What’s better: (A) voluntarily reducing your salt intake, or (B) having the government mandate that you do so? Naturally, if you don’t opt for A, you get B, which we can call the Bloomberg option.
Why reduce salt? Well, there’s a chance—a small one, but non-zero—of exacerbating your high blood pressure, assuming you have that condition, and because of the possibility of exacerbation, you might live a slightly shorter life. Sure, this possibly shorter life you lead will be full of flavor, and the time you spend here will be more savory, but no citizen should choose quality over quantity when it comes to life. Right?
Linda Cobiac spends her days fretting about the amount of salt Australians ingest. She is so worried that she wrote the peer-reviewed paper “Cost-effectiveness of interventions to reduce dietary salt intake” in the eminent journal Heart. She and her co-authors conclude that “maybe there is an ethical justification for government to step in and legislate” the amount of salt citizens can buy in their food.
How did they come to this—nowadays, non-remarkable—conclusion? Why, with a computer model. Specifically:
We consider strategies ranging from those that aim to change individual dietary behaviour, to the current programme of incentives for voluntary changes by food manufacturers, to a more paternalistic approach with government legislation of more moderate salt levels in processed foods.
Shouldn’t that have read, in our more sensitive age, maternalistic approach? But never mind.
They began with a bag of assumptions, such as that as more salt is eaten, less life is lived. They then plugged more salt eaten into their model and were able to show that as more salt is eaten, less life is lived. They also assumed that government mandates to reduce salt will reduce salt most effectively; and they found, after modeling, government mandates reduce salt most effectively. This style of modeling will sound familiar to climatologists.
To quantify less life, they used the scientific-sounding DALY, which is to say disability-adjusted life years, a measure concocted and beloved by bureaucrats. I can think of no scale more easily abused, or more easy to abuse, than this curious number created in the laboratories of the World Health Organization.
DALY is bad; that is, high DALYs are worse than low ones. DALY is a sum of the years of life lost due to a person having an affliction and the number of years the person has lived with the malady.
This means that a 30-year old with chronic bursitis who dies at 80 has a DALY of 50, assuming that the man would have lived as long had he not had the bursitis. Another way to have a DALY of 50 is stroking out at 30. Of course, this also assumes that the man with the stroke would have certainly lived to 80—and not 81 or 79 etc.—had he not had the stroke.
When I used the word assumes in the above paragraph, I mean it in the same technical sense as our authors meant: that is, as a wild-ass, non-verifiable guess. Population DALYs are often used as replacements for individual DALYs, in the charming hope that averaging across many will reduce errors in the assumptions.
Who gets to decide what afflictions count toward the DALY? Bureaucrats. They always start with scary maladies like cancer, but they soon start tacking on less frightening illnesses like hypertension or post traumatic stress syndrome.
The consequence is that if you add on every little departure from “ideal” health, then soon a population’s average DALY will tend toward some fixed number because everybody has to die of something and everybody gets sick. Then, every time a government introduces a new program to decrease population DALY, they will fail, because DALY cannot go down. Which means more funds will be needed perpetually in the “war against high DALYs”. It becomes just like the “war against poverty” some politicians wage when they bellyache that half of all people earn less than the median income.
The real magic comes when DALY is married to money. All you have to do is to say each DALY is worth $X. Thus you can, like our authors did, say reducing salt not only saves lives, but it also saves money, which is more important. And certainly more tangible. Proposing laws to reduce spending are more palatable than laws proscribing salt.
This isn’t just Australia, friends. The authors say:
In an important step, the US Institute of Medicine, in their recent report on strategies to reduce sodium intake in the USA, recommended that voluntary strategies be considered only as an interim measure, with a primary recommendation to set mandatory national standards for salt content in both processed foods and foods prepared outside the home.
The key word is mandatory.
(And people thought this article was a joke.)
I can’t wait until we get mandatory Health Insurance then get mandatory requirements to keep that mandatory Health Insurance. And since those are bound to fail there’s the inevitable criminalization of say too much salt use along with the inevitable price, both monetary and social, of investigation, enforcement and punishment.
I would be interested in your opinion on the strength of the above paper from a statistical or scientific method point of view. It the paper basically right and only the politics are wrong? Or is the statistical analysis and computer model themselves weak?
I have looked at some of the studies and meta-studies on salt intake (there are dozens) and the conclusions do not seem that strongly supported. But I’m not a statistician. The reason I looked was because I live in the desert and am fairly active and my doctor has recommended I increase my salt intake. And I am not a young man!
We didn’t even have to wait for Obamacare to get the feds fiddling even more with our lives and health. The Stimulus Bill handed a billion bucks to 15 bureaucrats to unleash stuff like the study anatomized by our host.
“Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions. The bill creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money.”
http://www.nytimes.com/2009/02/16/health/policy/16health.html?_r=1&hp
This from February 2009, notice.
The bureaucrats are already in place and beavering away doing Zoroaster-knows-what.
In Portugal already the bread’s amount of salt was regulated and limited. More to come.
I remember a terrible movie with Sylvester Stallone, a sci fi in the future where salt, sugar, smoking, sex, cursing, etc., was strictly forbidden. At least there will still be “babes”.
How about: the public health policies affecting diet have a mandatory 30 year delay before they become law. It keeps turning out that the science they’re based on is, er, shit. (Read ‘Good Calories, Bad Calories’ for examples). This would also have the effect of reducing the messianic fervor of those who feel it’s their bounden duty to save us from ourselves. (As they would realize that their careers would have ended before the laws they help enact came into force).
I’ve got no problem at all with government acting to ensure that the food I eat is correctly described, free of adulterants and poisons, etc. Governments have a good track record over the past 100 years or so of making food safer in that way. But all the evidence is that when it comes to telling us what foods we should and shouldn’t eat, they’re completely useless. Look at the way the food pyramid (which was always, er, wrong) has transmuted into ‘here’s what agribusiness wants to feed you’.
All the evidence is that the human body can survive on a wide range of foodstuffs; the idea that we have to perilously ‘balance’ our diet does not seem well-founded. What is definitely the case is that we can’t expect to force feed ourselves garbage and get away with it indefinitely.
If governments really wanted to take action to reduce health risks from food, maybe they should ban ‘all you can eat’ buffets?
Another example of the creeping fascism of the nanny state. They will protect you from yourself if they have to kill you to do it.
As George pointed out, there are numerous studies on salt intake and the results are contradictory and this has resulted in the salt wars among the researchers.
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George,
There’s no investigation of the ill effects of salt: they are assumed as part of their model. From that model, they conclude that salt is bad news. For Australia, anyway.
So let’s see, first we decrease salt in processed foods, and then we discover salt DALY is still high. People must be adding salt. Then we ban salt purchase or ration it And then http://en.wikipedia.org/wiki/Salt_Satyagraha
Salt is to food as pop is to music. Bleah. Adding salt to food does not bring out it’s flavor, it just makes it tast salty. Bleah.
Naturally though i’m against government interference and attempted control over our lives. If the masses want their salty packaged foods, let ’em have it.
Buy more rope.
Primatives relied upon salt to preserve their food. And I’m still trying to get my head around salt-free sauerkraut and dill pickles. Pickled herring, salmon…the list goes on.
Potatoe chips without salt? How droll.
My annual prime rib is cooked on a bed of salt, covered in salt. It is perfect.
Having said that, I will admit that I decided to make a dietary change in February. Called the folks at Nutri-System and placed an order. The big difference between weighing 240 pounds and 195 pounds has been a real decrease in salt, a total decrease in fat, and a balance between protein, carbs and a load of vegetables and fruit. Yet, after 44 years of smoking, I’ve yet to find the balance between cigars and cigarettes. Cigars are too expensive, but cigarettes now have chemicals in them that inhibit their flammability and the chemical that does this miracle of industrial science is extremely irritating. A win/win, perhaps, for the anti-tobacco crowd, but a perceived, real threat to my personal health. For the lives saved from non-burning cigarettes, I guess I should be proud to be doing my own best for the good of the non-dead.
And I do detest second-hand smoke. Especially when I can’t smoke first-hand. Although, I don’t think my health is as threatened by second-hand smoke as most non-smokers are threatened. Can’t draw a simple correlation for that thought, but, causation and correlation are separate things. If I smoke, and am exposed to second-hand smoke, perhaps I should be dead. (Which makes me an outlier, so we’ll just eliminate me from the sample.)
I live next to the Pacific Ocean, which is inhabited by all types of sea creatures, none of whom exhibit the least sensitivity to salt. And yet salt is consumed by all these creatures in daily fashion. This could explain, I suppose, die-outs of different varieties of sea-creatures, among which must be numbered, the Krakken. If it killed the Krakken, it is obviously a bad thing.
.
In the spirit of not keeping with the analysis of the referenced article, I must say that salt, NaCl, is detrimental to human live, particularly me. I had a kidney removed four years ago because of renal cell carcinoma, a slow growing and almost symptom free disease.
The point is that my carefree diet days are over. With one kidney, and being six feet, two inches tall weighing 260 pounds, I am at great risk of high blood pressure killing my one remaining kidney, and the more NaCl I ingest, the worse things will get. Dialysis, anyone?
I have not been doing a credible job of controlling my weight, but I have implemented a strict sodium control program.
Do you realize that you cannot consume a can of beans without ingesting the better part of a gram of NaCl? Pretty much ALL processed foods have a LOT of salt, and most people equate salt with taste. Just ask any chef how much they add to food, let alone watch Food Channel cooks like Rachael Ray dump almost entire handfuls of salt into everything they cook.
Salt is a primary ingredient and preservative for pretty much any food product sold in today’s supermarkets, including Trader Joe’s where they pride themselves in “organic” foods. Trader Joe’s excuse is that they don’t add “un-natural” preservatives to food. Sodium is considered to be natural.
It is inevitable that you will see studies, for better or worse, advocating less salt. We are awash in the stuff, and any responsible physician will tell you that you are better off without that crap.
I don’t agree with a paternalistic program limiting my consumption of anything. If I let them get to me on salt consumption, as bad as that stuff is, they will eventually get to my whiskey.
That’s when things will really get ugly.
This is one of the unintended and nastier consequences of too many people going to graduate school! These so called scientists and researchers have to find something more useful to do – preferably where they get real and immediate feedback on how stupid their ideas are. If we do not, their self-serving, self-affirming and self-righteous pontifications and regulations will expand to fill every corner of our lives.
Hi Matt,
You’re right, nutrition is a lot like climate – there is a lot of unsettled science and everyone has an opinion.
The science of salt reduction in humans is not settled. To give one example from the Journal of the American Medical Association (see http://www.foodpolitics.com/wp-content/uploads/JAMA-Na+-Restriction-2-2-10.pdf ), while it’s clear that randomized control trials have shown blood pressure reductions from reduced sodium intake, in RCTs with heart patients lower sodium intake was correlated with poorer outcomes. And the recent study in press (American Journal of Clinical Nutrition) by Walter Willett of Harvard shows intake of sodium over the 46 year period 1957-2003 shows no trend in US adults. This supports the concept that sodium intake is regulated within a narrow physiological range.
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George Crews is interested in the statistical integrity of the results. In fact, the problem is considerably deeper than that. The basic assumptions made regarding the science are incorrect. This is the 4th statistical publication made on the subject this year and they are all based on the flawed Geoffrey Rose population strategy for reduced sodium. The variable never accounted for is the unintended negative consequence of sodium reduction – which is population-wide increased renin-angiotensin-aldosterone activity. This, without exception, pushes the population towards a higher cardiovascular (and other outcome) risk. Just last week, Garg and Williams at Harvard published in the journal, Metabolism – Clinical and Experimental on November 1, 2010, their work on testing the low-salt/insulin resistance hypothesis in subjects that were healthy. These healthy individuals were tested after 7 days of a low salt diet (1.2 g salt/d) and 7 days of high-salt diet (9 g salt/d) in a random order. Insulin resistance was measured after each diet and compared statistically. There was no question that a low-salt diet was found to be significantly associated with an increase in insulin resistance, while the high salt diet showed no negative consequences.
The statistics in the Cobiac paper are irrelevant – the science is wrong.