high blood pressure

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

Posted by Margot | Filed under:
Mar 15 2010

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. Read more

Salt Headlines That Make The Vein In My Forehead Throb

Posted by Margot | Filed under:
Jan 27 2010

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")

And:

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)