Jan. 27, 2010 -- Have a Coke and... some salt?
How about with some fat?
Brought to you by family medicine.
The American Academy of Family Physicians has again launched itself into murky ethical waters, this time ads for products that are high in salt and in fat.
The association, to which I belong, was widely criticized two months ago for accepting money in "the strong six figures" to partner with Coca Cola.
The purpose of this "funding" was for the AAFP to develop soft drink education so that consumers could "make informed decisions" about soft drink use "based on individual need."
The response to the AAFP included a critical letter to the AAFP from nationally esteemed nutritionists, the condemnation by the California Academy of Family Physicians -- a state affiliate -- and the well-publicized resignations of a number of physicians.
Nonetheless, the AAFP stuck to its guns, and has kept the Coca Cola Alliance in place. At a Dec. 11 meeting, the AAFP board decided -- despite near universal condemnation from dozens of health advocates and advocacy groups -- to continue the Coke partnership.
Now they are at it again, this time with sodium. And this time, we are talking about heart disease, heart attacks and strokes.
The New England Journal of Medicine published a study on Jan. 20 that suggests lowering the nation's daily sodium intake to 1,200 mg (or 3 grams of salt) could reduce heart disease by 120,000 cases annually; heart attacks by 99,000; and strokes by 66,000.
Dr. Kirsten Bibbens-Domingo and colleagues from the University of California, San Francisco, used computer modeling based on population studies. They found not only a reduction in heart disease and stroke. Amazingly, they also found that the cost savings would approach $24 billion annually.
Indeed, the authors note, "Such an intervention would be cost-saving even if only a modest reduction ... were achieved gradually between 2010 and 2019 and would be more cost-effective than using medications to lower blood pressure in all persons with hypertension."
Enter the AAFP.
Salt, fat and calories are highly associated with the development of diabetes, hypertension, strokes and heart disease. In the context of the UCSF study, advertising salty foods breaks medicine's age-old pledge: Primum non nocere. First, do no harm.
Let's start with salt, known medically as sodium. Since sodium is necessary for life, it is in everything that we eat. Fortunately, healthy foods such as fruits and vegetables are naturally low in sodium.
High levels of sodium in the diet come from processed foods to which salt has been added -- processed meats, potato chips, pickles, canned foods and many other products.
According to the respected Institute of Medicine, the upper limit of sodium intake should be no more than 2,300 mg a day for healthy individuals. However, for "[o]lder individuals, African Americans, and people with chronic diseases including hypertension, diabetes, and kidney disease," the limit should be much less -- no more than 1,500 mg.
Buddig products prides itself in achieving the American Heart Association's "heart check mark," which certifies a product is low in fat and cholesterol.
However, although Buddig's products are low in fat and cholesterol, they are fairly high in sodium.
For example, Buddig's Fix Quix Smoked Ham contains up 460 mg of sodium for a 2 oz. serving. For someone with hypertension, diabetes or kidney disease, that is 31 percent of their 1,500 mg daily allotment.
Buddig does not tell you this up front. I had to click through five Web pages to find the sodium content. Some products on this Web site do not even list their sodium content.
Moreover, other products found on Buddig's Web site contain even more sodium that its smoked ham. The Old Wisconsin brand Pepperoni Snack Sticks yield 650 mg of sodium -- nearly half of a day's allotment for someone with these chronic diseases.
This might not seem like such a big deal, but for some patients, the extra sodium can be lethal, as the UCSF study points out. Patients with congestive heart failure, for example, need extreme sodium restriction. Extra sodium can push them into dangerous heart failure.
All brought to you by a link provided by the AAFP!
Next, let's look at the fat that the AAFP advertises.
Fats, especially animal or saturated fats, not only are very high in calories, but increase your cholesterol. Since they are so calorie-dense, they also add extra weight to your frame much more quickly than other foods.
On AAFP's familydoctor.org Website, Hellmann's mayonnaise is advertised. The tag line? "It is time for real taste -- Best Foods Light® recipes here" ... at which point you click and are taken to the Best Foods Web site. When I checked the link last week, the only recipe I found was for "Creamy Loaded Mashed Potatoes."
Since then, I have checked again and this recipe is no longer on the first Web page. But this recipe, by the way, calls for 1 1/2 cups of cheddar cheese, 1 cup of sour cream, 1 cup of mayonnaise, and six slices of bacon. The bacon and cheese alone are loaded with both fat and sodium.
But wait! Familydoctor.org is not finished!
There is also an advertisement for canola oil, with the tag line on the familydoctor.org Web page: "Reduce the risk of heart disease 1 1/2 tbsp at a time."
There is no explanation of how often one should take this 1 1/2 tbsp of canola oil. Once a day? Twice a day?
Heck, some people might say, the more heart disease risk reduction the better -- let's do this ten times a day!
You actually have to click onto the canola oil Web site, sponsored by the Canola Council, to find out that this is a daily allotment. The AAFP does not tell you.
The Canola Council's Web site also spells out that the 1 1/2 tbsp of oil should replace other fats in your diet so that it will not increase your daily calories. The AAFP does not tell you this either.
Remember, fat and oil are the same chemically. Canola oil is just another form of fat. While switching from, say, lard to canola oil in cooking is healthier, it would not be good to simply increase your canola oil intake without cutting calories elsewhere.
Some of Old Wisconsin brands' and Hellmann's mayonnaise recipes pack the fat and thus increase the calories of these foods if you eat them.
When I contacted the AAFP, spokesman Michael Springer responded by e-mail, "Rest assured the AAFP and FamilyDoctor.org will not collaborate with companies that do not share the common goal of educating consumers, as well as medical professionals, about making informed decisions about their health." In addition, Springer wrote, "The Academy is pleased to see companies offer new products that are healthier than many of their original products."
But healthier than the original is not healthy enough. The AAFP should be reminded that we are in the midst of an obesity epidemic.
Some of these physicians might want to go back to third year in medical school and relearn that sodium is very dangerous in many diseases like unstable heart failure.
And they should stop advertising for food products that that could contribute to health problems in a country that already eats too much fat and salt.
Dr. John Spangler is director of tobacco-intervention programs and a professor of family medicine at Wake Forest University School of Medicine in North Carolina. The opinions expressed in this column are the personal opinions of Dr. Spangler and do not necessarily reflect the views or findings of Wake Forest University School of Medicine or ABC News.