"It's my view that Consensus Action on Salt & Health (CASH) has lived up to its name and built a genuine consensus. Simply, we need to reduce the amount of salt that we eat," proclaimed public health minister Gillian Merron at the National Salt Awareness Week launch last week. Noting that a gram of salt had already been trimmed from our average intake since salt reduction targets began, she continued: "Many would like to see daily limits reduced further. Throughout this year, the next series of voluntary targets kick in, so let's keep up the momentum."
CASH has indeed pressed the accelerator, signing up nine health charities to the cause (see BB, 12 Feb). The rationale? A whole new list of reasons to fear salt. New Kantar Worldpanel research published by CASH suggested few people were aware of salt's link to osteoporosis (4%), stomach cancer (6%), obesity (13%), kidney stones and kidney disease (27%).
Meanwhile, the Food Standards Agency's (FSA's) consumer trac-king shows salt concerns are on the rise. "For salt, there was a statistically significant increase in total concern (see definition), from 42%-48% last quarter," report author Danielle De Feo told BB.
Those salt anxieties were prodded by the FSA's salt-in-bread poster campaign last September, which upset a lot of bakers. "It certainly did, you don't need to tell me!" chief executive Tim Smith told BB. "What we were trying to do was urge people to look at the loaf they're buying to see which of the salt levels were low, then make their decision. Warburtons, Premier and others got very excited about it, but the fact is there was an alternative in lower-salt versions from supermarkets, made on exactly the same equipment. The fact is, a quarter of salt intake in the UK comes from bread."
This was disputed by Federation of Bakers director Gordon Polson, who said the FSA had in fact been assuming a 20% figure, but that was based on 20-year-old data that ignored changed eating habits and salt cuts. He put bread's salt contribution at 15-17%.
So is the industry doing enough to cut salt? Despite recognising the progress made thus far, Professor Graham MacGregor of CASH answers with a flat "No". "We have tried to get the biggest reductions in salt in the cheapest products, and the cheapest supermarket breads have had the biggest reductions, in general. The bread brands have had fewer reductions," he said.
But before we hurtle towards more cuts, is there really a consensus or is there a one-way information flow from the slickly organised CASH to government? The anti-salt science is not cut-and-dried. Reducing salt might be good for those on blood pressure drugs, but a British Medical Journal review seven years ago found no clear evidence for everyone benefiting from it. Other studies have suggested there are health risks from eating less than 6g salt a day, or that the amount of salt in our diet is not a sole factor it's whether that salt is balanced out by potassium in the diet. There are even health risks associated with being on a low-salt diet while on diuretic drugs, such as blood pressure tablets.
MacGregor attributed the groundswell of dissenting evidence to "largely originating from the salt lobby in the US". But is this a healthy way to frame the debate or a means of stifling a complex scientific discussion on whether reducing salt is a good thing for everyone? With recent news reports pointing to a rise in people self-diagnosing, the FSA and government risk consumer trust if they go around gung-ho with health messages and targets that have far-reaching consequences for industry, consumers and the nation's health alike.
So the question remains, are we going to see a repeat of the FSA's anti-bread antics this year? Smith's answer doesn't bode well: "You can lead me in that direction! We're not interested in manufacturers and retailers per se, we're interested in consumers and public health outcomes. That's what manufacturers find difficult to accept: we smile a lot, but we have a steel approach when it comes to this."