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releases 23/12/2002 Response of The Salt Manufacturers’ Association to the Salt Review of the Scientific Advisory Committee on Nutrition The Salt Manufacturers’ Association rejects the draft conclusions of the Salt Review of the Scientific Advisory Committee on Nutrition. It is unbalanced, superficial, lacking in evidential support and it can in no way be regarded as a serious scientific review. There is total inconsistency between the words of the report and the summary conclusions which purport to be drawn from them. It is also patently untrue that the evidence for salt reduction is now stronger than in 1994. Although there has been an attempt by SACN to consider some relevant issues in the body of the report, it is clear that the summation amounts to a highly politically motivated attempt to justify the Government’s current stance on salt and health with scant regard for the content of the report or the scientific facts. The report correctly confirms that ‘sodium is an essential nutrient at all stages of life. Consumption of salt, however, should be within a range compatible with health.’ The problem remains to define that range. Without compelling evidence of what constitutes a ‘healthy’ range of salt intake, public health policy should not dictate population intake levels. There is no consistent evidence that current UK salt intake causes high blood pressure or disease in the general population. The review infers that the SACN team has limited reliable data on current levels of daily salt consumption beyond a fifteen year old study. This takes no account either of any changes since then or of the effects of Government anti-salt campaign in the intervening years. It also ignores the huge variations in individual blood pressure levels. The conclusion and resultant advice, actions and pressures for the entire population to reduce its salt intake by an uncontrolled amount from one unknown and unmeasured level to another unknown and unmeasured level is scientifically untenable, medically irresponsible and contrary to the Governments own stated approach to the precautionary principle. As Laragh points out, a ‘one size fits all’ strategy is an inappropriate approach to public health policy. This is particularly important when dealing with an essential nutrient. The major 1988 Intersalt study is widely quoted in the report, but the fact that this study failed to prove its own primary hypothesis that systolic blood pressure is associated directly with sodium excretion is conveniently put aside, resulting in unscientific conclusions. There is no consistent, comprehensive data to show that reducing sodium intake:
The potential health dangers of sodium restriction have been ignored in this report and by the Government in the introduction of its ‘precautionary principle’. The report dismisses the possibility raised by Alderman that low sodium intake may be linked to increased mortality and effectively ignores all other potential dangers. The reviewers admit freely that they have little or no data on which to base recommendation for sodium consumption by children. They then make sweeping recommendations for children, based on this lack of information. This again seems irresponsible in the extreme. A disproportionate amount of the report considers data from extreme dietary distortions such as primitive populations and restricted animal studies. For instance, it devotes an inordinate amount of space to a small, questionable study where a majority of chimpanzees, fed fifteen times their normal intake of salt, became hypertensive. It fails to point out adequately the difference in human physiology or that had they been fed fifteen times their normal diet of bananas they would probably have become ill. It is dangerous to draw conclusions for general population advice from such extremes. The Salt Manufacturers’ Association accepts that a minority of individuals who are clinically diagnosed as already suffering from hypertension may benefit from reducing their dietary intake of sodium, under strict medical supervision, as part of their treatment. We also agree that the electrolyte intake of babies should be restricted. However, there is no consensus that salt causes high blood pressure or that reducing salt intake for the population as a whole is either effective, or safe. Almost every respected meta-analysis of research since the 1994 COMA report has concluded that the evidence does not support any recommendation to reduce salt intake for the general population. The latest such authoritative independent review by Hooper et al was published in the BMJ on 21st September 2002. It once more concluded that ‘Intensive interventions, unsuited to primary care or population prevention programmes, provide only small reductions in blood pressure...’, ‘produce uncertain effects on mortality and cardiovascular events...’, and that the ‘...contradictory findings ...make it less clear that salt restriction is without hazards’. Although this paper has been briefly referred to in the draft review, these important conclusions have been ignored in preference to an, as yet, unpublished paper by McGregor and He. The bias of the SACN review has elevated salt disproportionately when the balance of evidence suggests that obesity, inactivity and excessive alcohol are the primary risk factors for high blood pressure. These should be addressed as the priorities. The Salt Manufacturers’ Association has repeatedly asked the Government to submit the science on salt and health to a genuinely independent systematic review of the evidence at York or Oxford which have recognised protocols for such reviews. We have even offered to contribute towards the cost. The Salt Manufacturers’ Association again calls upon the Government to reject this flawed review and to submit the evidence to genuinely independent scientific scrutiny with no political agenda.
References: Laragh J. Laragh’s Lessons in Pathophysiology and Clinical Pearls
for Treating Hypertenson. American Journal of Hypertension 2001; 14(5):
397-404. Hooper L, Bartlett C, Davey Smith G, Ebrahim S. Alderman MH, Madhaven S, Cohen H, Sealey EJ, Laragh JH. Alderman MH, Cohen H, Madhaven S.
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