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RomeoStevens comments on Lifestyle interventions to increase longevity - Less Wrong

122 Post author: RomeoStevens 28 February 2014 06:28AM

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Comment author: RomeoStevens 04 February 2015 11:18:26PM *  2 points [-]

I am having a hard time finding places I disagree significantly with them. Are you referring to sodium? Here is their article on the salt controversy: http://www.hsph.harvard.edu/nutritionsource/the-new-salt-controversy/

"pointing out that the committee’s conclusions discounted effects of sodium reduction on blood pressure."

“Discounting the especially large blood pressure reduction going from 2,300 to 1,500 mg in prehypertensives, hypertensives, older adults and blacks who are especially vulnerable to the effects of high sodium betrays an unbalanced weighing of the evidence.”

-Dr. Frank Sacks

There are a couple problems with this critique.

  1. It does not seem to me after reading the IoM report that they are discounting BP effects. They are explicitly noting that the BP reducing effects are not resulting in the expected mortality reduction if salt had no positive health effects. BP is a proxy measure for CVD and mortality risk. We shouldn't stick religiously to the proxy if we can gain access to the actual underlying thing we care about.

  2. the "especially large reduction" comment seems inappropriate given that the IoM was NOT asked to establish sodium guidelines for people who display an especially high sodium sensitivity or have medical conditions but for the general populace. It also seems to be disregarding the fact that extreme sodium reduction has resulted in higher hospitalizations even in these "at risk" groups. I agree there is ambiguity about where in the 2g-4g consumption level is ideal. I also agree that the recommendation for certain sub-populations might be different. But the evidence of <2g=harm seems pretty solid. This evidence is not exclusively from mortality statistics as Dr. Sacks implies but also from hospitalizations as mentioned.

I have not been able to figure out why the low sodium is being pushed so aggressively. Much of the language used (in that article for instance) leads me to believe that perhaps the belief is that they need to set a very low target in order to effect any change at all. i.e. if we tell them 1500mg maybe they will only overshoot to 2000mg, because they are currently eating 4-5g a day which is definitely harmful. Heavily pushing the salt=bad narrative with no nuance seems dangerous though because there are also people going in the other direction: eating under a gram a day and passing out or having other serious complications. One of the most common hospitalizations being getting lightheaded and falling.

Anyway, was there some other contradiction between my recommendations and the HSPH rec's that you were concerned about?

Comment author: michael_b 06 February 2015 09:15:22AM *  1 point [-]

Sorry for the confusion. I'm picking authorities at random and asking why I should trust you over them, not vouching for any authority in particular. Perhaps I should have asked more bluntly: who are you and why are you qualified to give us health advice?

No offense. :)

I am having a hard time finding places I disagree significantly with them.

More a curiosity than anything: dairy isn't represented at all on the HSPH's "healthy eating plate" but is specifically highlighted in your section on nutrition. Why the discrepancy?

Comment author: RomeoStevens 06 February 2015 09:03:42PM *  0 points [-]

I'm not. I'm a random person who is investigating the advice of professionals and trying to determine the interventions with the highest reported effect sizes in the literature. I'm not running studies myself or claiming anything in the absence of studies.

Milk and eggs is because of the Adventist health study and others:

"mortality from ischemic heart disease was 20% lower in occasional meat eaters, 34% lower in people who ate fish but not meat, 34% lower in lactoovovegetarians, and 26% lower in vegans. "


Keep in mind that it is perfectly valid to infer that if I disagree with a mainstream source on healthy advice this is minor evidence I am wrong.