is to be one of those people who find cilantro tastes soapy. I support euthanasia just for that and Zika babies.

        1. My thoughts and prayers are with the anti-cilantro people. Life without Mexican, Thai, or Vietnamese cuisine is no life at all.

        2. It’s not so bad. Especially if your palate reads the average diet as too salty to begin with.

          That’s kind of what I was thinking in the middle paragraph. But to my taste, food just isn’t that appetizing if it doesn’t have the right amount of salt.

        3. My wife has the cilantro thing, but I kept her anyway.

          I find it does taste a little soapy, but in a good way.

          1. I never noticed it until someone pointed it out. I wouldn’t eat it by itself but chopped into little bits and mixed with tomatoes and stuff is fine.

          2. Wouldn’t the proper pronoun be “she”?

        4. A friend of my parents is allergic to garlic. Not sure I’d still find life worth living if I were similarly afflicted.

        5. Maybe not a genetic disposition, but I dated a girl who complained about bell peppers being spicy. The hell?

          1. I’m may be a little low on the spice tolerability index myself. I like normal hot sauce. Sriracha in tiny doses is pushing it. But anything over that is just remarkably unpleasant.

            1. I’ll season with jalapeno or habanero, but no way am I popping one in my mouth. A nice hot green chili pepper is more my speed.

    2. Same here on the blood pressure. The key to being a good cook, i’ve found, is using the right amount of salt, which almost always turns out to be more than you’d think.

      1. From what I’ve seen, the most common mistakes made by home cooks are not knowing what “done” means and under-seasoning. Most people who think they aren’t very good cooks would be surprised how tasty their stuff is with just a bit more salt.

      2. which almost always turns out to be more than you’d think.

        Quoted for truth.

      3. A little MSG doesn’t hurt either. A tiny amount makes things taste so much better.

      4. This times 3400.

        And I’ve noticed that everything pre-packaged needs a ton of salt now too, thanks to our overlords.

        1. Pretty much. I suspect the sodium-induced hypertension a lot of people experience is from eating a lot of prepackaged food. I wouldn’t guess that eating salty-but-homecooked food makes much difference.

  3. Treat people as individuals not just as members of an undifferentiated public health herd

    Bailey said that? On purpose?

    1. It takes a herdless fucking hamster to note that delight. A congenial doom-clad fuzzbutton I might add…

      1. Aww, that’s the nicest thing anyone’s said about me all week.

  4. Wait a second, three teaspoons of salt is a lot?

    1. Not from where I’m sitting. If the government’s claims about salt were true, I’d have died years ago.

    2. Three teaspoons added to what quantity of food?

      1. Four teaspoons.

        1. That might be a bad ratio. You’ll only taste the salt.

  5. HoD: The amount of salt you choose to eat will not infect me or other people. Just saying.

    1. Did the squirrels get you? *sympathizes*

      HoD: The amount of salt you choose to eat will not infect me or other people. Just saying.

      Neither will being unvaccinated, since unvaccinated is not the same thing as infected.

      1. But they are related in some way.

      2. HoD: And yet unvaccinated people are more likely to spread infectious diseases than people who are vaccinated against them are.

        1. Still conflating unvaccinated with infected.

          Men are more likely to be rapists, Ron. Blacks are more likely to be convicted of crime. I thought we established that treating individuals as part of an undifferentiated public health herd was a bad thing.

          1. I’m pretty sure that’s a true statement that Ron made. What you want to do with that information is another matter.

            1. That’s the point, Zeb. The statements I made were true as well. The devil, as always, is in the details.

        2. HoD: And yet unvaccinated people are more likely to spread infectious diseases than people who are vaccinated against them are.

          Ron, meet Bayes’s theorem. Bayes’s theorem, please smack Ron around a bit.

  6. TSA already does, so why not more deadly gov’t agencies?

  7. Tell you what–after dealing with a serious illness, I have a great appreciation for the variation among individuals, even with the same disease. There are things that can be said generally, of course, but there are plenty of exceptions.

    1. You caught the cilantro thing?

      1. Glioblastoma. Which may be caused by cilantro abuse.

          1. Doing well, no recurrences yet, have some motor deficits but nothing too bad. Still working and cogitating.

  8. I always wondered what it actually means to save 500,000 lives and whatever billion in healthcare costs from a particular initiative.

    Obviously these #s are inflated bullshit, but really what does it mean? I guess it would be that 500k people would have died from salt, but now they’ll die of something else? How much time does it buy these projected salt victims? If your salt death occurs at 75, but your cancer death happens at 76 – I guess that’s a life saved?

    And if we’re deducting your salt-death costs from the ledger, are we adding your cancer-death costs?

    1. I don’t think they are so much inflated bullshit as bullshit based on incorrect assumptions about how salt affects different people. They also seem to undercount the number of people who could be harmed by low salt diet.

      I think, but I’m not completely sure, that the 500k number means that that many people would have died within a certain time period without the reduced sodium.

    2. And if we’re deducting your salt-death costs from the ledger, are we adding your cancer-death costs?

      Stop that!

      Seriously, see Ron’s arguments about viral infections, risk, and The Precautionary Principle. These people don’t throw up their hands and go ‘Oh, right! That’d be a lot of work to not really save a lot of lives or only save 1-6 mos.’ or ‘Geez, this is really too complicated.’ They don their best TOP MEN uniforms, pass out the phones and pens to their underlings, and derp harder.

    3. I have to ask, is Bronson, Missouri just a funny name, or does it have anything to go with Branson? As in are you from around those parts?

        1. Now I feel dumb…

  9. Just back from the doctor. He wants me to cut down my salt.
    Cuz I have slightly high blood pressure.
    And I’m fat.
    Oh yeah, he wants me to lose weight.

    1. PT: The association between higher BMI and higher blood pressure is much stronger than any association between salt consumption and high blood pressure. Just saying.

    2. Drop your carb intake, eat more fat. Also fish oil pills and exercise, though those aren’t as important as the first two.
      More info: https://www.dietdoctor.com/low-carb

      In a few years I’ll be knocking on 50, but I’m not overweight nor do I have high blood pressure. My cholesterol numbers are great. I also take no medication.

      1. What a coincidence.

        1. Not really, since you’re both just Tulpa.

      2. I’m uncomfortably close to 50, myself. I recently switch docs because I got tired of my super-nice, but overweight doc telling me to eat more whole grains and keep my fats low.

        It’s really not that hard. My Italian grandmother was a fantastic cook, but we didn’t eat tons of starches and sugars. News flash: Olive Garden portions are not how they eat in Italy.

        I’m with you. No meds and the only supplements I take are vitamin D, fish oil and protein.

        And cilantro. Lots of cilantro.

        1. “I’m uncomfortably close to 50”

          Lies make baby jesus cry.

    3. Reducing salt will do fuckall for your chronic blood pressure.
      I recommend this for a permanent solution, which, by the way, will require your to raise your salt intake.

  10. Heads up to my fellow crazy prepper bunker dwellers…

    Morakniv seems to be having some sort of sale on Amazon and you can get some of their better knives from 35 to 50 percent off. Even their cheapos are reliable workhorses, imo.

    1. I love their blades. Really nicely ground and easy to keep a good edge on. I might have to pick up another one.

  11. Treat people as individuals not just as members of an undifferentiated public health herd. Let’s hope that the FDA will heed this advice and withdraw its misguided draft guidance.

    HAHAHAHAHAHAHAHA lol ron you’re funny.

  12. CDC has compiled a number of key studies,

    Key, meaning, cherry picked. Our modern day Ministry Of Truth. Don’t you guys fucking love science?

    1. They’re puritans. Anything that makes food taste good must be bad for you, facts be damned. (Of course, this is true in the case of sugar/starches.)

    2. I would actually guess that they took steps to avoid cherry-picking studies; without RTFR, I’d guess CDC did a systematic review of the published research. Whether papers finding “dietary salt isn’t a big deal” are less likely to get published is a better question to ask.

      The bigger problem is the “populations vs individuals” one Ron points to. Medical research is all about estimating average effects over (hopefully representative) study populations, but it absolutely does not follow that (a) a lot of people are going to experience something like the average effect, or (b) that we can ignore the tails of that effect distribution if a lot of people are experiencing exceptionally poor outcomes.

  13. Who the fuck pays attention to the FDA? I love salt, put it on everything. I’m still alive. Fuck the FDA.

  14. Please let me get my medical advice from a doctor of my own choosing. Govt is not wanted nor welcome on these issues.

  15. Two words: Essential Nutrient.

  16. Veiling the unpalatable is a talent salt yields indiscriminately.

  17. Science is only ever “settled” til its not. Thats, like, what science is.

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