The tasteless aim of the war on salt
Why are health campaigners so down on the white stuff when all the evidence suggests it isn't bad for us?
The advice to reduce our salt intake has been so ubiquitous for so long that it simply must be correct, right? Those white crystals may make our food taste better, but it’s a Scientific Fact that salt increases blood pressure and, therefore, cutting back on it will reduce blood pressure and we’ll live longer. Trouble is, while this seems to make sense, the evidence keeps failing to back it up – and a study published today raises further questions about this simplistic advice.
The new study is the latest Cochrane Review, an effort to revisit the evidence on a wide variety of healthcare interventions to provide clearer guidance to medical practitioners and patients. The review took in seven studies involving 6,489 patients. ‘Intensive support and encouragement to reduce salt intake did lead to a reduction in salt eaten and a small reduction in blood pressure after more than six months’, according to the article’s lead author, Professor Rod Taylor of the University of Exeter. But the real question was ‘whether this dietary change also reduced a person’s risk of dying or suffering from cardiovascular events’.
And the answer was ‘not really’. That shouldn’t be a surprise. Previous studies have come to a similar conclusion: reducing salt does seem to reduce blood pressure a little, but the effect on cardiovascular disease is so small as to be hardly worth bothering with. If your blood pressure is high enough that you’ve been prescribed drugs to reduce it, then there may be some benefit in also reducing how much salt you eat. But that’s about it.
Taylor argues that a bigger effect would have been seen if people had cut back on salt further than they did in the studies that he and the review team examined. They might also have found a statistically significant effect on heart disease and strokes if the studies had simply included more people.
But given that the people in these studies were given ‘intensive support and encouragement’ to eat less salt, and managed only moderate reductions, it suggests that this is pretty much the limit of what people with a Western diet are likely to tolerate. Why would you make every meal taste worse in the hope of a small, perhaps even non-existent, reduction in your risk of dying?
Of course, there has been a backlash from campaigners and public-health experts against the new study’s findings. A spokesperson for the most high-profile campaign on the issue, Consensus Action on Salt and Health, told the Daily Mail: ‘It is very disappointing that the message from this small review indicates that salt reduction may not be beneficial. This is a completely inappropriate conclusion, given the strong evidence and the overwhelming public health consensus that salt raises blood pressure which leads to cardiovascular disease.’
What evidence? The big international studies on the matter have actually come to similar results: cutting salt leads to small reductions in blood pressure in people with hypertension, and barely measurable falls in blood pressure for those who don’t have hypertension. Of course, it may be argued, small changes in blood pressure may, when spread over the mass of the population, result in a few saved lives. But equally, we might also see an increase in negative effects, too. For example, the new review suggests cutting salt in people who have suffered heart failure might actually increase deaths.
So, if imploring the population to cut back on salt doesn’t work, maybe getting food manufacturers to do so will sneak in salt reductions without us all noticing. But we do notice. So, for example, the Food Standards Agency in Scotland has been pushing food producers to reduce salt in their products – and they have. But research produced by the agency published last month found no reduction in salt intake, suggesting that consumers simply add salt to make up the difference or switch to products that have more salt.
But why should campaigners and medics on a mission fret about such trivialities as the flavour of our food or our ability to make free choices? Theirs is a political vision in which health overrides all other considerations, where the extension of life rather than its quality is the be-all and end-all. And if they can save a few lives at the expense of making millions more lives a little bit worse by making food taste, well, less tasty, that is a price worth paying in their eyes.
However, studies like the one published today on salt show that even in its own terms, the anti-salt campaign makes little sense. It either doesn’t save lives or it makes so little difference that it is hardly worth bothering with. Whether it is salt, fat, sugar or alcohol, we should take the lectures from our health guardians with a pinch of the white stuff.
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