1. - Salt Reduction - Trojan Horse of Public Health Policy Appears attractive on surface, but conceals great risk to consumers! Morton Satin Vice President, Science and Research Salt Institute Alexandria, VA 22314

2. The benefits of blood pressure reduction depend on how it’s done! Salt Institute (SI) agrees blood pressure reduction may benefit hypertensive individuals Exercise, the Mediterranean diet or relaxation reduce BP with no negative consequences Salt reduction is a dangerous strategy to reduce BP because of the negative consequences The latest evidence, just published in the American Journal of Hypertension: However, = + +

3. The benefits of population-wide salt reduction are minimal! Graudal, N.A., Hubeck-Graudal, T & Jurgens, J., “Effects of Low-Sodium Diet Vs High-Sodium Diet on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterol and Triglyceride (Cochrane Review), Am J Hypertension, 2011, 24

4. The risks of population-wide salt reduction are significant! Stolarz-Skrzypek K, Kuznwtsova T, Thijs L, et al. “Fatal and nonfatal outcomes, incidence of hypertension, and BP changes in relation to urinary sodium excretion,” JAMA. 2011;305:1777-1785. All are risk factors for cardiovascular disease, diabetes and increased all-cause mortality! Graudal, N.A., Hubeck-Graudal, T & Jurgens, J., “Effects of Low-Sodium Diet Vs High-Sodium Diet on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterol and Triglyceride (Cochrane Review), Am J Hypertension, 2011, 24

5. The risks of population-wide salt reduction are significant! Stolarz-Skrzypek K, Kuznwtsova T, Thijs L, et al. “Fatal and nonfatal outcomes, incidence of hypertension, and BP changes in relation to urinary sodium excretion,” JAMA. 2011;305:1777-1785. Risk factors for cardiovascular disease, heart attach, stroke and increased all-cause mortality!

6. No relationship between rates of hypertension and salt consumption! Hypertensives per 100,000 Hypertension increasing Salt intake stable No relationship Bernstein, A.M, Willett, W.C., “Trends in 24-h urinary sodium excretion in the United States, 1957–2003: a systematic review,” Am J Clin Nutr 2011;92:1172–80. Ayala, C., Croft, J.B., Wattigney, W.A., and Mensah, G.A., “Trends in Hypertension- Related Death in the United States: 1980- 1998,” J Clin Hypertens, 6(12):675-681, (2004).

7. Salt reduction precipitates strong international criticism Given the side effects of sodium reduction, this effect is not sufficient to recommend general sodium reduction. Sodium reduction is probably the largest delusion in the history of preventive medicine. “ Given the side effects of sodium reduction, this effect is not sufficient to recommend general sodium reduction. Sodium reduction is probably the largest delusion in the history of preventive medicine. ” BMJ 2011;343:d6119 Scandinavian Cardiovascular Journal, 2011; 45: 194–197 The IOM recommendations regarding a population-based policy of salt restriction may not be valid since important evidence has not been included in their analysis. “ The IOM recommendations regarding a population-based policy of salt restriction may not be valid since important evidence has not been included in their analysis. ”

8. Population-wide salt reduction will place consumers at risk! The peer-reviewed clinical evidence is clear and incontrovertible! American consumers will be the victims of increased morbidity and mortality! If we limit salt intake to the levels recommended in the Dietary Guidelines, American consumers will be the victims of increased morbidity and mortality! must bear this responsibility and burden. All who knowingly chose to ignore the clinical evidence and pursue the myth of salt reduction must bear this responsibility and burden.