Why is high blood pressure a big problem?
Is salt good or bad for you?
My name is Laurence and I am a saltaholic. I am also a doctor and have a degree in biochemistry, so am well aware that too much salt is associated with heart disease, raised blood pressure and stomach cancer.
But salt is also a necessary fuel without which the body would not function. So how much salt is too much? Who says so and why? And is there a grain of truth in the conclusions of a leading cardiovascular scientist who says the dangers of salt have been over-emphasised?
The salt years
I have been addicted to salt for as long as I remember. My father was a saltaholic too so I always wondered if my addiction was genetic. However, twin studies put the kibosh on that one. So I guess it was learned behaviour. Watching Dad sprinkling pounds of the magic mineral on his fish and chips sent a message to my immature brain that this was good stuff.
Those of you old enough to remember the days before crisps came in 17 different flavours and were not advertised by footballers may recall the little blue paper twists of salt you found in the bag. So bad had my habit become that by the age of 10 I was buying crisps, emptying the blue packet straight into my eager gob and throwing the crisps away.
Of course, it all had to come to an end sooner or later. I remember the day well. A lady in a long white dress and a veil turned up at the synagogue and that was the end of my love affair with Madame Salt. My wife was a diehard anti-salt activist.
Salt is bad for you
You couldn't blame my beloved. By the time we got married in the 70s, salt was beginning to get a bad press. Huang Ti Nei Ching Su Wein, a Chinese physician, suspected a link between salt and raised blood pressure in 1700 BC and the first scientific paper linking salt and hypertension was published in 1904 by two French physicians, Ambard and Beaujard. However, it wasn't until 1974 that COMA (the UK's Committee on the Medical Aspects of food policy) acknowledged the concerns about salt and sales of table salt began to fall. By 1996 Cambridge University Press saw fit to publish a book with the totally balanced title 'Neptune's Poison Chalice'.
So, knowing that moderation is not a word that saltaholics understand, my wife banned salt from the house entirely. This didn't deter me in the least. Like any true addict, I found inventive ways of concealing my stash. I once had to take a guest aside and furtively explain why the talcum powder container did not deliver the substance he was expecting. And on another occasion I had to demonstrate to my daughter's (police officer) boyfriend that the little packets of white powder he found in my sock drawer were entirely innocuous.
The received wisdom
As time has passed, the scientific evidence against salt has grown. Worthy organisations such as the World Health Organization sounded warnings. The Consensus Action on Salt and Health (CASH), a group of specialists concerned with the effects of salt on health, say Public Health England (PHE) could save 14,000 deaths a year by agreeing to compulsory legislation for the food industry. Reducing salt intakes from the current daily average intake of 8 g to the recommended 6 g limit (slightly less than a teaspoon) would, it is predicted, save the NHS a further £3 billion a year.
Professor Graham MacGregor, professor of cardiovascular medicine at Queen Mary University of London and chairman of CASH says: "This is a national scandal. The UK was leading the world in salt reduction, but PHE is doing nothing to ensure that the 2017 salt targets are met."
Strangely, it wasn't the link to raised blood pressure, heart disease or stomach cancer that led me to give up salt, but the association with tinnitus. I'd had this for years, and the chance of getting rid of the sound of a thousand snakes hissing into my lugholes was enough to make me give up my habit.
And so out went the packets of 'flour' in the kitchen, bags of unidentifiable white crystals behind the bookshelf and innocent-looking pill boxes in the medicine cabinet. We became 'salt-free' in reality as well as name.
We also tackled the issue of hidden salt, salt that was added to foods during processing. Our shopping trips became challenging, trying to find the cereals, bread and processed meats with the lowest salt content.
Salt is good for you
I started using pepper, pretending it was salt. The tinnitus didn't improve and I began to lose my motivation. However, I remained resigned to my life sentence as a salt-free ex-saltaholic. And then along came Dr James DiNicolantonio, American cardiovascular research scientist and associate editor of the British Medical Journal's Open Heart magazine. In a (salted) nutshell, Dr DiNicolantonio's opinion is that the dangers of salt have been grossly exaggerated and that low-salt diets may do more harm than good.
"Instead of ignoring your salt cravings, you should give in to them - they are guiding you to better health," says Dr DiNicolantonio. "Most of us don't need to eat low-salt diets. In fact, for most of us, more salt would be better for our health rather than less." He reckons we should listen to our 'salt thermostats'; our bodies will tell us when we have had enough.
Dr DiNicolantonio says people need salt to live. When left to their own devices they will consume about a teaspoon and a half of salt a day. This is constant among all cultures, climates and social backgrounds across the world. Salt craving is a natural phenomenon and can be seen in elephants, gorillas and monkeys. Low-salt diets can reduce male fertility (admittedly the only evidence is in rats) and increase pregnancy loss (albeit only if you're severely deficient in the stuff).
Dr DiNicolantonio has reviewed the evidence on which the 'salt is bad for you' theories are based and concludes that the facts don't stack up. The Ambard and Beaujard paper was based on just six patients, a number which would be laughed out of court today. The research which confirmed the link between raised blood pressure and salt (by a scientist called Dahl) used rats which were specially bred to be sensitive to salt. The experiment didn't work on the majority of (non-sensitive) rats.
He points out that the average Korean diet is very high in salt, but Koreans have one of the lowest rates for hypertension and heart disease in the world. This is known as the 'Korean Paradox', although I must say that some of this myth has been debunked. Research has shown a correlation between high sodium and heart disease, while a high potassium intake is associated with a low incidence of hypertension and stroke. So in fact, DiNicolantonio's point actually works for the anti-salt opposition.
Dr DiNicolantonio believes that salt deficiency can magnify our risk of heart disease by increasing heart rate and compromising kidney function. His most controversial view involves the issue of insulin resistance (the way the body's cells react to insulin). His opinion is that salt depletion sends a message to the body that it is starving. This leads to a rise in insulin production, which signals the cells to increase their storage of glucose. Obesity results, which can in turn lead to diabetes and other complications.
All addicts seek ways to validate their behaviour and saltaholics revere Dr DiNicolantonio's words as if he is the true savour(y).
The rehab years
Armed with the new evidence, I begged leave for an appeal against the salt ban.
My wife though, was unimpressed by the assortment of rats, monkeys, gorillas, elephants and Koreans I paraded before her. Her verdict was that Dr DiNicolantonio was "only one man". Unless his voice could be joined by a whole choir of like-minded cardiovascular research scientists, the salt ban would not be lifted.
Thus I must remain on a healthy low-salt diet. I was surprised to find how quickly it's grown on me. Astonishing as it may seem, once you do away with salt, food actually tastes of food.
You, dear reader, will have to make up your own mind. You may consider that the cautionary advice of eminent and respected bodies such as the World Health Organization and Public Health England is too important to ignore.
On the other hand, you may be swayed by the views expressed by Dr DiNicolantonio and take such warnings with a very large pinch of salt.