Key 12 - Use Salt Sparingly

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Use SALT SPARINGLY and limit salty foods.

It would appear that for the largest part of our evolution, people’s salt intake was less than 250mg per day.  Hypertension and age related blood pressure is virtually absent in populations where salt intake is low.  In South Africa our average salt intake is about 8g per day, almost double the recommendation with proof of a relationship with certain illnesses. It is only endurance sportsmen who need a higher sodium intake.

Salt consists of about 40% sodium and 60% chloride.  Chloride is often shunned, but it is an important component in the link between salt and hypertension.  Although people differ in their sensitivity to salt, there is a direct progressive relationship between salt intake and hypertension.  The worrying factor here is that blood pressure in children follows a pattern which shows that salt intake during one’s younger years has a programming effect on one’s blood pressure in later years.  Salt intake among children and adolescents is particularly high as a result of their high intake of processed foods.

Research shows that a high salt intake is a direct risk factor for stroke, heart failure and chronic kidney disease, independently of high blood pressure. You can watch this video to understand it better.   A high salt intake relates to kidney stones, osteoporosis and the seriousness of asthma and is possibly a significant cause of stomach cancer.  Although 1 out of 5 South Africans add salt to food before tasting, more than 48% of excessive salt comes from the food industry.  Legislation has been passed to limit the salt in processed foods. Endorsement bodies strive towards only endorsing foods which comply with the specifications for a healthier sodium content.

Recommendation:  Maximum 5g salt/day or not more than 2000mg sodium.

Sodium content/100g

Low

Medium

High

<120mg

120-600mg

>600mg

Choose mostly

Sometimes

Careful

In order to control salt intake, the most important principle is to limit the use of processed foods and to rather eat unprocessed foods.  A simple comparison is the sodium content of oats (12mg/100g raw) vs Bran flakes (804mg/100g). Be especially wary of the use of packets, powders and sauces. With processing and as the fat content increases, the energy content increases and replaces proteins and other nutrients.  In the case of processed products, the salt content increases drastically with certain processing techniques and results in unhealthy products.  Refer to the following examples in the illustration below:

Energy/100g

Protein/100g

Fat/100g

Salt/100g

Fish fingers

1136kJ

15.7g

12.2g

582mg

Grilled fish

462kJ

23.2g

1.3g

105mg

Boerewors

1658kJ

13.8g

36.3g

805mg

Lean beef mince

917kJ

27.4g

11.3g

70mg

Limit added salt to a half a teaspoon per day.  Fresh herbs and spices give life to any dish and increase the nutrient content of a meal.  Choose the orange, red, green and blue lids (except garlic salt) from the spice rack as seasoning.  Lemon juice and the peel become the new salt! The Greeks from the Blue Zone island of Ikaria drink fresh herbal teas every day which helps to control their blood pressure and also acts as a mild diuretic.

Remember that salt is a learned taste and that one’s taste buds become numbed – one needs more and more for taste.   To make a real difference, diminish your salt intake gradually and increase the natural flavour! Also try to increase your intake of fruit and vegetables, as they contain potassium, which also plays a major role in helping to lower blood pressure.

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References:
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Appel CJ, Moore TJ, Obarzanek E, et al (1997): A clinical trial of the effects of dietary patterns on blood pressure.  DASH Collaborative Research Group. N Engl J of Medicine, 336(16): 1117 – 1124. 
Blumenthal, JA, Babyak, MA, Hinderliter, A et al (2010): Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Archives of Internal Medicine, 170(2):126 – 135.
Danaei G, Ding EL, Mozaffarian D, et al (2009): The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle and metabolic risk factors. PloS Medicine, 6:1 – 23.
Levitan, EB, Wolk, A & Mittleman, MA (2009): Relation of consistency with the Dietary Approaches to Stop Hypertension diet and the incidence of heart failure in en aged 45 – 79 years. American Journal of Cardiology, 104 (10): 1416 – 1420.
McNeill S and Van Elswyk ME (2012): Red meat in global nutrition. Meat Science, 92:166 – 173.
NIH (National Insitute of Health) (2003): The seventh report on the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. US Department of Health and Human Services. NIH Publication, 03 – 5233.
NIH (2006): Your guide to lowering Blood Pressure with DASH. US Department of Health and Human Services. NIH Publication, 06 – 4082.
Micha, R & Mozaffarian, D (2010): Saturated fat and Cardio-metabolic Risk Factors, Coronary Heart Disease, Stroke and Diabetes: A Fresh Look at the Evidence. Lipids, 45:893 – 905.
Recommendations of the World Cancer Research Fund and the American Insitute for Cancer Research. Food, Nutrition, Physical activity and the Prevention of Cancer. 2007
Seedat YK and Rayner BL (2012): South African Hypertension Guide 2011. SAMJ, 102(1): 60 – 83. 
Taylor EN, Fung TT & Curhan GC (2009): DASH-style diet associated with reduced risk for kidney stones. Journal of the American Society of Nephrology, 20(10): - 2259.
Frisoli TM, Schmieder RE, Grodzicki T and Messerli FH (2012): Salt and Hypertension: Is salt dietary reduction worth the effort?   Am J Medicine, 125(5): 433 – 439.
WHO. Hypertension – Fact sheet. World health Organization Regional Office for South East Asia. Department of Sustainable Development and Healthy Environments. 2011