Most people underestimate the amount of salt they consume in their diet. Grossly. Like by a factor of six!
For example, many are unaware that an Everything Bagel contains 630 mg of salt — without cream cheese or lox. An ordinary salt bagel is loaded with no less than 3,380 mg! To put these numbers in perspective, consider that the American Heart Association puts 2,300 milligrams as the maximum safely allowable daily intake, and recommends no more than 1,500 a day.
Researchers questioning people about their eating habits found that despite decades of publicity about high-sodium foods, they still had little concept of how much of it is in such foods, according to an article in the new issue of Appetite.
Then, on Wednesday, came the stunning revelation that the received wisdom about the link between salt intake and high blood pressure and heart disease may be about as accurate as the link between worry and ulcers.
The source is the Framingham Offspring Study report, the most extensive to date — based on a population of over 2,600 men and women whose medical condition was tracked for 16 years.
The report not only challenges convention, it upends it. Consuming less than 2,500 milligrams of sodium daily is actually associated with higher blood pressure, it says. The implication, further, is that most Americans are consuming a healthy amount of salt in their daily diet.
Framingham is not the first to say such things. Other studies have appeared in recent years with similar findings. But they were on a smaller scale and less authoritative. They were merely signs of a storm coming; Framingham is the storm.
Not since two Australian researchers won the 2005 Nobel Prize for Medicine by establishing that most ulcers are not caused by worry but by bacteria in the stomach lining has the medical profession — and its clients — been so agog at the overturning of an axiomatic truth.
Think of all those ulcer patients tortured for years on baby diets and getting parts of their stomachs cut out. It took ten years of scoffing and harrumphing for the medical establishment to finally cave in and admit that the evidence was irrefutable and they had all — but all — been wrong about ulcers the whole time.
So it does not surprise us that the initial reaction from an establishment source was not one of immediate acceptance.
Thus, Cheryl Anderson, an associate professor in the Department of Family and Preventive Medicine at the University of California, San Diego and a member of the American Heart Association’s Nutrition Committee, had this to say:
“When I put it in the broader context of the general literature around dietary sodium assessment and blood pressure, particularly from what we know about clinical trials, (the study) didn’t bother me in any way,” she said.
More specifically, Anderson noted that Framingham did not employ a 24-hour multiple urine collections protocol, regarded as the most reliable measure of the salt-blood pressure effect. (Although she admitted that the protocol was totally impractical in a study of this size, since you cannot get thousands of people to take the samples every day of their lives for 16 years.)
Their methodology was too broadly statistical, she said, using dietary records and self-reporting, and could have loopholes, such as the possibility that some of those subjects may have lowered their sodium intake level after developing high blood pressure, which would throw off the correlation. She said she would have to study their actual findings before she would think about changing her mind.
Anderson may have a point, but what is really needed now is a period of careful review by the medical establishment. That would seem to be the salutary response at this point, although a certain defensiveness is understandable in the circumstances.
Having said all this, we must also stress that the Framingham study is not a license to begin consuming vast quantities of salted bagels with cream cheese and lox.
First, it does not settle the matter. It only puts a heavy counterweight on one side of the discussion. The numerous studies confirming the salt-blood pressure link remain, and the medical establishment has yet to abandon or even reconsider them. They aren’t the types to just say “never mind,” and draw a line through decades of research and stern warnings.
There’s another factor to bear in mind, as well. As Framingham points out, 20 percent to 25 percent of the general population has been categorized as salt-sensitive, and will still need to restrict their intake.
While we wait for the medical experts to thrash it out, we might look for a social impact in the short term.
Take the high-sodium warnings that appeared in the image of a little salt shaker on New York City restaurant menus in November 2015. New York was the first to impose such a warning, but as part of a “National Salt Initiative,” the hope was that other cities would follow suit.
This week’s news could cause an audible hiccup in this particular trend in nanny government. Other cities will presumably hold off on similar measures until the medical profession again speaks with one voice, if it ever does.
We might even see the removal of those little salt shaker icons on restaurant menus in New York as well.