No need to pickle children: get Big Food to cut salt for better health

The World Health Organisation and governments around the world make clear recommendations about maximum salt consumption for kids. But everywhere they are measured, these safe levels are being exceeded.

A recent national nutrition survey in Australia found almost every child aged between two and eight exceeded recommended salt consumption levels. Worse still, children were more likely to exceed recommended intakes than adults. But even these estimates are rosy because salt added during cooking or as seasoning at the table is not usually recorded.

Way too much

Excess salt consumed in childhood leads to high blood pressure, which sets the stage for hypertension as an adult. Increased risks of stroke, heart attack and kidney disease are long-term but direct consequences.

Around the world, excess salt consumption is estimated to cause more than a million and a half deaths each year. And salt-reduction programs have been identified as one of the most cost-effective possible interventions for the prevention of disease.

While there’s been some debate about whether salt reduction will deliver benefits, there’s actually little doubt. Still, both the general and medical media thrive on controversy and peer review is an imperfect tool. This works well for ill-informed or opportunistic researchers; it’s not just politicians who live or die in the media.

Salt added during cooking or as seasoning at the table is not usually recorded in nutritional surveys.mmmsedap/Flickr, CC BY-NC

The World Health Organisation and a series of other reputable bodies have carefully reviewed all the evidence relating to salt and disease. All draw the same basic conclusions: salt is consumed vastly in excess of requirements, reducing consumption would almost certainly produce benefit, and taking salt out of the diet would almost certainly not cause harm.

Hidden in plain sight

So why does the world continue to pickle its children? Well, mostly because it’s now the default option. Salt was scarce for most of human history and we have a taste for it, much as we do for sugar and fat. The food industry has made the most of this by hooking kids from an early age and creating lifelong customers for their most profitable, least healthy products.

Adults need less than a gram of salt a day to maintain good health. Average worldwide consumption is now ten times that. Children need much less but careless choices at the takeout or the supermarket can quickly breach their limit.

A big part of the problem is that most of the salt we eat is hidden. Food labelling is technically accurate but it’s not designed to enable parents or children to easily identify healthy foods. Moves toward standardised front-of-pack labelling with stars or traffic lights are welcome but will only work if implementation is universal.

Another challenge is that the harmful effects of salt on children don’t show until much later in life. This makes it a hard sell to policymakers on a three-year election cycle, and irrelevant to quarterly reporting of big business. The real benefits of reducing salt consumption in children will take decades to show, but no one outside of public health works on this sort of time frame.

The right steps

Fortunately, children need not always be the hapless victims; a fascinating recent paper in the British Medical Journal shows how they can become the vehicle for change instead. The paper discusses health educations sessions included in the Chinese school curriculum, which were modified to include specific messaging about the harms caused by salt and how to reduce salt intake.

Salt was scarce for most of human history and we have a taste for it, much as we do for sugar and fat.Pewari/Flickr, CC BY-NC-SA

The children took these messages home to their parents. Over the course of a school term, salt consumption by children and their families fell by about a quarter. There were corresponding falls in the blood pressure levels of the adults.

High blood pressure is rife in China and stroke is the leading cause of death. This novel, cost-effective and potentially lifelong strategy for reducing salt intake could prevent some 200,000 stroke and heart attack deaths each year if scaled across the country.

But the power of China’s little emperors (and empresses) may not translate directly to other countries. For the other six billion of us, cooking from fresh produce, using minimally processed products and not adding salt is a surefire way to control salt intake for the family.

For most, cutting out packaged foods is implausible but reading nutrition panels can help. The technical definition of a low-salt food is one with less than 120 milligrams of sodium in every 100 grams of the food. If you find the label hard to decipher, then smartphone apps such as FoodSwitch (with its SaltSwitch filter) can make this easier.

Parents want the best for their children but will be largely powerless until the commercial and policy environment prioritises health over profit. Unattractive as it may be to those with the power and the money, mandatory limits on salt, regulated maximum portion sizes, and fat taxes will be what turns the tide on diet-related ill health.

It took 50 years to get concerted action on tobacco. Let’s hope it doesn’t take as long to control the excesses of Big Food.

Bruce Neal receives funding from the National Health and Medical Research Council of Australia, the World Health Organisation and VicHealth for his work on salt reduction and he is Chair of the Australian Division on World Action on Salt and Health.

Kathy Trieu receives funding from VicHealth for her work on salt reduction.