What's worse: salt or sugar? That's what I was asked on the radio the other day when being interviewed about the most recent research into diet and health. The research, published in the Lancet, found that too much salt (sodium) is responsible for the disease-related deaths of three million people worldwide each year.

Media reports of this research highlighted the salt thing quite heavily. But in reality, while salt is a big problem we should be paying more attention to, there were 15 other dietary risk factors examined in this research – and we probably need to be keeping an eye on all of them if we really want to have the best health.

This study was big: it aimed to evaluate the consumption of major foods and nutrients across 195 countries, and to quantify the impact of their "suboptimal intake" – in other words getting not enough or too much of them – on death and disability from non-communicable diseases - heart disease, diabetes and colorectal cancer.


What they found was probably surprising to zero health experts. Globally, in 2017, suboptimal diet was responsible for 11 million deaths. Poor diet, they say, is responsible for more deaths than any other risks globally, including smoking.

The biggest chunk of diet-related deaths was due to high intake of sodium. Hot on its heels was a low intake of whole grains. Low intake of fruits; low levels of nuts and seeds; not enough vegetables; not enough omega-3 and too little fibre were other major killers.

Interestingly, sugar intake was not looked at specifically, although sugar-sweetened beverages were. Intake of these was well above recommended levels in most places, although high intake was quite far down the list of killers compared to other risk factors. So was high red meat intake.

So what does this mean? The researchers say it means at a government level, we need better strategies around the world for reducing the risk of preventable, non-communicable diseases, and we need reform of the global food system. But what about for us at home in our kitchens?

For me this highlights (again) that we always need to look at the big picture when it comes to food and health. If we just focus on sugar – which you could argue we have collectively been doing in recent years – we might miss the salt-crusted forest for the trees. And we can't just concentrate on cutting back on salt, because we also need to boost our whole grains, nuts, seeds and legumes.

What's good though, is that when we focus on adding more good things in, it tends to crowd out the bad things. The more good-quality, high-fibre whole foods we eat, the less highly-processed, high-sodium foods we will tend to have. The more plants on the plate, of all kinds – fruits, vegetables, nuts, seeds, legumes, grains – the less room there is for anything else. I like the subtle positive shift in thinking that comes from adding things in to our diet, rather than banning them.

Niki Bezzant is editor-at-large for Healthy Food Guide