COMMENTARY

Dear Food Industry: Lower the Salt, Save Lives

Henry R. Black, MD; Graham MacGregor, MB BChir

Disclosures

December 04, 2013

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In This Article

Lose Salt, Not Sales

Henry R. Black, MD: Hi. I'm Dr. Henry Black, Adjunct Professor of Medicine at the Langone New York University School of Medicine. I am here today with my friend, Dr. Graham MacGregor, from London.

Graham MacGregor, MB BChir: I'm Graham MacGregor, Professor of Cardiovascular Medicine at Barts and London Hospital Medical School in London, and also Chairman of the Action Group on Salt, both in the United Kingdom and worldwide.

Dr. Black: I want to talk about something that you have been interested in, possibly for your whole career: the so-called "salt controversy." Why is there a controversy?

Dr. MacGregor: That is a good question. I am not sure, but my guess is that it is mainly due to pressure from the salt and food industry.

The evidence for salt is overwhelming. Look at the wealth of the epidemiologic migration; all the animal evidence studies in chimpanzees; the treatment, genetic, and outcome studies that we have now. The evidence is overwhelming that salt raises blood pressure and is responsible for a very large number of strokes, heart attacks, and heart failure. In countries where it is high, such as China and Japan -- even higher than in the United States -- cancer of the stomach is very clearly related to a high salt intake.

Dr. Black: That is obvious, at least to me and many others. Why don't people accept the physiologic evidence (which is clear) and the epidemiologic evidence (which is even clearer)? What's the problem?

Dr. MacGregor: It isa bit like tobacco. I remember as a student in the 1960s, it was very clear that tobacco caused cancer of the lung, and then subsequently, it was a major factor in heart attacks. But it has taken 40 years for that evidence to come through, and the tobacco industry has fought a very careful, well-conducted campaign or war against that evidence.

Dr. Black: "War" is probably the right word.

Dr. MacGregor: Yes. The salt industry -- particularly in the United States, with the Salt Institute -- has done the same. The food industry used to be against it, but certainly in the United Kingdom, the food industry is now, on the whole, in favor of salt reduction because of the success that we have had. They have seen that salt can be reduced in food without loss of sales, which is what they are concerned about. They think that if they reduce salt in foods, they might lose sales, and so they are resistant to the idea.

In the United Kingdom, we have shown that it is possible to slowly reduce salt intake -- that's the key -- and not lose sales, because people will get used to it.

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