The Great Salt Debate: So Bad?

This week experts warned against the dangers of overdoing low-sodium diets. That's a step toward what salt advocates like "The Salt Guru" Morton Satin have enjoined for years.
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When I first meet Morton Satin, he's seated in an office chair on a Tuesday morning, shaking his head at his computer screen. He glances over, sighing, and motions toward the monitor. Displayed is a press release from Science Daily claiming that salt depletes the body's calcium stores. "Every morning brings a new headline," he says sadly before launching into a diatribe about the supposedly shoddy science used in the article. "Sometimes, you feel like you're spinning your wheels, not moving forward but trying to prevent misinformation."

"More people die when they are on a low-sodium diet than when they are on a regular-salt diet," he proclaims.

The misinformation he's worried about concerns one of the most ubiquitous substances in our daily lives: salt. This week, experts convened by the Institute of Medicine concluded that "the evidence on direct health outcomes does not support recommendations to lower sodium intake ... to or even below 1,500 mg per day." The current recommendation is not to exceed 2,300 mg per day, though most Americans do. This slight paradigm shift -- to an idea that less salt is not always better, which is already disputed and will be slow to be accepted -- comes after years of advocacy from people like Satin.

SHARK300200.jpgMorton Satin

Satin, a molecular biologist, has begrudgingly accepted the nickname "The Salt Guru," after coming out of retirement to be the Vice President of Science and Research at The Salt Institute, a non-profit trade association based in Alexandria, Virginia. Before that, Satin spent sixteen years as the Director of the United Nations Food and Agriculture Organization's Agribusiness Program. It was there he achieved two of his most important successes: a patent for coconut water and one for the creation of gluten-free bread.

His office is more that of a man who writes coffee table books on coffee (which he recently did, to warm reception by The New Yorker) than of a molecular biologist who thinks the public institutes of health are spouting untruths. But, he does think that. He says the 2,300 mg line is too low, and he's not the only one. 

Science writer Gary Taubes, a salt defender and author of Good Calories, Bad Calories and Why We Get Fat, has written columns for The New York Times in which he defends salt's health properties. The problem with Satin as the loudest salt advocate, though, is that even while a close look at data does seem to lend credence to his claims, he works for the Salt Institute -- which salt companies help support. Credibility goes out the window, Taubes says, and it doesn't matter how loud you are, no one will listen.

Satin has a propensity for ambling off into his life's stories, eyes racing around the room as he wanders lazily into these arbitrary yarns. When telling these stories, he seems calm, at peace. And he stays that way until he speaks about salt's reception. At that point, his eyes narrow and mouth pinches, his voice rises, and his anger is prominent, ardent. "More people die when they are on a low-sodium diet than when they are on a regular-salt diet," he proclaims. "You have to look this thing with a truly open mind, and it's difficult because we really don't like to think of public institutions fooling us and screwing us ... [But] nothing justifies lying. Nothing justifies exaggerating. Nothing justifies misleading the public."

And that's exactly what he thinks most public health institutions, such as the United States Department of Agriculture and the Centers for Disease Control, are doing. The American Heart Association (AHA) has argued that 2,300 mg is too high. The argument is that high sodium intake increases blood pressure and leads to cardiovascular disease, strokes, and kidney disease. Consuming 2,300 mg at most helps keep this in check, according to the AHA. 

Satin readily admits, though, while disagreeing with these guidelines, that he doesn't know what the right amount is. His bible is the Dietary Reference Intake, which is an Institute of Medicine study supported by the National Academy of Sciences, The National Heart, Lung, and Blood Institute of the National Institutes of Health and the U.S. Department of Health and Human Services' Office of Disease Prevention and Health Promotion, among others.

The six-page letter refutes the Times piece, concluding that it could lead to "more hypertension, heart disease, deaths, misery, and medical costs down the road" if taken seriously.

The book offers an estimated average requirement (EAR) of various elements and minerals. Satin eagerly points at the top of page 270, which reads, "Because of insufficient data from dose-response trials, an EAR could not be established, and thus a Recommended Dietary Allowance could not be derived. Hence, an Adequate Intake is provided."

In plain language: It was impossible to determine how much salt we should be consuming, leaving Satin further incensed that someone would claim to know how much we shouldn't be eating. "You can guarantee if they had the evidence, it'd be there," he says. His view of the 2,300 mg line is that it was invented out of thin air. "It was a lie," he says. "I know scientists, and I know how they think: if there is no evidence, they made it up."

This, of course, raises the question: why would someone launch a national campaign against salt? Satin thinks it's a mixture of laziness, convenience, and the easy path to scientific popularity. It's easy to launch a campaign against something, and it becomes easier as more people think it's detrimental to their health

Satin cites Michael Jacobson, PhD, cofounder of the D.C.-based Center for Science in the Public Interest, as one of the leaders of the anti-salt movement. The website for his foundation states, "Salt, at the levels present in the diets of most people around the world, is probably the single most harmful substance in the food supply," and he's written an incendiary article titled "Salt: The Forgotten Killer and FDA's Failure to Protect the Public's Health."

"I admire him for all the wrong reasons," Satin says of Jacobson. "I don't think he's done a lick of homework since he left school. You have such a problem with people who want to do good but don't take the time to do the homework."

SHARK300200.jpgtimsimpson1/flickr

Jacobson, though, says the science is there, in black and white. Lowering salt intake leads to longer life. "The key thing with salt or with sodium," he told me, "is that it promotes high blood pressure, and high blood pressure promotes heart attacks and strokes, which isn't conducive to long life," he says. "That's the elephant in the room."

Salt defenders, of course, disagree. Taubes has written, "The result [of eating salt] can be a temporary increase in blood pressure ... The scientific question is whether this temporary phenomenon translates to chronic problems."

Taubes, like Satin, doesn't think so. In fact, he also goes so far to say, "the possibility has been raised that if we were to eat as little salt as the USDA and CDC recommend, we'd be harming rather than helping ourselves." He too cites Jacobson as a leader in the anti-salt movement, well-intentioned but ultimately misguided.

"It's a kind of interesting phenomenon," Taubes says. "The people who care have always cared. The anti-salt people are convinced that salt is bad, and they convince themselves that they have to change the world. [But] the medical research community really doesn't know how to do science properly." Instead, he postulates that people believe salt is bad simply because that seems logical, even if it isn't. "The gist of it is that we jumped on salt early as a potential cause of hypertension because it seemed like an obvious cause," Taubes says. "The effort alone becomes reason to believe it. There's so much smoke, there must be fire."

If there's so little science actually supporting the fact that salt is detrimental to our collective health, it stands to reason that more people would be pointing this out. After all, almost everyone seems to be attempting to curb his sodium intake (or at least, pretending to attempt to curb it). But Taubes points out, "There's not a lot of pleasure to be taken by spending a majority of your life trying to prove that someone else's science is bad."

Even so, after Taubes' piece in the Times, Jacobson sent a letter to the editors on behalf of himself and seven medical doctors including Dr. Steve Havas, an adjunct professor at Northwestern University's medical school and a former American Medical Association vice president. The six-page letter refutes the Times piece, concluding that it could lead to "more hypertension, heart disease, deaths, misery, and medical costs down the road" if taken seriously.

This is the exact sort of statement Taubes thinks the salt industry needs to defend itself against. After all, it's not as if this is the first time the scientific community has found itself split over a particular foodstuff. In the 1970s, sugar was the major culprit. So the sugar industry attempted to shift the blame. "One of other offenses that the sugar industry threw up in the 70s ... was to hire anti-fat people to prove sugar was innocent," Taubes says. "When your livelihood is on the line, you do whatever is necessary."

In this case, The Salt Institute has hired Morton Satin and has reached out to Taubes. It has launched a series of videos featuring Satin as "The Salt Guru." In them, he fights against "misinformation" by offering litanies of facts about salt. The Institute has launched media campaigns defending salt, and Taubes has defended the polemical element in his articles.

"The salt industry has to protect itself," Taubes says. "They were getting hammered by bad science." In the next breath he follows with, "If [The Salt Institute] offered me money to do something, I would turn them down." He's worried about his credibility and, though he denies this, Satin claims he won't answer the Institute's calls. "[Taubes] doesn't want to be connected with our shit," Satin says over lunch. "It's discouraging. [I] end up feeling like I'm the candy man, and he doesn't want anything to do with us."

He lifts a piece of bread, which is appropriately crusted with large crystals of salt. "You're not supposed to put your credibility in the Institute or in a person," Satin says. "You're supposed to put your credibility in the evidence."

But the Institute comes with a reputation, even if it's given and not earned. Havas, the doctor at Northwestern, compares American salt intake's health detriments to a jumbo jet crashing every single day, says "[The interest of] The Salt Institute, you have to recognize, [is] in having salt sales be higher. It's like believing stuff coming out of the cigarette companies. They've got a commercial interest."

When I present this idea, Satin shakes his head as if it pains him. "It's not in our interest for anyone to get sick," Satin says. "The industry takes care of itself." In fact, "Food salt is only about 15 percent of the salt in the salt industry." There's also animal salt, road salt, industrial salt, and medical salt. Satin and Taubes have the same motto: they're not fighting for salt to profit. They're fighting because if salt isn't what's leading so many people to early graves -- something else is. Keeping an eye on salt means keeping an eye off whatever the true culprit might be.

"I would like to see it resolved, even if they say salt is bad for you," Satin says tiredly. "I'd like to just see it resolved."

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Travis M. Andrews is a journalist based in Washington, D.C., and New Orleans. His has written for SalonThe Washingtonian, and The Washington Post Express. He is a contributing editor for the NBC website DVICE.

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