That lovin' spoonful
Salt is poison
Salty history
Intersalt assault
Big study. Big problems?
Millimeters of megadeath
Finding common ground

Can we agree?
Enough of the "salt-in-your-wounds" sniping among the adversaries. What else can we do to reduce blood pressure?

How about eating lots of vegies and going low-fat? According to the Dietary Approaches to Stop Hypertension study (see "A Clinical Trial... " in the bibliography), you can get dramatic reductions without worrying much about sodium.

"People actually followed the diet, got a blood pressure reduction, it was more significant than sodium reduction," says David Freedman of UC-Berkeley. Indeed, the combination of high-vegies and low fat reduced blood pressure by 5.5/3.0, far more than most non-drug interventions.

However, before we get too carried away, let's remember that this is one study, conducted in an elaborate manner. Meals, for example, were prepared for the subjects.

A follow-up study will compare three levels of sodium intake to the high-vegie, low-fat DASH diet, Whelton says. He cautions that while the DASH improvement does seem impressive, the study has not been repeated yet.
\

A second idea is to broaden the focus from sodium to other minerals, primarily potassium. "Everything we are learning about potassium shows that it's the converse of sodium," says Whelton. "It seems to protect blood vessels in animals, and epidemiology shows that a higher intake is associated with a better cardiovascular outcome," meaning fewer heart attacks and strokes.

Lessons
A third focus is to look at how the science develops. In any public health squabble of this magnitude, it helps to ask questions:

What are the preconceptions – are we prisoners of our expectations? Have the anti-salt crusaders exceeded the evidence, forcing them to stick with untenable recommendations?

Who is paying for the research, and where is it published? Despite charges that the Salt Institute, an industry group, was behind the critics, we found some financial support. Alderman says he gave a few talks sponsored by the Institute a few years ago, and attended two meeting at the Institute. Logan says he accepted "a small honorarium from the Salt Institute for my advice to offset the loss of practice income." Davey Smith and Freedman say they've taken no Salt Institute money. McCarron did not answer. Before you jump to the conclusion that Salt Institute funding has biased the results, however, remember that many of the key critiques of the salt hypothesis published by these scientists have appeared in major medical journals.

What's missing? Do the contradictory results mean that we're studying the wrong thing? How, for example, do other minerals and genetics play into the situation?

What is the limit of human endurance: Can people actually make the changes we're asking? How much credibility has been lost in the vendetta against salt?

Is there another way to skin this cat? Could a better diet – with less focus on sodium – achieve the same goal? Should we worry more about the total diet, and less about individual nutrients? Will drugs for controlling blood pressure be more effective in the long run?

How long can we, or should we, wait for a definitive answer before taking action, as individuals or a society?