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Lo Salt respond to draft NICE Hypertension guidelines

Making sense of the salt debate for the benefit of the UK population

Information about the population’s salt intake has been gaining the media’s attention recently but the public, along with the health and food industries, are still no clearer about reducing sodium levels. Policymakers now need to provide cohesive and accurate guidance so the public can make informed decisions on their salt intake to improve their health.

Ahead of the imminent green paper from Secretary of State for Health and Social Care, Matt Hancock, which is expected to progress the government’s vision that “prevention is better than cure” into actual policy, we want to highlight a story making headlines in last week’s newspapers.

The story, based on research published in The Lancet, has put salt consumption once again at the forefront of the nation’s health debate thanks to coverage in the Independent, Daily Telegraph, Metro, The Sun, the Daily Mirror as well as the BBC and Sky News.

The key facts LoSalt take from this extensive study in The Lancet [130 scientists working across 195 countries, gathering data across more than 27 years] include:

• “improvement of diet could potentially prevent one in every five deaths globally”
• “dietary risks affected people regardless of age, sex, and sociodemographic development of their place of residence”
• “suboptimal diet is responsible for more deaths than any other risks globally, including tobacco smoking”
• “Although the impact of individual dietary factors varied across countries, non-optimal intake of three dietary factors (whole grains, fruits, and sodium) accounted for more than 50% of deaths”

There is no debate that reducing the population’s salt consumption will reduce the global burden of disease.

Where once our sodium reduction programme was seen as world-leading, sodium reduction in the UK has actually slowed. As published by PHE in the Salt Progress Report December 2018 - in 2005/6, when sodium reduction work started, daily intake was 8.8g per day, in 2014 this had only reduced to 8g per day, less than 1g in nine years.Whilst a new assessment of current salt intake for adults is underway and is expected to be published in 2020, it is clear there is significant work still to be done in achieving a further reduction of 2g to reach the daily target of 6g.

For that reason alone, it has never been so important for the population to be guided to make the right salt choices in all its sources: at home, processed foods and out-of-home and this can only be achieved by providing sensible coherent information and real alternatives.

Disappointingly, NICE’s proposed update of the guidance to healthcare professionals, _Hypertension in adults, diagnosis and management_, has removed the application of common sense by revising the existing guidelines:

Changing:

“Encourage people to keep their dietary sodium intake low, either by reducing or substituting sodium salt, as this can reduce blood pressure” (ref. 1.4.6)

To:

“Encourage people to keep their dietary sodium intake low by reducing sodium salt, as this can reduce blood pressure.” (ref. 1.4.5)

NICE states the justification for the revision as: “Recommendation amended to remove ‘substituting sodium salt’ because of concerns about the risks of salt substitutes.”

These “concerns” are surely now historical following the government’s commissioned SACN/COT report, published in 2017, which states:

1. At a population level, the potential benefits of using potassium-based sodium replacers to help reduce sodium in foods outweigh the potential risks.
2. The beneficial effects at an individual level are likely to be small in size but will impact a large proportion of the population.

It is clear from data we have received this week [ref. AC Nielsen] that people’s eating habits are not going to change any time soon. The main headlines from this retail sourced research, looking at the total salt market (i.e. table/cooking salt, sea salt, rock salt, reduced sodium salt) are:

• Total weight salt sold Mar ’18 – Mar ’19 is the same as Mar ’15- Mar ’16 therefore no overall reduction (circa. 21.4k tonnes per annum)
• Volume of sea and rocks salts sold continue to rise, showing people are switching from table/cooking salt to these more premium products.

At LoSalt, we believe we should be educating the consumer and the food industry with accurate cohesive information so they can make informed choices when it comes to making reductions to their sodium levels to improve their health.

We should be championing the SACN report and highlighting that potassium-based sodium salts are perfectly safe to use, natural and won’t compromise on the taste for the consumer or the food industry, but ultimately they could make a big impact on the health of the population.