Elizabeth Dunford: Too salty

WHEN a patient is diagnosed with hypertension, their doctor will most likely suggest, among other things, that they improve their diet including reducing salt.

The National Heart Foundation of Australia’s guide to hypertension management says people with high blood pressure (BP) should consume no more than 4 g per day of salt, and that low- and reduced-salt foods should be consumed as part of a healthy eating program.
    
But it’s not quite so simple for the average Australian to reduce the amount of salt they eat.

The average Australian consumes around 9 g of salt each day, well above the suggested dietary target for prevention of chronic disease. Most salt (> 75%) comes from processed and fast foods, with a much smaller proportion from salt added during cooking and at the table.

Simply telling a patient, or indeed any Australian, to reduce their dietary salt intake presents a battle in itself. Research indicates that only two-thirds of Australians know that salt is bad for health and less than a third know the recommended maximum daily intake.

Consumers diagnosed with hypertension may be more likely to check salt on food labels, but the majority of consumers have difficulty reading and understanding food labels. In Australia, salt is currently labelled as “sodium” on the nutrition label of processed foods. This can be confusing as many people are not aware of what constitutes a “high” or a “low” salt food choice.

For example, most people are unaware that bread is one of the biggest contributors to dietary salt intake. Recent studies show that around 19% of salt in the Australian diet comes from bread, and that the bread and cereals group together contribute 32.5%.

Recognising the high contribution of processed foods to Australians' dietary salt intake, the federal government established the Food and Health Dialogue to improve the food supply by setting salt reduction targets for a number of packaged food categories. So far, the dialogue has developed targets for the maximum levels of sodium food manufacturers should aim for in bread, ready-to-eat breakfast cereals, simmer sauces, processed meats, soups, savoury pies, savoury crackers, and savoury snacks.

If all food companies achieve these targets it will be good news, as the average person will be consuming less salt without necessarily making changes to their food choices.

So what can health professionals do to aid salt reduction efforts?

Taking a strong interest is the first step, as reducing dietary sodium is likely the most important public intervention impacting BP. In fact, the benefit extends well beyond hypertension, with a high salt intake implicated in a variety of other health problems including osteoarthritis, cancer, asthma, Ménière’s disease and obesity.

There is a plethora of information to help health professionals keep up to date with the evidence base on salt reduction and that they can recommend to patients. There are also simple yet effective tools for patients and colleagues to help reduce salt intake:

•    Consumer groups such as Salt Matters
•    Smartphone applications such as FoodSwitch (in SaltSwitch mode)
•    Health star ratings on packaged foods, which officially started on 27 June but will take 5 years to be phased in
•    Hypertension Talk, which provides weekly updates of all articles related to salt reduction published in the academic literature

Health professionals can advocate for population salt reduction through active engagement with groups such as World Action on Salt and Health and through professional organisations such as the High Blood Pressure Research Council.

There is no “one-size-fits-all” when it comes to reducing population salt intake. Health professionals, the food industry, the government and consumers all need to be part of the process.
 

Dr Elizabeth Dunford is a nutritionist, global database manager for The George Institute for Global Health’s food policy group and a project officer for the Australian Division of World Action on Salt and Health’s (AWASH) Drop the Salt! Campaign.