The link between salt intake and high blood pressure has been known for decades. That’s why, if you have high blood pressure, your doctor will tell you to reduce your salt intake. The reason is that excess salt makes your body retain more water. And more water in your circulation means more fluid in your vascular pipes, making the pressure in the pipes higher. That’s also why one of the first line treatments for high blood pressure is a diuretic, a drug that makes your kidneys release more water into the urine. It’s one thing to put down the salt shaker and also reduce (or eliminate) your consumption of salty snacks. But there is a hidden source of salt we often don’t think about — the salt in processed foods. When you are cooking raw food you control how much salt you add. But you are not in control of how much salt is in processed foods, such as prepared things you might get in the frozen food section or out of a box. Food companies add quite a bit of salt to these since the perception is that doing so makes the foods tastier. Do they need to do that? How much different would foods taste if they didn’t? A recent study gives some answers to those questions.
The research was published in a recent edition of the British Medical Journal. The investigators used a national survey database to look at changes in the incidence of high blood pressure, stroke, and heart attacks over the past decade and found improvements in all of these. There are several possible explanations, including better treatment for these conditions. However, the investigators also had access to urinary salt values in many patients. The improvement particularly in blood pressure correlated with lower salt consumption. Of note, since 2003 the amount of salt in processed foods has been gradually reduced in the United Kingdom. Overall salt consumption fell by 15%. It is reasonable to conclude that at least part of the reduction in cardiovascular disease they observed was because of this salt reduction.
Although it would be difficult to accomplish, I don’t see any reason such improvements couldn’t be carried out in the USA. From everything we know, particularly high blood pressure is a long-term killer, and most people with it don’t know they have it because blood pressure needs to become very high before a person has any symptoms that would bring them to the doctor.
Anyone who has worked in a hospital knows that there are a lot of treats around. These include cakes, cookies, and — most prized — boxes of candy, usually chocolates. Most of these are brought in by appreciative patients’ families and, in my experience, are always intended to be shared among the staff. The contents disappear quickly. A fun little paper in the British Medical Journal entitled “The survival time of chocolates on hospital wards” examines how fast they go.
The authors worked at three different hospitals in the United Kingdom. They placed two unopened boxes of chocolates (without revealing their origin) in each of four different patient care wards. They then kept these boxes “under continuous covert surveillance” to see what happened. They used two common UK brands — one by Cadbury and another by Nestle. The tongue-in-cheek use of clinical study language is probably the most fun part of the whole thing.
The median survival time of a chocolate was 51 minutes (39 to 63). The model of chocolate consumption was non-linear, with an initial rapid rate of consumption that slowed with time. An exponential decay model best fitted these findings (model R2=0.844, P<0.001), with a survival half life (time taken for 50% of the chocolates to be eaten) of 99 minutes. The mean time taken to open a box of chocolates from first appearance on the ward was 12 minutes (95% confidence interval 0 to 24). . . . The highest percentages of chocolates were consumed by healthcare assistants (28%) and nurses (28%), followed by doctors (15%).
These findings are in accord with my own experience. Nurses and heathcare assistants get the first bites owing to their increased access opportunities. Passing doctors, if they are lucky enough to be there when the box is opened, may get first crack, but generally they rank further back.
I wasn’t familiar with the chocolate brands and if the contents were the same, but I’d add my own observations on what disappears first from a mixed box. The caramels always go first, followed by anything crunchy. Those cream filled items, especially if the filling is fruity, are the last to go — they can languish for hours. Sometimes it’s difficult to tell what’s inside an individual chocolate. I’ve actually turned over a prospective candidate chocolate to find that the bottom has been pierced with a needle by an ingenious person to see what the filling was, then replaced because the findings were apparently unsatisfactory.
Also in my experience, hospital workers whose job entails covering several units or wards (such as respiratory therapists) often have acute antennae for detecting an open box of chocolates and make multiple passes through those particular areas, nipping one with each pass. Also in my experience, dieticians rarely partake. That is to be expected, I suppose.
A recent study by the Commonwealth Fund highlights what Americans experience in what passes for our healthcare “system” — higher costs, higher risks, and more stress. You can read about it on Chris Fleming’s excellent Health Affairs blog here, or else see the full study published here, in the journal Health Affairs.
The study surveyed eleven countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Survey samples sizes per country ranged from 1,000 to more than 3,500. From Chris Fleming’s blog, here’s a taste of a few things the survey showed.
• Twenty percent of US adults surveyed said they had had serious problems paying medical bills in the previous year. Responses to the same question from the other ten countries were all in the single digits. US respondents were also significantly more likely than adults in other countries to have gone without care because of cost.
• Thirty-five percent of US adults had out-of-pocket medical spending of $1,000 during the previous year, a far higher percentage than in any other country.
• Nearly one third of US adults (31 percent) reported either denial of payments by insurers or time-consuming interactions with insurers, a higher rate than in all other countries. Twenty-five percent of US respondents reported that their insurance company denied payment or did not pay as much as expected; 17 percent said they spent a lot of time on paperwork or disputes for medical bills or insurance — the highest rates in the survey.
• The United States had the widest and most pervasive differences in access and affordability by income of the eleven countries. The United Kingdom had the least.
We didn’t finish last in everything, at least — patients in Canada, Norway, and Sweden reported longer waits on average to see the doctor. But the key point to me is that America spends far, far more per capita on healthcare than any other country. For what we’re paying, we should get the best. We’re not. And those costs just have to come down — they’re unsustainable.