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World Health Organization Says We Seriously Need to Cut Back on Salt

World Health Organization Says We Seriously Need to Cut Back on Salt

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Americans are addicted to salt. Tell us something we didn’t know.

We can’t get enough of salt. So it really isn’t that surprising that, as a nation, we’re consuming too much sodium. According to a recent four-nation study by the World Health Organization, which polled 16,000 people in the United States, U.K., France, and Mexico, only .5 percent of participants had enough potassium and didn’t overdo the recommended daily sodium intake.

WHO guidelines recommend consuming 2,000 milligrams of sodium and 3,510 milligrams of potassium daily. To put that in perspective, a Chipotle carnitas burrito tips the scale at 2,390 milligrams of sodium. According to the survey, the worst offender is the U.K., which had .1 percent of compliance with potassium and sodium guidelines. The U.S. participants had .3 percent compliance. These results sound pretty scary, but another team of scientists is calling WHO out on its impossible guidelines. After all, that’s less than a teaspoon of salt per day.

"The problem is that sodium and potassium are found in many of the same foods," Dr. Adam Drewnowski, a professor of epidemiology who directs the Center for Public Health Nutrition at the School of Public Health at the University of Washington, told Science Daily. "Milk has sodium in it, so if you want to reduce your sodium intake you can drink less milk. But milk also has potassium, so if you want to increase your potassium intake, you have to drink more milk. So you cannot have a recommendation that tells you to reduce the amount of sodium you eat by two thirds and to double the amount of potassium you take in."

Sounds like a real catch-22. However, increasing your potassium intake while reducing your salt intake even moderately couldn’t do any harm (and will also significantly lower your chances of heart disease).

When You Stop Eating Salt, This Is What Really Happens To Your Body

When you stop eating salt, quite a few things happen, as we often eat plenty of it in our day-to-day lives. Although you might not realize it, salt is one of the most important ingredients when it comes to cooking tasty food. Learning how to season properly is an art form — too little salt means the flavor won't pop, and too much salt will overwhelm the dish. Additionally, salt can be used to preserve food for extended periods of time, making it an even more essential cupboard staple.

But as important as salt is, consuming too much of it can pose a wide variety of health risks, according to Harvard University. Combine that with the fact that most Americans consume far too much salt on a daily basis, according to the CDC, and it becomes apparent that we have a bit of a problem on our hands. To that end, it can be a good idea to be conscious of your salt intake and reduce it to a healthier amount.

What sorts of physical changes can you expect when you decrease your sodium intake? Read on to find out what happens to your body when you stop eating salt — specifically table salt.

Making Sense of the Salt Shaker

The best way to lower your sodium intake is to cook from scratch as much as possible: Three-quarters of the sodium in the U.S. diet comes from dining out and prepared and processed foods, while only 5% comes from salt added during the home-cooking process and 6% from salt added at the table, according to the Centers for Disease Control and Prevention.

New guidelines to reduce salt in Americans’ diets have left many cooks in a pickle (a high-sodium snack, by the way).

Many home cooks wonder how to tell if the amount of salt they habitually use is unhealthy and how they might cut back. Professional chefs also are befuddled by the changing advice. “Are we all going to be tasked with hiring somebody to come in and test salt levels?” asks chef Marco Canora of the New York City restaurant Hearth. Salt isn’t something that is often measured, he says. “Cooks in kitchens salt-taste and add a lot á la minute.”

The Food and Drug Administration released new draft guidance for reducing salt in commercial and processed foods in June. The recommendations call for Americans to reduce their sodium intake to 2,300 milligrams a day, compared with the current daily average of 3,400 mg. People who have hypertension, or are at risk for it, should reduce their intake even further to 1,500 mg a day, the FDA says.

This summer, New York City put fines into effect for chain restaurants that fail to comply with a citywide regulation requiring menu warnings for items with 2,300 mg of sodium or more per serving.

To put that in perspective, there are 2,300 mg of sodium in a teaspoon of table salt.

Everything We Thought We Knew About Salt and Health Was Right

An interview with health policy advocate Michael F. Jacobson about the decades-long struggle to regulate dangerous levels of salt in the food supply.

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Unlike sugar and trans fats, we might accept salt in our food as a human necessity, an ancient mineral that conveniently boosts flavors in bland fare.

But we’ve been fed a line about sodium chloride. That’s what Dr. Michael F. Jacobson claims in his new book Salt Wars: The Battle Over the Biggest Killer in the American Diet.

For decades, Jacobson has worked with the Center for Science in the Public Interest — a group he helped found — to advocate for tighter health regulations on American food, writing a heap of books along the way advising on the science behind nutrition.

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It might seem as though scientists just can’t make up their minds about the health effects of a salt-heavy diet, but Jacobson says the conflicting messages are a mix of junk science and industry deception. He argues that science has long confirmed that we consume too much salt, leading to unnecessarily high rates of cardiovascular disease, and his book tracks the half-century-long fight between “Big Salt” and health advocates — like himself — seeking to reduce the stuff in our food. Jacobson says it’s finally time to cut the salt in our food by one-third and act on the facts we’ve known all along.

The Saturday Evening Post: How do you defend the science you put forth in your book? Is there a scientific consensus that sodium consumption is too high?

Michael F. Jacobson: There has long been a consensus that we should reduce sodium intake to reduce the risk of heart attacks and strokes. The consensus is reflected in statements from organizations like the U.S. Department of Health and Human Services, the World Health Organization, and the American Heart Association. These are not organizations that take risky positions or base their statements on flimsy evidence. Typically, in fact, they wait far too long to tell the public to do one thing or another.

In contrast, the “opposing side” — if you want to put it that way — has a comparative handful of studies that have been criticized for basic flaws from the day they were published. At this point, I hope that the debate over salt has ended. Last year the National Academy of Sciences issued a report that summarily dismissed those contrarian studies as being basically flawed. They dismissed them with a sentence, citing the other evidence that has long been mainstream.

SEP: You write about the “J-shaped curve” — the finding that lower salt intake also results in a high risk of cardiovascular disease — as the basis of a lot of these “contrarian” theories around salt. What do you make of the science behind it?

Jacobson: It’s junk. The PURE studies [Prospective Urban Rural Epidemiology], which have been the most widely publicized as showing that consuming less salt could be harmful, are based on taking one urine sample from a number of participants at the beginning of the study. One sample. It’s not even a 24-hour collection, which is the standard for measuring sodium intake. The next assumption they make is that one sample is representative of a person’s lifetime consumption, but it’s not. Maybe that person ate out that day, or maybe they had cancer and were barely eating. People have long criticized that research, but in the last few years two studies completely debunked it.

Last year, the NAS did a report on sodium and cardiovascular disease. They did a meta-analysis of the best studies that involve 24-hour urine collections and found the expected linear relationship. They dismissed the PURE studies and others that found the J-shaped curve, as fatally flawed. I hope that ends the controversy.

A few years ago, Congress said the government shouldn’t take action to reduce sodium until the NAS did a study to look at sodium’s direct relationship to cardiovascular disease. Well, now they have done that study, concluding that lowering sodium is beneficial and not harmful.

SEP: How would you say that news media figures into the controversy around diet science like this?

Jacobson: I don’t understand why health journalists have given unwarranted credence to the PURE studies and their predecessors, because they’re so contrary to what the bulk of the research says. I think they, starting with The Washington Post and The New York Times, have been really irresponsible. Maybe it is an example of “man bites dog” to some extent. I bet editors love those stories that publicize the contrarian view, especially when the researchers are at respected institutions.

In the case of the PURE studies, they’re not tainted with industry funding. Rhetorically, it’s easier to shoot down studies that are funded by the snack food industry or something. But I’m really puzzled, and many other people in the field of hypertension and cardiovascular disease are shocked that those [PURE] researchers continue to get funding for that kind of research, and that respected publishers — like the Lancet or British Medical Journal — accept these studies. They certainly confuse the public.

The same phenomenon has taken place on a whole range of public health issues of great importance. With the lead industry — defending lead in gasoline — it goes back 100 years. Typically, it’s industry either sponsoring the research, or, if the research is independent, then ballyhooing the research that supports their views, saying, now government can’t act until we do studies that may be impossible to do.

With salt, there’s been a “moving of the goalposts.” Thirty years ago, the evidence was clear that increasing sodium intake increased blood pressure, and increased blood pressure then increased the risk of cardiovascular disease. Almost every researcher agreed then that raising salt increased the risk of cardiovascular disease, but after a couple of studies contrarians said that those conclusions couldn’t be coupled, that we had to prove directly, with randomized controlled studies, that raising sodium increases the risk of cardiovascular disease. Those studies are almost impossible to do. A few studies (I mention them in Salt Wars) provide some evidence, but they’re all limited in one way or another. But the American Heart Association and the WHO and others say that that research is totally unnecessary, they are certainly not funding the research, and we have far more evidence than we need to call for policies to reduce salt in the food supply and diet.

The thrust of the bulk of the field is to say, let’s reduce sodium throughout the food supply to “make the healthy choice the easy choice.” There are studies showing that if you start with lower-sodium foods and add salt, you’ll generally end up with less salt than what we see in most of our foods now.

SEP: You’ve been involved in health advocacy for many decades. What have you seen change in industry and policy as far as the American diet is concerned?

Jacobson: With salt, the policy battles began in 1969 when the White House Conference on Food, Nutrition, and Health said that sodium in the food supply should be lowered. At that time, and currently, the Food and Drug Administration considers salt to be “generally recognized as safe,” and could be used in any amount. But on the basis of the existing research back in 1978, we [Center for Science in the Public Interest] petitioned the FDA to adopt regulations to lower sodium, and top researchers supported the petitions.

A few years later, the FDA in the Reagan administration was headed by a hypertension expert, and he said that we should lower sodium by taking a voluntary approach and that if industry didn’t lower sodium, he would mandate it. That commissioner left the agency after two years, and meanwhile industry did next to nothing. Then, CSPI focused on getting sodium labeling on all foods, and we helped get the nutrition labeling law passed, which mandated labeling like the Nutrition Facts labels that list sodium on all packaged foods. So we waited to see whether labeling would reduce sodium intakes, and when I looked at it 10 years later I saw that, no, it didn’t seem to have any effect. Sodium consumption stayed the same. So in 2005 we re-sued the FDA and filed a new petition. By then, the evidence was far greater that sodium boosted blood pressure. But the government did nothing. So we then succeeded in getting Congress to fund the NAS to do a study on how to lower sodium intakes.

In 2010, the NAS published a landmark report saying the FDA should mandate lower sodium levels in the food supply, but the FDA commissioner immediately said they would push again for voluntary reductions. It took a while — six years in fact — for the FDA to come up with voluntary targets for lowering sodium in packaged foods. That was in June 2016, just months before the Obama administration left office, so clearly there was not enough time to finalize those targets.

Four years later, the Trump administration still has done nothing. Absolutely nothing. Although, two years ago, the FDA commissioner Scott Gottlieb — who’s been in the news about COVID-19 — said that reducing sodium is probably the single most important thing the FDA could do in the nutrition world. Unfortunately, he left office a few months later and the FDA did nothing.

It’s been 10 and a half years since the NAS called for mandatory reductions in sodium, and the last time that the CDC looked, in 2016, there had been no change in sodium intake in 30 years. At this point, I think the most we can hope for is the implementation of those voluntary targets. The FDA chose targets that would lower sodium to recommended levels — if all food manufacturers complied, which they won’t — in 10 years. In 10 years, a lot of people are going to be dying unnecessarily.

SEP: What was the Salt Institute? Would you characterize it in the same way that people think of the tobacco lobby or the oil lobby?

Jacobson: Steven Colbert said that the Salt Institute shouldn’t be confused with the Salk Institute, because the Salk Institute cures polio while the Salt Institute cures hams. That got a laugh from the audience [when Jacobson was a guest on Comedy Central’s The Colbert Report in 2010]. The Salt Institute was long a lobbying group set up by salt manufacturers, like Morton Salt and Cargill.

In the book I call it “the mouse that roared.” It was a small organization — five or six staff members and an annual budget of about three million dollars — but they were real tigers when it came to defending salt. Any time people criticized sodium levels in the food supply and recommended changes, the Salt Institute would be out there with vitriolic statements, pamphlets, interviews. They generated a large amount of press that I think contributed significantly to muddying the waters. They made much of that J-shaped curve theory, that reducing sodium dramatically could actually increase the risk of heart disease. But in March of 2019, they abruptly went out of business, and no one, to my knowledge has explained why.

SEP: Since the Salt Institute has disbanded, do you see an opening for salt regulation?

Jacobson: Well, the Salt Institute was never the real powerhouse. The major player was the mainstream food industry, including Kellogg’s, General Mills, McDonald’s — all the big companies, through their trade associations, and especially the Grocery Manufacturers Association. The industry kind of begrudgingly went along with voluntary reduction, but when the FDA proposed action, they nitpicked almost every single number in the FDA’s proposal. The butter and cheese industries wanted their products entirely dropped from the plan. Surprisingly, at the beginning of 2020, the Grocery Manufacturers changed its name [to Consumer Brands Association], changed its focus away from nutrition labeling and nutrition issues in general. The two main lobbying groups essentially withdrew from the playing field.

That certainly should make it easier for the government to take stronger action on sodium. But will it? I don’t know. Many of those big companies will lobby on their own. The snack food industry has SNAC, frozen food companies have the Frozen Food Institute, pickle makers have Pickle Packers International, restaurants are defended by the National Restaurant Association, and the meat industry has the North American Meat Institute. It’s hard to know how the disappearance of those two groups will affect things but making progress won’t be a cakewalk.

Between voluntary and mandatory approaches, the voluntary approach rewards companies that don’t do anything. I talked to one official at Kraft Foods, and he said that Kraft has tried to reduce sodium, but its competitors didn’t, so Kraft felt it had to go back and restore the salt. The advantage of mandatory regulation is that it provides a level playing field for companies that want to do the right thing.

SEP: Looking at the whole scope of the last 50 years or so, what would you say makes it so difficult for the U.S. to make and pass policy regarding dietary health?

Jacobson: It’s the power of industry. But also, much of the public sees a smaller role for government compared to countries in Europe, for example. Here, we have a culture of “rugged individualism.” There’s a feeling that people can lower their sodium intake if they want, a much more voluntary, individual approach.

In contrast, the British government, in the mid-2000s, adopted recommendations to lower sodium and backed that up with a pretty aggressive public education campaign. Then they used the bully pulpit to press industry to lower sodium. Within five years, the UK achieved a 10 to 15 percent reduction in sodium intake, compared to a goal of 33 percent reduction. But after a change in government, the new government lost interest.

Chile, Mexico, Israel, and a couple of other countries have passed laws requiring warning notices on packaging when foods are high in calories, saturated fat, sodium, or sugar. These are put on front labels and are very noticeable. In Chile, the law has been in place long enough to measure some results. There have been a significant number of products that have lower sodium, sugar, or fat content to escape those warning labels. That has been the most effective policy I know of to lower the sodium content in foods and presumably to lower sodium intake.

SEP: Have we seen better health outcomes in Chile as well?

Jacobson: It’s too early to know. Something like cardiovascular disease takes so long to show up. There are also so many other things going on in Chile that come into play.

SEP: Do we see sodium affecting communities differently in the U.S.? For instance, African-American communities?

Jacobson: African Americans seem to be more salt-sensitive than whites. They also have higher rates of hypertension. African-American women have much higher rates of obesity. So, when you couple obesity with hypertension, that’s a formula for cardiovascular disease. But every subgroup of the population ends up with hypertension. By the time Americans are in their 70s and older, 80 to 90 percent have hypertension. That’s why people should lower their sodium intake, lose weight, and avoid too much alcohol, to avoid gradually increasing blood pressure.

SEP: What would a lower sodium diet look like for a lot of people?

Jacobson: Packaged foods and restaurant foods would be lower in sodium. At restaurants, portions would even be smaller. There would be little effect on taste. Let me remind you that no one is saying that industry should eliminate all salt. Rather, it’s lowering salt as much as possible without destroying the taste of the food, and maybe replacing some of the salt with flavorful ingredients.

Using less salt is the cheapest, easiest thing to do. Another way is to replace salt with potassium salt. It doesn’t taste as salty, but it helps counteract the blood pressure-raising effect of a high-sodium diet. Companies can also add more real ingredients and herbs and spices. For home chefs, McCormick, Chef Paul Prudhomme, and Mrs. Dash sell salt-free seasonings. The classic study is the DASH-sodium study. It’s a randomized controlled study — the best you can do — done by researchers at Harvard, Johns Hopkins, and elsewhere. They lowered sodium by one third, from 3,400 mg, the current average daily intake, to 2,300 mg, the recommended intake, and they found that people consuming the 2,300-mg level of sodium liked the food even more than the higher level! So, I think concerns about taste are completely overblown. People quickly get accustomed to less-salty foods.

SEP: What are some personal decisions that people can make to decrease their sodium intake?

Jacobson: Sodium levels in the food supply will not drop to healthy levels instantly, no matter what the FDA does. In the meantime, consumers have to protect their health. When you’re eating processed foods, you should compare labels, because there is wide variation among different brands of the same or similar foods. Swiss cheese has one-fifth or less of the sodium in American cheese, and you can make a perfectly good sandwich with Swiss cheese. For that sandwich, you can also choose a lower-sodium bread. Bread, because we consume so much of it, turns out to be one of the major sources of sodium. You can make lots of modest changes to achieve major reductions in sodium.

We should also be cooking more natural ingredients from scratch. That invariably results in lower-sodium foods, because we’re controlling the salt. The third thing is to eat out less often. Restaurant foods have huge amounts of sodium, especially table-service restaurants like IHOP or Chili’s. That’s partly because the portions are enormous. The more food you eat, the more sodium you consume. From a chef’s point of view, the two magical ingredients are salt and butter. And it’s not just chain restaurants. Chefs have generally not been trained to lower sodium. The best thing you could do is to cook at home from scratch using lower-sodium recipes.

I mentioned how some companies are using potassium salt, and consumers can use it too. Look for “lite salt” at the supermarket. Morton and other companies sell this, and half of the table salt has been replaced by potassium salt, so you automatically cut back when you’re cooking or sprinkle it on your meal.

SEP: Looking back at the last year of presidential debates, moderators always ask a question about the biggest issue facing Americans, and I’ve never heard a candidate say that it’s salt. So, what would you say to people who think we have bigger problems and salt just isn’t that important?

Jacobson: We do have other pressing problems. Tobacco is killing a lot more people than salt. But high-sodium diets are killing tens of thousands of people each year. Health economists and epidemiologists estimate that if we can cut our sodium intake by one-third to one-half, that would prevent 50,000 to 100,000 premature deaths every year. We’re seeing the same thing around the world, where high-sodium diets are causing more than one million deaths a year. I see salty diets as the cause of a pandemic.

We have to deal with COVID-19, that’s the immediate pandemic. High-sodium diets are harmful over a longer time frame. But our society really needs to take these problems seriously even though the deaths are not immediately linked to the cause. An airplane crash kills 300 people and that gets a lot of attention, and it should. But with public health crises, where deaths are less easily associated with the cause, solving the problem is easily postponed, especially when industry stands to gain by not solving the problem. High-salt diets are absolutely something that political leaders need to address.

Featured image: © 2020 The MIT Press, Photo by Chris Kleponis

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From the Newsletter: A Word on Salt

If you’re reading this, please raise your hand if you’ve heard the phrase “Americans eat too much salt” or, alternatively, that we should “cut back our salt intake”? Show of hands? Ah, yes- seems like everyone has heard that or even possibly said that perhaps.

However, what does the evidence say about salt intake and chronic disease? The current World Health Organization’s (WHO) recommendation is that we take in 2000-2400mg of sodium per day, with some organizations like the American Heart Association suggesting that we should take in <2000mg of sodium per day. For reference, sodium and salt are not the same thing- 1 gram of salt has 400mg sodium.

Briefly, salt is made up of both sodium and chloride so salt intake is not equivalent to sodium intake. For context, the average daily sodium intake in the US is

3400mg per day, which is about 7-10g of salt per day from all dietary sources combined. Interestingly, sea salt tends to have about 10% as much sodium in it as table salt- though admittedly there are many different formulations available and different concentrations. One could argue that sea salt is not a good “salt-substitute” and that, potentially anyway- we don’t need to be substituting for salt anyway.

The Institutes of Medicine (IOM)- now termed the National Academy of Medicine, one of the big public health recommendation organizations, did a review in 2013 and concluded that

“The evidence from studies on direct health outcomes was insufficient and inconsistent regarding an association between sodium intake below 2,300 mg per day and benefit or risk of CVD outcomes (including stroke and CVD mortality) or all-cause mortality in the general U.S. population.”

Basically, there is no good evidence to support the WHO’s recommendation for the general population. Interestingly, there are additional studies reviewed by the IOM in their analysis that suggested potentially negative outcomes to eating too little sodium. An editorial comment on the review remarks:

“The evidence supports a strong association of sodium with BP and cardiovascular disease events in hypertensive individuals, the elderly, and those who consume > 6 g/d of sodium. However, there is no association of sodium with clinical events at 3 to 6 g/day and a paradoxical higher rate of events at < 3 g/day.”

In short, it looks like there’s a sweet spot of sodium intake at 3-6g/day, which is basically where most Americans fall into. Athletes are a whole different story too, as sodium losses from vigorous exercise can exceed 17g per day. That would require on the order of 30+ gallons of Gatorade to replace, but because the sodium concentration is diluted by all the fluid, this can cause worsening hyponatremia (low salt in the blood) and be fatal, as evidenced by two HS football players who died this past year from trying to replace salt with tons of Gatorade.

The current recommendation by the American College of Sports Medicine (ACSM) is to take 500-700mg of sodium per liter of fluid pre and post workout, which seems about right to me for a good place to start- though this needs to be modified for the individual. It appears that most who train seriously will become hyponatremic (have low salt as measured by blood tests)- though asymptomatic– after training and this may alter future performance. This is especially true for those who do not eat a lot of processed foods, as their sodium intake is lower to begin with.

There also appears to be some performance benefit by replacing salt appropriately, though this is most certainly not with pills, Gatorade or similar, or La Croix…lol. Think more like bouillon cube or salting most meals that are consumed, which effectively deals with this nicely in folks who train once daily.

It should be stated that some with high blood pressure (e.g. the salt sensitive folks), those with congestive heart failure, or other cardiovascular abnormalities should know the above does not necessarily apply to them.

Overall, this whole topic is filled with lots of caveats and interesting points. My main takeaway is that for a non hypertensive, non CHF patient, who eats a diet composed of minimally processed foods- they would likely be better served by adding table salt to most meals and their pre and post workout nutrition.

Dr. Fauci Said This Idea of "Herd Immunity" is An Elusive One, So Stop Watching the Clock

"You gotta be careful because that's kind of an elusive terminology," Dr. Fauci said of "herd immunity." "You get as many people vaccinated as you possibly can, and you can turn around the dynamics of the outbreak. So we don't want to get stuck on this type of a terminology. It's important, but we can go a long way before we get there." He said America will be safer if we can get as many people vaccinated as possible.

Here’s what the latest science says about MSG

Despite the extensive number of symptoms reportedly linked to MSG, the FDA says that MSG is safe. Other health authorities including the World Health Organization, Health Canada and the Federation of American Societies for Experimental Biology agree. What’s more, one recent review study concluded that there is inadequate evidence to support many health concerns surrounding MSG, pointing out that much of the research has used doses of MSG that far exceed what people normally consume.

That doesn’t, however, mean everyone can eat MSG-containing foods problem-free. Research suggests that for a small number of highly sensitive people MSG may trigger the same symptoms listed above. As unpleasant and scary as these reactions may be, medical experts don’t consider them to be dangerous. It can also be helpful to know that they’re generally short-lived, starting about 20 minutes after eating and clearing up within two hours.


Food Nutrition facts labels just got a big makeover – can you spot the difference?

On the flip side, there may be an unsung positive for MSG. Because it’s so flavorful, it may actually help food manufacturers reduce the amount of sodium they would normally add to foods. And don’t be misled by the “sodium” in its name. “MSG has two-thirds less sodium compared to table salt,” said Amidor. “So it’s a nice seasoning to use if you’re trying to cut back on sodium, especially since it can increase the depth of a dish by adding umami flavor.”

In the end, if you’re one of those people who is MSG sensitive, it makes sense to avoid it. For everyone else, there’s no need to stress about it.

World leaders must 'take tobacco much more seriously' to achieve development goals

In order to cut premature death rates, the world's politicians need to focus on "simple measures" like anti-tobacco policies, cutting salt levels in food, and improving access to affordable heart disease drugs, according to experts writing in The Lancet today.

The report focuses on preventing 'non-communicable' diseases, or NCDs – i.e. cancers, heart disease, strokes, chronic lung diseases, and diabetes.

Rates of these diseases – which are often linked to lifestyle – are set to soar across the developing world in coming decades.

According to recent estimates, 34.5 million people died from NCDs in 2010, representing two-thirds of the 52.8 million deaths worldwide that year.

In May 2012, the World Health Organisation (WHO) committed to reducing preventable NCD deaths by 25 per cent by 2025.

But in order to make this reality urgent action is needed, the panel of international experts said.

The key is to regard health not as a "goal" of development, but "an instrument to bring it about," according to Sir George Alleyne, Emeritus Director of the Pan American Health Organization and contributor to the report.

"Any realistic attempt to make human development sustainable must take NCDs into account."

That means regulating the marketing of tobacco, alcohol, and 'ultra-processed' food and drinks, said Professor Rob Moodie from the University of Melbourne.

"These companies say they're part of the solution, but the evidence says otherwise. They should have no role in formulating health policy. Put it this way – you wouldn't let a burglar change your locks," he added.

According to the report, there is growing evidence that multinational food, drink and alcohol manufacturers are adopting similar strategies to tobacco industry to undermine public health policies. They should thus be similarly regulated, argue the authors.

Tobacco is the most important preventable cause of cancer, but the disease is also linked to obesity, high alcohol consumption and poor diet.

Policymakers also need to focus on equal access to healthcare, including vaccines and drugs – particularly cheaper generic drugs which could "prevent or treat most NCDs".

Hazel Nunn, Cancer Research UK's head of evidence and information, welcomed the report.

"Cancer is often seen as a disease of the richer world, but just over half of the 12.7 million people diagnosed every year live in less developed countries, and this proportion is rising fast," she said.

"This new report is an important and timely reminder to keep non-communicable diseases high on the global political agenda. Just like the other major NCDs, cancer is a social and economic issue as well as a health issue, and requires strong and joined-up action."

"The Framework Convention on Tobacco Control has given policymakers much-needed guidance in setting national anti-tobacco agendas. This new report suggests that the time may be right to mirror this approach in other areas, particularly alcohol and 'ultra-processed' food and drinks," she added.

What Sugar Does To Your Body

I am a sugar addict. A child of the ’80s (gotta love Jem and Ghostbusters ), sugar was in absolutely everything we consumed. Sugary cereal was a dream, packaged fruit snacks were a must squeeze-it bottles in every lunch, happy meals for the weekend—you know, because we all ate the same way.

At twenty-three, fresh out of culinary school, I retired from my modeling career and moved on to television, hosting shows on Lifetime, E! and TLC. I judged on shows like Iron Chef America and Beat Bobby Flay and traveled across the country for shoots. The way I was eating—sweetened yogurt, sugary creamer in my coffee, sneaking cookies and processed cereal bars between takes, drinking sweetened lattes and fraps from Starbucks, not to mention eating out a lot —began to add up, and the subsequent inflammation was causing my skin to break-out. Worse still, we were shooting in HD, which made it really, really hard for me to hide my breakouts from the camera and my colleagues.

More and more, research is showing us that inflammation is the root cause of many of our health problems. The bummer for each of us is that added sugar is lurking in almost everything we like to eat: pasta sauce, dressings, bread, and yes, all those bottled juices fronting as “healthy”—they’re simply the opposite.

As a professionally trained chef, I thought people who cut sugar from their diets were totally insane! Plus, I wrote clean cookbooks for a living and judged TV cooking competitions . I couldn’t cut out sugar! Could I? Over the past year, I began to taper off sugar (you’ll see how below) in the hopes that I would gain more energy, boost my immunity, and reap all the rest of the rewards that we’re now being told come with a lower-sugar diet.

The World Health Organization recommends consuming less than 10% of your daily calories from added sugar—5% for “additional health benefits.” In practical terms, according to the American Heart Association, that’s 25 grams of sugar (6 teaspoons) for women and 37.5 grams (9 teaspoons) for men. My friend, registered dietician and nutritionist Keri Glassman, notes that most American’s get two- to three-times that amount. (Yikes!)

I remember the first few weeks of my sugar experiment being seriously tough. I love my dark chocolate! But I was committed to my cause. The one thing I knew I could control if I wanted to cut sugar was the way I nourished myself at home. I blended my own smoothies (seriously, those smoothies and juices in the fridge at your grocery store and gym are packed with sugar—just read the labels), I paid close attention to the nutrition information of the ingredients I was buying, and ate out much less. Simply cooking for yourself can improve your whole life.

I started to feel much better. My energy levels soared. Best of all? My skin started to clear up—it was also tighter, firmer, and less oily—and I began to see that elusive glow. Today, with the help of a few tips and tricks (and recipes!) I’ve shared below, I’m proud to say I’ve managed to keep added sugar to a minimum and detox my diet. If someone had told me years ago that it was my sugar-filled diet that was causing my breakouts and inflammation in my body all along, I would have saved myself from years of suffering. And that’s why I’m sharing my story with you—so you don’t have to go through the pain and the embarrassment, so you can reclaim your health on your own, by simply cutting down on the sug!

Candice’s Sugar Detox Guide

When setting out to cut down on sugar, remember to take it one day at a time. Also, this isn’t about all or nothing: For example, don’t worry so much about cutting down on fruit (according to a recent report from the World Health Organization, natural sugars found in fruit haven’t been linked to adverse health effects). Instead, focus on cutting out all of that processed, added sugar—bottled juices and smoothies, packaged cookies, chips, and crackers, soda, candy, cereal, bread, granola, yogurt, any kind of processed bars (protein, granola, chocolate), sweetened latte crap, and stop using that gross bottled sugary French vanilla creamer in your coffee! The easiest way to track your sugar intake? Read food labels and start cooking more at home. Remember, cooking during your sugar detox is also empowering! To help you, I’ve come up with an easy guide, plus a few sugar-free recipes that will satisfy your cravings while you cut down on the bad stuff.

  • Purchase only whole foods at the grocery store and toss out the processed stuff. You may find yourself shopping more often, but you’ll end up saving money by cooking more at home
  • Pay attention to food labels!
  • Aim to consume 20g or less of added sugar each day
  • Cook for yourself, blend your own smoothies, and pack lunches!
  • Make a delish and low-sugar dinner, like tofu and broccoli rabe over quinoa or a full meal arugula salad with adzuki beans, roasted veggies and top off with hemp seeds.
  • Make your own dressings, marinades and sauces
  • Enlist a friend or family member to cut down on sugar with you you’ll keep one another supported and encouraged

Best snacks whilst cutting down on sugar:

  • Raw almonds
  • Avocado with a touch of lemon and Tamari
  • Raw cashews
  • Homemade Kale Chips
  • Organic edamame, 1 cup
  • Pistachios, handful
  • Popcorn, air popped with tabasco or coconut oil + sea salt
  • I add a few drops of stevia to my smoothies, or my oatmeal etc. when needed
  • My favorite protein powders are naturally sweetened with monk fruit
  • I eat a handful of delish berries like raspberries, blueberries, blackberries and strawberries when I need to get my sweet fix on.

Here are some of my fave Sugar Detox Recipes to keep you full on nutrition, not sugar!

Breakfast: Greek Yogurt & Amaranth Berry Porridge

A new trend, from ancient times is arising, grain porridge – aka hot cereal – in the am. Try everything from quinoa to sorghum to amaranth or even teff. Just cook your grains with a delicious, unsweetened coconut or almond milk, add a touch of berries and low sugar Greek yogurt, and you have the perfect morning starter to a fabulous day! Total bonus? Some of these grains like quinoa and amaranth are also gluten-free! Yippee!

Recipe from Candice Kumai’s Clean Green Eats


1 cup amaranth (Gluten-free grain, naturally!) you can also opt for oatmeal or quinoa

1 cup unsweetened coconut milk beverage or unsweetened almond milk

1 cup mixed berries (I love blueberries, strawberries and blackberries – did you know strawberries are low in natural sugar?)

2 tablespoons unsweetened almond butter, natural (optional) for protein!

2 tablespoons 2% Greek yogurt

1. In a medium saucepan, boil the two cups water and 1 cup coconut milk beverage or almond milk. When water boils, pour in the amaranth and reduce heat to a light simmer and add ¼ teaspoon sea salt. Cook for approximately 20 minutes or until a porridge like consistency forms.

2. When the amaranth is all cooked through, pour into two bowls. Top with 1 tablespoon each of the almond butter, if using, yogurt or any additional toppings. Take your instagram photo, and then mix it all to eat! Top each bowl with your choice of mixed berries and almond/coconut milk if desired. Sprinkle with some flax seed meal! Enjoy for a delicious fiber and protein filled power breakfast this weekend! YUM!

Lunch/Dinner: Macrobiotic Hijiki-Avocado Salad

Macrobiotic foods are naturally clean and detoxifying and low in sugar—they are plant-based and include sea vegetables, local produce, healthy grains, and fermented foods. Seaweed, naturally full of iodine, Vitamin C, manganese, and Vitamin B2, is clean eating’s best friend! I like to prepare my heritage-inspired macrobiotic meals after a period of food indulgence, such as the holidays or a vacation, as a way of resetting and balancing my body. Try this salad in your week of clean eating and you’ll love the way you look and feel!

Recipe from Candice Kumai’s Clean Green Eats


1 cup soaked/reconstituted hijiki seaweed,*drained (measure: 1⁄4 cup + 1 tablespoon dried hijki with 3/4 cup water)

2 cups cooked quinoa

One 15-ounce can adzuki beans, rinsed and drained

1 ripe avocado, pitted and cut into cubes

For the Dressing:

2 tablespoons Bragg Liquid Aminos or reduced-sodium tamari soy sauce

1⁄4 cup rice vinegar

1 tablespoon toasted sesame oil


In a medium bowl, soak and reconstitute 1⁄4 cup, plus one tablespoon dried hijiki in 3/4 cup water for about 15–20 minutes. Drain all excess liquid.

In a large bowl, whisk together the Bragg Liquid Aminos or reduced-sodium tamari soy sauce, rice vinegar, and toasted sesame oil. Add the reconstituted hijiki, quinoa, and adzuki beans to the dressing, and toss to coat. Top with avocado cubes and serve immediately.


Adzuki beans (also referred to as azuki beans) are a delicious Japanese red bean that is packed with protein, potassium, and fiber. I love tossing these beans with rice, adding them to my full-meal grain salads. Cook with more no-sugar legumes and beans, this summer and fall!

Meal Replacement/Snack: Blueberry Almond Smoothie

Definitely an intermediate-level smoothie, this beautiful blueberry blend is full of real and clean low-sugar ingredients that will help you glow.

Recipe from Candice Kumai’s Clean Green Drinks


2 cups unsweetened almond milk

1 cup kale or baby spinach

3 tablespoons unsweetened almond butter

2 cups frozen blueberries

2 tablespoons chia seeds (optional)


Add ingredients into a blender and blend until smooth.

Meal Replacement/Snack: Chocolate Morning Wake-Up Smoothie

Chocolate does a body good – but most chocolate bars and milkshakes add so much additional sugar! With all the benefits that cocoa powder and cacao nibs can bring into your life, I’ve created a recipe that still allows for some chocolate cravings but keep you sugar-free! Your taste buds can thank me later.

Recipe from Candice Kumai’s Clean Green Drinks


1 cup unsweetened almond milk

1 cup baby spinach

2 tablespoons unsweetened cocoa powder

1 tablespoon green superfood powder

2 tablespoons cacao nibs (optional)

Stevia drops to sweeten

1 cup ice


Add ingredients into a blender and blend until smooth.

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The first on our list is perhaps the most obvious culprit, but despite numerous studies backing up the negative effects both diet and regular soda have on your body, our pros say it's shocking how much of it people drink. "This is not a benign food!" says Carissa Bealert, RD and co-owner of Evolution Fitness Orlando. "Artificial sweeteners and aspartame in diet soda in particular can mess with our body's regulatory system. Plus, soda doesn't nourish you. It doesn't give your body anything at all." In addition to excess calories, studies have linked soda to tooth decay, headaches, increased risk of type 2 diabetes, and decreased bone health. And despite its name, diet soda is no better: researchers at the University of Texas found that in the course of a decade, diet soda drinkers had a 70% greater waist circumference than non-drinkers. To quit a soda habit, Bealert suggests overloading your glass with ice. The soda will be diluted, and you can steadily wean yourself off. If you still need a little extra something, Bealert suggests zero-calorie sparkling water with natural flavors.

8 Denying yourself all treats

Deciding to manage weight by never eating so-called ‘naughty’ foods again? Good luck with that! Yes, there’ll be some things you can live without but, for most of us, being able to enjoy the occasional treat is a more sustainable health strategy than total deprivation. ‘It comes back to the mantra: everything in moderation,’ says Helen. ‘I’m a great believer in the 80/20 rule, whereby if 80 per cent of the time you eat a healthy diet, you can enjoy treats 20 per cent of the time.’

Get back on track

Eat treats mindfully: focus on what you’re eating and savour each mouthful. This will help make food more satisfying, which means you’ll be less likely to overeat.

Watch the video: WHOs Science in 5 on COVID-19: Breastfeeding u0026 COVID-19 (June 2022).


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