The Man Who Ate Everything (24 page)

Serge Renaud of INSERM (the French equivalent of NIH, our National Institutes of Health), in Lyons, told me that any advantage wine-drinking countries have in the coronary sweepstakes probably comes from the fact that wine is usually drunk slowly with meals and not hastily, with a handful of pretzels, in some dimly lit bar; food slows the absorption of alcohol into the bloodstream, which may, according to a paper Renaud is about to publish, be ideal for decreasing the tendency of the blood to clot. Binge drinking may work just as well as slow drinking on your HDLs, but not on your platelets. Renaud might also have added that wine-drinking countries generally show the highest consumption of alcohol.

Research continues on chemical compounds found in the skins of wine grapes that may find their way into red wine but not into white, which is made without the skins. Resveratrol is produced by grapes and other plants to ward off fungal infections and has been reported in Japanese research to lower cholesterol in rats; a paper on resveratrol by two fruit scientists at Cornell will be published by the time you read this. Another treasure in the skins of vine grapes (and yellow onions) is quercetin, which has
;
owerful antitumor and anticlotting effects in the laboratory. But
it will be years before researchers figure out how much of either substance actually enters our bloodstreams after we drink red wine and what effect they may have in our bodies.

Now that you know more about why alcohol protects the heart, how will this change your life? In the course of poring over hundreds of papers and abstracts, I became increasingly convinced that doctors who refuse to recommend a drink or two a day should be liable for medical malpractice and that the surgeon general, with her completely one-sided warning label, should be censured.

Now I’m not so sure, except about the surgeon general. Most health officials feel that publicizing the positive effects of alcohol would do more harm than good because of the dangers of both heavy drinking and alcoholism. As one doctor wrote, “Our inability to recommend [alcohol] is attributable not to the properties of alcohol but to the properties of human nature.” But saving a handful of potential alcoholics may be heavily outweighed by the coronary benefits of sanctioned drinking.

Three groups should be careful about even moderate drinking: anybody who is about to drive an automobile, people who have had an alcohol problem (or even a family history of alcoholism), and some women.

Women at high risk for breast cancer should be especially careful; this includes women with a family history of early breast cancer and those who did not have children before the age of thirty. Only 4 percent of women die of breast cancer (compared with 38 percent for heart disease and 10 percent for stroke). And there is no evidence that
occasional
drinking (one to three drinks a week) raises the risk of breast cancer. But breast cancer does strike in the prime of life, while heart disease threatens women mainly after menopause.

Pregnant women should also be cautious, given the effects of alcohol on the fetus. But almost nothing is known about the effects of light alcohol intake during pregnancy. Most research has been done with severely alcoholic women; an occasional drink does not appear to be a problem.

People who have stopped taking one or two drinks a day because they believed that alcohol was hazardous to their health, and particularly bad for their hearts, can certainly resume, especially if it brings them pleasure. Anybody like me who currently averages one or two drinks a day should feel elated and smug. And if you don’t drink now but don’t know why, you might begin by taking a few sips of good red wine or old malt Scotch. A little alcohol now and then has always made the world a more endurable place.

April 1992

The Yanomamo Indians of northern Brazil have the most famous blood pressure in the world because it is the lowest. You can hardly read an article about blood pressure these days that doesn’t drag in the Yanomamo Indians of northern Brazil. I am amazed that the Yanomami can stay so calm surrounded by giant bugs, snakes, and investigators forever taking their blood pressure, which at last report averaged an amazingly low 95 over 61. The average blood pressure in the United States is 120 over 80— halfway between the Yanomami and hypertension, which is another word for high blood pressure and starts at 140 over 90. A fifth of all Americans are hypertensive, but none of the Yanomami are. This is lucky for the Yanomami because high blood pressure multiplies your chances of having a heart attack, kidney disease, or a stroke.

The Yanomami eat incredibly tiny amounts of salt, and we eat lots of it, which has led some doctors to imagine that eating salt causes hypertension. The Yanomami consume about 87 milligrams of salt a day, which occurs naturally in their food and equals two shakes from a standard saltshaker. This minuscule amount, among the lowest in the world, is explained by the Yanomami’s isolation from commerce, the briny sea, and mineral salt deposits. Americans eat 12,000 milligrams of salt a day, about! 266 shakes, most of it added in cooking and processing.

(The weight of an average shake has, to my knowledge, never before been investigated. To compute it, I loaded my salt-shaker with 15 grams of salt, counted 330 shakes before it was empty, did it again for accuracy’s sake, reached the same result, divided 330 shakes into 15 grams and arrived at 45 milligrams per shake.)

Does eating salt cause high blood pressure? Mankind has a great deal riding on this question, because—no matter what some people may tell you—salt is indispensable to good food and good cooking. It sharpens and defines the inherent flavors of foods and magnifies their natural aromas. Salt unites the diverse tastes in a dish, marries the sauce with the meat, and turns the pallid sweetness of vegetables into something complex and savory. Salt also deepens the color of most fruits and vegetables and keeps cauliflower white. Salt controls the ripening of cheese and improves its texture, strengthens the gluten in bread, and can preserve meat and fish, while transforming its texture. Cooked without salt, most dishes taste dull, lifeless, and lacking in complexity; in some, flavors are unbalanced and sweetness predominates, according to Michael Bauer in a terrific article on salt in the August 30, 1989,
San Francisco Chronicle,
reporting in part on a series of blind taste tests that he and Marion Cunningham had arranged. And in a recent issue of
Cook’s
magazine, a vast majority of America’s leading chefs lined up behind the culinary value of salt. As Robert Farrar Capon has put it, “To undersalt deliberately in the name of dietary chic is to omit from the music of cookery the indispensable bass line over which all tastes and smells form their harmonies.”

There are thirty-five low-salt cookbooks on the market today. Most of them substitute heaps of herbs, spices, garlic, and onions for salt. When you try these recipes, the food tastes mainly of herbs, spices, garlic, and onions instead of what you wanted for dinner in the first place, like a nice plump four-pound chicken rubbed with a tablespoon of poultry fat and then a teaspoon of salt and roasted at 425 degrees for ninety minutes until the skin
is golden and crackling and the juices run rich with flavor. Be sure to baste every ten minutes.

We are probably the first generation since the beginning of the world to be paranoid about salt. We would all die without salt. It is the only mineral we eat straight out of the ground. Salt was venerated in primitive cultures and exchanged as money where it was scarce. Our blood and our bodies are as salty as the seas from which life emerged, which may explain cannibalism in places where salt is in short supply. The earliest roads were built to transport salt, the earliest taxes were levied on it, military campaigns were launched to secure it, and African children were sold into slavery for it. Salt gave Venice its start in the sixth century as the commercial capital of Europe, caused the French Revolution, nearly defeated Mao Tse-tung, and helped Gandhi bring India to independence.

Because we need salt to live, we are genetically programmed to crave it starting four months after we are born. Salt phobics argue that since only a fifth of a gram of salt a day—200 milligrams, or a medium-large pinch—is absolutely essential to our survival, anything more than that must surely be excessive. This reasoning is absurd. How much music or poetry a day is essential for our survival? How much sex do we absolutely need to propagate the species? How much salt must we eat to survive, and how much do we need to have a very nice day? Every human society with easy access to salt eats forty times the minimum, and the reason is simple. Salt gives us pleasure by making food taste better. Then, after dinner, our bodies eliminate the salt we don’t need. That is why God gave us kidneys.

Even lowering your intake to 500 milligrams of sodium a day, about 10 percent of the American average, would involve exquisite torture. First of all, you would have to eliminate all processed foods—canned, frozen, and packaged—which account for at least a third of the salt in our diet. Canned peas or a frozen side dish of rice can contain a hundred times the salt in raw peas and rice. A cup of fresh corn has only 7 milligrams of sodium, but a cup of
canned creamed corn has 671, more than your allowance of sodium for an entire day; a serving of canned soup contains one full gram of sodium, two days’ supply. An ounce of cornflakes contains as much salt as the same amount of salted peanuts.

Even after you eliminate processed foods and salt added in cooking or at the table, you will still be eating double or triple your 500-milligram sodium ration. That’s because many foods are inherently salty, like dairy products (an ounce of cottage cheese is saltier than a bowl of thirty potato chips), breads, spinach, celery, Swiss chard, seafood, turnips, kale, and artichokes. If you want to eat a wide range of foods, you will have to leach out the salt and most of the taste from these vegetables by boiling them in distilled water. (In some places, tap water is too salty for a 500-milligram diet.) And meat is considerably saltier than vegetables.

If salt caused high blood pressure, the average American would be hypertensive, which is not the case. I eat all the salt I want, much more than the Yanomami do, and my blood pressure is slightly below normal. My wife’s is even lower—not much different from the Yanomami—and she eats what I do because I do all the cooking. American vegetarians generally have lower blood pressure than American carnivores, yet both take in about the same amount of salt.

The Yanomami differ from Americans in many ways besides salt. They are very skinny, they drink absolutely no alcohol, they are geographically isolated and therefore genetically distinct, and they get lots of exercise under the lush leafy canopy of their Brazilian rain forest, where automobiles are extremely scarce. The Solomon Islanders used to be almost as popular among salt phobics as the Yanomami—until they were brought into the modern age and their blood pressure rose. But this was not attributable to salt. Obesity and lack of exercise were identified as the causes.

It was while contemplating the vacuous taste of an unsalted potato chip that I decided to read through the medical research
about salt and hypertension from the past decade or so and find out why America’s public-health establishment gets so steamed up about it. Having done so, I still can’t understand what the fuss is all about. The animal studies are completely inconclusive-some animals are sensitive to salt; others are resistant; some get high blood pressure when they are stressed; others do not. One research group managed to raise the blood pressure of healthy laboratory rats only by feeding them an 8-percent-salt diet, the equivalent of two cups a day for you and me. Clinical studies with human beings have never shown that salt can cause hypertension in healthy people. At worst, salt can exacerbate hypertension in some of those already afflicted with it.

Nineteen eighty-eight was the year of the great salt showdown, the massive and rigorous Intersalt study. Fifty-two centers were established in thirty-two countries around the world, from Argentina to Zimbabwe (the Yanomami were included, of course, along with three other isolated Stone Age peoples), and 10,079 subjects in all were tested. Each was measured for a small number of variables: blood pressure, sodium and potassium excretion (which in healthy people is an accurate measure of sodium and potassium intake), age, alcohol use, height, and weight. All urine samples were flown to a central lab in Belgium; some samples were split in two and tested separately, and the results were compared to gauge the lab’s consistency. All measurements were sent to London, entered twice into a computer, and the double entries compared to ensure accuracy. Never before has such care been taken in a blood pressure study of this size and geographic scope. Funding came from the World Health Organization, heart associations around the world, the U.S. government, and a British foundation.

The results were extremely distressing to those who had hoped to prove a link, once and for all, between salt and blood pressure. The four hunter-gatherer cultures did show extremely low salt excretion and extremely low blood pressure. But the researchers could find no significant link in the rest of the world between salt and hypertension.

The Yanomami eat bananas and starchy roots all day; you need to go to such extremes to lower your blood pressure through diet. Nearly everybody in the modern world eats between 2 and 5 grams of sodium a day (1 to
2
^l
/2
teaspoons of salt). Tinkering with your salt intake in this range will not affect your blood pressure. As the Harvard Medical School
Health Letter
concluded about the Intersalt study: “It seems unlikely that salt intake is a major influence on the development of hypertension in most of the world’s populations.”