At intervals the Australian Government will look at strategies to reduce the cost of health care – they are doing what we want them to do in a way – and attempting to manage the budget – perhaps even bring it (as it was in the days of John Howard), back into surplus.
However, leaving politics aside, and focusing on ‘science’ and ‘health’ I want to discuss how one of the newest suggestions may affect us all in the next few years.
The Assessing Cost-Effectiveness in Prevention report was launched on 8 September 2010. ACE Prevention is a large, 5-year study that was funded by the National Health and Medical Research Council (NHMRC) and jointly led by professor Theo Vos of the Centre for Burden of Disease and Cost-Effectiveness at the University of Queensland and professor Rob Carter of the Deakin Health Economics Unit at Deakin University.
The overall aim of this project was to provide a comprehensive analysis of the comparative cost-effectiveness of preventive intervention options addressing the non-communicable disease burden in Australia, with a specific focus on Indigenous Australians.
The full text of this document can be accessedhere.
One of the strategies highly recommended in this report is the cost effectiveness of interventions to reduce salt intake. (The following is taken from the pamphlet available online for you to read)
High blood pressure is the leading risk factor for cardiovascular disease, with elevated risks of disease with systolic blood pressure as low as 115 mmHg. Diets high in sodium have been linked to high blood pressure levels and reducing blood pressure can lead to a lower incidence of cardiovascular events. Many countries now recommend restricting daily sodium intake to 100 mmol (approximately 6 g of table salt) or less.
Now it just so happens that I personally eat little if any processed foods. Due to major food chemical intolerances, I cook all my foods from scratch, and have no fear of eating too much salt. This report recommends making salt restriction mandatory for some manufacturers in the processed food industry as a way of dealing with elevated blood pressure and cardiac events in the general population.
Blind Freddie could stand in the supermarket aisles any day of the week and calculate just how much processed foods the average shopper takes home to consume. There are the sliced cold cuts of meat, purchased at the deli – for work and school lunches, the tins of beans, vegetables and fish products, the frozen pies and sausage rolls, pizza’s and frozen dinners. Then there are breakfast cereals, chips, pretzels and other nibbles, loaves of bread, tortillas and dips and cheeses to accompany them – the list is endless.
If you base your diet largely on these types of food – then YES you are consuming a high amount of salt – sodium as it is called in the industry. So keep that fact in mind as we delve into the reasons it is strongly suggested we consume less of this product ~SALT~ Mind you I would suggest we stop consuming pre packaged processed foods altogether – but that is for another blog.
Again keep in the front of your mind the fact that the Government wants us to limit the amount of salt we consume because THEY SAY it will reduce the incidence of high blood pressure, which will in turn reduce the incidence of Cardiac events (heart problems).
This week (quite timely for my blog) I received a couple of articles from The Skeptic’s Health Journal Club (blog) pertaining to this very issue. For those of you not familiar with this particular blog I can highly recommend it to you (link below). The article (so far) has arrived in two parts. It is the second part which I am politely borrowing this information from.
Doc Writes: There is a lengthy and scholarly review of the salt/hypertension hypothesis available online, Salt and Blood Pressure: Conventional Wisdom Reconsidered.
He goes on to tell us: The authors also do an elaborate statistical analysis to buttress the position that there is publication bias (i.e. positive studies are more likely to be submitted and/or accepted for publication.) As the authors contend in their summary:
Experimental evidence suggests that the effect of a large reduction in salt intake on blood pressure is modest, and health consequences remain to be determined. Funding agencies and medical journals have taken a stronger position favouring the salt hypothesis than is warranted, raising questions about the interaction between the policy process and science.
Doc goes on to say: I do not, however, even want to get caught up in overly debating the strengths and weaknesses of the salt/hypertension argument in that there is a real elephant in the china shop in the form of a study published in the prestigious medical journal Lancet in March of 1998, Dietary sodium intake and mortality. The full text of the article is available for free online behind a registration firewall. The authors in this article did a retrospective analysis of the massive National Health and Nutrition Examination Survey database. To jump right to the findings as reported in the abstract.
All-cause mortality (per 1000 person-years; adjusted for age and sex) was inversely associated with sex-specific quartiles of sodium intake (lowest to highest quartile 23•18 to 19•01, p<0•0001) and total calorie intake (25•03 to 18•40, p<0•0001) and showed a weak positive association with quartiles of sodium/calorie ratio (20•27 to 21•71, p=0•14). The pattern for CVD mortality was similar (sodium 11•80 to 9•60, p<0•0019; calories 12•80 to 8•94, p<0•0002; sodium/calorie ratio 9•73 to 11•35, p=0•017).
So not only did the authors find that higher sodium intake was protective in all cause mortality, it was also associated with less death from cardiovascular disease, i.e. the very disease which salt restriction is supposed to prevent through its effect on blood pressure. (emphasis mine)
Moving right along here folks – as if that was not sufficient for us to be questioning just why we, and our food manufacturers are going to find SALT RESTRICTION mandatory ????? Doc continues:
Perhaps equally disturbing is that this is not an isolated study. The authors of this study cite a previously published study, Low Urinary Sodium Is Associated With Greater Risk of Myocardial Infarction Among Treated Hypertensive Men. From the abstract,
The 24-hour urinary excretion of sodium (UNaV), potassium, creatinine, and plasma renin activity was measured in 2937 mildly and moderately hypertensive subjects who were unmedicated for at least 3-4 weeks. Morbidity and mortality in these systematically treated subjects were ascertained. Men and women were stratified according to sex-specific quartiles of UNaV. Subjects in these strata were similar in race, cardiovascular status, and pretreatment and intreatment blood pressure. Subjects with lower UNaV were thinner, excreted less potassium, and had higher plasma renin activity. During an average 3.8 years of follow-up, a total of 55 myocardial infarctions occurred. Myocardial infarction and UNaV were inversely associated in the total population and in men but not in women, who sustained only nine events. In men, age- and race-adjusted myocardial infarction incidence in the lowest versus highest UNaV quartile was 11.5 versus 2.5 (relative risk, 4.3, 95% confidence interval, 1.7-10.6).
To summarize the summary, men with the lowest sodium had a greater than 4 fold increased risk of heart attack.
OK people, I do strongly suggest you read Doc’s entire blog – it is a real eye opener from a Medical Doctor and former FDA employee. This is just one example of how he sees things, and he isn’t afraid to tell it as he sees it either!
The point he is making, and that I was already writing about when his latest blog surfaced – is that there is NO REAL EVIDENCE that an increase in salt will cause people to suffer an increased risk of heart attack….. The studies are there for all to see for themselves, so why is there a push to lower our sodium (salt) intake?
As I inferred earlier in this blog – I can see the point of reducing all the processed and ‘fast’ foods we consume. I can see the point in perhaps even increasing taxes on this type of food…. the theory being follow the dollar, if it is more expensive perhaps less people will buy it – and more people will return to eating a healthier style of food. You may even be cranky with me suggesting increasing taxes on fat and processed food items – but wait just one minute – you think I am being mean?
ACE Prevention 0.2.3 suggests:
• A 10% tax on unhealthy foods and lap banding for very obese people could avert 270,000 DALYs caused by obesity. A diet and exercise program for overweight people identified in primary care, while considered cost-effective, would contribute just a tiny additional health gain to the package of obesity interventions.
Interpreted by myself to mean that while a strong emphasis on diet and exercise is still needed – it achieves little and a TAX would be more beneficial and cost effective in the long term.
Oh yes did I also mention there are other suggested interventions too, such as increasing the legal drinking age (alcohol) to 21 years; getting people onto a ‘poly-pill’ (three drugs in one) a combination of three generic blood-pressure-lowering drugs – diuretic, calcium channel blocker and ACE (angiotensin-converting enzyme) inhibitor – at half strength and a statin in a single pill) and others (read it here).
And when it all boils down – the bottom line here is the mighty dollar – cost effectiveness. Hummmm I wonder where that phrase ‘First do no harm’ comes into play?
No doubt I will have more to say later…. till then be as well as you can and keep learning, so you can challenge those who spout “know it all” facts at you. The push to restrict salt is already under way – if you do not consume tons of pre packaged and manufactured foods, you will have no need to hide the salt shaker!
The Skeptic’s Health Journal Club – part two