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Less salt on your plate

You have probably seen the many public health promotion campaigns advocating the importance of eating less fat, sugar and salt. Whether or not they are effective in influencing industry actions and consumer decisions, they are in line with the recommendations of various recognised health organisations that have stressed the great need to reduce the consumption of these nutrients, among which salt. And that is exactly what the WHOa member states set out to do in 2013 when they set an ambitious aim to reduce salt by 30% before 2025.1 But while these concrete objectives are necessary, they hardly speak to us as consumers. To better understand the ins and outs of such targets, today’s article will focus on salt consumption, its impact on health, guidelines and advice and, finally, what is being done to promote the health of the population.

Role and risks

Salt is the common name for sodium chloride, or NaCl, which contains sodium (a mineral) as its name suggests. Although sodium has been criticised for its negative impact on our health, it is nevertheless an essential nutrient that performs a range of physiological functions in our bodies. It contributes, among other things, to the maintenance of a normal fluid balance and the normal functioning of the nerves, muscles and heart.1,2 But as with most nutrients in our diet, it is all a question of moderation, and excessive consumption is generally not advisable. To date, there is strong evidence that high sodium intake contributes to high blood pressure in many populations, which has been directly linked to the development of cardiovascular and kidney diseases. Multiple studies have also shown that high sodium intake is associated with an increased risk of cardiovascular events, such as heart disease and stroke.1,2,3,4

In contrast, reduced sodium intake has been associated with lower blood pressure, and lower morbidity and mortality from all causes and from cardiovascular disease.3

Guidelines on salt intake

Guidelines for salt consumption have been developed just the same as for other nutrients whose consumption should be limited. They vary slightly from country to country, but remain within the same range. As an indication, the recommended maximum daily salt intake level on a global (FAO/WHOb) and European level is 5 g, which is equivalent to about one teaspoon of salt.1,2 Other regions, such as the USA and the People’s Republic of China (PRC), recommend an intake level equivalent to 3.75 g of salt per day.3,5 The recommendations for the Taiwanese and Japanese populations are somewhat less strict, with a maximum daily intake of 6 g and 7 g of salt, respectively.6,7

In the context of disease prevention, the thresholds proposed by renowned international expert groups are ultimately in the same range as the general recommendations for a healthy lifestyle. The 2019 US guidelines for cardiovascular prevention and the 2018 European guidelines for the management of hypertension set a limit of 3.75 g and 5 g of salt per day, respectively.8,9

Practical tips

When it comes to limiting your salt intake, making healthier food choices is essential. You can therefore easily benefit from the following tips, whether or not you are willing to cut down on salt in your diet:1,4,9

  • Choose fresh, unprocessed foods (e.g. fresh vegetables rather than canned or prepared vegetables, fresh poultry, fish and meat rather than processed fish and meats such as sausages, bacon and smoked salmon and ham)
  • Learn to read food labels, especially for salt content, and choose foods that contain the least amount of salt. Also beware that a range of foods have a naturally high salt content, often due to the manufacturing process (e.g. olives, cheeses and especially hard and blue cheeses, a series of condiments including soy sauce and Worcestershire sauce, some mineral-rich waters, etc.)
  • Cook your own meals and learn new recipes instead of buying ready-made meals or eating out. Use herbs and spices rather than salt during preparation and at the table.

While this may seem tricky at first depending on your own lifestyle, know that a low-salt diet can be tasty if you choose the right ingredients and cooking methods. Many practical tips for reducing sodium consumption are generally available on official consumer websites of national health organisations. Or you may also find it easier to make these changes by consulting a dietician who can help you find the best options depending on your personal preferences and background.

Government initiatives

Although salt reduction is primarily a personal decision driven by various factors, this would not be possible without the involvement of governments and industries. In many developed countries, the consumption of processed foods accounts for about 80% of total salt intake.1,9 This explains why numerous governments have taken initiatives to improve consumer health and contain healthcare costs by collaborating with food manufacturers to reformulate and lower the salt levels of marketed products (e.g. bread, cheeses, processed meats, salted snacks), setting targets for salt levels in public and private sectors (e.g. schools, workplaces, hospitals), releasing guidelines and educational materials on healthy living (e.g. through consumer awareness campaigns), salt taxation, and front-of-pack labelling, on a mandatory or voluntary basis (e.g. Nutri-score, traffic lights, nutrition claims).10

For this same purpose, Monde Selection has released its new ‘Low Salt‘ and ‘Salt-free‘ Nutrition Labels to support producers’ efforts to develop healthier products. Featuring these labels on food packaging can both help consumers and give them more confidence by providing proof that the nutrition claim has been verified through a strict certification process and that it complies with regulations in many countries, as those described below.

Although salt reduction is primarily a personal decision driven by various factors, this could not be achieved without the involvement of governments and industries.

Labelling regulations

With regard to legislation on sodium content claims in foods, there is currently a consensus between national and international regulations and standards issued by the FAO/WHOb, the European Union, Japan, the PRC and the Republic of China (Taiwan).10,11,12,13,14 According to the Codex Alimentarius and the official texts of the cited territories, any food bearing the claim ‘low sodium‘ or ‘low salt‘ on its packaging must not contain over 120 mg of sodium (or the equivalent value for salt, i.e. 0.3 g of salt) per 100 g or 100 ml. As for the claim ‘sodium-free‘ or ‘salt-free‘, the sodium content must be less than 5 mg of sodium (equivalent to 0.0125 g of salt) per 100 g or 100 ml. Consequently, this means that any product sold in the EU, Japan, China or Taiwan is subject to the same binding rule when these sodium content claims are displayed on a package.

Conclusion

As with a lot of other nutrition topics, there are many misconceptions about the health effects of salt. Sodium remains an essential nutrient for our bodies; however, salt intake should be limited for disease prevention purposes. Applying practical tips to reduce your salt intake, such as choosing fresh foods and cooking your own meals, will also improve your diet quality overall.

And while it is true that most people find it difficult to change their dietary habits, in particular their salt intake level, you can learn to enjoy flavours differently. Remember to make gradual changes in order to give yourself the chance to adapt, otherwise you may perceive the food as tasteless.

To conclude, salt consumption does not only concern consumers but also involves governments and industries that have a great role to play in maintaining this balance. It is therefore essential to implement initiatives to reduce the population’s salt intake, including front-of-pack labels such as Monde Selection’s Nutrition Labels, which can make it easier to find low-salt foods in supermarket aisles.

Last updated: June 2021

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References

a The World Health Organization (WHO)

b The Food and Agriculture Organization (FAO) and the World Health Organization (WHO)

1 World Health Organization. (2020). Salt reduction. Retrieved June 2021, from https://www.who.int/news-room/fact-sheets/detail/salt-reduction

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2 European Food Safety Authority. (2019). Dietary reference values for sodium. EFSA Journal, 17(9), p. 5778. doi:10.2903/j.efsa.2019.5778

3 National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board. (2019). Dietary Reference Intakes for sodium and potassium: Summary. Washington, DC: The National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK545430/

4 Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., . . . Schutte, A. E. (2020). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension, 75(6), pp. 1334–1357. doi:10.1161/HYPERTENSIONAHA.120.15026

5 National Health Commission of the People’s Republic of China. (2018). Dietary Reference Intakes for Chinese Residents Part 2: Macroelements (中国居民膳食营养素参考摄入量 第2部分:常量元素). Retrieved from http://www.nhc.gov.cn/wjw/yingyang/201805/f2c614be95fe41dba8123c23a6e6fb55.shtml

6 Health Promotion Administration, Taiwan Ministry of Health and Welfare. (2016). Salt Reduction Handbook (減鹽秘笈手冊) (last updated: 2020). Retrieved from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1161&pid=6648

7 Ministry of Health, Labour and Welfare, Government of Japan. (2020). Dietary Reference Intakes for Japanese (2020): Report of the Study Group on the Dietary Reference Intakes for Japanese People (日本人の食事摂取基準(2020 年版): 「日本人の食事摂取基準」策定検討会報告書). Retrieved from https://www.mhlw.go.jp/stf/newpage_08517.html

8 Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., . . . Ziaeian, B. (2019). 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 140(11), pp. e596–e646. doi:10.1161/CIR.0000000000000678

9 Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., Kahan, T., Mahfoud, F., Redon, J., Ruilope, L., Zanchetti, A., Kerins, M., … ESC Scientific Document Group. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal, 39(33), pp. 3021–3104. doi:10.1093/eurheartj/ehy339

10 Food and Agriculture Organization of the United Nations & World Health Organization. (1997). CAC/GL 23-1997: Guidelines for use of nutrition and health claims (last updated: 2013). Codex Alimentarius, pp. 1-8. Retrieved from http://www.fao.org/fao-who-codexalimentarius/codex-texts/guidelines/en/

11 European Parliament & Council of the European Union. (2006). Regulation (EC) n°1924/2006 of the European Parliament and of the Council of 20 December 2006 on nutrition and health claims made on foods (consolidated version: 2014). Official Journal of the European Union, L 404, 9-25.

12 Consumer Affairs Agency of Japan. (2013). Food Labelling Act (Act n°70) (食品表示法 (平成二十五年法律第七十号)) (last updated: 2019). Retrieved from https://elaws.e-gov.go.jp/document?lawid=427M60000002010

13 Ministry of Health of the People’s Republic of China. (2011). National Standards of the People’s Republic of China GB 28050-2011: Standard for nutrition labelling of prepackaged foods (食品安全国家标准 预包装食品营养标签通则).

14 Taiwan Ministry of Health and Welfare. (2015). Regulations on Nutrition Claim for Prepackaged Food Products (包裝食品營養宣稱應遵行事項) (last updated: 2021). Retrieved from https://www.foodlabel.org.tw/FdaFrontEndApp/Law/Edit?SystemId=e518c1d9-78e0-4207-b988-cc302dc58754&clPublishStatus=1&key=%E7%87%9F%E9%A4%8A

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