A study finds over-consumption may have contributed to 15% of heart-related fatalities in 2010.
The Heart and Stroke Foundation South Africa is launching a new lobby group, called Salt Watch, to alert South Africans to the fact that too much salt could be killing them.
Over-abundant salt intake was a factor in nearly 2.3 million deaths from heart attacks, strokes and other heart-related causes that occurred worldwide in 2010, according to a new study. That number represents 15% of all heart-related deaths that year, the researchers said.
With 6.3 million people living with high blood pressure, South Africa has one of the highest rates of hypertension worldwide. This makes South Africans more susceptible to life-threatening diseases like stroke and heart disease. Statistics show that about 130 heart attacks and 240 strokes occur daily in South Africa. This means that 10 people will suffer a stroke and five people will have a heart attack every hour.
Nearly 1 million deaths (40%) caused by eating too much salt were considered premature, occurring in people aged 69 and younger, the study found. 60% of the deaths were in men.
The United States ranked 19th out of the 30 largest countries, with 429 deaths per million adults caused by eating too much salt. That works out to one in 10 of all heart-related deaths in the United States, the study authors noted.
Heart attacks and strokes
Heart attacks caused 42% of the deaths worldwide, while strokes caused 41%. The rest of the deaths were caused by other types of cardiovascular disease. 84% of the deaths were in low- and middle-income countries. (The United States is considered a high-income nation.)
Among the 30 largest countries, those with the highest death rates due to excess salt consumption per million adults were: Ukraine, 2 109; Russia, 1 803; and Egypt, 836.
Among all countries, those with the lowest death rates related to salt consumption per million adults were: Qatar, 73; Kenya, 78; and United Arab Emirates, 134.
"National and global public health measures, such as comprehensive sodium reduction programs, could potentially save millions of lives," lead author Dr Dariush Mozaffarian, an associate professor of medicine and epidemiology at Harvard Medical School and the Harvard School of Public Health, said in an AHA news release.
According to the Heart and Stroke Foundation SA, a staggering 80% of these cardiovascular diseases could be prevented through modified behaviour – like reducing salt. This is the central message of the new group: Salt Watch.
Led by the Heart and Stroke Foundation SA and including experts in the field of salt reduction, the Association for Dietetics in South Africa (ADSA), the Nutrition Society of South Africa (NNSA) and the Consumer Goods Council of South Africa, Salt Watch is working in association with World Action on Salt and Health (WASH) and is set to launch a major national awareness campaign to help reduce population salt intake.
Its work will complement moves by government to legislate a reduction in salt in South African food.
Mandatory salt regulation
The World Health Organisation recommends that adults eat less than 5g of salt (a teaspoon) a day, but in South Africa some experts put the average salt intake by South Africans as high as 40g of salt a day. “The problem is that up to 60% of this salt is hidden in products and consumed by people probably unaware of the high salt content in their food,” says Dr Vash Mungal-Singh, CEO of the Heart and Stroke Foundation SA.
This has prompted the South African Department of Health to investigate taking a legislative route towards lowering salt content in SA foods. Internationally, the model followed by most countries has been based on voluntary reduction. But during discussions with the SA food industry, almost half of stakeholders revealed that they would prefer salt regulation to be mandatory, to level the playing field and to ensure no one company is disadvantaged.
Salt reduction initiatives have been very successful in the UK, France, Finland and the US and have resulted in a drop in salt levels in some processed foods like bread. According to the proposed draft legislation, South Africa will give food manufacturers until June 2016 to comply with the first set of salt guidelines. Different products have been given different time frames allowing producers to adapt their strategies for reducing sodium – the dangerous component in salt – in their products.
Pioneering step
Meanwhile South Africa has been hailed internationally for taking such concrete steps for reducing salt or sodium consumption. Professor Graham Macgregor, chairman of the World Action on Salt and Health (WASH) described South Africa as taking a “pioneering” role in salt reduction programmes.
“Achieving a long and healthy life, free from disease, is a right not just for South Africans but for everybody in the world. It is time that Western governments stopped being pressurised by their tobacco and food industry and follow South Africa’s example by setting specific targets for reducing non-communicable diseases (NCDs), including salt reduction to less than 5g a day, particularly in developing countries where the major burden of NCDs lies,” said Professor Macgregor.
But as the health department is aware, food regulation is not enough to wean South Africans off salt. “Educating the public is crucial to the success of the salt reduction programme,” comments Dr Mungal-Singh.
“The link between salt and high blood pressure is well-documented and accepted as medical fact. But what is less widely known, is that South African foods are laden with salt – or sodium,” says Dr Mungal-Singh.
The biggest culprit
Internationally accepted guidelines state that any food with more than 600mg of sodium per 100g can be considered unhealthy. In South Africa, many products exceed this limit. And the biggest culprit is bread, followed closely by margarine, butter spreads, stock cubes, soup powders, breakfast cereals and savoury snacks. But consumers are often surprised to find high sodium content in foods that are sweet or not salty at all.
Another concern is that South Africans rate high on the list of discretionary salt use – that is the amount of salt they add to the food themselves. In most Westernised countries, discretionary use is small – only about 15%. But in South Africa, up to 40% of salt is added by individuals to their food, says Professor Krisela Steyn, associate director of the Chronic Diseases Initiative in Africa (CDIA) based at UCT. This shows the lack of awareness of the dangers that salt poses to health, especially those who suffer from high blood pressure, says Dr Mungal-Singh. “The public need to be warned of the risks.”
Professor Melvyn Freeman of the Department of Health adds: “Part of industry’s objection (to the proposed legislation) has been the suggestion that once salt in processed foods is reduced, people will make up lost flavour with discretionary salt, so we need an education campaign to follow the legislation.”
“This is why programmes will be launched across SA to warn the public on the dangers of high salt consumption and encourage them to cut down on salt,” says Dr Mungal-Singh.
“The number one black sheep is bread - both locally and internationally. It has been estimated that by reducing the sodium content of bread by 50%, along with other reductions, salt intake will be decreased by 0.085g a day, resulting in 7 400 fewer deaths due to cardiovascular disease annually in SA,” she says.
“For consumers the best way to go about cutting down on salt is to begin by reading labels carefully and to become aware of salt, tailoring shopping habits to lower salt content foods. The aim should be to reduce salt slowly and to look out for high-salt foods and buy alternatives instead. In time the body will adjust and eating a healthy low-salt diet will become much less of a chore – and will actually become a pleasure instead.
“It is time for people to realise that salt is killing South Africans and it is time to take action!”
Although the study found an association between high salt intake and higher risk of death, it did not prove a cause-and-effect relationship.
By Chief Dembe
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