Salt is of course a very good and necessary thing. I think my favourite sequence in all of David Attenborough’s copious and brilliant nature programmes is a procession of elephant families making their way in pitch darkness to a remote cave, at the end of which they lick salt from its walls. But for the best part of century, doctors have had it in for sodium chloride: it has become a moral issue, and the thought police are out, looking for halophiles. It is extraordinary how little evidence of harm has emerged from a vast array of studies. In TOHP, as in all other studies, salt restriction had a negligible effect on blood pressure; but the group of Americans who were given intensive advice about which foods contained the most salt, and how to prepare their own food, had a 25% reduction in cardiovascular events over 10-15 years. The moral: avoid American junk food.
Anorexia nervosa is a mental illness recorded throughout history, and carries a gloomy prognosis in 30% of cases. This nice short review (a bit longer on the website) outlines what we understand about the aetiology and which treatment approaches work (to a degree) and which don’t. Don’t expect success within less than a year or two.
Should we be going through our registers of stroke patients and putting them all on dipyridamole as well as aspirin? I think we should, having read this Change Page. I think the BMJ should commission a study in one or two years’ time to see if what is written in these pages gets into practice: in this case it would be a simple little study using existing GP databases.