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Sensationalism and Salt: JAMA study has many flaws

My son, who works in Belgium, sent me the recent Journal of the American Medical Association (JAMA) salt study, knowing that I had served on the Institute of Medicine’s (IOM) sodium committee. I asked him what he thought and here’s his answer, verbatim: “Salt is bad! I think the fact that they try to claim that decreasing salt can actually hurt you in the long run is just an attempt at sensationalism.”

For the confirmed “non scientist” in the family, I think he hit the nail on the head.

I’m not a medical doctor, never mind a cardiologist, but I recalled my final biochemistry degree paper (many years ago) on cell wall transport mechanisms as we started our deliberations at the IOM. The critical role of sodium potassium channels came back to me, and I recognized that most of us consume less potassium than sodium, despite a need for at least 2–3 times more potassium. The IOM’s committee’s goal was to develop strategies to reduce sodium consumption in the United States, not to evaluate the science supporting this need. However, given past failures to reduce consumption, we concluded that aggressive strategies were required and to justify these we did spend significant time reviewing the basis of that science. I will not take up space here to review that, rather refer those interested to the IOM report appendix which summarizes 40 years of reports and recommendations from the United States and around the world.

Statisticians teach us that one or two data points will often lie outside the “line” so we should expect to see the occasional study that appears to contradict the need for the vast majority of us to reduce sodium consumption. Some of these may be better designed and more representative than this study. Again, there have been several excellent reviews over the past week pointing out the shortcomings of this study, but to me the most obvious relate to the sample.

Although the study quotes a sample size of 3,681, the conclusions about cardiovascular disease (CVD) are based solely on the 84 who died during the study. The low number is probably due to the good health and the young average age of the sample. The inference that only a small percentage of people should be concerned about sodium consumption is misleading, since here in the United States those aged 50 or older have a 90% probability of developing hypertension.

Another weakness is that sodium intake was only determined for a single day over the course of the study and no calorie or other nutritional data was collected. There is an 80% correlation between caloric intake and sodium consumption so the high sodium group would almost certainly have higher caloric intake. Hence, there are many other factors not tracked in this study which would lead to the reported weak inverse correlation between sodium consumption and CVD.

Sodium is safe and necessary, but only up to a point … and most of us are way past that point!

John RuffJohn Ruff
Retired from Kraft as Senior Vice President
Global Quality, Scientific Affairs and Nutrition

10 Responses

  1. In my recent neuroanatomy class we were taught the sodium-potasium pump theory. We were told that we would need to know it for board exams. We were also taught that sodium-potasium pump is now believed to account for about 3% of celular transport. There are many new transport mechinism being discovered. Any literature that looks strictly at sodium and poatasium is of limited use. All of the ions and minerals must be looked at as a whole system.

    Every day brings new findings, new innovations, new breakthroughs, and new conversations…

  2. Although the JAMA article may have its flaws, continuing to urge salt or sodium reduction to reduce risk of heart disease risk is like trying to move a shoe in the road, when a large truck is blocking the way. Curbing obesity can both reduce risk of hypertension and lower cardiovascular risk. We should focus efforts on cutting calories and use salt primarily as a condiment to enhance flavors of healthful foods.

  3. […] A new investigate published in a Journal of a American Medical Association (JAMA) proposes that even medium reductions in salt intake might be compared with an increasing risk of cardiovascular illness and death. The researchers news that people with a lowest levels of sodium in their urine (a pen of salt intake) during a start of a investigate had a 56% aloft risk of failing from cardiovascular illness than people with a top levels. This positively contradicts a recommendation of a infancy of health and sovereign bodies, who have been revelation consumers to drastically cut behind on their sodium consumption. So, who is correct? John Ruff, late Senior Vice President of Global Quality, Scientific Affairs and Nutrition during Kraft, served on a Institute of Medicine’s (IOM) sodium committee. In a latest ePerspective post, Ruff points out some pivotal flaws in a JAMA study, that impact a researchers’ findings. According to Ruff, nonetheless a investigate quotes a representation distance of 3,681, a conclusions about cardiovascular illness (CVD) are formed usually on a 84 who died during a study. The low series is substantially due to a good health and a immature normal age of a sample. Another debility is that sodium intake was usually dynamic for a singular day over a march of a investigate and no calorie or other nutritive information was collected. What are your thoughts on a JAMA study? Share your opinions currently during IFT’s ePerspective blog. […]

  4. I do not generally reply to blog posts but I will in this case. Truly a big thumbs up for this one!

  5. Yes, an excellent post, Mr. Ruff!

  6. Hi, I’m MD (Angiology) from Poland. I would like All of You focus on only one problem: maybe that study have methodological limitations, but is there any other combining cardiovascular events in a healthy population and sodium intake? or just intervention study in hypertensive population regarding only blood pressure levels? Who gives a right to form recommendation for general population about sodium restriction?
    Thank You for reading


  7. […] Sensationalism and Salt: JAMA Study Has Many Flaws […]

  8. By far the majority of peer-reviewed clinical papers in the last 4 years (2009-2012) caution against population-wide salt reduction. It is likely that this trend will continue in the future. However, the policy argument for sodium reduction continues to be driven by opinion rather than evidence. It’s time we get back heeding the science and where it is deficient, we need to do the research. This is not an excuse for delay – it is a respect for science.

  9. I know an elderly gentleman who was diagnosed as having dememtia. This man had only recently started to display confused behavior, etc. Another doctor looked at his labwork and said, no dementia there: just low sodium. The man is BACK TO NORMAL. We need sodium – we need to question why they are pushing low salt.

  10. Potassium is a crucial mineral for the functioning of the heart and tissues. This mineral aids muscle function and digestion, and it plays a vital role in nerve function. Additionally, potassium functions as an electrolyte in the body, meaning it conducts electricity. Some studies indicate that potassium may be instrumental in b^

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