Gulf Daily News - Bahrain

Bahrain, May 12: THERE is a hidden killer in almost everything we eat and on every dining table.

Salt is being blamed for millions of deaths a year worldwide and is directly linked to heart disease - the biggest killer in Bahrain.

Individual salt consumption worldwide is almost twice to three times the recommended intake, the World Health Organisation (WHO) says in a new report.

"Despite the fact that salt intake in most countries is very high, commitment to reduce it is still not a priority in most countries," it says.

The WHO recommends a maximum salt intake for adults of 5gms a day.

Its report cites the current high individual salt intake (9-15gms) as the major determinant of high blood pressure.

High blood pressure is the biggest cause of cardiovascular disease, which kills more people worldwide - around 12.7 million each year - than any other illness, says the report, released last month.

Raised blood pressure accounts for 62 per cent of strokes and 49pc of heart disease cases, it says.

The organisation believes that reducing individual salt intake by 6gms a day could cut deaths from strokes by 24pc and from coronary heart disease by 18pc - saving 2.6m lives a year.

"Ministries of health throughout the world should be implementing policies to reduce population salt consumption, whilst food companies should be lowering the salt content of their products," Professor Graham MacGregor, chairman of World Action on Salt and Health (Wash), says in the report.

Bahrain is already taking the issue seriously, with a national campaign in the making to cut salt consumption.

"The Health Ministry in Bahrain goes by the WHO guideline of 5gms a day. A food-based guideline, however, is in the process of being drawn," says ministry nutrition section head Dr Khairya Moosa.

"Excess salt can lead to hypertension and cardiovascular disease, which is the single largest cause of death among Bahrainis.

"The problem is a global one and not just prevalent in Bahrain."

Guidelines are being drawn up which will be circulated to all fast-food outlets and restaurants in Bahrain, urging them to reduce the salt levels in their products.

The campaign will also be aimed at making the public more aware.

But first it is imperative to gauge just how big the problem is and how much salt is actually being consumed by the general population, said Dr Moosa.

Bahrain is also planning to relaunch a campaign targeting fast food outlets, to get them to offer healthier children's meals.

An earlier campaign floundered after some initial success, partly due to parents' demands.

"Fast food chains were charging BD1 for a kids' meal and giving away free gifts and targeting children in their advertising," said Dr Moosa.

"We met with these chains and explained our concerns about the health of children and together we decided that in a kids' meal, instead of a soft drink (which is given free with the meal) they would be offered juice, milk or water.

"If a parent asked for a soft drink, they would have to pay extra. Also, mayonnaise was to be replaced by a fresh salad."

The campaign ran into difficulty, however, due to a large number of parents insisting that their children be given a soft drink with their meal.

Also, employees at some fast food chains didn't realise that they could offer a healthy substitute to a soft drink.

"The ministry is looking into reactivating the campaign and is also trying to get fast food outlets to provide nutritional details of each item to the consumer," said Dr Moosa.

She was very clear when talking about the health pitfalls of obesity.

"Obesity among children is dangerous and can lead to cardiovascular problems and Type II diabetes," said Dr Moosa.

A few years ago, TV food channels were extolling the virtues of sea salt, as opposed to processed salt and celebrity chefs gushed over the stunning flavours it could bring out in food.

But when the British Medical Journal (BMJ) began releasing its findings during a 15-year study of people's salt intake and health, the world sat up and took notice.

The study found that "those who ate less salty food were found to have a 25pc lower risk of cardiac arrest or stroke and a 20pc lower risk of premature death".

"Our study provides unique evidence that sodium reduction might prevent cardiovascular disease and should dispel any residual concern that sodium reduction might be harmful," says the BMJ report.

Results have been released in the journal every six months throughout the years over which the study was carried out and its final, damning report was published last month.

Now everyone is jumping on the salt-bashing bandwagon.

Celebrity chefs like Antony Worrall Thompson and Nick Nairn decried the overuse of salt, and nutritionists harped about how they knew all this decades ago.

"I've been very concerned about the levels of salt in processed foods, particularly in products aimed at children, so a health campaign to highlight the dangers of eating too much is very welcome," Thompson was quoted as saying.

Chefs in Bahrain echo the concern.

"I agree with the recent scientific studies about the health problem related to excessive salt intake," said Mšvenpick Hotel executive chef Ery Irmansjah.

He says salt should be used with care and that in his kitchen, staff understand that while exciting diners' tastebuds is important, it is crucial to also make sure the meals are healthy.

"The use of salt and oil is controlled at all times," said Chef Irmansjah.

"Chefs should try to minimise the use of salt in their cooking, after all the salt and pepper shaker on every table is there for a purpose.

"A dish with less salt can always be transformed by adding some more. The opposite, however, isn't possible."

His view is shared by Gulf Hotel executive chef Neil Mason, who says chefs should set a healthy example.

"Reducing your salt intake helps reduce hypertension and dehydration," he said.

As far back as 2004, the group Consensus Action on Salt and Health (Cash) released a list of 127 goods that were "too salty".

Of that list, 66pc had reduced their salt content by this year.

The campaign group singled out Bird's Eye, and Heinz for their progress in making reductions in salt.

One product that came under scrutiny from Cash was Unilever's Peperami Sticks (a product that graces the shelves of many of Bahrain's large supermarket chains). Unilever has since stated that sticks with a salt content cut to 3.6g per 100g would be made available to retailers.

If medical publications like the BMJ and The Lancet are to be believed (and there is very rarely reason not to), then salt is a silent assassin.

Yet according to the US-based Salt Institute, we have known - for 400 years ! - that salt intakes can affect blood pressure.

But it disputes what it calls the 'salt hypothesis' that suggests that since salt intakes are related to blood pressure and since cardiovascular risks are also related to blood pressure, that, surely, salt intake levels are related to cardiovascular risk.

The institute insists that more data is needed to confirm or reject the hypothesis.

But what can you do to make sure that the food you and your family eat has the right salt content ?

There are many ways to keep hypertension (high blood pressure) at bay, or at least make sure that it doesn't rise due to the food you eat.

Here are some tips:

l Eat more fresh foods and fewer processed foods. Most fresh fruits and vegetables are naturally low in sodium. Also, fresh meat is lower in sodium than processed products such as luncheon meat, bacon, hot dogs, sausage and ham.

l Opt for low-sodium products. If you do buy processed foods, select those that have reduced sodium.

l Remove salt from recipes whenever possible. You can leave out the salt in many recipes, including casseroles, stews and other main dishes. Baked goods are an exception. Leaving out the salt could affect the quality as well as the taste of the food.

l Limit your use of sodium-laden condiments. Salad dressings, sauces, dips, ketchup, mustard and relish all contain sodium.

l Use herbs, spices and other flavorings to enhance foods. Learn how to use fresh or dried herbs, spices, zest from citrus fruit and fruit juices to jazz up your meals.

The Mayo Clinic, which is based in the US, but has a global footprint, suggests that a daily salt intake of 2.4gms is ideal for healthy adults.

It says that nearly 77pc of our daily salt intake comes from processed food, 12pc from natural sources, 6pc is added while we eat and 5pc is added when we cook.

The question at this point is why are processed foods so salty?

"In addition to making food more flavourful, salt makes soups thicker, reduces dryness in crackers and pretzels and increases sweetness in cakes and cookies. Salt also helps disguise metallic or chemical aftertaste in products such as soft drinks," says Mayo Clinic dietician Katherine Zeratsky.

It's fairly easy to be blindsided by the salt content in your diet and it is invariably a painstaking process to minimise its use in food.

Salt has become a gastronomic culture of sorts, whereby we associate taste with its prevalence in a dish.

It will take a truly global movement if we are to cut down our intake and save - as the WHO says - 2.6m people a year.