Sodium under the spotlight

Gourmets the world over admire the exotic flavours and fragrances of Thai cuisine so why is it that Thais cannot eat these delicious dishes without adding condiments? Nampla prik (minced chilli in fish sauce) is liberally mixed in with steamed rice, sugar and fish sauce liven up a bowl of noodles, fresh fruit is dipped in prik klua (a mix of sugar, salt and minced chilli) and even soft drinks don't survive unscathed, usually getting a liberal addition of salt.

Little surprise then to learn that folks in Thailand consume twice as much salt than is good for them.

Recommended daily intake of sodium or salt shouldn't exceed 2,400mg per day, which is equivalent to five grams of salt and two tablespoon of fish sauce. Most of us make inroads into that just by adding nampla prik to lunchtime favourite khao krapao kai khai dao (steamed rice topped with stir fried chicken with chilli and holy basil) while the ever-popular snack of som tam has the sodium meter screaming with around 2,000mg courtesy of the fish sauce, pla raa (fermented fish) and poo dong (salted crabs).

Since salt is the basic and cheapest substance for preserving food, it's found in most of the dishes we eat. Getting people to change their eating habits, even though these may be risky to their health, is never easy but doctors are determined to make a difference, launching a full week of activities that continue through Sunday to mark World Kidney Day on Thursday. The aim is to cut salt intake by as much as 50 per cent.

"Part of the problem is that Thais buy cooked food from food stalls or markets and these tend to have a stronger taste. Our tongues get used to salt and when we eat less salty food, we don't find it tasty enough so add condiments," says Dr Surasak Kantachuvesiri, chairman of the Low Salt Thailand Network, which was founded late last year.

"We can change our eating habit gradually, by say 10 per cent a year to let our tongues get used to less salt," Surasak adds.

Though sodium is one of the major electrolytes and essential to control the fluids going in and out of the body, too much can cause kidney disease, meaning the kidneys will no longer be able to eliminate excess sodium and fluid, As sodium and fluid increase, the fluid in the bloodstream leads to an increase in blood pressure. High blood pressure can damage the artery wall and lead to kidney malfunction.

Sodium comes from various sources and is found in salt (sodium and chloride), monosodium glutamate (MSG) and sodium bicarbonate, which is contained in baking powder and soft drinks.

Around 70 per cent of sodium comes from the cooking process, with seasoning sauce, oyster sauce, fish sauce and salt added most dishes before they're consumed. Preserved foods like pla raa (fermented fish), fermented ground pork, poo dong (salted crab) or Chinese sausage have a high sodium content as does canned and frozen foods.

Children get their salt kicks from potato chips, popcorn and soft drinks, thus opening them to health problems at a very early age.

"Before adding condiments, always taste the dish because sometimes it is already salty. Actually, it's best not to add condiments at all," says Surasak.

The Low Salt Network is working with the Institute of Food Research and Product Development at Kasetsart University in adapting Thai recipes to use lower salt and also approaching major food processors like CP and S&P to introduce low-salt products to the market.

Many low salt condiments are already available in supermarkets along with reduced sodium snacks and other foods.

Dr Anutra Chittinantana, the president of Nephrology Society of Thailand says that around 17.6 million of Thai people have kidney disease and 11.5 million suffer from hypertension. Many are receiving expensive hemodialysis at least twice a week.

"Once the kidney reaches the stage of needing dialysis, there's no turning back. Surely it's better to tackle the problem at the cause and just eat less salt," says Dr Anutra. Kidney disease creeps up slowly and many patients don't see a doctor until symptoms are severe. An annual health check-up that includes such simple kidney-function tests as BUN (blood-urea-nitrogen) and creatinine measurements is recommended for all adults.

Dr Kriang Tungsanga, president of the Royal College of Physicians of Thailand says that lowering consumption of salt by just three grams a day will decrease blood pressure and reduce the chance of developing coronary artery diseases or kidney failures.

Those who still hanker after salt can find a replacement for sodium in potassium salt or simply by eating food that has mixed tastes. However, anyone with kidney problems should avoid even potassium salt since it can cause cardiac arrhythmia.

You can cut back

>>> Don't use salt, fish sauce, seasoning sauce or MSG (monosodium glutamate) in cooking.

>>> Add only a little seasoning to your noodles or nampla prik.

>>> Avoid processed foods, especially salted egg, salted fish, dried fish, fermented fish, fermented pork, Chinese sausage or dried shredded pork.

>>> Switch to other seasoned dishes like gaeng som (sour soup made of tamarind paste) and use tom yum as a replacement for salted food.

>>> Soup tends to have high sodium content. Eat less soup and add water to dilute the sodium.

>>> Read ingredient labels to identify foods that are high in sodium or other additives, such as MSG.