Don’t Grin About Ingesting Salt: Banning Salt Can Save Lives

Many of Yogi Berra’s quips stop far short of substantive food for thought. A recent eulogy for Stan “The Man” Musial by Bob Costas contained a perplexing “Yogi-ism”: The late Mr Berra once opined that if you don’t go to other people’s funerals, they will not come to yours! Despite Yogi’s malapropisms, he may have offered sage advice on rare occasions. He was once quoted as saying, “Take it with a grin of salt.” Guess what, Yogi, politely smiling but not ingesting sodium has become the healthy way to go. Unfortunately, American culture is not there yet. A recent study suggests (once again) that excessive salt intake is a major public health hazard.

THREE COMPUTER MODELS

Coxson and coworkers¹ applied computer simulations from 3 different approaches to model the effect of sodium reductions in the US population over the next 10 years:

•Approach 1: Incorporating evidence for direct effects of decreased sodium consumption on cardiovascular mortality.

•Approach 2: Measuring “indirect” effects of decreased sodium consumption mediated by blood pressure changes measured in randomized, controlled trials using antihypertensives.

•Approach 3: Drawing conclusions from published epidemiological studies addressing the same question.

THREE INTERVENTION SCENARIOS

The same 3 computer models were then utilized to predict whether 3 different interventions—each reducing American salt ingestion over variable time frames—would confer health benefits in response to a “cardiovascular crisis” consequent to high salt intakes:

•Scenario 1: Gradual, uniform reduction of sodium intake equaling 40% over 10 years. Alternatively, a 4% reduction of sodium per year that would total 2200 mg/d by year 10.

•Scenario 2: An instantaneous 40% reduction (all at once) in sodium intake sustained for 10 years to reach a population-wide mean intake of 2200 mg/d.

•Scenario 3: An instantaneous reduction in sodium intake to 1500 mg/d also sustained for 10 years.

LIFESAVING IMPACT OF SALT REDUCTIONS

The authors proposed that Scenario 1 immediately above, that is, a gradual, uniform reduction in sodium intake over the ensuing decade, implemented by public health interventions, would lead to spectacular results: 280,000 to 500,000 averted deaths! Even more striking, the instantaneous reductions in sodium intakes (Scenarios 2 and 3 immediately above) would provide a further impact of 700,000 to 1.2 million deaths averted over the next 10 years. This scenario really saves lives but is unrealistic in American society, don’t you agree?

Are the authors “tilting at windmills” even with the gradual reduction scenarios? We have been told, again and again, that high salt intakes are unhealthy. Are we ready to listen over the next 10 years?