A Salty World

URS A Salty World
一个吃盐多多的世界 (Dixia 翻译)

When I was a medical intern at the Queen Mary Hospital (Hong Kong University), it seemed to me like every night someone was wheeled in with some kind of “stroke.” Again, and again, patients came in with hemiplegia (half the body paralyzed), inability to speak, or a massive bleed in the brain. Their families were often hysterical, shocked, or totally depressed. It was also immensely stressful to the medical and nursing staff, and especially to me as a developing doctor, and gave me a distinct life-long vivid impression and sensitivity about the devastating disease of strokes.

我在香港大学玛丽医院做实习医生的时候,觉得好像每天晚上都有人因为中风而被抬进来。一次又一次,看到病人半身不遂,不会说话或者大量脑出血。他们的家人一般都会很歇斯底里,非常震惊极其沮丧。这对医护人员来说压力非常大,尤其对我这样一个初出茅庐的医生来说。那些景象深深印在我脑海里,一生不能忘,因此也让我对中风的严重后果很敏感。

Strokes are the disease of clogging up or rupture of arteries that go to the brain, and tissue death in certain brain areas. Over the years, I began to realize that my own family history was loaded with high blood pressure (hypertension) and strokes. In addition, I realized many friends and contacts also had the disease, or were at high risk. It was more than disturbing.

中风一般是因为通往大脑的血管堵塞或者破裂,然后引起大脑某些部位脑组织死亡。渐渐地,我意识到我自己的家族有很多高血压和中风的案例。此外我的很多朋友和相识的人得过中风或者是高风险,这很让我困扰。

Photo 1: Brain stroke: it’s not funny when your dead brain area shows up as dark spot on one side.
图一:中风,当你的部分脑区死亡,在图像上显示出的是黑点,这并不好玩。

However, it was actually odd that, in contrast to strokes, we had very few patients at the time who had “heart attacks.” The few patients we had were mostly British and American men who were visiting the colony. I later realized that later, after I had left for America, increasing numbers of Hong Kong Chinese acquired this “modern disease” of heart attacks, or heart artery disease, just like in the West. But, surprisingly, strokes, which are brain artery diseases, had preceded all that. Even without flagrant “westernization,” Asians already had acquired the dreaded brain artery problem.

然而,让人奇怪的是相比较中风,当时在香港得心肌梗塞的病人少很多。我所处理过的心肌梗塞病人,基本上是到香港这个殖民地来的英美男子。后来我意识到,尤其是我离开香港到美国以后,越来越多的香港华人也得心肌梗塞这个现代病或者是心血管病。但是令人惊讶的是,中风,即脑血管病,与西化生活方式无直接关联。 很多亚洲人未及西化生活,早就得了可怕的脑血管疾病。

The more I studied the strokes problem, the more I felt also that this disease was like a tightening noose around our family’s necks. Hypertension and strokes in my parent’s generation, my own generation, and later even the next generation, meant that our family DNA was highly problematic. But I quickly realized also that DNA is not destiny, and that there are many things that we could actually do to break the “DNA curse,” and prevent the DNA effect.

随着我对中风这个病研究的越多,我更加意识到这个病,就像勒在我家族脖子上的绞索,高血压和中风在我父母那一辈,我这一辈,甚至于我的下一辈,都不鲜见,这意味着我家的DNA是有问题的,但是我也很快意识到DNA并不是我们的宿命,因为有很多事情我们可以做来打破这个DNA魔咒,从而防止DNA作梗。

A few decades ago, my wife and I took the drastic step of reducing our salt intake to very low levels, especially for homemade meals. It was an abrupt decision, but once we made it, to our great surprise, after a few days or weeks, we practically forgot that we had done it! I used to liberally pour soy sauce over my fried eggs, ever since childhood, since I loved eggs and thought soy sauce was a “normal part” of fried or boiled, or any, eggs. After we made the salt reduction decision, I suddenly realized I did not have to pour soy sauce on my beloved eggs at all! Once I stopped it, I found eggs tasted just as great, even better, without the salt! A pleasant surprise indeed.

几十年前太太和我决定大大降低我们摄入的盐量,尤其是在家里做饭的时候。这是一个很突然的决定,但是当我们做了这个决定,我们就很意外地发现,几天或者几周以后我们都基本上都忘了我们已经减少了食盐的摄入量。以前我总是在我的煎鸡蛋上倒很多酱油,从我童年时代开始我特别喜欢吃蛋,并且一直认为不管是煎蛋还是煮蛋,酱油是必不可少的。自从我们决定要减少盐的摄入量,以后我突然意识到我喜欢吃蛋,但我并不需要倒酱油。一旦我不放酱油,我发现鸡蛋也还是一样好吃,甚至更好吃,这真让我喜出望外。

Photo 2: Eggs taste perfectly fine without Chinese soy sauce, British Maggie sauce (my childhood favorite), or ubiquitous salt. I once never knew that.
图二: 不加中国的酱油,或者英国的玛姬酱(我孩童时代最爱),或者盐。鸡蛋的味道也还是很好的。我以前却不知道。

And similarly, for most of our food, we just adapted to the “new norm.” Our home salt intake has become so low, that sometimes, when exposed to the “usual” salt, especially from restaurant food, legs might swell up from the salt and resulting water retention. Which just reminds us that there’s hidden salt everywhere, and low salt bodies can become like human sensors detecting hidden salt wherever it is! In contrast, most people are so used to it, there’s little way to actually sense having too much salt. However, getting used to it doesn’t mean its deleterious effects are not there; quite the contrary, the bad effects are cumulative, slowly and secretly harming our body over years.

同样类似的,大多数的食物,少盐我们也就习惯了,我们家里吃盐变得非常少。有的时候我们吃到一般盐量的食物,例如在餐馆吃饭的时候,腿会因为盐摄入过多而水肿。这就让我想到。生活中到处都有没有意识到的盐。已经习惯低盐的身体会像一个感应器,侦察到隐而未现的盐。相反的很多人吃习惯了他们就没有这种敏感性,基本上不能发觉吃了太多盐了。但是当你习惯了吃很多盐,并不意味着多盐的后果就没有了。正相反,那些不好的后果是经年累月慢慢积累的,不知不觉中就侵害了我们的身体。

The question could be asked, that, even though there is a tremendous amount of information about the dangers of extra salt intake on hypertension and strokes, for nearly everyone, why is it that people do not actually change their habits? The easy answer is simply that habits are so difficult to change, for any habits. Just think of smoking, or alcohol, or carbohydrates, or fat. And getting food merchants to change their food contents, and likely profit margins, is hugely difficult. Just look at the very minor changes in the major “fast food” restaurants, in spite of the overwhelmingly negative things they do to our bodies. We even merrily call them, and eat them, as “junk food.”

所以我们要问的问题是,虽然我们都知道多盐增加高血压和中风的风险,那为什么每一个人不去改变他们的习惯呢?显然答案是习惯很难被改变,无论是哪种习惯,如抽烟,喝酒,或碳水化合物,或脂肪。另外让食品商家去改变他们的食物内容是极为困难的,因为这会影响到他们的利润。就看一看几家主要的快餐连锁店,让他们做很小的改变都无比艰难,虽然他们的这些食物对我们的身体是非常负面的,我们还是很乐意地称这些食物为垃圾食物,并且很乐意地吃。

Photo 3: Watch the labels: salt and salt and salt.
图三: 仔细看标签:盐,盐,盐,盐。

And, all of us actually love salt, because it is an amazing substance. Remember that in the past, salt used to be very expensive, people would fight over it, and practically start wars over it. Thousands of years ago, people already realized that salt was extremely valuable, giving extra taste to all kinds of food, and allowing food to be preserved for long journeys, before the days of refrigeration. Just think of all the salted fish and meats down the ages.

实际上,我们每一个人都喜欢盐,这是因为它是一种很好的必需品。在过去盐曾经是很贵的,人们要抢购,而且曾经因为盐而发起战争。几千年以前,人们已经意识到盐是很珍贵的。它能增加所有食物的味道,并能够让食物保存的更久,尤其是在冰箱普及之前。就想想那些经年传下来的咸鱼,咸肉。

Salt is essential to life. But, essential doesn’t mean that we have to add extra salt. In fact, it means that, being essential, it is already there, in great valuable amounts in all the meats and vegetables that we eat. Without the need to add anything salty at all. So, basically nearly all the salt that we add “normally,” in many cultures, is truly in addition to what our “natural” needs are. We don’t need to have “salt licks” like we might read about for some salt deprived animals!

盐对于生命至关重要,但是重要并不意味着我们要吃很多的盐。实际上盐至关重要,就是因为它已经存在那里了,在我们吃的各种肉类和蔬菜里边就已经存在了,我们根本没必要再加。在很多文化当中,我们普通加的盐实际上是超过了我们自然所需要的量。有些动物缺盐,他们要到盐渍石 处舔盐来满足他们身体的需要,但我们人并不需要这样做。

Of course, if we are sweaty runners, we will lose extra salts, and sure enough drinking water alone is not enough for that, and we need to have water that contains extra salt and other minerals. But that’s not the normal life of people today. Normal modern-day life today doesn’t really lead to much salt loss, so we don’t need all that extra salt!

当然,如果我们喜欢跑步大汗淋漓,那我们会流失一部分盐分,那时光喝水是不够的,我们就需要喝含有盐和其他矿物质的水,但那并不是一般人的日常。现代的日常生活中,我们并没有流失很多的盐分,所以我们根本就不需要加额外的盐。

In most homes, modern sauces of all kinds provide just wonderful taste and variety: there are all kinds of sauces, and literally all kinds of tastes, but they mostly especially contain loads of salt. From a careful look at the labels on the bottles, we quickly realize we are getting a lot of extra “gifts” of salt. And if we watch people cooking at home, it is quite clear that they usually do not realize that they are pouring on the salt, even as they declare loudly that they’re very careful with salt. But from the way that the salt is being sprinkled liberally all over the food, plus all the sauces being sprayed left and right, you can begin to guess that the amount of salt isn’t going to be small.

在很多人家里,很多现代的这些调料就提供了很好的口味,各种酱料适合各种各样的口味,但是大部分都含了很多盐。如果你仔细看按瓶子上的标签,你很快就会发现盐的含量很高。人们在家做饭的时候,很多人没意识到,他们加了很多盐,包括那些自以为很小心盐的摄入量的人。你可以看到人们喜欢把大量的盐撒在食物上,然后再加上很多调料,你可以想象这个盐的含量不会少。

Photo 4: Humans do not need salt licks, but we may lick a lot more than that.
图四: 人类不需要盐渍地石,但是实际上我们摄入的盐可能比这个多得多。

Yes, the essential wonderful salt has morphed into a serious culprit: it’s just too much, too cheap and too available, everywhere, just more and more and more. You may know that I like to say, the simplest nutritional advice is “eat like Adam and Eve,” or “eat like a dinosaur.” Indeed, neither Adam and Eve, nor dinosaurs, had added salt in their food! They certainly never sprinkled salt, or added sauce to anything they ate!

是的,这奇妙的盐已经变成了一个严重的问题,盐太多太便宜了且唾手可得。你可能知道我很喜欢说,最简单的营养建议是,像亚当和夏娃一样吃,或者是像恐龙一样吃,实际上亚当夏娃或者恐龙,他们并没有在他们食物里边加盐。他们从来没有在他们吃的食物,上撒盐或加其他调料。

Well, it’s definitely not glamorous advice for most people and therefore it’s difficult for anyone to change their lifestyle. Salt is good and essential, saltiness not so. Moderation in everything, as usual, is usually sound foundational nutritional advice.

当然了,当你这样去跟别人提建议,很多人并不是很容易接受,并且也很难改变一个人的生活方式。盐是好的,也是不可或缺的,但却不需要太咸。就像我们所做的,任何事情上都适中,这是很重要的营养建议。

Addendum

In my academic career, I was very involved in the American College of Nutrition, which focused on the relation of nutrition and chronic diseases, and especially disease prevention. I became one of its Journal Editors (International), Secretary-treasurer, and later President. In the course of my nutrition journey, I came across a classic older graph of the provinces of China, which likely became graphically inspirational for my interest, and for this story. It showed salt intake, hypertension and strokes as highly correlated, being highest together in certain provinces, and lowest together in others. A result that I felt had personal family resonance. And worldwide, even up to today, the relationship of salt and hypertension remains strong, summarized in a recent report by the NIH, the American National Institutes of Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105387/

附录

在我的学术生涯中,我积极参与美国营养学会(American College of Nutrition)。美国营养学会特别重视营养和慢性病的关联性,尤其是疾病防治的上。我曾任美国营养学会杂志的国际编辑,财务秘书,也曾任学会主席。在我的营养生涯中,我看到过中国各省的一个图表,这个图表成了我研究营养的一个动力,也启发我写下了这个故事。那张图显示盐的摄入量,高血压和中风是高度相关的。在有些省这几样都很高,在另外一些省这几样都很低。这在我家族里也得到了印证。在世界各地如今盐和高血压还是高度相关的,这个研究总结发表在美国卫生研究院(NIH)最近的一个报告上。

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105387/

References:
https://www.medicalnewstoday.com/content/images/articles/286/286305/ct-scan-of-ischemic-stroke.jpg
https://farm4.staticflickr.com/3065/2452297992_92312dc8ce_b.jpg