Pass the salt? Docs praise S. Africa's health initiative

Doctors here are lauding South Africa's decision to get its people to eat less salt and say that Singapore can take a leaf out of its book.

The South African initiative, presented at the World Congress on Cardiology in Melbourne last week, aims to reduce salt intake by 2020 to less than 5g - or a full teaspoon - per person a day.

Last year, it passed a law limiting the amount of salt allowed in bread and other common processed food.

A study by University of Cape Town in South Africa and University of Washington in the United States suggests that doing so would cut deaths from cardiovascular disease by 11 per cent and save South Africa US$55 million (S$68.7 million) a year in treating salt-linked diseases.

"It's a wonderful initiative," said Changi General Hospital's (CGH) head of cardiology, Dr Tong Khim Leng. "It saves lives and saves money."

The bad effects of salt on health is evidence-based, he said, and consuming less salt helps both people with or without high blood pressure.

In Singapore, heart diseases account for more than one in five deaths. The Health Promotion Board says people here take an average of 8.3g of salt a day.

Dr Kenneth Ng, who practises at Mount Elizabeth Novena Hospital, tells his patients not to add any salt or soya sauce to their food, as most food already contains salt.

The Government can mandate the labelling of salt in food and the introduction of more low-salt foods to help people here consume less salt, he suggested.

Reducing salt intake to less than 4g a day would lower the risk of stroke and heart attack by at least 20 per cent, he said.

Associate Professor Yeo Khung Keong, a senior cardiologist at the National Heart Centre, also felt that Singapore can learn from the South Africans.

He said: "What may not be apparent is that there is a lot of salt in processed foods and fast foods, such as burgers and fries, including chilli sauce and ketchup, as well as soya sauce.

"Salt is also present in soups and processed or preserved meats and vegetables."

But even uncooked natural food - such as fish, eggs and vegetables - contains salt.

Dr Ong Hean Yee, head of cardiology at Khoo Teck Puat Hospital, said: "The (South African) targets are actually not low enough.

"But it is a difficult compromise between what can be done versus what is ideal but impossible for people to adapt to."

People need no more than 2g of salt a day, he said, but many people here consume three to six times that amount, leaving their kidneys and heart working extra hard to get rid of the excess.

He blames the low price of salt for the high rate of high blood pressure here.

"There is irrefutable scientific evidence that excessive salt intake is a major reason why almost one in four adults in Singapore has hypertension," he said.

For Dr Lee Yian Ping, a cardiologist at Raffles Heart Centre, 1.5g of salt a day is all he recommends, while Dr Ong tells his patients to have food that is "as bland as possible".

Over time, their palate will adjust, he added.

For businessman Ravinder Singh, however, salt is essential.

"What's the point of eating if the food is tasteless? I like to enjoy my food," he said, but added that he does not think his consumption of salt is excessive.

Any initiative to help reduce salt intake will require a wider, collective effort, said Dr Lee.

"We need the food industry's cooperation as well because most of the salt is in processed food."

This article was published on May 12 in The Straits Times.

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