Duelling Medical Experts

"The zeal to recommend extreme reductions in sodium that are difficult to achieve in the entire population ... is a case of ideology replacing good science. 
"Is it wise to divert resources to poorly proven strategies when so much more can be achieved by interventions where the evidence is far stronger?
Dr. Salim Yusuf, Heart and Stroke Foundation Chair, Cardiovascular Science, McMaster University, Hamilton, Ontario

[He is a ] "very influential cardiologist" but the cited studies arguing for bypassing salt reduction are rife with "fatal flaws.
""[Dr. Yusuf" is way off his area of expertise. His strength has been in conducting randomized controlled trials of drugs, and I think he's wandering into an area where he doesn't have a strong understanding of what the evidence is."
Dr. Norm Campbell, University of Calgary

"When we worry about exactly how many grams of sodium a person is consuming, we forget to worry about the fact we're eating way too much crap -- and that's the issue."
Dr. Yoni Freedman, weight-loss physician, professor, University of Ottawa

Dr. Yusuf charges, from his elevated position as an expert heart researcher, knowledgeable on the matter of sodium's effects on human health, that the current focus on encouraging people to become more aware of their salt intake and to sharply curb salt consumption, is based on zealotry, not science. Public-health advocates have been passionate in their relaying to the public dire warnings of the result of too much salt intake on the human body.

Dr. Yusuf argues that only modest evidence that cutting back on salt exists, when others state that the end result will be a reduction in high blood pressure. And that a reduction in salt intake would help to prevent heart attacks, along with other, related cardiovascular problems. He does agree that some people with very high salt intakes would do well to eat less, or risk health problems.

He zeroes in on the drive by Health Canada to produce population-wide, deep cuts in salt ingestion.
Cardiovascular disease remains Canada's number-two killer disease.

Dr. Yusuf feels the focus should be re-adjusted to further reduce rates of smoking, to use more energy to alert people of the dangers existing in obesity, and to promote the prescription use of inexpensive, reliable pharmaceuticals in controlling high blood pressure.  He published his study in the American Journal of Hypertension.

His critique and alter-suggestions have not impressed one of the country's leading experts on sodium and its effect on hypertension. Dr. Yusuf, as far as Dr. Norm Campbell of the University of Calgary is concerned, has misinterpreted the evidence in his analysis and has relied on research that supports his thesis, ignoring other medical scientific results.

Major medical groups along with the World Health Organization conclude salt consumption needs to be cut after their own reviews of the available evidence. What has been pointedly recommended is the eschewing of processed food and preparing wholesome meals from fresh fruit, vegetables, meat and fish.

If the salt reduction recommendations are followed, they can only be accomplished by avoiding processed, overly-salted food.

"Norman", responded Dr. Yusuf edgily, "has been one of those -- in polite terms -- evangelists about sodium - in impolite terms, Talibans about sodium". Dr. Yusuf talks of a relatively limited number of well-meaning experts promoting dramatic public health measures based, he feels, on scant evidence to support their thesis of salt reduction premiums for optimum health outcomes.

The World Health Organization for their part estimates hypertension represents the single largest cause of death worldwide. Eating too much salt, as far as they are concerned is directly linked to raised blood pressure. And Health Canada's recommendations is that Canadian adults cut by at least half what is considered to be the current average sodium consumption level of 3,400 milligrams daily.

The Institute of Medicine, a highly regarded U.S. scientific advisory body, recently issued a report claiming that insufficient evidence currently exists to support the drive to have people dramatically cut their salt ingestion. While taking the precautionary step of also stating that people should avoid consuming "high" volumes of salt.

When Dr. Campbell reviewed the studies cited in the IOM's report he classed the result as "not one of their stellar efforts". All ten studies the Institute cited in their conclusion were burdened with fatal flaws, he contended. Among those flaws studied were "reverse causation"; using already-ill patients who, because of sickness ate little food and thus had less salt uptake; Dr. Campbell pointed out.

Dr. Yoni Freedman has his own opinion. Cutting to the chase, he claims emphatically that high salt content presents as a marker for generally poor diets too reliant on processed foods. "...we're eating way too much crap -- and that's the issue", he clarified in plain parlance.

Perhaps there's a bit of tunnel vision involved in the issue. That experts in a very particular field have narrowed their vision, rather than taking in the whole, generalized impression required to find balance, reason, and reduction leading to an intelligent conclusion.

If the experts cannot collaborate and find agreement, what is the consumer of health science to take from it?