Category Archives: high blood pressure

Restaurants of New York: Stop Serving Assemblyman Felix Ortiz Food Prepared With Salt In Any Form

My sincere apologies to any lookalikes. Perhaps you could go moustache-less for a while? No salt for you!

Just over a week ago, a New York state assemblyman from Brooklyn named Felix Ortiz proposed a bill that would prohibit “the use of salt in any form in the preparation of any food for consumption” with penalties of “not more than one thousand dollars for each violation.” Presumably that wouldn’t prevent restaurants from providing salt for customers to add at their own discretion, but the bill offers no further details about what would and wouldn’t be considered a “violation” of the law or what is and isn’t included in the definition of “salt in any form”: see the full text here (hat tip: Reason).

Surely table salt (NaCl) would count, but what about any of the other edible ionic compounds that are chemically considered to be salts, like MSG (a sodium salt with the molecular formula C5H8NNaO4) or cream of tartar (a potassium acid salt with the formula KC4H5O6)? What about salty condiments like soy sauce, fish sauce, and ketchup? Would a restaurant that serves a ketchup-topped meatloaf have to forego the salt in the loaf mixture but still be able to slather ketchup on top (if so, why wouldn’t they just start adding ketchup to the mix as well, and finding ways to incorporate condensed soups and bouillon into dozens of other things that don’t already have them)? Or would they have to find or make their own salt-free ketchup—obviously a much larger burden on some kinds of restaurants? Even if it could make you live forever, would it be worth it?What about all the other prepared foods that already include salt and get used as ingredients in the preparation of other foods? Would Momofuku Milk Bar be banned from serving its famous compost cookies, which call for the addition of two “snack foods” like potato chips and salted pretzels?

House-baked, cured, and brined things would clearly suffer most from a law like this. It’s one thing to have to salt a soup or curry or burger at the table, but everything from deli pickles and salami to homemade cinnamon rolls and pie crusts would become completely unpalatable, if not impossible, without salt. When questioned by the Albany Times Union about salt-cured meats and pickles:

Ortiz didn’t have answers, saying repeatedly, "This all needs to be debated."

Of course, it’s probably not worth worrying about the ramifications of a bill that I can’t imagine has any chance of passing. Even the NYTimes has backed down from their initial, crazypants coverage of the recent NEJM study that claimed a small reduction in sodium consumption would save 44,000 lives a year—which is exactly the sort of statistic that gives legs to hysterical nutritional crusades (hysterical both in the funny-ha-ha sense and in the wandering-uterus-induced-insanity sense). The best example of that phenomenon is probably the equally batshit claim that obesity causes 300,000 deaths per year, but even anti-obesity crusaders have struggled to get far less aggressive measures passed, like the mandatory inclusion of calorie counts on fast food menus (which, incidentally, do not seem to reliably reduce how many calories people purchase).

Ortiz’s bill is actually so preposterous and so much more aggressive than the other recent proposals for reducing salt consumption, like the New York City Department of Health and Mental Hygiene’s campaign to persuade food manufacturers to reduce the salt content of processed food by 40 percent over the next 10 years, that I initially thought it might be a sort of “straw man” bill designed by restaurateurs and/or salt-reform-skeptics to win people over by making salt reform seem even crazier than it actually is. But according to Ortiz, it was actually inspired by his father’s death:

He said he was prompted to introduce the bill because his father used salt excessively for many years, developed high blood pressure and had a heart attack (Albany Times Union).

Pity his father’s heart attack couldn’t be attributed to excessive exposure to creepy moustaches.

I've been trying to come up with equivalents and most of them end up being alcoholic: "As much as gin loves olives," "As much as tequila loves lime." There are so few other set-in-stone pairings. "As much as manchego loves quince"? "As much as rich gravies and stews love just a little bit of acid"? Ortiz’s salt-banning tribute to his dad is sort of like an inversion of the stories about filial love and salt that show up in traditional folklore of many different cultures from England to Central Europe to the Himalayan foothills. Many of them begin with a Lear-like scenario where a King or a nobleman in the unfortunate situation of having three daughters in a patriarchal society demands professions of love from each of them to help him decide how to divide his kingdom or estate between them (or, more accurately, their husbands). The elder daughters supply all the hyperbolic declarations of love you’d expect from adult children trying to protect their inheritance, although we’re meant to understand that they’re duplicitous opportunists who love their father’s money and power more than they love him. The youngest, who really loves him, says that she loves her father either as much as she loves salt or “as much as meat loves salt."

The King balks at being equated with a lowly condiment and banishes her for her seemingly insufficient devotion. Then, one of two things usually happens: either her departure magically causes salt to stop coming into the kingdom, their supplies begin to dwindle and people begin to sicken and die until the daughter returns and feeds her ailing father a nourishing, salty broth or bit of bread spread with butter and sprinkled with salt and he realizes that she was the one who loved him best of all OR someone arranges to have a feast prepared without salt, and as course after course comes out of the kitchen completely inedible, the King realizes his error and welcomes his daughter back. In Ortiz’s case, it’s the father who loves salt too much and the son who doesn’t realize its value.

The crux of the trope is that it’s only after people are deprived of salt that they realize how important it is to their happiness, and everyone gets to live happily ever after. In the English version called “Cap o’Rushes,” after the Lear bit, the story proceeds basically like the Grimm brothers’ “Allerleiruah” or “All-Kinds-of-Fur.” After banished from her father’s house, the daughter disguises herself in a cloak of rushes and becomes a servant in another nobleman’s home. He happens to have a son of marrying age so there are series of wife-seeking balls, Cinderella-style, and she’s the mysterious girl who steals his heart and disappears, though Cap o’Rushes manages to hang onto her shoes. Instead, the prince-figure gives her a ring, and when he falls into a deep depression because he doesn’t know how to find her, she prepares a stew or some gruel for him and slips the ring into it. Her identity is revealed and he proposes—and the interesting part is that the story doesn’t end there the way it normally would, not just in fairytales but in most English bildungsroman involving female protagonists until the 20th C. Boys become men and get jobs; girls become women and get married, The End. But in “Cap o’Rushes,” the resolution is about the salt as much as the marriage. The girl’s father is invited to the wedding, and she instructs the cooks to prepare her wedding feast without a grain of salt. By the last course, the man bursts into tears, finally realizing how much the daughter he sent away really loved him. The bride comes to his side, he recognizes her, she forgives him, and that’s what makes people happy ever after.

So here’s my proposal: if Felix Ortiz really wants restaurants to stop serving food prepared with salt “in any form,” I think that’s precisely what they should give him, but only him. I suppose, like the bill, what “in any form” means should be left up to the restaurants themselves, but I would encourage them to take a broad interpretation in case that’s how the court would chose to interpret it. Probably none of whatever the nibbles in the lower right corner are, either. Catering counts as restaurant-prepared food, too.So, no soy sauce or MSG, although I suppose we can let non-sodium salts like cream of tartar slide. But definitely no ham, bacon, salami, pepperoni, mortadella, corned beef, pickles, or kippered herring. No meats that have been brined, rubbed with salt, or dipped in a salted batter before cooking—let him taste what fried chicken and blackened fish are like without salt, what pulled pork is like without salt in the dry rub, and what roast chicken is like without any salt rubbed under the skin. No Chinese-style tofu (silken tofu, which is often made from soy milk coagulated with acid instead of salt could theoretically be okay, but be sure to check the label). No ketchup, mustard, mayonnaise, salad dressing, or cheese unless they’re house-made and can be made without salt. The same goes for pasta, bread, pastries, and puddings. No salt in the patty of any burger or in eggs cooked any style. No packaged potato or corn chips, pretzels, crackers, or cookies. No soups made with bouillon, no canned tomatoes. He can have them at home, but not at any establishment that would be covered by the ban.

If he goes to a noodle bar for ramen, he should be served a bowl of unsalted noodles in a salt-less broth with unsalted toppings. If he orders a BLT, he can have salt-free bread with lettuce, tomato, and salt-less mayonnaise—if there’s no salt-free bread or mayonnaise available, just the lettuce and tomato. Let him try salting cheesecake, ice cream, caramels, cookies, and croissants to taste at the table with a salt shaker. I don’t expect him to burst into sobs in the manner of Cap o’Rushes father, but we’ll just see how long it takes before he reconsiders the wisdom of banishing salt from the kitchens of New York.

Salt Headlines That Make The Vein In My Forehead Throb

Salt has been all over the news this week because of a study just published in The New England Journal of Medicine claiming that if everyone in the U.S. reduced their sodium consumption by 3 grams/day, there would be 32,000 fewer strokes, 54,000 fewer heart attacks, and 44,000 fewer deaths every year. The story that got my attention was:

Remaining Arctic Ice Seen Melting Away Completely! (...on a computer screen)

That’s surprising, I thought. Everything I’ve read suggests that the relationship between salt consumption and cardiovascular disease is weak, inconsistent, and probably only valid for 20-30% of the population. So I expected the article to refer to some new research where, you know, “big benefits” were “seen.” As in observed. Like, in the world. And, given the claim about the magnitude, probably also measured.

To their credit, the authors of the study claim no such thing. The numbers are projections based on the application of several assumed effects of salt reduction, adjusted for different demographics and then applied to a model of the entire U.S. population. Thus, the title of the study: “Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease.”

The article seems to grasp the essentially speculative nature of the findings. The very first sentence uses the conditional tense:

…scientists writing in The New England Journal of Medicine conclude that lowering the amount of salt people eat by even a small amount could reduce cases of heart disease, stroke and heart attacks as much as reductions in smoking, obesity, and cholesterol levels.

The headline, on the other hand, seems to have confused the “scientists” with clairvoyants. Never mind doing any checking into the validity of their assumptions.

And the claim about how the benefits compare to smoking and obesity reduction led to a few headlines like this:

webmd salt

This crazypants idea initially sounds a lot like what the study’s lead author claims:

"The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels."

But the logic behind the claim is that a small improvement in the health of every single American would be as significant as a large health improvement in the health of every single smoker:

Dr. Bibbins-Domingo said that for many people the decrease in blood pressure would be modest, which is why, she said, “many physicians have thrown up their hands and said, ‘I’m not going to advise my patients to reduce salt because it’s too hard for patients and the benefits for any individual are small.’

“But small incremental changes in salt, such as lowering salt in tomato sauce or breads and cereals by a small amount, would achieve small changes in blood pressure that would have a measurable effect across the whole population,” she said. “That’s the reason why this intervention works better than just targeting smokers.”

For any given individual, there is no question about whether cutting salt is even close to “as good” as quitting smoking. The evidence for the link between smoking and lung cancer and death is strong, reliable, consistent, and has a clear causal mechanism (carcinogens). The link between salt and cardiovascular disease and death is weak, inconsistent, and still poorly understood.

That latter point starts to get at the problems with the study itself, and not just the headlines it inspired. A number of the assumptions the projection was based on are either demonstrably false or simply unsubstantiated. More on this some other time; for now, a few quotes and links to the essays they come from in Esquire and the medical journal Hypertension:

In a more recent statement, the founder of the American Society of Hypertension, Dr. John Laragh, goes further: "Is there any proven reason for us to grossly modify our salt intake or systematically avoid table salt? Generally speaking the answer is either a resounding no, or at that, at best, there is not any positive direct evidence to support such recommendations."

Studies show that 30 percent of the Americans who have high blood pressure would greatly benefit from a low-sodium diet. But that’s about 10 percent of the overall population — the rest of us are fine with sodium. And drastically cutting out sodium may actually hurt some people. ( "Go Ahead, Salt Your Food")


The available data suggest that the association of sodium intake to health outcomes reflected in morbidity and mortality rates is modest and inconsistent. Therefore, on the basis of the existing evidence, it seems highly unlikely that any single dietary sodium intake will be appropriate or desirable for each member of an entire population…. The decision to adopt a low sodium diet should be made with awareness that there is no evidence that this approach to blood pressure reduction is either safe, in terms of ultimate health impact, or that it is as effective in producing cardioprotection as has been proven for some drug therapies. (Salt, Blood Pressure, and Human Health)