Random thoughts on diet soda...

What's new this week? Well, it appears that drinking as little as one can of diet soda per day increases your risk of stroke by 48%. Especially if you're over the age of 65.

I may be jaded from reporting about health and nutrition for too long, but this sounds ridiculous to me. So, I dug a little and here's what I found.

The results were reported from a poster session at the American Stroke Association's International Stroke Conference 2011. The study analyzed data on 2,564 participants of the ethnically diverse, longitudinal Northern Manhattan Study (NOMAS), divided people into several groups based on their soda consumption: those who drank no soda; those who drank regular soda, either moderately (one to six servings per week) or every day; and those who drank diet soda, either moderately or every day. There were two other groups who went back and forth between regular and diet soda, drinking either moderately or every day.

The researchers found that people who drank diet soda every day were 48% more likely to suffer a stroke or other vascular event over a nine-year span, compared with people who didn't drink any soda. That risk was calculated after researchers accounted for factors like participants' age, sex, smoking status, exercise, alcohol consumption and peripheral vascular disease or heart disease history. However, they didn't factor in family history of stroke or weight change over the 9 years--because they didn't have that information! So it could be that weight gain of 75 lbs. over the 9 years of the study accounted for the increased stroke risk, as opposed to the diet soda. Also, 86% of people in the study were black or Hispanic; both groups who are at higher risk for vascular events, such as stroke.

It's important to note that this study was presented at a poster session at the meeting and was not peer reviewed; in the hierarchy of evidence, this is the lowest level of evidence.

This type of media frenzy makes me nuts (even if it does provide job security)! However, to their credit, many scientists/physicians/researchers came forward and stated their doubts about the methodology and urged us to rethink the data in light of the poor study design. A step forward, for sure. In the meantime, I think you're more likely to die from being hit with a can of diet soda than from drinking one.

Can Americans Lick their Salt Craving?

In 2008, Congress asked the Institute of Medicine (IOM) to recommend strategies for reducing sodium intake to levels recommended in the Dietary Guidelines for Americans newly published this past week). In the spring of 2010, the IOM concluded that reducing sodium content in food requires new government standards for the accept­able level of sodium. Food manufacturers and restaurants need to meet these standards so that all sources in the food supply are involved. The goal is to slowly, over time, reduce the sodium content of the food supply in a way that goes unnoticed by most consumers as individuals’ taste sensors adjust to the lower levels of sodium.

As a young dietitian, I'd have bet that Americans were incapable of reducing their salt cravings. But ever so slowly, I'm coming around. I grew up in a family that regarded salt as a precious commodity, to be savored and used as liberally as possible. My dad actually salted his potato chips--until his first heart attack at age 47, when he was placed on a low-sodium diet. Mom rolled up her sleeves and began to study labels, take cooking classes, and buy 'healthy' cookbooks. She learned to replace the salt in her world-famous chicken soup with fresh herbs and spices and to bake with unsalted butter. After grousing and mumbling for the 6 months about how 'bland' everything tasted, we eventually stopped complaining. Over the next few months, everything we at home tasted delicious--and everything we ate outside tasted too salty!

Salt is an acquired taste; the more salt you use, the less you taste it, and the more you want it. The Institute of Medicine report is asking for a multipronged approach to help lower Americans' desire for sodium by reducing levels of sodium in processed foods, restaurant recipes, and federal feeding programs, and by setting a proscribed level of sodium that is acceptable for processed foods.

Some news features have pounced on this story as a "Big Brother" initiative to allow FDA to monitor the food industry's use of salt. Not true. Other news features have suggested that people who eat excess salt will face higher insurance rates. This is one time that I think the IOM got it right--it is much easier to change Americans' preference and taste for salt than it is to convince them to reduce salt intake on their own. A slow, gradual withdrawal will probably work wonders!

Here's my favorite recipe for chicken noodle soup, requiring only a teensy tiny amount of salt

3 lbs of cut-up chix parts
2 qts water
1 can low-fat chix broth
5 carrots, chopped
3 ribs celery, chopped
2 small white onions, chopped
1 butternut squash, frozen, chopped
1/2 bag broad egg noodles

rosemary
oregano
bay leaf
fresh parsley
1/2 tsp salt (1200 mg)

Put chicken and all remaining ingredients except noodles, salt and spices in stock pot with water and chicken broth. Cook on low until chicken is cooked all the way through. Remove chicken from bones and put the chicken back into the pot. Add noodles, herbs and salt; simmer for another 2 hours. Mash the squash until it's smooth.

The squash gives the soup a beautiful golden color and in combination with the herbs, provides a taste pallet that highlights the flavors of the chicken and the vegetables. You won't miss the salt at all!