Calling All Physicians: The Salt ‘Debate’ Must Stop

My last blog highlighted the bully boy tactics used to silence critics of mainstream medicine. Normally by threatening anyone who dares question the experts of ‘killing patients’, or words to that effect. It is a well-worn tactic which, surprisingly, seems to work every time.

‘If you dare to question breast cancer screening, women will die.’

‘If you question the use of statins, millions will die.’

‘If you….’ well you get the general gist.

There are of course slightly more subtle versions of this. However, when a medical ‘expert’ deigns to address mere mortals, we know what they mean when they say ‘The salt ‘debate’ must stop.’ What they are saying, albeit indirectly, is that if you don’t stop questioning what I say, millions will die. Maybe billions…..over the years, perhaps an entire Google.

On this note, several different people pointed me at a recent debate at the conference of the European Society of Hypertension (ESH) and the International Society of Hypertension (ISH) in Athens. Well, not a debate really, more of a tirade. Here is one part of the report

‘Any “controversy” over whether dietary salt is a cause of heart disease and stroke is the result of weak research methodology or commercial interference, Dr Norm Campbell (Libin Cardiovascular Institute of Alberta, Calgary) and Dr Graham MacGregor (Wolfson Institute of Preventive Medicine, London, UK) argued here….’1

I shall translate their statement. If you do not believe that excess salt consumption is a cause of heart disease and stroke you are a flawed and misdirected scientist (weak research methodology), or you are corrupt (commercial interference). No other explanation is, of course, possible. You are either an idiot, or corrupt, and therefore – by definition – should be ignored. Or perhaps stoned to death for being an unbeliever.

Ah well, that put me in my place. Along with anyone else who dares to disagree with the mighty Norm Campbell and Graham MacGregor. Now Graham MacGregor makes great play of the fact that grubby commercial companies are pushing hard to get us to put more salt in his food. He, of course, has no commercial affiliations.

Hold on. Is he not on the board of the Blood Pressure Association? An organisation that receives funding from various different sources……

You may like to know that we have been very fortunate to have received substantial funding from a number of organisations who have helped the Association get off the ground. These Founder Members are listed below:2

  • Astra-Zeneca UK Limited
  • Bristol-Myers Squibb Pharmaceuticals Limited
  • Merck Sharp & Dohme Limited
  • The Community Fund
  • Omron Healthcare UK Limited
  • Pfizer Limited
  • Servier Laboratories Ltd
  • Solvay Healthcare Limited

Would some of these companies not be pharmaceutical companies? Would some of them make tablets to lower blood pressure? Well, gosh, let me think….

Astra-Zeneca, just to look at the first company on the list. They make:

  • Candestartan
  • Lisinopril
  • Felodipine
  • Metoprolol
  • Atenolol

Well, that’s only five blood pressure lowering agents. Which means that Astra-Zeneca clearly have little interest in blood pressure lowering….not. If you were being a little cynical, you would think that an organisation almost entirely funded by pharmaceutical companies might be considered to have a dog in this fight? You might think that Graham MacGregor could, just possibly, have a little conflict of interest going on. No, surely not.

As for Norm Campbell.

‘Dr. Norm Campbell has given talks sponsored by Bayer, Sanofi Aventis, Biovail, Bristol Myers Squibb, Pfizer, Novartis and Merck Frosst and also has been on advisory boards for Novartis, Pfizer, Servier, Boehringer Ingelheim and Schering Plough.’ 3

As per usual. Seek the commercial conflicts, and ye shall find. You don’t get to be the sort of professor who gets to stand up, command the stage, and intone your words of wisdom at an international medical conference without a little background helping hand from a few pharmaceutical companies. Anyway, what were these two saying about commercial interference again? Difficult to think with the sound of all these cash registers ringing in my ears.

Of course, if confronted, these two will state that all the money they receive goes to charity, or that any funding makes no difference to what they say….or suchlike. As Robbie Burns once remarked. ‘Oh wad some power the giftie gie us, to see ourselves as others see us.’

You, are corrupt because you have accepted money from a commercial source; I, on the other hand, am not. Because I am a superior being incapable of being tainted by money.’

However, the main point here is the fact that we have more bully boy tactics going on. Two ‘grand fromages’ take the stage to beat the opposition into pulp.

‘When a member of the audience pointed to the PURE analysis showing that most of the world eats much higher levels of sodium than those recommended by most international organizations, MacGregor and Campbell leaped on this as an example of a study that had radically failed to measure salt in an appropriate fashion, even devising a new “formula” to estimate salt intake because even spot urine testing had been inadequate. “Please let [PURE principal investigator Dr] Salim Yusuf [McMaster University, Hamilton, ON] know that he should stop using spot urine analysis,” MacGregor said curtly.’

I do hope that everyone in the audience made their own minds up about what they were hearing. I suspect the reporter had their own view, by including the word ‘curtly’.

May I make, yet another, plea for medical experts to stop, cease and desist, attempting to bully into submission anyone who dares disagree with them. It is demeaning.

References (may require site registration or membership to access)

1: http://www.medscape.com/viewarticle/826970?src=emailthis

2: http://www.surgerydoor.co.uk/advice/living-with/living-with-high-blood-pressure/what-blood-pressure-association-do-for-you/

3:http://archive.cme.mcgill.ca/html/videos/2009.rural_en/20090923_JacquesGenest/homeblank.html

42 thoughts on “Calling All Physicians: The Salt ‘Debate’ Must Stop

  1. Sue Richardson

    Bullies are bullies because beneath their nasty exterior, there is an insecure being. The ‘medical experts’ you refer to must be very insecure – they know they are wrong, and they are fighting for their careers/reputation/bank balance. Surely it must be possible that one day, the ones they are seeking to bully will wake up, realise this and stand up for themselves. We are talking about intelligent men and women here aren’t we?

    Reply
  2. Flyinthesky

    You have touched on the commercial aspect of the situation, there is also the governmental aspect. Some junior health ministry official/s will have sponsored attendance to some of these presentations, hotfooting back to the ministry with these new found wisdoms. The prospect of salt consumption reduction in the population will result in overall reduction in liability. As to there being any truth in the theory is irrelevant, seeds have been sown.
    Then we complete the circle, if the populace are resistant to this new found wisdom the relevant originating expert will be wheeled in at great expense to reinforce the position and if required , conditionally, greatly remunerated to illustrate it. This phenomenon in itself has the potential to start another circle, once secured by a government as an opinon former the eminence factor is increased leading to greater remuneration and opportunity from the corporate sector. Once this circle is completed it then changes to a spiral with almost limitless potential.
    The despairing element, it all works the same, these huge balls can be set rolling without any, settled or otherwise, science at all.
    None of it has to be true, it is no longer what is and what isn’t, it’s the percieved eminence of the expert that said it and the percieved opportunity for those who listen to it.

    Reply
  3. Christopher Palmer

    Dr Kendrick,

    I wonder have you read ‘Methyl Magic’ (book); Cooney & Lawren, 1999? The book was probably the first to describe the antioxidant process of ‘methylation’ for an interested lay readership.

    Perhaps in the intervening years methylation has become more significant to health science because methylation is not only prominent amongst the four leading antioxidant processes, but is is increasingly acknowledged that genetic expression controlled by the simple addition or removal of simple methyl tags annexed to the genes themselves is the more responsive facet of genetic expression within a persons life. In addition methylation dovetails neatly with the homocysteine theory pursued and and advanced by Dr Kilmer McCully.

    Cooney suggests his methyl magic program — which centres around optimising supply of B group vitamins — targets homocysteine and lowers levels of this highly radical oxidant, with the claimed added benefit of lowering blood pressure.

    In private practice I believe you offer homocysteine testing. Is it in accord with your experience in practice that lowering levels of homocysteine results in normalisation of blood pressure? in your opinion is supplementing with vitamins or generally improving supply of potential methyl donating antioxidants a practice that can result in clinical improvement in blood pressure and/or homocysteine? Should we get out in sun more frequently and top up on vitamin D or sulphated-vitamin D, but do so with care so we tan progressively and without burning?

    Reply
  4. Spokey

    I think it’s hilarious. Medical professionals telling us the quarter teaspoon of salt on our chips can kill us as different medical professionals pump salt water into people in trauma wards to the tune of nine grams per litre (and I’ve read that they sometimes use hypertonic solutions that are even more concentrated) to stop them dying. The former must think we were all born yesterday. I can’t imagine what the latter think.

    Reply
      1. dearieme

        Failing to make connections is common. A teacher once told me about a father complaining that it was puzzling that little Johnny was no good at chemistry since it had been his, Dad’s, strongest subject..

        Dad was a Professor of Genetics.

  5. Flyinthesky

    “‘If you dare to question breast cancer screening, women will die.’”
    Once awaiting, the often protraced, result of the current screening process one has to be aware of the inferred outcome of the next one. You may well not ever be subject to breast cancer but you could have a cardiac event worrying about it, notwithstanding no fear, no power.
    The overwhelming inference is if you don’t have all your girly bits evaluated on a regular basis they’re going to self destruct and take you with them!
    My sister died of breast cancer at 42, what isn’t listed on her death certificate is her prior propensity for spontaneous pneumothorax, of course her word could not be taken that it’s happened again, not being an expert and all, so an xray was indicated every time for diagnosis, 12 in as many months.
    Despite “expert” opinion as to their safety the manifestations of these xray investigations may not appear for decades, they are cumulative but considering the timescale they are rarely cited or explored.
    I welcome a hypothesis presented as a hypothesis, what I object to is a hypothesis presented as fact.
    I would have the greatest respect for an an expert who says I think, but I’m not sure, whereas one who states I know, don’t think, would raise the greatest suspicion. But hey, that’s me.

    Reply
  6. thetinfoilhatsociety

    I know this is a completely off the wall question, but could one’s climate have bearing on whether your salt consumption might (or might not) contribute to hypertension? And another question: could one’s daily level of aerobic activity – enough to produce a good sweat for an hour or two – have a bearing on blood pressure?

    What I mean is, I live in a very hot desert climate. I do not have air conditioning in my truck, so when I go places I have the windows open and I have water with me at all times. I have water because I sweat. I crave salty foods in the summer, much more so than in the winter. I’m sure it’s because I lose salt as part of the sweating process though I’ve not done any studies to prove it. So does eating more salt in the summer because I sweat it out cancel out the blood pressure problems too much salt supposedly causes?

    Does hard aerobic exercise such as farming cause enough sweating with its water and salt loss that it doesn’t make a difference how much salt one eats?

    I think about the historical eating patterns, and salt usage for preserving, and I just have to wonder if lifestyle differences aren’t a much bigger culprit than pure salt consumption.

    Reply
    1. Stephen Rhodes

      I’m sure you will get a proper answer at some stage, but sodium is just part of the complex electrolyte balance you need to maintain to stay healthy/alive. Potassium, magnesium, and calcium are also important and if you are concerned about losing electrolytes in sweat in the heat you could do worse than drink the sort of drink that athletes use during intense exercise. Just completed a fairly intense (for my age and fitness) cycle through the Pyrenees using such drinks and didn’t suffer cramping or heat stroke despite my advanced years 😉
      Note: During training I suffered frequent leg cramps until advised to try the electrolyte drinks.

      Reply
    2. dearieme

      When I lived in Australia there were salt pills on sale for you to take in hot weather to compensate for the salt lost in sweat.

      Reply
      1. Judy B

        I tried to buy salt tablets at a drug store recently. Nothing on the shelf, so I asked the pharmacist. She looked at me like I had asked for heroin. Turns out you COULD buy them but they were outrageously expensive….

  7. David Bailey

    Malcolm

    I think it would help if you could supply links to the most relevant articles about salt. I know the Scientific American article that claims there is very little need to worry about salt intake. I tend to think of salt and saturated fat in the same way!

    David

    Reply
    1. Stephen Rhodes

      I agree re: the salt (NaCl) and saturated fat, but there is good reason to be concerned about magnesium, and, to a lesser extent, potassium.

      Reply
      1. mikecawdery

        Agree entirely. Particularly magnesium as after centuries of cultivation much land is deficient in magnesium. I take supplemental Mg and K and saturated fats incl. coconut oil As a vet, Mg is a common deficiciency in cows. In my raspberry patch I threw on a Lb of Epsom salts (MgSO4) on 4 ft canes to get 8 ft monsters. Unfortunately doctors’ training is inadequate in nutrition.

  8. Lori Miller

    When I saw the title of the article, I thought it was a call for doctors to stop warning their patients about salt. Personally, I feel lousy if I don’t eat enough salt.

    Reply
  9. mikecawdery

    I am sick and tired of hearing about salt reduction. There follows a few of the many references I have found that debunks this claim. Prof Stephen Hawking pointed out that an hypothesis stood until a study report could not be fitted into it. A new hypothesis was required. it seems that this is not true in medicine; in medicine contrary evidence is simply IGNORED – a great example of open-minded, unbiased research!

    J Ren Nutr. 2009 Jan;19(1):57-60. doi: 10.1053/j.jrn.2008.10.006.
    Dietary sodium intake and arterial blood pressure.
    Dumler F.
    Sodium intake correlates with the rise in blood pressure with age, but not with the prevalence of hypertension. The population study identified a minimal impact of sodium intake on blood pressure (0.9 mm Hg/10 mmol difference in salt intake). DASH: This diet induced significant reductions in blood pressure compared with the control diet. Further decreases were observed with DASH and a 50 mmol/day sodium intake.

    Blood pressure was inversely related to urinary potassium, calcium and magnesium but not to sodium excretion. TONE: Cardiovascular events were highest in the usual care group (83%) and lowest in the sodium reduction-plus-weight loss group (56%).
    META-ANALYSIS:

    A systematic review of 11 long-term controlled randomized trials reported a small decrease (1.1 mm Hg) in median systolic but not diastolic blood pressure with a reduced dietary sodium intake. In conclusion, (1) sodium restriction in hypertensive patients reduces blood pressure, and (2) the long-term impact of reduced salt intake on blood pressure, mortality, and morbidity remains to be defined.

    PMID: 19121772 [PubMed – indexed for MEDLINE]

    J Gen Intern Med. 2008 September; 23(9): 1297–1302
    Conclusion
    Observed associations of lower sodium with higher mortality were modest and mostly not statistically significant. However, these findings also suggest that for the general US adult population, higher sodium is unlikely to be independently associated with higher CVD or all-cause mortality

    Elliott, P. Et al (1988) BMJ, 297:319-328
    Folkow B (2003) Lakartidningen, 100:3142-3147
    The Cochrane review of sodium and health.
    Intensive support and encouragement to reduce salt intake did lead to reduction in salt eaten. It also lowered blood pressure but only by a small amount (about 1 mmHg for systolic blood pressure, less for diastolic) after more than a year. This reduction was not enough to expect an important health benefit. It was also very hard to keep to a low salt diet. However, the reduction in blood pressure appeared larger for people with higher blood pressure.

    Ikeda N, Gakidou E, Hasegawa T, Murray CJ. Understanding the decline of mean systolic blood pressure in Japan: an analysis of pooled data from the National Nutrition Survey, 1986–2002.
    Bull World Health Organ 2008; 86: 978–88.
    Adding detail to this observation, the Ikeda et al. study stated,
    Reduced mean daily salt intake contributed [in a statistically significant manner] to the decline of mean SBP by -0.4 to -0.2 mmHg in all age groups in both sexes.
    But SBP is meaningless on a population level, and fractional mmHg changes in SBP are miniscule and likely not even detectable on a clinical basis for an individual — after all, “ideal” SBP is on the order of 120 mmHg. It’s no wonder that Ikeda et al. go on to acknowledge that,
    Lifestyle-related factors such as physical activity, alcohol drinking and dietary salt intake made only limited contributions to the decline of mean SBP in this study.

    Reply
      1. Sue Richardson

        Why? I mean, what’s in it for them? I don’t quite understand this one – why do they bother. Statins I see – they make money from pushing them, but what do they get from demonising salt?

    1. David Bailey

      Mike,

      Your link contains this statement: “More people die of adverse drug effects in Europe alone each year than die of colon cancer, or breast cancer, or prostate cancer. It’s the equivalent of more than a jumbo jet or two every day.”

      This seems an extraordinary fact, do you have any details of how it was calculated?

      Reply
      1. Tyrannocaster

        Wouldn’t you want to ask Dr. Mangin that (since she wrote the article), rather than the person who posted the link to the site?

  10. Maureen Berry

    Hi Dr Kendrick

    Could you please advise as to some suitable reading for an honest, non pharmaceutical industry biased, over-view of High blood pressure. To put the question in context, I used to have very high BP, went into panic mode, was put on 2 different meds, Amolopodine? And Ramipril, one made me like an old woman, terribly painful Achilles’ tendons, felt like they were going to snap, so had to stop ‘country walking’. By chance I decided to lose weight by the Atkins diet, and by magic BP went down to normal, stopped Amolodopine, Achilles’ tendons returned to normal, GERD stopped overnight, stopped Omeprazole, reduced then stopped Ramipril, and am now happy healthy 61 year old on no drugs. Now my husband’s blood pressure has gone up, on 10mg Ramipril, dr seems content if it stays about 140/85 ish, but lately it’s been up to 160/95. He does not want more meds, Ramipril gives him terrible morning cough, used to be on Atenolol, very bad swollen ankles. He also follows Atkins diet, but can’t resist occasional beer, so his carbs aren’t as low as mine. Now my question is, I am sure that I have gathered from previous posts that you are sceptical about whether reducing BP by pharmaceuticals actually improves outcomes. Ideally, I’d like to find the equivalent of ‘The Great Cholesterol Con’ written by somebody with your passion and integrity. Does such a book exist?

    Reply
    1. David Bailey

      That video is absolutely brilliant – and very easy to listen to! It would be great if Dr Kendrick could highlight it on this blog in some way.

      Reply
      1. Ash Simmonds

        Unfortunately if folk like Dr K put it forth it’s just preaching to the choir still.

        I’m not here because I’m trying to learn new stuff about cholesterol and fat and disease and the various other maladies of modern life etc, I think most of us here are just consoling each other and this is a semi safe-haven in a world of otherwise madness.

      2. David Bailey

        Ash,

        Don’t be quite so negative! I bumped into someone just this morning (at an ice rink, not a medical conference!) and she remembered that last time we met I was having problems. Thus we got on to talking about statins, and she had already heard of Dr K!

        When I was struggling with Simvastatin poisoning, another friend warned me about statins. I didn’t take notice at the time because she isn’t a doctor, but of course she was absolutely right!

        (OK, that is a different medical issue, but I think the spreading of awareness is very similar.)
        My gut feeling is that before long there will be a flood of media stories about how medical science mislead us – and the culprits won’t have a leg to stand on!

      3. Ash Simmonds

        *I WANT TO BELIEVE*

        Sadly I still get the “oi how’s your cholesterol mate?” from people who leave the fat from their steaks on the plate, yet have been around me for many years.

        I don’t consider myself cynical, I’ve just given up the Sysiphus Complex and choose to enjoy my own life unexamined.

  11. Mark John

    Ash, Thanks for the link.
    Just watched the vid and a couple more of his. The guy’s good!

    The world hasn’t entirely gone mad with guys like Drs Kendrick and Fung around – thank goodness!

    Reply
  12. Ash Simmonds

    Hey MJ, I find most of Fung’s stuff pretty repetetive and derivative of stuff that’s been around seemingly forever (5 years feels like forever in science), however it’s mostly the right stuff!

    If someone is better swayed by an Asian doctor in a lab coat with a stethoscope around their neck than Dr Oz or a random guy on the interwebs then that’s great, I’m not out there booing the cause!

    I’ve compiled a bunch of his stuff here:

    –> http://highsteaks.com/forum/health-nutrition-and-science/video-series-the-aetiology-obesity-dr-jason-fung-564.0.html

    Reply
    1. David Bailey

      I found the part about the funnel plot particularly interesting. It clearly indicated that almost all the salt studies that produced the ‘wrong’ result had never been published!

      I suppose I was surprised that studies of this sort could be performed and then scrapped in this way – it explains a lot!

      Reply

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