Salty South Africa – are we doing better after salt legislation?

Chat 1 Comment March 20, 2017 nutritionadsa

Despite South Africa passing world-leading legislation to reduce salt intake, too many South Africans eat too much salt, putting themselves at risk of heart disease and strokes. Today is the start of  Salt Awareness Week which runs from 20-26 March.

 

Salt – a forgotten killer

Excess salt intake directly increases blood pressure in most people, and exacerbates high blood pressure in people who already have this condition. “High blood pressure is not only caused by high salt intake, and factors such as genetics, obesity, fruit and vegetable intake, stress, smoking and a lack of exercise all contribute. However, reducing salt intake is a safe, affordable and effective strategy to reduce high blood pressure or avoid developing high blood pressure” says Prof Naidoo, CEO of the Heart and Stroke Foundation South Africa (HSFSA).

The World Health Organization (WHO) reports that it’s African region has the highest prevalence of high blood pressure globally. People of African origin are more prone to salt sensitivity, and excess salt is consumed through both liberal addition of salt to meals and as salt hidden in many processed foods. In South Africa, the prevalence of high blood pressure ranges from 30% to as high as 80% in adults over the age of 50 years (1) .

A world-leader in salt reduction

South Africa is ahead of the pack with ground-breaking legislation to limit the salt content of certain foods. June 2016 marked the implementation of these regulations that have reduced salt in commonly consumed foods such as breads, breakfast cereals, and processed meats. So far legislation has been hugely successful with most manufacturers complying, and some products have reduced salt content by 30 to 40%.

What can the food industry do?

During World Salt Awareness Week, WASH and the HSFSA are calling on manufacturers to put less salt in our food, and challenge everyone to read food labels and choose the lower salt options – it’s as easy as that! Salt legislation will reduce salt intake by approximately 0.85 grams per person per day, depending on the individual’s food choices. One study estimated that this level of salt reduction will result in 7 400 fewer cardiovascular deaths and 4 300 fewer non-fatal strokes every year in South Africa (2) .

The WHO recommends that total salt intake should not exceed one teaspoon a day, an amount equal to 5 grams. The average South African eats roughly 8.5 grams of salt per day (range of 6 – 11 grams), with some people eating significantly more than this (3) . Salt legislation is a good start, but it is inadequate to curb excess salt intake.

How do we eat so much salt?

“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 2.5 grams of salt, already half the daily limit” says Gabriel Eksteen, Dietitian and Exercise Physiologist at the foundation.

Do YOU eat too much salt?

The Heart and Stroke Foundation SA launched an online salt calculator in 2015 in partnership with Unilever South Africa. This is the easiest way to see how much salt you eat, and which are the main salty culprits in your diet. The calculator has been carefully updated to improve accuracy and to reflect changes after salt legislation. Test your salt intake at www.saltcalculator.co.za . You may be surprised where your salt comes from!

How to reduce salt intake

Total salt intake includes what is already in the food, and what people add to food while preparing or eating the food. Choose foods wisely, keeping an eye out for food products with the Heart Mark logo and eat salty foods less often. How much salt is added at home is completely in the individual’s hands. When using salty ingredients like stock cubes, soy sauce or chicken spice as part of cooking, don’t add any further salt. Taste food while cooking and at the table, and think twice before adding more salt!

Get tested

One in every two South Africans with high blood pressure remain unaware of their condition. This prevents effective care and increases the risk of heart diseases and strokes. The HSFSA recommends that all adults test their blood pressure at least once every year. The public can get their blood pressure measured for free from 17 March until 9 April at all Dis-Chem pharmacies nationwide.

The next step forward

South African salt legislation will further reduce the salt levels of certain foods by 2019. Yet many foods are excluded from legislation, including fast foods. The HSFSA call on the fast food industry to clearly display the salt content of their meals, and to start reducing the salt content of their offerings. Graham MacGregor, Professor of Cardiovascular Medicine at The Wolfson Institute of Preventive Medicine and Chairman of WASH comments: “Salt damages our health. Salt reduction is the simplest and most cost effective measure to prevent thousands of unnecessary deaths from stroke and heart attacks every year. It is not just down to the individuals; manufactures must stop adding salt to our foods. During World Salt Awareness Week you can do something great for your health by eating less salt“.

 

1) Lloyd-Sherlock P, et al. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control.
Int J Epidemiol. 2014 Feb;43(1):116-28. doi: 10.1093/ije/dyt215

2) Bertram et al. Reducing the sodium content of high-salt foods: Effect on cardiovascular disease in South Africa. S Afr Med J
2012;102(9):743-745. DOI:10.7196/SAMJ.5832

3) Wentzel-Viljoen et al. “Use salt and foods high in salt sparingly”: a food-based dietary guideline for South Africa. South African Journal of Clinical Nutrition 2013; 26(3): S105-S113

“Sensible, long-term healthy eating is not the sexiest of subjects” – meet dietitian, Hlanzeka Mpanza

3 Comments June 8, 2016 nutritionadsa

Why did you become a Registered Dietitian?

By accident actually. My father brought a career guidance book home that featured a dietitian when I was in standard 9.  I was fascinated about the idea that everyday food could help with getting the most out of life whether in sports, work, disease and general mental well-being. I still am.

What do you enjoy most about the work you do? What are the most satisfying moments?

I work in the food industry. I believe this is the most exciting area to work in in dietetics today as there is so much happening in the field of food policy worldwide. My job as an industry dietitian is to make nutrition relevant and accessible to our consumers through relevant  products, messages and projects. And most importantly to provide our consumers with nutrition information that they need to make informed choices.  I like knowing that when we hit that sweet spot between the right health message and product/ project, we can positively change lives of millions of people every-day.

What has been your career highlight?

For a black girl from very humble beginnings, my job has allowed me to travel to places I never thought I’d see in my life. After qualifying, I registered as a dietitian in the UK, where I later went to work as I travelled my way around the continent over a number of years.  I not only got to work and live with diverse people from all over the world, I did it whilst still feeling like I was making a difference in peoples’ lives. Those years were special for me.

What are the most challenging aspects of your career?

Sensible long-term healthy eating is not the sexiest of subjects.  How do we as a profession get better at enabling the general public to eat better, without bells and whistles?  I’d like us to crack the key to population-wide healthy eating messages that are based on nutrition science yet are simple, engaging and accessible (not just financially but culturally as well).  We have to get to a point where investing in credible nutrition is the only sensible choice. At the moment, there is so much information clutter that the general public is mostly confused about what sensible healthy eating is. And when people are not food literate, they are not able to make lifestyle changes that they need to make for them live longer, more productive lives.

How do you cope after a day of nutrition disaster and bad eating choices?

Except I don’t call them nutrition disasters. I call them celebration days like when your BFF gets a promotion and you share one big cake between the two of you or sad days when you get ceremoniously dumped by your ‘not-really-serious-boyfriend’ and you eat all the food in the house.  The problem is when sad and celebration day kind of eating becomes the norm, which is when you need to start recreating a healthier normal.  How I cope is I pick myself up the following day and go live my best life, it’s all about trying to do better every-day. I believe food is a legitimate way of coping with emotional events and marking milestones, that’s ok.  I don’t think shame and guilt are useful when it comes to sustainable healthy eating.

What are the three things that you think people should stop saying when they meet a dietitian?

Are you really going to eat that?

How do I gain muscle or lose weight?

Don’t look at what I’m eating! (this makes us feel like the food police, which we’d like to think we are not)

What should clients look out for when deciding which dietitian to work with?

Find someone who gets you and your vision. Someone who understands what you want to achieve. Other than when dealing with certain medical conditions, success in nutrition is mostly relative. Define what success means for you, your health, your culture, your work, your mental well-being, your budget, stage of life, support system, etc. Choose someone that can help you navigate what success means for you and how to get there without giving up the most basic parts of yourself that make you YOU. You are more likely to be successful when you do that.

What is your favourite dish and your favourite treat food?

It changes, right now I am loving ujeqe obrown ( steamed brown bread) that I make at home a serve with everything. As a treat, I have a weakness for  spicy chicken wings from the orange fast food chain.