Tuesday, August 04, 2015

Salt: killer or scapegoat?

"New Scientist" is fighting a rearguard action to reduce salt in our diet, despite a lot of evidence that salt does no harm.  I reproduce the key passages below.  I will add my comments following that

In 2009, cardiologist Francesco Cappuccio of the University of Warwick, UK, pooled all the data and found a strong relationship between a salty diet and cardiovascular disease (BMJ, vol 339, p b4567).

 Another way is to intervene directly in people's diets - take two groups of people, get one of them to eat less salt for a while and see what the outcome is. These trials take more work than observational studies but several have been done. The biggest managed to get thousands of people to cut down on salt by about 2 grams a day for up to four years and saw a 25 per cent fall in cardiovascular disease (BMJ, vol 334, p 885).

 Or you can look at whole countries, taking the before-and-after approach. Fifty years ago northern Japan had one of the world's biggest appetites for salt - an average of 18 grams a day per person - and shockingly high numbers of strokes. The government implemented a salt reduction programme and by the late 1960s average salt consumption had fallen by 4 grams a day and stroke deaths were down by 80 per cent.  Finland, another salt-guzzling nation, achieved similar gains in the 1970s.

However, the evidence is not always so clear. In July the Salt Institute was presented with its biggest PR coup for years when the Cochrane Collaboration, an internationally renowned body dedicated to assessing medical evidence, published a long-awaited study on salt and cardiovascular disease. As is usual for Cochrane, the study was a "meta-analysis", pooling the results of all the best-designed randomised controlled trials that have been done, the highest standard of proof in medicine.

Seven trials met the quality criteria, with over 6000 subjects in total. The analysis did show that people who cut back on salt have slightly lower blood pressure and are less likely to die from heart attacks and strokes. But, crucially, the effect on deaths wasn't big enough to be statistically significant. The Cochrane team could not rule out the possibility that the reductions had happened by chance.

The research was published simultaneously by Cochrane and the American Journal of Hypertension (vol 24, p 843), whose editor-in-chief Michael Alderman is a long-time critic of salt reduction. In an accompanying editorial (vol 24, p 854), Alderman, who was once a paid consultant for the Salt Institute, repeated his oft-stated claims that there is not enough evidence for salt reduction. Sensing a story, many newspapers ran with his line.

 Is Alderman correct? Not surprisingly, MacGregor thinks not. For one thing, he claims the Cochrane study is flawed. When he reanalysed the same data in a slightly different way, he found a reduction that was statistically significant (The Lancet, vol 378, p 380). Alderman criticises this as "salami epidemiology", but even in the original analysis the link between salt and death rates only just slipped below statistical significance. Far from casting doubt on salt reduction, some argued that the findings supported it.

The Cochrane report wasn't the end of it. Last month Alderman's journal published a further meta-analysis purporting to show that salt reduction could actually be harmful (doi:10.1038/ajh.2011.210). It concluded that while cutting salt lowered blood pressure, blood levels of certain hormones and lipids were increased, which could theoretically raise cardiovascular risk.

But many of the studies included in the analysis lasted just a few days and involved big salt reductions. MacGregor accepts that sudden and steep salt reduction can lead to counterproductive hormonal changes, but says that modest reductions, say from 8 to 6 grams, do not. "There's no evidence whatsoever that a modest reduction does any harm," he says.

 Even the chief author of the Cochrane study, statistician Rod Taylor at the Peninsula Medical School in Exeter, UK, agrees with MacGregor that the findings lend further support to salt reduction. "Our results do not mean that asking people to reduce their intake of salt is not a good thing," he says. "We have much stronger evidence for salt than we do for fat, for the benefits of eating fruit and vegetables or losing weight," argues MacGregor.


Most of the studies  that found harm from salt were epidemiological and what such studies show is always contestable.   Let me illustrate:  The authors above use Japan to argue for salt reduction.  I can use Japan in exactly the opposite way.  Even after the various anti-salt campaigns, the Japanese are still huge salt consumers.  If ever you have tasted Japan's favourite sauce -- soy sauce -- you will know why.  It's almost solid salt.  Yet Japan is renowned for it multitude of centenarians and long life generally.  So, on that evidence, heavy salt consumption is clearly not harmful and may be beneficial.

So in that context the Cochrane study is all-important.   It filtered out the most contestable findings and zeroed in on the findings that are least contestable.   And that study showed no statistically sigificant harm from salt ingestion.

"New Scientist" acknowledges that but argues that a different analysis of the Cochrane data DOES produce statistical significance.  But to argue that way fails to understand what statistical significance does.  It compares a given result with what would happen by chance alone.  And if a result is on the borderline of conventional significance -- whether a bit above or a bit below -- hardly matters for policy decisions.  In any case, the effect is tiny.

If there were any kind of robust effect going on, statistical significance would hardly be worth calculating.   So the key thing that Cochrane showed was not the statistical  significance or otherwise of the result but rather that any effect from salt consumption was TINY -- and hence not worth bothering with.

And since anecdotes tend to be more persuasive than statistics, let me report that I have always put PLENTY of salt on my food  -- and yet my blood pressure is within the accepted safe range.  My blood pressure was up a bit once but I started doing a walk around the block most evenings and that fixed my blood pressure.  If you are worried about your blood pressure do some light exercise.  Exercise matters far more to your blood pressure than any trivial effect of salt. UPDATE: There's an article here which confirms the significant benefit of light exercise.

A final comment:  I liked the last sentence in the excerpts above:

"We have much stronger evidence for salt than we do for fat, for the benefits of eating fruit and vegetables or losing weight," argues MacGregor."

That rightly shows that all the other food fads are even more poorly founded.  LOL.

Further reading:  A big European study showed that LOW salt in your blood is most likely to lead to heart attacks.  See JAMA. 2011;305(17):1777-1785.  More here and here and here for similar findings.  Salt is harmless but a deficiency of it is not.  We need it.  See also here


FOIA reveals unions assisted Labor Dept. with absurd regulations

By Richard McCarty

For decades, companions who sit with the elderly and infirm have been exempt from overtime and the minimum wage under the Fair Labor Standards Act. In 2013, Obama’s Department of Labor issued new regulations determining which companions would continue to be exempt from the minimum wage and overtime. These new regulations exceeded what Congress had intended when it passed the legislation, and the regulations were so complex that young and healthy people would have struggled to determine who was exempt, much less the elderly and infirm.

Just how bad were the new regulations? Companions would have been limited in how many times they could help an elderly person change their clothes. Companions would have been unable to use a vacuum cleaner if an infirm person were to create a safety hazard by spilling food on the floor. Companions would have been unable to prepare food for anyone other than the elderly person they were caring for, and any food that they did prepare would have had to have been consumed in their presence. If these rules weren’t exactly followed, then the new regulations would have required the companion to be paid more.

Because Medicare and Medicaid pay for the vast majority of the care provided by companions, it could be expected that the costs for those programs — which are already increasing rapidly — would rise even more quickly. Furthermore, it’s quite likely that some elderly or infirm people would be unable to pay their portion of costs for companion care. And it’s quite likely that some sick people would have had to suffer alone or with a reduction in needed care. Perhaps they would have had to remain in soiled clothes for hours or have missed a meal thanks to these regulations.

And who helped the Labor Department with planning for these absurd rules? Unions — the Service Employees International Union (SEIU) and the Association of Federal, State, County, and Municipal Employees (AFSCME).

In response to a Freedom of Information Act (FOIA) request filed by Americans for Limited Government, the U.S. Department of Labor turned over a stack of documents showing how these unions are colluding with the Department on this subject.

On January 9, 2014, a senior SEIU staffer emailed a 60-page memo on large home care programs likely to be affected by the new companionship regulation to a list of senior Department of Labor officials and other union officials from SEIU and AFSCME. Also included was a 10-page chart summarizing the memo.

Carol Golubock (SEIU’s Policy Director) addressed this email to Laura McClintock (Associate Deputy Secretary of Labor), Michael Artz (AFSCME’s Associate General Counsel), Sally Tyler (AFSCME’s Senior Health Policy Analyst), Mary Beth Maxwell (then-Deputy Chief of Staff at the Labor Department), Patricia Smith (Solicitor for the Department of Labor), Malvina Ford (sic) (Senior Policy Advisor for the Administrator of the Wage and Hour Division), Jennifer Brand (Associate Solicitor for Fair Labor Standards), Ryan Griffin (an attorney with James & Hoffman, who was working on an FLSA case against McDonalds around this time period), Laura Fortman (Deputy Administrator of the Wage and Hour Division), and Elizabeth Royal (SEIU’s Senior Policy Coordinator).

It appears that this information had been requested by one or more of the recipients: SEIU’s Golubock wrote, “I didn’t imagine it would take us this long to get you this mapping of large home care programs likely to be impacted by the new companionship rule, but gathering and checking the information took much longer than we had anticipated… Thank you all for your patience and hope this proves to be helpful.”

Shortly before guidance on the new companionship regulation was issued, Golubock set up a meeting to discuss the issue with an employee in the Office of the Secretary of Labor. On March 5, 2014, Golubock emailed the following to Mary Beth Maxwell (who took over as Principal Deputy Assistant Secretary for Policy that month): “Are we on for Friday? To discuss companionship rule?” Maxwell responded, “Yes!” less than a half-hour later.

So complex were the regulations that the Obama Administration announced that it wouldn’t bother to enforce them for the first six months after they were to take effect. Fortunately, the U.S District Court for the District of Columbia blocked the regulations. However, the case is now on appeal, and final resolution of the issue will not happen for some time.



Donald Trump and the Fed-Up Crowd

Watching Trump’s rise, America’s middle class “fed-up crowd” is enjoying the comeuppance of an elite that never pays for the ramifications of its own ideology

by Victor Davis Hanson

Donald Trump — a former liberal and benefactor of Democrats — is still surging. But his loud New York lingo, popular put-downs of obnoxious reporters and trashing of the D.C. establishment are symptoms, not the catalyst, of the growing popular outrage of lots of angry Americans who are fed up.

The fed-up crowd likes the payback of watching blood sport in an arena where niceties just don’t apply anymore. At least for a while longer, they enjoy the smug getting their comeuppance, as an uncouth, bullheaded Trump charges about, snorting and spearing liberal pieties and more sober and judicious Republicans at random.

Perhaps they don’t see the abjectly crude Trump as any more crude that Barack Obama calmly in academic tones assuring Americans that they all could keep their doctors and health plans when he knew that was simply untrue or announcing to the nation that his own grandmother was a “typical white person” or advising supporters to “get in their face.”  They see Trump as no more vindictive that Harry Reid lying about Mitt Romney’s tax returns (and then bragging that such a lie helped defeat him), or a Sen. Barbara Boxer publicly attac­­king the single, non-parental status of then-Secretary of State Condoleezza Rice. And they certainly don’t see Trump as uncouth as an Al Sharpton — former presidential candidate, chief advisor on matters of race to Barack Obama, and current TV news show host. Trump’s crass bombast is enjoyed by the fed-up crowd as the proper antidote to the even greater bombast of the Left, who created Trump’s latest manifestations.

The conservative base is tired of illegal immigration. Their furor peaked with the horrific killing of Kate Steinle by a seven-time convicted felon and five-time deported illegal alien.  They are baffled that one apparently exempt and privileged ethnic group can arbitrarily decide to ignore federal law. They are irate that they are lectured about their supposed racism from an open-borders movement predicated on La Raza-like ethnic chauvinism. They do not want to hear about nativism from a lobby that so often at rallies waves the flag of the country that none of the protestors seems to wish to return to, a country whose authoritarianism is romanticized as much as their host country is faulted for its magnanimity. Call this what you will, but emotion over neglecting federal law is much less worrisome than cool calculation over violating it.


There is a  new  lot of postings by Chris Brand just up -- on his usual vastly "incorrect" themes of race, genes, IQ etc.


For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated) and Coral reef compendium. (Updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on A WESTERN HEART.

List of backup or "mirror" sites here or  here -- for when blogspot is "down" or failing to  update.  Email me  here (Hotmail address). My Home Pages are here (Academic) or  here (Pictorial) or  here  (Personal)


No comments: