Salt and the primrose path

Perhaps because of its English origin, the image of a primrose path leapt to mind when I read about the UK's Food Standards Agency this week announcing a second round of "more challenging" sodium targets for British food manufacturers. The theory is that if people eat foods lower in sodium they will lower their overall sodium intake. The theory's beguiling simplicity is easy to embrace rather than the "steep and thorny way" of rigorous science.

William Shakespeare immortalized the expression in Hamlet where Ophelia warns her brother Laertes against succumbing to libertine indulgence, the feel-good path, if you will. Rather, she suggests, he practice what he's preached to her ("reck not his own rede"). Groups claiming to represent good science in pursuit of noble social causes should heed Ophelia's advice to "reck their own rede" and put science foremost.

Do not, as some ungracious pastors do,
Show me the steep and thorny way to heaven,
Whilst like a puffed and reckless libertine
Himself the primrose path of dalliance treads,
And recks not his own rede.
Hamlet, act 1, sc. 3, l. 47-51

The image of this enjoyable garden pathway, so easy to traverse, but ultimately leading to misery, not heavenly bliss, is the modern reading of Shakespeare's dialogue. Most people would think of the primrose path as being a path ease and pleasure; the easy path out of a hard situation. It implies that those taking the enjoyable stroll down the path do so in ignorance, and those who lead others down the primrose path deserve condemnation for misportraying the journey as easy, since it will not lead to the desired destination and leave the travelers in a desparate situation.

So it is with the new FSA targets. Remember, the objective isn't to have an enjoyable stroll through food choices, the idea is to use those choices to reach the goal of improved health.

We don't subscribe to the notion that healthy diets must be filled with unpalatable choices; just the opposite. But a quality diet, especially in society today, isn't a primrose path where choosing the foods that look, smell and taste best are always the best for you. FSA has persuaded food manufacturers to reduce the salt level of their foods; that was the first round of targets. Food companies were eager to please and removing a portion of salt seemed like a stroll in the garden. Now comes the second round. Tougher targets. Challenging to technologists. Closer to the line on food safety.

Worse, although British consumers have played along and added more low-sodium foods to their shopping baskets, the British diet has the same amount of salt in it that it had 20 years ago (and, probably a good deal longer than that). The Intersalt Study published in the British Medical Journal in 1998 confirmed sodium intakes of about 150 mmol Na; the same as it is today (and in the middle of the same consistent intake range that has endured ever since we've had the technology to measure it).

Small wonder that FSA feels it needs a second round of tougher targets. It has made no progress to date. Food manufacturers should be warned that if they haven't recognized their situation as a classic "primrose path" they will eventually make the connection. Perhaps it will be the still more agressive targets of round three or round four. To paraphrase the expression: "Beatings will continue until morale improves." Targets will continue to tighten until public health responds.

Guess what? Public health IS responding, FSA just doesn't recognize the response. They are looking for sodium intakes to fall. Ain't gonna happen. But if they looked at total food intake, they'd find that the sodium-calorie ratio IS responding to their stimulus. Britons are choosing more low-sodium foods, but their intakes take their marching orders from their unconscious brain, not their conscious behaviors. They are following their hard-wired salt appetite and just eating more calories to get the salt their brains are signaling they need.

The "brains" at FSA are wrong. The brains in our bodies are, by design, right. Taking the easy primrose path and foresaking the "steep and thorny" path of scientific integrity is the wrong path. Thanks, Ophelia. I'm sure her father, Polonius, would endorse her pre-trip advice to his son Laertes just as he added his own: "To thine own self be true." Let's be true to the science and shun the primrose path.

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