Salt Intake, How Much is Too Much?


Salt Intake, How Much is Too Much?


Rapid urbanization has increased the production of more and more processed food which in turn transforming dietary patterns. Nutrition transition or change in dietary patterns is taking place in the nation where people around the world consume more energy dense but less nutrients food. For instance, food that are high in saturated fats, trans fat, refined carbohydrates, sugar and salts. On the contrary, people are consuming less vegetables and fruits that are key components of a healthy diet.

 


Study titled “Malaysian Community Salt Study 2017/18” showed that the average salt intake per day among Malaysian is 7.9g or 1.6 teaspoons. Four out of five Malaysians consumed excessive salt which is above the level recommended by the World Health Organization (< 5g per day or equivalent to one teaspoon) (7).

 

A study showed that Malays had 21% higher odds of having pre-hypertension and 64% higher odds of having Stage 2 hypertension compared to the Chinese. The traditional cuisine of Asian people is well known to contain high amounts of salt. It has been widely used in fish fermentation, pickling, and the production of local Asian sauces. This result may related to high sodium intake among the ethnicity as previous research has established that excessive sodium intake leads to uncontrolled blood pressure among adults (1).

 


 

Sodium: what is the main dietary sources? (5,6,8)

 

Salt is the primary source of sodium however high sodium consumption is generally associated with health problems such as high blood pressure, fatal coronary heart disease or higher risk of incident of stroke.

Salt in the diet can obtain either from processed foods that are normally high in salt such as instant noodles, snack foods, sausage or added to food during cooking such as stock cubes or at the table such as soy sauce, fish sauce and table salt. Fried rice, omelette, fish cake, nasi lemak, thick soy sauce, tomato sauce, chilli sauce, oyster sauce, roti canai, meat soups and fried mee are also major source of sodium.

 


 

 

Sodium: How much is too much? (4, 8)

 



In general, World Health Organization (WHO) recommends consume less than 5g (just under a teaspoon) of salt per day or equivalent to less than 2000mg of sodium per day. However, this recommendation for children does not address the period of exclusive breastfeeding or the period of complementary breastfeeding.

 

Read the Nutrition Facts Label! (5,6,8)

 

Nutrition facts label found on packaged or processed foods list the amount of sodium in each serving and be sure how many serving are in a package.  Normally, sodium is found in most foods  as sodium chloride (NaCl) generally known as salt. In addition to  NaCl, sodium may also present in other forms, such as monosodium glutamate, baking soda, baking powder, disodium phosphate, sodium nitrate, sodium citrate, sodium benzoate and sodium alginate. However, sodium chloride (salt) is still the major source of sodium.

 


 

Tips for Cutting Back on Sodium (4,5,6,8)

 

  • Eat more fresh food. Increase the intake of fresh fruits and vegetables meanwhile cut down on consumption of salty foods such as salted fish, salted eggs, salted vegetables and high sodium snacks (potato crips, fish crips) and highly processed foods (sausages, nuggets, meatball and burger)

 


 

  • Read the ingredients list on the food label and take note on all sources of sodium. Note the sodium content of a food in the Nutrition Information Panel, compare with other products and choose the ones with the lower sodium content

 


  • Enhance the flavour of food using natural herbs and condiments such as garlic, onion, spices, lemon grass and lemon juice. Whilst, reduce the addition of flavor enhancers such as monosodium glutamate (MSG), sauces (oyster sauce, chili sauce, light soy sauce) and flavoring cubes.

 


 

  • Limit your fast food consumption or eating out. Eat home cooked meals more frequent as this offers more control over the use of salt and sauces. Request for low salt or sauces dishes or no MSG added meals if eating out.


 

 

  • Avoid adding salt and sauces at the table; Eat well and shake off the salt.
  • For children, do not add salts or condiments then replace with natural flavor enhancers when preparing their foods. Provide healthy and low salt snacks for school children.

 



 


Misconceptions about Salt Reduction

 


 

  • You need more salt in your diet when you sweat on humid and hot day. Extra salt is not needed even on a hot and humid day but it is important to drink a lot of water.
  • “Sea salt is better”. No matter what is the source of salt, it is the sodium content that causes bad health outcomes.

 


 

  • “Foods high in salt taste salty”. Other ingredients in the food may mask the salty taste. It is important to read the food label to find out the sodium levels.
  • “Only old people need to aware of salt intake”. No, eating too much sodium can increase the risk of hypertension at any age.

Go Low and Take it Slow! (2)





Reduce your salt intake gradually and your taste buds will adjust as our taste for salt is acquired. Consider using low salt or salt free flavour enhancers during cooking and reduce addition of salt or soy sauce at the table.

After a few weeks of cutting back on salt, you probably won’t miss it, and some foods may even taste too salty.

 

 

References

  1. Balkish, M., N., Muhammad, F., M., Y., Sarimah, A., Kamarul Imran, M., Najib Majdi, Y., Maria, S., M., Norhafizah, S. and Tahir, A. 2019. Factors associated with the severity of hypertenstion among Malaysian adults. PLoS ONE 14(1): e0207472. https://doi.org/10.1371/journal. pone.0207472
  2. Mayo Clinic. 2019. Healty Lifestyle: Nutrition and healthy eating [online]. Available from: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/sodium/art-20045479 [Accessed on 6 April 2020].
  3. Ministry of Healthy Malaysia. 2018. Guidelines for Healthcare Professionals: Health Education and Communication Tools to Reduce Salt Intake in Malaysia [online]. Available from http://www.moh.gov.my/moh/resources/Penerbitan/Rujukan/NCD/Garam/Guideline_for_healthcare_professionals.pdf [Accessed on 6 April 2020].
  4. Ministry of Health Malaysia. 2018. Manual Penggunaan Bahan Pendidikan Kesihatan: Penjagaan Pemakanan Dalam Pengawalan Pengambilan Garam [online]. Available from http://www.moh.gov.my/moh/resources/Penerbitan/Rujukan/NCD/Garam/Buku_manual.pdf [Accessed on 6 April 2020].
  5. National Coordinating Committee on Food and Nutrition. 2013. Malaysian Dietary Guidelines for Children and Adolescents [online]. Available from http://nutrition.moh.gov.my/wp-content/uploads/penerbitan/buku/MDG_Children_adolescent_2014.pdf [Accessed on 6 April 2020].
  6. National Coordinating Committee on Food and Nutrition. 2017. Recommended Nutrient Intakes for Malaysia [online]. Available from http://nutrition.moh.gov.my/wp-content/uploads/2017/05/FA-Buku-RNI.pdf [Accessed on 6 April 2020].
  7. New Straits Times. 2019. 4 out of 5 Malaysians eat too much salt [online]. Available from https://www.nst.com.my/news/nation/2019/04/479149/4-out-5-malaysians-eat-too-much-salt [Accessed on 6 April 2020].
  8. World Health Organization. 2016. Salt reduction [online]. Available from https://www.who.int/news-room/fact-sheets/detail/salt-reduction [Accessed on 6 April 2020].