Declaring War on Salt

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This piece originally appeared in the Washington Times.

New York City Mayor Michael R. Bloomberg's latest public health initiative is to get Americans to cut their salt consumption by at least 25% over the next five years. Mr. Bloomberg, who loves consuming large amounts of salt himself (he reportedly pours it on everything from pizza to potato chips), and his health commissioner, Dr. Thomas Farley, claim such salt reduction would save "tens of thousands of lives" by preventing hypertension (high blood pressure) and the resulting heart attacks and strokes.

Mr. Bloomberg, the third-term mayor of New York, is focusing his efforts not just on the Big Apple, but on the nation as a whole. His plan is to pressure food companies and restaurants to make salt reductions, given that 70% to 80% of the salt we take in daily comes not from the salt shaker, but from restaurant fare and processed foods. He says this recommendation is "voluntary," but then again, he said the same thing when he urged restaurants to use less trans fats (though they are harmless at the level we have in our diet). He later put regulatory teeth into the "recommendation."

The mayor and his health advisers have championed many questionable regulations allegedly to protect our health -- and in most cases what happens in New York City does not stay in New York City. The rules and regulations quickly migrate to other cities and states. In 2006, Mr. Bloomberg, et al., instituted a ban on trans fats in city restaurants. They touted a specific number of lives that would be saved: 500. Where did they get that number?

Trans fats for decades have represented a minute percentage of the calories we take in daily -- about 3%. Contrary to what many people think, the caloric value of all fats is the same, nine calories per gram. At the level consumed, trans fats don't raise blood lipid levels any more than other saturated fats (and dietary factors are only one minor risk factor for heart disease).

When restaurants stop using trans fats, they substitute another fat, or as a manager at one famous New York restaurant put it, instead of trans fat, "we use a large amount of wonderful, farm-fresh butter."

The Bloomberg health team also went after the purported dangers of secondhand smoke in restaurant and bars, banning all smoking in such establishments. Again there was an estimate of the number of deaths this action would prevent: 1,000. Were restaurant or bar patrons dying from exposure to the smoke from other patrons during dinner? Were employees dying from secondhand smoke? No.

Exposure to secondhand smoke does have negative health effects: It worsens respiratory ailments, can trigger asthma attacks and headaches, and causes severe ear infections, especially in children. But causing 1,000 deaths? Highly improbable. This is not to say that the majority of New Yorkers don't welcome the smoking ban -- not because secondhand smoke was killing people, but simply because cigarette smoke is disgusting, saturates your hair and clothes, and can ruin a dining experience.

There was, apparently, one healthy side effect resulting from the Bloomberg ban on smoking in almost any public place, though: New York City now has the lowest smoking rate in the country, down to about 16% from 22% just a few years ago.

Mr. Bloomberg's actions against salt should be a clear sign to us that the more government gets involved in the provision of health care, the more government will assume the authority to tell us what lifestyle factors (including dietary choices) will be tolerated.

A few observations:

¢ High blood pressure is admittedly a very serious risk factor for heart disease, stroke and other life-threatening ailments. It is an underdiagnosed and undertreated condition.

¢ Some people are "salt sensitive," and if they are consuming high levels of salt, they will see their blood pressure rise. Typically, a patient with a high blood pressure reading (at multiple doctor's office visits) will be asked if he or she is on a high-salt diet. (Most people do not know how much salt they are consuming and might say they never use salt because they don't add salt to food -- unaware of the salt in their processed food.) The physician may recommend a careful dietary analysis and salt reduction -- but the fact is that this "less salt" advice works for very few people. Most with high blood pressure need to have it controlled with drugs.

¢ There is no evidence available to back up the claim that we could prevent "tens of thousands" of deaths by reducing salt intake nationwide. This is a number pulled out of Mr. Bloomberg's hat.

¢ Salt is an essential element in our diet (and in preventing spoilage, enhancing flavor and improving shelf life). For example, we need it for hydration. Older people, in particular, need to ensure that they have enough salt in their diet. There are those, including Dr. Michael Alderman, a hypertension specialist at Albert Einstein College of Medicine, who feel that an across-the-board recommendation of salt reduction -- without any data at hand to show that it is effective in reducing hypertension or is even safe -- would put all of us in a large, uncontrolled experiment. In speaking of the proposed salt reduction initiatives, Dr. Alderman says, "I am always worried about unintended consequences."

Mr. Bloomberg and his associates would save far more lives by abandoning the salt-reduction plans and instead instituting programs to get all adults screened for hypertension -- through simple blood pressure readings -- with follow-up administration of safe and effective medications to bring those specific individuals' blood pressure to normal, healthy levels.

Thus, the assault on salt is purely diversionary, and Mr. Bloomberg, et al., have no evidence whatsoever that it will save lives. One sign that even the mayor is unsure about the efficacy or necessity of his latest so-called health campaign is that he is now lapsing into hyperbole about salt's risk.

He recently defended this nanny initiative by likening the risks of salt to asbestos exposure: "If we know there's asbestos in a schoolroom [what do we do], say it's not our business?" He flatly stated, "Salt and asbestos are not good for you."

He should know that the best way to lose a debate is to be caught exaggerating your case.