Somewhere along the way, while we were reducing our meat intake and swapping cow’s milk for almond, then oat, then pea; while our sugar was being taxed, our calories counted and our fat levels scrutinised, we forgot about salt.
It is perhaps the ingredient in our kitchens that has gone through the most significant rebranding in the past half century, going from something to be used sparingly to a foodie essential, with no kitchen counter complete without a box of Maldon flakes. It was sugar that was making us overweight and causing inflammation; salt was no longer our problem. Except that it always was. And now, experts say, we need to get it back under control.
The British Heart Foundation (BHF), the UK’s leading heart charity, has urged ministers to bring in a new levy on salt, calling for a tax to combat the high levels of it in prepared food. High salt intake, they say, leads to high blood pressure which causes heart attacks and strokes. So what’s the problem with salt? Sodium makes our bodies hold on to water, which makes it harder for the heart to pump blood around the body. And the stats on our heart health as a nation paint a worrying picture. “About 28 per cent of adults in the UK have high blood pressure, that’s about 15 million,” says Tracy Parker, senior dietitian at the BHF.
Meanwhile, she says, it’s estimated that somewhere between six and eight million are living with “undiagnosed or uncontrolled high blood pressure”. It’s a “silent time bomb” that can go unnoticed until it’s too late, which could result in rising numbers of heart attacks, stroke, kidney disease and other life-threatening illnesses.
The problems start with pre-prepared food that already contains high levels of salt even before it reaches our plates. There’s no doubt that our skyrocketing junk food addiction is adding to our salt intake, but it is far from the only culprit. It is often the foods we wouldn’t even consider as being especially unhealthy (and would never place in the junk food bracket) that are the worst offenders, containing worryingly high levels of salt. Breakfast cereals, cheese, certain meat products and meat and dairy alternatives, breads and soups, pre-cooked vegetables and tinned fish are all culprits, says the BHF. In fact, 75 per cent of our salt intake comes from processed food, with just 10 per cent from the table. The remaining 15 per cent occurs naturally in foods.
So what went wrong, and how can we fix it?
In the early Noughties, a nationwide programme to slowly reduce the salt content in pre-prepared food sought to gradually wean us off our insatiable taste for sodium. And it worked. The Food Standards Agency had instructed the industry to cut the amount of salt they were adding to food, and per-capita consumption of salt fell from over 9g to 8.1g a day. Adults should eat no more than 6g a day, say experts, but we have never quite managed this target, and as all eyes turned to other evils like sugar, the calls to keep on top of our salt intake seemed to melt away. In the meantime, though, the vast majority of us continue to surpass 6g daily.
In 2014, British Medical Journal analysis showed a nationwide reduction in salt consumption had contributed to a fall in blood pressure between 2003 and 2011, which in turn had helped the number of stroke and heart attack deaths come down. Meanwhile, the campaigning group Action on Salt claims that for every gram of salt removed from the average UK diet we can save 4,147 lives every year through the reduction in deaths from stroke and heart attack and prevent a further 4,147 non-fatal strokes and heart attacks each year.
“We know that adults in England on average have about 8.4g of salt per day, which is about 40 per cent over our recommended maximum of 6g, or a teaspoon of salt,” says Parker. “85 per cent of the salt we eat is already in the foods that we buy, so it’s not as simple as thinking about reducing our salt intake at the table or in our cooking. Most of us are eating more salt than we realise, because it’s already in our food.”
Part of the problem, says nutritionist Jane Clarke, is that regulations on sugar meant manufacturers had to up the salt levels to ensure products still tasted good. “Breakfast cereal can have [a lot of] salt in it – you’d be surprised. Because they’ve been hit on the sugar, they’re trying to get the flavour from the salt.” Currently there are no regulations on salt. The Government’s targets for salt reduction in food are purely voluntary, hence our creeping intake.
Even the things that claim to be healthy, like pre-cooked grain pouches, veggie burgers or supermarket soups, contain high levels. A bean stew, marketed as a healthy ready meal, could contain a third of your daily allowance of salt. Add more at the table, whether in the form of flakes, or perhaps a liberal grating of cheese or a side of toast with salty butter – and you could surpass your daily teaspoon in one sitting.
Plant-based alternatives, such as fake chicken or dairy, are among the worst offenders. “We have to be mindful about what’s going into these plant-based foods,” says Parker. “You could have two meals – one with some lean meat vs a plant-based meat alternative – and if you look at the packaging, the nutritional information can look very different. The meat one could end up being the healthier option (when it comes to salt).”
But what about those minimally processed gourmet salts, like Maldon salt or pink Himalayan rock salt, are they really any better for us? Sadly the sodium content is pretty much the same as ordinary table salt. So choose the one you like the taste of and use in moderation.
We need to become more salt aware, says Clarke, who suggests using more imaginative flavourings, like lemon juice, chilli or spices, and making salt-sensible swaps by, for example, choosing tuna tinned in oil over brine. “Because fat has been demonised you think you’re better off with salty water, but actually what you could do (if you’re watching calories) is just run your fish [in oil] under a tap in a sieve and pat it dry with some kitchen towel.”
Clarke does not believe that a salt tax is the way forward. Far from it. She wants us to address the bigger picture of our diets, arguing that anything less is akin to shuffling the chairs around on the Titanic. Sweeping food legislation, argues Clarke, doesn’t address our obesity problem, which, she says, should be of more concern to us than our salt intake. “As a practitioner I see it week in, week out. People come to me with high blood pressure, and I could simply say cut out all salt, or I could say right, this is where you need to get the flavour in your food.”
If she simply reduced their salt intake, Clarke says her clients would come back six weeks later overweight and bored with their eating. “Because if you decrease the flavour of food, it means that we don’t feel satisfied.”
Other experts, however, are certain that a salt tax would be a step in the right direction.
Parker refers to the call by the BHF to reduce salt levels in everyday foods as “health by stealth”. “If it’s done gradually, you get used to lower salt foods all the time. This was a really important part of the UK’s salt reduction programme that was started way back in 2006. Food industries reduced the salt content in the products really gradually so over time our taste buds got used to less salt in food.”
Time, then, to clear out the pre-prepared food in our store cupboards, cut down on cereals, cheese and bread, and make that liberal sprinkling of salt flakes on our dinner more of a pinch. Our heart health could depend on it.
11 salt-saving swaps
The aim is to keep your sodium intake under a teaspoon of salt, or 6 grams, a day.
Swap stock cubes, which can be relatively high in sodium, for a homemade stock using dried mushrooms. Simply pour boiling water over dried mushrooms, leave for 20 minutes and use the liquor.
Use spices or citrus rather than salt to season your food.
Exchange soy sauce, at 0.3g sodium per 5ml teaspoon, for coconut aminos, at 0.13g per teaspoon (5ml).
Swap tinned veg for frozen or no-salt canned veg. A can of tinned carrots contains 0.35g of sodium, with no-salt tinned carrots at 0.042g.
Use a teaspoon of reduced salt Marmite at 0.4g per 8g to season sauces rather than soy, which is 1.08g per 10ml.
Processed meats are amongst the biggest salt offenders. Swap ham at 1.25g of sodium per serving of three slices for tuna at 0.12g per 30g portion.
Hot dogs might be quick and easy but they are loaded with salt (0.67g of sodium per sausage). Swap a hot dog for a grilled drumstick (0.12g).
Swap shop-bought for homemade dressing. Ditch salad cream (0.1g per tablespoon) for olive oil (0.08g) and lemon.
Replace tomato sauce (0.16g per tbs) with no-added salt version (0.005g per tbs).
Even so-called healthy cereals can be loaded with salt. Swap cornflakes (0.16g of sodium per 40g bowl) for porridge oats (0.0024g).
Swap eating out for eating in. You’ll likely come out ahead in the salt stakes.