Sodium in the News

A pinch of reality about “A pinch of reality about salt” and other misleading media stories.

Several articles have appeared in the popular media over the last few months suggesting that we need not be concerned about the high levels of sodium in our diet and that low intakes may be dangerous. They have been written to highlight studies that have recently been published in the scientific literature.

What has not received much media coverage however, is the subsequent extensive and condemning reaction of the scientific community to these studies. A European study by Stolarz-Skrzypek et al., published in May in the Journal of the American Medical Association linked a low sodium diet to increased risk of death from heart disease. Scientists at Harvard School of Public Health responded by describing the study as “flawed science on sodium” (http://134.174.190.199/nutritionsource/salt/jama-sodium-study-flawed/index.html). Letters to the Journal (http://jama.ama-assn.org/content/306/10/1083.1.full) and a commentary published in August in Kidney International (http://www.nature.com/ki/journal/v80/n7/full/ki2011246a.html) discussing the Stolarz-Skrzypek study, further highlighted significant methodological issues.

In July a review was published in the American Journal of Hypertension that questioned the benefits of dietary sodium reduction. Commentary on the review followed quickly in the leading medical journal The Lancet noting issues with the science and that the conclusions of the authors were incorrect (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61174-4/fulltext#article_upsell).

Despite the rapid rebuttals in the scientific literature media articles suggesting that lowering sodium intake may be dangerous continued to appear. For example, a September 15th Macleans magazine article had the title “A pinch of reality about salt. Health Canada’s war on salt has detractors who say low-sodium diets can be hazardous to your health” (ww2.macleans.ca/2011/09/15/a-pinch-of-reality/). The article mislead the public by drawing attention to the recent studies without noting that they are outliers that have been heavily criticized. It also misleadingly implies that the health benefits of dietary sodium reduction are not widely supported by the scientific community. While it is true that some of the individual scientists and clinicians quoted in the Macleans article do not support sodium reduction, it is not the case that “In fact, many scientists believe high-salt diets are better for the body”. The Macleans article further misleads its readers by portraying the detracting commentators as independent academics without disclosing their potentially conflicting food and salt industry connections.

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United Nations High-Level Meeting on Non-communicable Diseases

Perhaps not coincidentally the negative scientific publications and media articles appeared just prior to the United Nations High-Level Meeting on Non-communicable Diseases, held in New York on 19 and 20 September and involving heads of state and government from around the world. This meeting marks only the second time the UN has held a high level meeting on a global disease issue and the focus was on cardiovascular diseases (heart disease and stroke), chronic respiratory diseases, cancers, and diabetes. There was intense lobbying in the lead-up to the meeting as to what the priority interventions should be to address the prevention and control of non-communicable diseases worldwide. Reflecting its significant potential impact salt (sodium) reduction figured prominently in the resulting Resolution adopted by the United Nations General Assembly. Food and drink industry lobbyists were successful however, in keeping specific targets and timelines out of the final Resolution. The Resolution on the Prevention and Control of Non-communicable Diseases was endorsed by 194 governments, including Canada (excerpt):

Section 43. Reduce risk factors and create health-promoting environments

(f) Promote the implementation of the WHO Set of recommendations on the marketing of foods and non-alcoholic beverages to children, including foods that are high in saturated fats, trans-fatty acids, free sugars, or salt, recognizing that research shows that food advertising to children is extensive, that a significant amount of the marketing is for foods with a high content of fat, sugar or salt and that television advertising influences children’s food preferences, purchase requests and consumption patterns, while taking into account the existing legislation and national policies, as appropriate;

(g) Promote the development and initiate the implementation, as appropriate, of cost-effective interventions to reduce salt, sugar and saturated fats, and eliminate industrially produced trans-fats in foods, including through discouraging the production and marketing of foods that contribute to unhealthy diet, while taking into account existing legislation and policies;

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US National Academy of Sciences reports on “Front of pack” food labeling.

The US National Academy’s Institute of Medicine (IOM) was directed by congress to study the rating systems and symbols used on the front of food packages to promote “healthful” choices. In a report released on October 20, the IOM concluded that front of pack information would be most useful to consumers if it highlighted four key diet-related health metrics – calories, saturated fat, trans fats and sodium. http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12957

The report effectively rejects the food industry mantra that there is no such thing as a bad food, only a bad diet by recommending that the front of pack information gives clear guidance as to relative “healthfulness” rather than simply providing nutritional information. Given the need to harmonize food labeling across North American markets this is likely to impact foods sold in Canada in the future. The next report in this series to be released by the IOM will likely recommend a design for a single standardized front-label guidance system that will could be regulated by the Food and Drug Administration.

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American Heart Association (AHA) releases fact sheet on sodium in chilren’s diets.

A terrific new fact sheet has been produced by the AHA laying out a strong case why it is important for children to reduce their sodium intake:

http://healthyamericans.org/health-issues/wp-content/uploads/2011/10/Sodium-Fact-Sheet.pdf