Graham MacGregor 盐与健康世界行动组织”主席、英国高血压学会主席
<International Circulation>: What are the areas you would like to see doctors investigating more?
《国际循环》：MacGregor教授您好！请问您希望医生能对哪个领域进行更多的研究？
Prof. MacGregor: There are two things that are more important， one is that we need better treatment of blood pressure， we know blood pressure is a major risk for strokes and heart attacks and we know that lowering it with drugs or life style changes is very important for lowering the number of people suffering from these adverse events， as well as heart failure. Yet we are very bad at delivering good blood pressure care so it is important to focus on this issue. The other very important thing is the public health approach in order to stop people from developing hypertension and lowering it in the whole population. This is where salt plays such an important role. We know that salt is the major factor that elevates blood pressure and we as a population eat far too much salt. If we ate a lot less salt then there would be far fewer people with high blood pressure， we would see a big reduction in strokes， heart attacks， and heart failure. We must now focus on reducing salt intake and at the same time think about how we could treat patients with high blood pressure better.
MacGregor教授：有两件事情非常重要，一件是我们需要更好的治疗高血压，我们已经知道高血压是中风和心肌梗死主要的危险因素而且我们还知道用药物或生活方式的改变降低血压对减少发生这些严重事件以及心力衰竭的患者数量非常重要。但是我们在推广良好的血压护理方面做的非常不好，因此这是一个很需要关注的问题。其他很重要的事情还有找到公共健康途径来预防人们罹患高血压并在整个人群中降低高血压的发病率。在这里盐起到了非常重要的作用。我们都知道盐是使血压升高的主要原因而且我们每日食用的盐太多。如果我们能吃更少的盐，那么罹患高血压的人群数量将远远比现在少，接着我们就会发现中风、心肌梗死和心力衰竭的发生率会显著降低。目前我们必须关注降低食盐摄取量并且同时思考我们如何才能更好地治疗高血压患者。
<International Circulation>: How do you get people to reduce salt intake?
《国际循环》：那么您有没有什么好的建议来帮助人们减少食盐摄入量呢？
Prof. MacGregor: It all depends on where the salt comes from in the diet. We are perhaps lucky， or unlucky rather， that nearly all the salt in our diets comes from the food industry. Nearly 80% of the salt we eat is already put in the food before we have any control. Nearly all the things you buy at the supermarket， when you eat out， go to the canteen， and fast food， that is where our salt comes from. Nowadays we don’t actually cook all that much so only about 15% of people’s salt intake comes from salt we add ourselves. The main target in western countries is to get the food industry to slowly reduce the amount of salt， most of which are totally unnecessary， put in our food. That has been very successful in the United Kingdom. We now have most of the products in the UK have been reduced in terms of their salt content by about 30%. Bread is the biggest single source of salt in our diet and all the bread in the UK has been reduced by about 30%. That means that everyone has a reduction in salt intake while still go on eating the same foods as normal. As much as we would like to we are not trying to change the diet of people， but rather just reduce the salt intake. The problem in Asian-Pacific areas， in particular northern China， is that most of the salt is added by the consumer. In this case you have to try to persuade the consumer to use less salt. This is much more difficult because you have got to persuade them that it is a toxic substance that is killing millions of Chinese， and I am quite serious that high salt intake is indeed killing millions of Chinese， that they have to stop using it in such large quantities. The beauty of that is that if you do start to slowly reduce salt intake people actually get used to food with less salt， salt taste receptors become more sensitive， and people will then much prefer food with less salt. We find that now in the UK and England that people prefer food with less salt more. When I’m abroad I find that the food is so salty that it tastes horrible. High salt foods is an acquired taste where people get used to eating so much salt that it becomes sort of addictive. It is necessary to wean people off of it slowly and get them to eat less salt.
MacGregor教授：这取决于我们饮食中的食盐来自于哪里。我们可能很幸运，或者说是更不幸运的是，我们饮食中几乎所有的食盐都来自于食品工业。我们食用的几乎80%的食盐在我们进行任何控制之前就已经加入到食品中了。你在超级市场中购买的几乎所有外带食物，你在室外、食堂吃的饭或者食用的快餐都是我们摄入食盐的来源。现在我们实际上并不像以前那样常常在家做饭，所以人们摄入食盐总量中只有15%来自于我们自己添加的食盐。西方发达国家主要的目标是让食品工业缓慢减少使用的食盐量，其中的大部分食盐是完全不需要添加到我们食品中的。这在英国中实施的很成功。现在英国生产的大部分食品的食盐含量下降了30%。面包是我们饮食中最大的食盐来源，英国所有的面包中食盐含量都减少了大约30%。这意味着人们在继续食用和平时一样的食物时食盐摄入量减少了。只要我们愿意，我们就能在不改变人们饮食的情况下减少食盐摄入量。亚太地区特别是中国北方的问题是，大部分的食盐是被消费者自己添加的。在这种情况下你不得不劝说消费者们减少食盐用量。这就很不容易做到，因为你必须劝说人们食盐是一种有害物质，能杀死成千上万的中国人，我非常认真的声明，高食盐摄入量真的是能导致成千上万的中国人死亡，所以他们必须停止使用如此大量的食盐。庆幸的事情是，如果你开始缓慢的减少食盐摄入量，就会逐渐习惯于更低盐含量的饮食。我们发现现在在英国和英格兰，人们更喜欢低盐含量的食物。当我去国外就会发现，食物非常咸，吃起来味道很可怕。高盐含量的饮食是后天获得的味觉，当人们习惯于使用大量食盐的时候就会对此表现出依赖。必须使人们缓慢戒掉高盐饮食并让他们习惯于食用低盐食物。
<International Circulation>: What are some tactics we could use in places where people are adding the salt themselves?
《国际循环》：那么您认为在那些人们自己添加大量食盐的地方我们用什么办法来促使他们减少食盐摄入量呢？
Prof. MacGregor: It is necessary to have a public health campaign telling them how dangerous it is and make it clear to them that they should be using less salt. Another way is to use a mineral salt， which is a mixture of sodium chloride， potassium chloride， and magnesium chloride. There is a salt company in Japan that already has a salt such as this available. It is possible that it would be better to use that one in place of regular sodium chloride. There have been studies in China showing that mineral salt substitutes does lower blood pressure. It may well be that this is another tactic that could be used to get people to replace regular salt with mineral salt. That would be a very quick way of changing things. Actually， potassium has the opposite effect on blood pressure than sodium.
MacGregor教授：很必要进行一场公共卫生运动来告诉他们摄入过量的食盐有多大的危害，并且让他们意识到自己应该使用更少的盐。另一种方法是使用矿物盐，矿物盐是一种氯化钠、氯化钾和氯化镁的混合物。在日本有一家盐业公司已经推出了这样的食用性矿物盐。用这种矿物盐来替代常规的氯化钠可能更好。在中国已经有研究显示用矿物盐替代普通食盐能使血压更低。很可能这是另一种使人们用矿物盐替代普通食盐的策略。这会是一种改变现状的快速途径。实际上，钾和钠在对血压的影响上具有相反的作用。
<International Circulation>: Are there any specific directions you would like to see Chinese researchers to take as far as reducing salt or how it precisely affects the body?
《国际循环》：请问您希望看到中国的研究者在那些特别的方面进行研究来减少食盐用量？或者在高盐饮食对我们身体影响的精确机制方面进行研究？
Prof. MacGregor: Not really， no. We know what salt does and how it affects blood pressure. What we really need in China is more research looking at where the salt is coming from， looking at the precise salt intake levels. At the moment there is a big salt study going on in Shandong Province looking at where salt is coming from in the diet with the goal of formulating a plan as to how to reduce it， then spreading that out through the whole of China. What I think would be good is to， overnight， switch to mineral salt in industry and supermarkets， withdrawing ordinary salt and everyone could just use the healthier substitute. With the right publicity this could rapidly stop thousands and thousands of people dying from strokes， heart failure， and kidney disease.
MacGregor教授：实际上没有。我们已经知道食盐会影响血压以及它如何影响我们的血压。我们需要在中国做的是更多的研究来发现这些食盐来源于哪里，发现精确的食盐摄入水平。此时在山东已经开始了一项重大的食盐研究来发现食用盐来源于饮食中的哪里，并致力于构建出一个如何减少食盐摄入量的规划，然后再把这项规划推广到全中国。我认为有益的是，这种方针突然转变到矿物盐工业和超市，回收所有的普通食盐，因此每个人都能使用这种更健康的替代品。只要宣传得力，就能快速减少成千上万因中风、心力衰竭和肾脏疾病死亡的患者。
<International Circulation>: Can you talk about the relationship between salt and capillary density?
《国际循环》：您能谈谈食盐和毛细血管密度之间的关系吗？
Prof. MacGregor: That is a separate issue about what salt does to capillary density. We know that in people with high blood pressure there is a reduction in the number of capillaries and a reduction in microcirculation. There is a reduction in the overall arteriole number and subsequent reduction in circulation and capillaries that go with the arterioles. The question is whether it is directly related to the blood pressure or is it some other effect. Now it is still unclear from the studies that we and others have done whether or not this decrease in capillary density is directly related to blood pressure. There is a lot of evidence in animal studies that salt may be an important cause of the capillary rarifaction. We did a study on effect of a reduction of salt in people with mild hypertension and showed very clearly that when there was a small reduction in salt intake in this very carefully controlled trial there was a big increase in capillary density. This certainly suggests that salt may have a direct effect on capillary density. Salt is not only putting up blood pressure but is having a lot of other dangerous effects as well.
MacGregor教授：食盐对毛细血管密度的作用是另外一个问题。我们知道高血压的患者毛细血管的数量会减少，微循环也会减少。在这些患者体内所有细动脉的数量减少并且随之出现循环以及和小动脉相连的毛细血管的减少。问题是这种情况是直接与血压相关还是由高血压的其他方面所引起。我们和其他研究者进行的研究到目前为止还不清楚是否这种毛细血管密度的降低与血压直接相关。在动物实验中发现了很多关于食盐可能是导致毛细血管减少的重要原因的证据。我们进行了一项研究观察了减少食盐摄入量对轻度高血压患者的作用，结果很清楚的显示在这个严格对照的试验中，当食盐摄入量少量降低时毛细血管的密度就会明显增加。这明确表示食盐可能对毛细血管密度有直接作用。食盐不仅升高血压而且还存在很多其他的危险作用。
<International Circulation>: There are many people in China who are trying to do studies on reduced salt intake and I know you have a lot of experience conducting these types of studies. What do you think is important for an effective study on reduced salt intake and controlling salt in a patient’s diet?
《国际循环》：中国有很多人正尝试进行减少食盐摄入量的研究，我们知道您在指导这样的试验中有很多经验。您认为在减少食盐摄入和控制人们饮食中食盐摄入量方面的有效研究中什么最重要呢?
Prof. MacGregor: The major thing is to get them to reduce their salt， which may seem obvious but it not easy to get people to use less salt and stick to it. You can do it for a few days but with the variations in how food is prepared and who prepares it it is difficult to adhere to a strict regimen of salt reduction. After a few weeks of sticking to a firm salt reduction plan the salt receptors adjust and become much more sensitive to salt. Then one much prefers food with less salt. When I got out to eat in Beijing I find the food far too salty. Once you get used to less salt and become more sensitive to it food with high amounts of added salt tastes metallic and just terrible. I would much rather taste the real fish， real vegetables， or what have you rather than those things with copious amounts of added salt. Salt really isn’t necessary once normal sensitization returns.
MacGregor教授：主要的问题是使人们减少食盐用量，这看起来很容易但是要让人们减少食盐用量并坚持低盐饮食并不是一件简单的事情。你能坚持几天的低盐饮食但是食物如何烹煮以及由谁来烹煮的可变性很难用一个严格的减少食盐用量规则来控制。在坚持了几周的严格食盐用量限制计划后，计划的接受者开始适应并变得对食盐更敏感。这时人们会更喜欢低盐食物。当我到北京后在外面吃饭我就发现食物太咸了。当你习惯于低盐饮食并变得对食盐更敏感时高盐含量的食物尝起来就会有金属味道并且很可怕。我更喜欢品尝清淡的鱼和蔬菜，而不是在加入大量食盐的情况下品尝这些食物。一旦你的味觉敏感性回归到正常程度，你就会发现食盐并不是必须的。
<International Circulation>: I beg your pardon but that sounds a bit biased.
《国际循环》：对不起，请原谅我认为这种观点听起来似乎有些偏见。
Prof. MacGregor: Well you just try it， you’ll see. In the UK everyone said the same thing as what you’re saying and what all the Chinese will say. You try it and see. You will much prefer the food with less salt once you’ve gotten used to it. For the first time in your life you taste the real taste of food rather than this mineral metallic taste. Sodium is a metal and I can’t think of much sense in adding a metal to one’s food.
MacGregor教授：你只要去尝试，就会发现我是对的。在英国，每个人的看法和你的一样，所有的中国人也都会这么说。你尝试一下就会看到效果。一旦你适应了低盐饮食，你就会更喜欢低盐的食物。你应该在你的人生中第一次品尝食物的真正味道而不是这种金属矿物质的味道。钠是一种金属并且我不能想象把金属加入到人们的食物中会是什么样的情景。
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