South Africa is known as one of the nations which uses salt generously, with current research suggesting we consume as much as 40% of the recommended salt intake of 5g or a teaspoon a day.
According to the Heart and Stroke Foundation, it is this high salt intake, which is consumed through the liberal addition of salt to meals and as salt hidden in processed foods, that is responsible for the high prevalence of high blood pressure.
The prevalence of high blood pressure ranges from 30% to as high as 80% in adults over the age of 50.
As the country is joining the world to commemorate Salt Awareness Week (from March 20-26), Professor Pamela Naidoo has called on the country’s food manufacturers to put less salt in food and for consumers to carefully calculate their salt intake by reading food labels and choosing the lower salt options.
While the country has since introduced legislation to reduce the use of salt consumption from last year - a move that has been estimated to reduce 7400 cardiovascular deaths and 4300 strokes annually - Naidoo said many South Africans were still making unwise food choices, with many still eating roughly about 8.5g of salt a day.
From June last year, food manufacturers started to reduce salt considerably in certain food items, such as breads, breakfast cereals, and processed meats.
The amendment to the Foodstuffs, Cosmetics and Disinfectants Act of 1976 requires that bread, butter, breakfast cereals, potato crisps, ready-to-eat snacks, processed meat, sausages, soup powder, gravy powder, two-minute noodles, stock cubes and jelly all be lighter on the salt. But Naidoo says while the legislation is a good start, it’s inadequate to curb excess salt intake.
“Salt intake is not easy to measure and is hidden in almost everything we eat, even sweet foods. When adding extra salt in cooking or at the table, all the pinches, shakes and grinds of salt add more salt than we actually need.
“One take-out meal can triple our salt limit for one day. Even something as simple as a cheese and ham sandwich can provide 2.5g of salt, already half the daily limit,” says Gabriel Eksteen, dietitian and exercise physiologist at the Heart and Stroke Foundation.
But Nicole Jennings from Pharma Dynamics, a South African pharmaceutical company that has launched a cooking campaign, Cooking from the Heart, has a view as to why South Africans consume so much salt.
She blamed the high salt consumption on the “supertaster” phenomenon - a condition where people tend to be more discretionary even though they are more sensitive to it.
Research has suggested that the supertaster gene, known as TAS2R38, which intensifies bitter tastes, is more prevalent among Africans.
“This puts a completely different spin on the entire salt debate, since it’s more than just a bad habit that needs to be reviewed.
"What we like to eat or what tastes good to us largely drives what we do eat at the end of the day, and if supertasters mask certain tastes by adding more salt, they may find it much more challenging than others to follow a low-salt diet,” said Jennings.
But it's not too late to change these habits as supertasters can also train their taste buds by shifting their sense of taste to enjoy foods made with less sodium by replacing salts with natural herbs such as basil, and garlic, lemon or red pepper flakes.
“The problem with consuming too much salt is that it increases blood pressure and is therefore indirectly responsible for many heart attacks and strokes. In our country, 215 South Africans die every day from heart disease or stroke, which can be reduced if salt consumption is curbed.
“Experts estimate that limiting salt consumption could decrease deaths from heart disease by 11% a year and save the SA government in the region of R713million a year in health care fees,” said Jennings.
According to the Nutrition Information Centre of Stellenbosch University (Nicus), not only does excessive salt intake increase the risk of hypertension, which in turn can result in strokes and heart disease, but it can can increase your risk of stomach cancer, kidney failure and dehydration.
“In most cases, people’s kidneys struggle to keep up with the high levels of sodium in the bloodstream, and as it accumulates, the body holds on to water to dilute the sodium.
"This increases both the amount of fluid surrounding cells and the volume of blood in the bloodstream. Increased blood volume means the heart has to work harder and that there is more pressure on blood vessels. Over time, the additional work and pressure can cause blood vessels to stiffen, leading to high blood pressure, heart attack and stroke, and even heart failure,” says Irene Labuschagne, spokesperson for the centre.
The World Cancer Research Fund and American Institute for Cancer Research concluded that salt, as well as salted and salty foods, are a “probable cause of stomach cancer”.
Results of observational studies and randomised trials indicated an association between a decreased salt intake and lower blood pressure.
To prevent hypertension, it is recommended that, on average, adults consume a diet that achieves the recommended intake of sodium, which for most individuals requires a substantial reduction in salt intake, fresh vegetables and fruits, and eating less bread, cheese and processed meat.
Guidelines for a low salt diet by Nicus:
* The main source of sodium is table salt, or sodium chloride (NaCl). One teaspoon (5g) of salt contains approximately 2000mg of sodium.
* One way to overcome this problem it to read food labels and the list of ingredients. Items that contain more than 1.5g a 100g are high in salt. Try to avoid these. Foods that have less than 0.3g of salt a 100g are low in salt and are the better choice.
* Also look for the Heart Mark to identify foods that have a lower salt content. Some products appear to have less salt than they actually do: "low sodium" can mean up to 120mg sodium for each 100g, whereas "virtually free from sodium" means there can be up to 5mg sodium for each 100g.
* Do not add extra salt to food at the table. Rather use alternative flavourings that do not contain salt, for example herbs, pepper, curry, vinegar, onions, peppers, garlic, ginger, rosemary and lemon.
* Avoid flavouring agents that contain salt, such as onion salt, celery salt, garlic salt, vegetable salt, barbecue and chicken spices, meat tenderisers, commercial sauces, soups, gravies, and stock cubes.
* Don’t be fooled into thinking that fancier types of salt are healthier. Whether it’s pink, black, rock, crystal or flakes, they still have the same effect on your blood pressure as standard table salt. Although less refined salts might contain more nutrients than everyday table salt, these will probably only be in very small quantities and can probably be sourced from other foods in your diet.