Indiscriminate Population-Wide Medical Experiments: Part Umpteen
By now you know that the Mayor of New York wants less sodium salt in your diet. You also know that the New England Journal of Medicine published an article in January claiming that if conservative assumptions about the health benefits of reduced salt intake are correct and would be true across the entire population then laws reducing salt intake would save "194,000 to 392,000 quality-adjusted life-years and $10 billion to $24 billion in health costs annually . Sounds like a law we ought to adopt tomorrow, right?
In this month's JAMA Dr. Michael H. Alderman of the Department of Epidemiology and Population Health at Albert Einstein College of Medicine has authored "Reducing Dietary Sodium: the Case for Caution". Alderman does a great job of setting out the positions of both the advocates and the skeptics of mass sodium restriction but then he points out the iron law of unintended consequences. "Multiple randomized clinical trials (RCTs) have established that reduction of sodium intake sufficient to lower blood pressure also increases sympathetic nerve activity, decreases insulin sensitivity, activates the renin angiotensin system, and stimulates aldosterone secretion. The health effects of sodium restriction will be the net of these conflicting effects."
Rather than the "rash route" of "universal sodium reduction" Alderman counsels a more cautious approach involving "rigorous, large-scale, population-based randomized clinical trials". He recognizes that a definitive answer would likely take years but, should it turn out that the supposed benefits don't materialize or the harm done to supposedly few people by universal sodium restriction turn out to be harm done to many many people, a lot of money and maybe lives, will have been saved.
A sensible recommendation given the track record of "consumer advocacy groups" - e.g. switching our diet to a starch pyramid and soon thereafter effecting the substitution of trans fats for traditional saturated fats. Maybe this time we can look before we leap.
