Simple advice to reduce salt intake

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The effect of dietary salt on health has caused much debate and a seemingly ongoing battle between the medical fraternity and the food industry.1 In the UK, more than the US, this appears to be being won by the medical establishment with a greater public awareness of salt consumption through government campaigns and improved food labelling.2 As yet, it is not clear whether these added measures have had a net effect in actually reducing sodium intake and although food products are being labelled more clearly, many continue to contain large amounts of added salt. The scientific data meriting reduced sodium intake also continues to mount. A Cochrane review states that in hypertensive patients a modest reduction in dietary salt intake over 4 or more weeks led, on average, to a decrease of 4.7 mmHg systolic blood pressure and 2.7 mmHg diastolic blood pressure, although it was unclear in this study whether the same reduction in salt intake lead to a decrease in cardiovascular risk or mortality.3 A subsequent study by The Trials of Hypertension Prevention Collaborative Research Group confirmed that reduced sodium intake lowers blood pressure in addition to the possible reduction of long-term cardiovascular events.4 With increasing evidence to recommend a reduced sodium intake the Food Standards Agency recommends that we should all aim to consume no more than 6 g of salt (2.5 g sodium) a day.2 This figure represents a compromise between the average daily UK consumption of (9–12 g) and what we actually need (1–2 g). With the mounting scientific data and government backing it is quite understandable that clinicians want clearer guidance as to how to translate methodology from successful trials into advice to a patient sitting in front of them in a consultation.5 Several of the published trials concluding that dietary salt reduction leads to a decrease in blood pressure do not give details of the advice that patients were given to reduce their overall salt intake. Other trials had tightly controlled diets where all meals in control and low-salt groups were provided for. Being able to extrapolate the results of these trials to public awareness and practice would be useful, providing the advice is both easy to understand and to follow. The first step must therefore be to put the reason for the intervention into context. Thus emphasising that even a modest (2 g) reduction of salt intake, over a relatively short period, can lead to a reduction in blood pressure, which could lead to a decreased incidence of stroke in the long term. We suggest that further advice can be delivered using a quick and easy acronym: S.A.L.T. (Box 1). Box 1 S.A.L.T. Stay away from processed foods Avoid adding salt to foods Look at sodium levels Try to eat a balanced diet