Friday 24 Mar 2017

Sweet or Salty: From Bad To Worse

“As doctors, we cannot prevent people from dying” began nephrologist and Professor of Cardiovascular Medicine at the Wolfson Institute of Preventive Medicine, Graham MacGregor, when speaking to a group of some 400 La Châtaigneraie students. “But we can prolong the life you live, and its quality, by preventing a number of illnesses such as heart disease and cancer”. 

In the UK and most developed countries, the primary causes of death are (in order): cardiovascular diseases such as stroke, heart attack and heart failure, cancer, and respiratory illnesses. Their main underlying causes are raised blood pressure (which kills on average over 10 million people worldwide every year), tobacco, and high cholesterol. Having fervently advocated throughout his career for reducing blood pressure, MacGregor knows all too well that many of these deaths can be prevented. But what can we do?

To begin with, MacGregor pointed to a distinction that must be made between modifiable and unmodifiable factors that account for high blood pressure. “On the one hand, you find those that you can influence through life choices, such as cholesterol levels, smoking, obesity, diabetes, nutrition and exercise. On the other are those over which we have no control, such as age or genetics,” he explained. Highlighting that there are more factors that we can modify than not, MacGregor primarily denounced the processed foods that we all consume, which can be full of salt, fat and sugar, which contribute to increases in blood pressure, cholesterol and blood sugar. 

Saving 2.5 million lives a year

“As he lay dying of lung cancer, the original Marlboro cowboy said he was living proof that tobacco kills,” said MacGregor. But despite it being the leading cause of death in the world, high blood pressure has yet to gain the same lethal reputation as tobacco has. Yet “the risk starts at a BP of systolic 115mmHg – which means that roughly 83% of adults are concerned,” he said.

But what raises blood pressure? MacGregor pointed to one overwhelmingly guilty party: salt. Found by the Chinese and Egyptians to have food conservation properties, it became an essential commodity throughout most of history. No longer necessary for food preservation thanks to refrigeration and the use of other, less harmful chemicals, dietary salt now mainly comes from the processed food industry. In fact, 80% of salt is hidden in processed food. “By reducing salt intake by 5-6 grams per day, you cut your risk of stroke by a quarter – that’s 2.5 million deaths prevented every year,” declared MacGregor.

As one of the first and most vocal advocates for salt reduction, MacGregor set up the action group Consensus Action on Salt and Health in 1996, aiming for a 40% reduction in the amount of salt the food industry is using, and a 40% reduction in the amount of salt we add in cooking. Setting targets per food group, this action group endeavoured to achieve a progressive reduction over two years. MacGregor pointed to an added advantage of this method as it relied on a new concept in public health: “instead of shouting at people to change their lifestyles, we changed the food that they were eating in such a progressive manner that they didn’t realise, and therefore didn’t reject the initiative.” 

11 bananas, 18 oranges and one half marathon

Notwithstanding this initial victory and apparent cooperation of the food industry, MacGregor still points to “the relentless pressure on consumers whereby food and drinks are available anytime and anywhere”. When we cave in to this pressure and eat a meal such as a Big Mac, large fries and soft drinks, it’s the equivalent of eating 11 bananas or 18 oranges, “and we would have to run half a marathon just to spend the calories we have just ingested” explained MacGregor. Affirming that the food industry is as deadly as the tobacco one, he called for a largescale ban on fast food advertisement, and the taxation of products containing high quantities of salt, sugar and fat.

In addition to fighting for salt reduction, MacGregor also set up Action on Sugar, with the objective of reducing sugar hidden in food and soft drinks. Showing his audience an alarming diagram indicating sugar content in various foods, he explained that sugar presented even more of a challenge than salt. Contrary to salt, it represents an important part of the weight of a given product for which there is no replacement, and to which are also added artificial sweeteners. Nonetheless, he remains confident that by setting incremental targets for sugar reduction, sugar intake can already be reduced by 100Kcal per person per day over a two-year period.  

Reminding La Chât students that, once again, those responsible are the global food industry, he concluded by pointing to an overlooked paradox: “if the food industry made healthier, less salty, less sweetened food, their consumers would live longer and would buy their foods longer”. Food for thought for Ecolint students who, as tomorrow’s doctors, global health advocates, leaders, but most of all consumers, will think again before eating fast foods and drinking soft drinks, and look twice before placing another item in their shopping trolley. 

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