Updated 26 January 2015

Sensitivity to salt puts black South Africans at stroke risk

DietDoc takes a closer look at why the SA government has started publishing regulations about reducing the sodium in foods and how it will positively affect us, especially when considering that our black population is 'salt sensitive'.

Previously I introduced the subject of electrolytes (sodium, potassium, magnesium, calcium, chloride, bicarbonate and phosphate) and the water balance of the human body and why these factors are so important for life.

Read: Why electrolytes are SO important

Now I would like to concentrate in more detail on sodium, one of the major electrolytes which is found on the outside of our cells. 

Too much sodium  is a bad thing

If sodium is so important for our health and well-being then why is there so much attention being paid to this electrolyte and why has the South African government started publishing regulations about reducing the sodium intake of the population?

The answer to this question is of course that we as humans are once again overdoing our intake of sodium, primarily in the form of sodium chloride or table salt, which is added to practically every commercially processed food sold in our supermarkets.

We are also happy to add even more salt to nearly every dish we eat, so that instead of “salt being worth its weight in gold” as was the case in the past when sodium chloride was a rare and sought after commodity, we are ruining our health by overindulging in salt.

The link between salt and hypertension

Excessive intake of sodium (mainly as sodium chloride), is linked to high blood pressure or hypertension.

Certain populations are what is called ‘salt sensitive’ and react to high salt intakes by developing dangerously high blood pressure levels.

In South Africa we have one of the highest hypertension rates in the world with 9% of total mortality and 50% of strokes being attributed to hypertension (Schönfeldt, 2013).

In similar fashion to African Americans, our black population has also been identified as “salt sensitive”.

Individuals who are “salt sensitive”, tend to react more negatively to high intakes of salt which then have more damaging effects on their health.

The high incidence of stroke in our black population is in part attributed to “salt sensitivity”(Schönfeldt, 2013).


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How much sodium should we have per day?

The WHO (World Health Organisation) recommends an intake of 5 gram of salt/sodium chloride or less per day. In the USA and many other countries intakes of approximately 6 gram of sodium chloride or salt per day, are recommended for adults.

This translates to a daily intake of about 2.4 g of sodium.

The chloride component of salt makes up approximately 60% of the salt molecule or 3,6 g of the 6 g of salt we should try to reduce our intake to (Schönfeldt, 2013).

Research has, however, shown that on average South Africans eat 8.1 g of salt per day which means that we exceed the recommended 5-6 g of salt by between 2.1 and 3.1g a day.

The Department of Health has reacted to these findings and the high levels of hypertension by setting a goal of reducing the average population intake of salt (sodium) to less than 5 g per day by 2020 (Schönfeldt, 2013).

Read: Motsoaledi signs new salt regulations 

What's in the legislation

Regulation No. R. 214 of the Foodstuffs, Cosmetics & Disinfectants Act, 1972 (Act 64 of 1972) which was published in March 2013, is one of the first steps undertaken by the government to reduce the sodium intake of the South African population (Government Gazette, 2013).

Basically this legislation aims to reduce the sodium content of the following foods:

Breakfast cereals
Margarines and table spreads
Read-to-eat snacks
Processed meats
Dry soups and gravies

The ultimate goal of the Department of Health is to reduce the intake of salt of each South African by about 0,6 gram per day and thereby achieve the following highly desirable results:

Reduce deaths due to cardiovascular disease by more than 7 400 per year, and lower non-fatal strokes by 4 300 per annum

This would not only save lives and prevent disability, but it could also add up to a cost saving of R300 million per year in health spend (Bertram et al, 2012).

This is a dramatic improvement which can be achieved by a slight decrease in salt of just more than half a gram per day for all South Africans.

Hopefully this first step will make a difference in the lives and health of our nation. Next time we will consider why it may be dangerous to reduce our salt intake too drastically.

Read more:

Take the test - am I at risk of developing hypertension?
Treat hypertension to prevent stroke
Alcohol and hypertension

Image, African man from Shutterstock

DIETDOC© Text copyright: Dr I V van Heerden Topic32-2014.wpd 25 August 2014

Reference: (Bertram MY et al (2012). Reducing the sodium content of high-salt foods: Effect on cardiovascular disease in South Africa: Ethical and legal perspectives.
SA Medical Journal, 102(9): 743-745; Government Gazette (2013).
Regulation No. R. 214 of the Foodstuffs, Cosmetics & Disinfectants Act, 1972 (Act 64 of 1972). Regulations relating to the reduction of sodium in certain foodstuffs and related matters. Published by the Government Printers, Pretoria. 20 March 2013; Schönfeldt, HC (2013).
Why should South Africans reduce their salt intake? SAAFoST Salt Workshop, October 2013. )

Dr Ingrid van Heerden is a registered dietician and holds a doctoral degree in Nutrition and Biochemistry. She believes that "we are what we eat" and offers free nutrition and weight loss advice via her DietDoc service on Read more of her articles.


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