The high national health costs that hypertension, stroke, and other salt-related diseases inflict in the form of medical and hospital expenses and lost work lives have now motivated some governments to mount long-lasting national campaigns to help their citizens decrease their salt intake. But the governments quickly realized that they couldn’t achieve that goal without enlisting the cooperation of the food industry to reduce the amounts of salt added by the industry to processed foods. The reductions have been gradual ones of just 10% or 20% less salt added to foods every year or two—a reduction too small for the public to notice. The UK, Japan, Finland, and Portugal have operated such campaigns for between two and four decades, resulting in the decreases in salt intake and consequent reductions in national medical costs and improvements in national health statistics that I already mentioned.
Are we citizens of industrial nations thus helpless pawns in the hands of food manufacturers, and is there little that we can do to lower our salt intake and blood pressure except to pray for an effective government anti-salt campaign? Actually, there is a big step that you can take besides avoiding use of salt-shakers: you can eat a healthy diet high in fresh foods and low in processed foods—specifically, a diet high in vegetables, fruits, fiber, complex carbohydrates, low-dairy products including cheeses, whole grains, poultry, fish (yes, you can eat fatty fish), vegetable oils, and nuts, but low in red meat, sweets, sugar-containing beverages, butter, cream, cholesterol, and saturated fats. In controlled experiments on volunteers, such a diet, termed a DASH diet—Dietary Approaches to Stop Hypertension—markedly lowers blood pressure.
Perhaps you’re already thinking: “There’s no way that I’ll subject myself to a tasteless low-fat diet and destroy my pleasure in food, just in order to live 10 more years! I’d rather enjoy 70 years filled with great food and wine than 80 years of tasteless low-salt crackers and water.” In fact, the DASH diet is modeled on the so-called Mediterranean diet, with a luscious fat content of 38%, getting its name from the fact that that’s what Italians, Spaniards, Greeks, and many French people actually eat traditionally. (That fat of the DASH and Mediterranean diets is high in so-called mono-unsaturated fat, the type of fat that is good for us.) Those people aren’t eating crackers and water: they’re enjoying the greatest cuisines of Western civilization. Italians, who spend hours every day consuming their glorious pastas, breads, cheeses, olive oils, and other triumphs of Italian kitchens and farms, are still on the average among the slimmest people in the Western world. At the same time, we Americans, whose diet is anything but Mediterranean, have on the average the biggest waistlines in the Western world. One-third of adult Americans are obese, and another one-third of us are “merely” overweight, but we don’t even have the consolation of knowing that it’s the price we pay for the pleasures of Italian cuisine. You, too, can enjoy great food and be healthy.
Diabetes
Western diets that are high in sugar and in sugar-yielding carbohydrates are to diabetes as salt is to hypertension. When my twin sons were still too young to have learned healthy eating habits, taking them to a supermarket meant for my wife and me traversing a gauntlet of sweet dangers. Among breakfast foods, my kids were tempted by the choice between Apple Cinnamon Cheerios and Fruit Loops, respectively 85% and 89% carbohydrate according to their manufacturers, with about half of that carbohydrate in the form of sugar. Boxes picturing the famous turtles with Ninja powers seduced children to ask for Teenage Mutant Ninja Turtles Cheese Pasta Dinner, 81% carbohydrate. Snack choices included Fruit Bears (92% carbohydrate, no protein) and Teddy Graham’s Bearwich chocolate cookies with vanilla cream (71% carbohydrate); both listed corn syrup, as well as sugar, among their ingredients.
All of these foods contained little or no fiber. Compared with the diet to which our evolutionary history adapted us, they differed in their much higher content of sugar and other carbohydrates (71% to 95% instead of about 15% to 55%) and much lower protein and fiber content. I mention these particular brands, not because they are unusual, but precisely because their content was typical of what was available. Around the year 1700 sugar intake was only about 4 pounds per year per person in England and the U.S. (then still a colony), but it is over 150 pounds per year per person today. One-quarter of the modern U.S. population eats over 200 pounds of sugar per year. A study of U.S. eighth-graders showed that 40% of their diet consisted of sugar and sugar-yielding carbohydrates. With foods like the ones I just mentioned lurking in supermarkets to tempt kids and their parents, it’s no wonder that consequences of diabetes, the commonest disease of carbohydrate metabolism, will be the cause of death for many readers of this book. It’s also no wonder that we readers suffer from tooth decay and cavities, which are very rare in the !Kung. While living in the 1970s in Scotland, where consumption of pastries and sweets was prodigious, I was told that some Scottish people had already as teen-agers lost most of their teeth due to tooth decay.
The ultimate cause of the many types of damage that diabetes wreaks on our bodies is high blood concentrations of the sugar glucose. They cause the spilling-over of glucose into the urine: a manifestation from which stems the disease’s full name, diabetes mellitus, meaning “running-through of honey.” Diabetes isn’t infectious or rapidly fatal, so it doesn’t command press headlines, as does AIDS. Nevertheless, the world epidemic of diabetes today far eclipses the AIDS epidemic in its toll of death and suffering. Diabetes disables its victims slowly and reduces their quality of life. Because all cells in our body become exposed to sugar from the bloodstream, diabetes can affect almost any organ system. Among its secondary consequences, it is the leading cause of adult blindness in the U.S.; the second leading cause of non-traumatic foot amputations; the cause of one-third of our cases of kidney failure; a major risk factor for stroke, heart attacks, peripheral vascular disease, and nerve degeneration; and the cause of over $100 billion of American health costs annually (15% of our costs due to all diseases combined). To quote Wilfrid Oakley, “Man may be the captain of his fate, but he is also the victim of his blood sugar.”
As of the year 2010, the number of diabetics in the world was estimated at around 300 million. This value may be an underestimate, because there were likely to be other undiagnosed cases, especially in medically undersurveyed countries of the developing world. The growth rate in the number of diabetics is about 2.2% per year, or nearly twice the growth rate of the world’s adult population: i.e., the percentage of the population that is diabetic is increasing. If nothing else changes in the world except that the world’s population continues to grow, to age, and to move to cities (associated with a more sedentary lifestyle and hence increased prevalence of diabetes), then the number of cases predicted for the year 2030 is around 500 million, which would make diabetes one of the world’s commonest diseases and biggest public health problems. But the prognosis is even worse than that, because other risk factors for diabetes (especially affluence and rural obesity) are also increasing, so that the number of cases in 2030 will probably be even higher. The current explosion in diabetes’ prevalence is occurring especially in the Third World, where the epidemic is still in its early stages in India and China, the world’s two most populous countries. Formerly considered a disease mainly of rich Europeans and North Americans, diabetes passed two milestones by the year 2010: more than half of the world’s diabetics are now Asians, and the two countries with the largest number of diabetics are now India and China.