If South Africa’s Minister of Health, Dr Aaron Motsoaledi, achieves his next dietary reform of reducing the salt intake of our population by means of legislation, he will indeed be striking a blow for good health. Earlier this year, the Minister announced in Parliament that he would “very, very soon” be introducing this legislation to reduce the salt content of SA foods (Payne, 2011A).
Excessive salt intake is linked to high blood pressure and our country has one of the highest hypertension rate in the world, especially among our black population. Any measure that could prevent this rampant epidemic of hypertension, will be welcomed.
Prevalence of hypertension
According to Norman and her co-workers (2007), an estimate of the burden of disease attributable to hypertension in South African adults aged 30 years and older in the year 2000, showed that nearly 47 000 deaths (9% of total mortality) and 50% of stroke, 42% of ischaemic heart disease, 72% of hypertensive disease and 22% of other cardiovascular diseases reported, were attributable to hypertension. In fact, hypertension was the second leading risk factor in terms of deaths. In their conclusions, Norman and her team (2007), stated that “population-based strategies to reduce salt and increase potassium intake, limit alcohol intake and promote physical activity are needed”.
The South African population is particularly prone to so-called “salt sensitive” hypertension which when coupled with obesity, a diet deficient in potassium and protective nutrients (e.g. low in fruits and vegetables, low-fat dairy products and whole grains) and lack of physical exercise, is responsible for the extremely high incidence of hypertension. According to Payne (2011B), 59% of our black, 55% of the Indian and coloured, and 50% of the white populations respectively suffer from hypertension.
How much salt do we consume?
For centuries salt or sodium chloride was a very scarce commodity and it is estimated that the average intake in Britain, for example, a few centuries ago, was only 0.1 gram per day. Nowadays, studies indicate that salt intake in Britain varies between 8-12 g/day, which represents an astronomical increase (Payne, 2011B). While we do not have comparative figures for salt intake in South Africa, it is very possible that our populations, especially those who are forced to eat bland staple foods such as maize meal, bread and rice for economic reasons, are also ingesting very large quantities of salt. Adding table salt, salt-based spices and salty relishes to staple foods is a common practice to make a monotonous diet more palatable.
Governments throughout the world have been advocating the reduction of salt consumption for a number of years. In Britain, for example, guidelines were drawn up to lower the sodium content of processed foods which were accepted by UK food manufacturers in 2006. These guidelines have already been revised once in 2009, and are starting to achieve the goal of reducing daily salt intake in Britain from an average of 9.5 g down to 6 g per day (Payne, 2011A).
The reason why we are evidently not going to use the consultative and voluntary route when it comes to lowering salt intake in South Africa, according to Prof Melvin Freeman of SA’s Department of Health, “is that regulation rather than agreement was being embarked upon here partly because larger companies had indicated that they would welcome regulation”. This rather surprising request by larger food manufacturers was evidently made to “level the playing fields between themselves and smaller companies”. (Payne, 2011A). The Heart and Stroke Foundation of SA has also indicated that we need a rapid reduction of our salt intake to counteract the hypertension epidemic (Payne, 2011B).
How to lower your intake of sodium
In this heading you will see that I have specifically mentioned sodium and not salt. This is because it is the sodium fraction of sodium chloride (table salt), that is linked to high blood pressure. The purpose of the intended legislation is to reduce our salt intake which will automatically lower how much sodium we ingest.
It has been estimated that if we could reduce our salt intake down to 5 g per day this would lower the incidences of stroke and coronary heart disease by 24% and 18%, respectively (Payne, 2011B).
However, it will not help if food manufacturers comply with the pending legislation and we, as consumers, continue to add masses of table salt to our foods. The ultimate irony would be eating a salt-reduced dish that you have covered with a liberal shake of table salt.
The following tips can help you lower your sodium intake:
If possible don’t add any table salt to foods you cook at home. Commercially prepared foods will already contain some salt/sodium, so you don’t need to add any during the cooking process.
Do not cover each dish you eat with a crust of salt to make it look like the Alps in winter. Start the reduction process gradually, so that you and your taste buds get used to the lower salt levels. If you go from 1 teaspoon of salt per dish per day to a zero salt intake, you will find it particularly difficult to adjust to the change in taste. But if you consciously add a bit less salt to your foods every 2nd or 3rd day, then you will be able to educate your taste buds over a period of a few weeks to accept this change in eating habits.
Avoid foods that have a high salt/sodium content due to processing. Cured and pickled foods and relishes contain very large quantities of salt, so products like bacon, ham, processed meats, salted dried fish, anchovies, atchar, pickles, etc, are loaded with salt.
Avoid condiments and flavouring aids that contain salt or sodium - read those labels and if you are unsure, rather avoid the use of products like stock cubes, meat extract, etc.
Check that you are not ingesting sodium via medications or toothpaste. Medicinal products are often a ‘hidden’ source of sodium.
Be creative when cooking and use fresh herbs, as well as spices that don’t contain salt/sodium (e.g. pepper, chillies, garlic, bay leaves, cloves, cinnamon, cardamon, etc), or lemon juice to add flavour to your dishes.
The Dash Diet
Earlier this year, I was privileged to meet Prof Catherine Champagne, currently based at the Pennington Biomedical Research Centre, in Baton Rouge, Louisiana, in the USA, who collaborated in the development of the Dash Diet (Dietary Approaches to Stop Hypertension). The Dash Diet, which is low in sodium and rich in potassium, dietary fibre and other protective nutrients, can also be used successfully to lower blood pressure and help with weight loss.
While we wait for Dr Motsoaledi’s legislation, there are many things that we, as individuals, can start doing to reduce our salt intake from a mountain to just a pinch!
- (Dr Ingrid van Heerden, DietDoc, August 2011)
(Norman R et al (2007). Estimating the burden of disease attributable to high blood pressure in South Africa in 2000. SA Medical Journal, 97(8): 692-698; Payne T, 2011A. Legislation to reduce salt in SA on the way. Food & Beverage Reporter, July 2011, pp. 4-7; Payne T, 2011B. The case against salt. Food & Beverage Reporter, July 2011, p. 5.)
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