A Pinch Of Salt
A doctor friend last summer received an invitation to attend an important-sounding conference on ‘New Directions in Cardiology’. Being a diligent sort of chap and genuinely interested in the welfare of his patients, he decided to go along - especially as the literature accompanying his invitation seemed to say that everything he had previously thought about the relationship between heart disease and high consumption of dairy fats was mistaken and old hat. He thought he might learn something new.
Late as usual, he scurried past the conference reception, dropping papers, shrugging off his coat and heading in the wrong direction. ‘Doctor Roberts?’ He heard his name being called by one of the receptionists. Don’t you remember me? We met at the Flora margarine conference on heart disease last year. They were blaming it all on milk and butter then. This one’s sponsored by the Butter Information Council and they say it’s everything except dairy fats. A bit of a joke really, isn’t it?’
For the one in three of British people who are likely to die of heart disease - and who would quite like not to - the humour of the situation has begun to wear a bit thin. They would prefer to have access to unequivocal information that would help them change their diet in order to live longer. What they see in the press and on radio and television is a welter of contradiction and confusion. So dozens of them write to me saying: ‘We respect your programme.* You tell me who’s right.’
Unfortunately - at the risk of sounding over-modest - how the hell do I know? I’m only a journalist! I suppose I could ring up every time I get a press release from a Public Relations company promising me new information on the debate between diet and health and ask who their clients are. But what does that tell me? Just because it turns out to be the Butter Information Council (BIC) yet again, does that mean I shouldn’t believe it? However, I do know that the BIC represents the interests of New Zealand, Britain, Denmark, Ireland and Holland - the main suppliers of butter to the British market - and that they have drawn up a strategy which involves spending over three million dollars to shore up falling demand for their product.
Their plan is simple - and quite effective. Sow confusion. Like a soft margarine, uncertainty is easy to spread. For every 20 committees that report conclusions suggesting high consumption of dairy fats contributes to heart disease, they will find one which refutes it. This approach exploits the media concern with balance. If 95 per cent of experts say ‘black’, television, radio and the press will be tempted to give equal time to a representative of the five per cent who say ‘white’. Like guerrillas, they work behind enemy lines planting ‘doubt bombs’ with slow time fuses so they can move well out of the way before the explosion. It’s no accident that journalists were in the first target group for a Butter Information Council leaflet called ‘Butter… the natural choice’ in 1982.
The confusion can be absolute. Someone wrote to the Advertising Standards Authority to complain about some butter advertising, presenting evidence drawn up by the Royal College of Physicians as proof, only to be told that the College was an ‘interested party’ whose evidence could not be considered impartial. It wasn’t explained exactly what their ‘interest’ might be.
PR companies, of course, do no more than you’d expect. But when the Oats Information Bureau turns out to be funded by Quaker Oats and the Committee for Responsible Nutrition is just another gathering of health food manufacturers like Booker McConnell (see Box), you begin to worry. Even the worthy-sounding British Nutrition Foundation gets 98 per cent of its money from food companies. And an international Food and Agriculture Organization/World Health Organization symposium on the use of hormones as growth promoters in beef production was ‘generously funded’ by the Paris-based Roussel Uclaf company, manufacturer of - you guessed it - the biggest-selling artificial hormone implant in Europe. It’s hard to find a nutritionist who isn’t personally or, through his or her department, indebted to some manufacturing interest. The register of British MPs interests only reveals a few members with directorships or financial interests in the food industry. But a cursory glance at Hansard reveals many more who are ‘honorary advisors’ to this or that company.
As a researcher in quest of truth I begin to feel terribly alone. If every source has an axe to grind who can I turn to for impartial advice? The government perhaps? Well it doesn’t have a very good track record either. There is a continuing ping-pong match played between the Ministry of Agriculture, Fisheries and Food (MAFF) and the Department of Health and Social Security (DHSS) when it comes to food.
Take a typical example: salt. It has been established that hypertension - high blood pressure - is a contributory factor to heart disease. Around ten per cent of the whole population suffer from it, and 20 per cent of people over the age of 40. Half of those who have high blood pressure don’t know it because they’ve never taken their complaint to a doctor. No one disputes any of these assertions. Nor is there much controversy about the fact that people with high blood pressure can ameliorate their symptoms by reducing their salt intake. What is debated, however, is whether a high salt intake causes high blood pressure.
It isn’t surprising that this is a matter of dispute. The World Health Organization has recommended that a daily intake of five grams per day is about right. But at present British consumption averages out at 12 grams a day. Only 30 per cent of that is actually added by the individual shaking it onto his or her food. Simple arithmetic shows that, even if we were to reduce the salt we add ourselves to zero, we would still, on average, be taking in nearly double the WHO recommendation.
Where does the other 70 per cent come from? Manufactured foods: soups, gravies, burgers, meat products, bedtime drinks. Bedtime drinks? That’s right. And breakfast cereals. An average helping of All Bran in the morning would give you just about your entire five fram allowance. Any you consume during the rest of the day is excess. It’s in bread, beans and biscuits. Another doctor friend wondered why so many of his F-Plan diet devotees were showing increased blood pressure… until he discovered the diet’s salt content. Admittedly food manufacturers aren’t deliberately trying to give us heart disease. They use salt simply because we’re used to it, it’s strong - and it’s cheap.
With so many official question marks over. our level of salt consumption, you might think the government would say something to guide us or the manufacturers. Wrong! I go to the Department of Health, They say, ‘Not us. MAFF is the leading ministry on food’. I ring MAFF. ‘Have any of your committees ever considered making recommendations to the Minister to control the use of salt in manufactured foods?’ ‘No’, they say, ‘we wouldn’t consider it because we only consider artificial additives to food. Salt is natural. We might think about it on health grounds if prompted by the Department of Health.’ Back to the DHSS. ‘We aren’t considering salt by itself,’ they say, ‘but we do have a committee looking at the overall subject of diet and heart disease and it will no doubt be mentioned in that’. Meanwhile the DHSS pamphlet, Eating for Health, which purports to give reasonable advice to the public, just says to be ‘moderate’ in salt intake. It doesn’t even say what ‘moderate’ is It’s a well-trodden road for the Ministries. In 1979 a group of experts was assembled under the title of the National Advisory Committee on Nutritional Education (NAGNE). Including representatives from the Health Education Council, the Department of Health, the British Nutritional Foundation, MAFF, the food industry and local authorities, the NACNE committee set out to respond to a call for simple, accurate information on diet and nutrition.
A draft report was produced in 1980 by a subcommittee of experts headed by Professor Philip James. It recommended a cut in overall fat intake of ten per cent and a 15 per cent cut in consumption of animal and dairy fats. Sugar was also recommended to be cut by nearly half and salt by a quarter.
The initial response - even from the DHSS representatives - was positive. I’ve seen their letters of commendation myself. But then the implications began to sink in. And the sugar and dairy industries began to put on pressure. Successive drafts of the report reveal how the recommendations became more and more dilute and hint at battles that must have been fought between James and his fellow committee-members.
James felt that it was vital that the report be published as a set of officially-endorsed nutrition guidelines for use in hospitals, schools, factories and the catering industry. Community dieticians could use it to back up their advice to caterers and consumers. The food industry could use it to design new products that would conform with ‘healthy’ intakes of fat, sugar, dietary fibre and salt. With such wide-ranging benefits in mind, he was prepared to dilute some of its conclusions.
But in the spring of 1983 it was announced that - even after being so diluted by concessions to the food industry, which had already made some of the figures absurd (the ‘objective’ of reducing sugar intake by ten per cent instead of the 50 per cent stated in the first draft is actually less than the fall in actual consumption anyway) - the report would not be officially endorsed after all. In October 1983 it was published as a mere ‘discussion document’.
The fate of the NACNE report compares very unfavourably with the example of Sweden. Here the government brought food manufacturers and nutritionists together to agree upon a national nutritional policy. Perhaps in Sweden journalists can be more confident in the authenticity of some of the data they receive, rather than taking everything with liberal sprinklings of (hyper tension-producing) salt.
*John Forsyth is a journalist working on BBC Radio Four’s Food Programme.