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Are you eating too much salt?

High blood pressure affects 25% of adult South Africans, with black African people appearing to be more susceptible than other groups[1]. Experts suggest this may have a lot to do with the high levels of salt in our diets and that reducing this excessive consumption might be an effective, easy way of helping to protect ourselves from this devastating condition[2].
(Image: Wikimedia Commons)
(Image: Wikimedia Commons)
High blood pressure is a grave health concern here in South Africa. Local studies suggest that one in every four South Africans between the ages of 15 and 64 already suffers from the condition - and that this number is rising rapidly[3].

Black South Africans appear to be more at risk than others are. A 2005 survey of nearly 10 000 South Africans over the age of 30 found that high blood pressure had the highest prevalence in the black community, with 59% of black African people, 55% of Indian and coloured people and 50% of white people diagnosed with the condition[4].

This reflects figures from the United States from 1999-2004, which show that adult blacks in the United States have the highest age-adjusted rates of high blood pressure prevalence at 39.1%, compared to 28.5% in whites and 27.8% in Mexicans[5]. Adult blacks are also prone to developing the condition at a younger age, to suffer from more elevated blood pressure levels if they do develop it, and to experience more damage and cardiovascular events as a result[6].

'High blood pressure a serious issue with South Africans'


"High blood pressure is a serious issue for South Africans," confirms Dr Mike Ramaboea from the Louis Pasteur Hospital in Pretoria. "Sadly, we don't have enough recent data and studies on prevalence, but my own experience mirrors the results of the American study. I see a lot of adult black patients with the condition. The average age is about 32 years old, but some are as young as 21 or 22."

While there are several potential causes of high blood pressure, most experts agree that diet is one of the chief culprits[7]. Numerous studies have linked excessive salt consumption to high blood pressure[8], for example, and some commentators believe this is likely to be a significant contributing factor here in South Africa. "Based on my own personal experience, I would argue that black people appear to have a lower tolerance for salt," agrees Dr Ramaboea.

The link between salt and high blood pressure


Our bodies need salt[9]. Among other tasks, the kidneys use the mineral to control the amount of water in the body and to ensure our blood's normal pH is maintained. The kidneys also regulate the amount of salt in our bodies by excreting the excess in our urine. If our salt intake is too high, however, the kidneys cannot keep up and the excess builds up in our bloodstream[10].

Salt retains or attracts water and so, the more of it there is in our blood, the more water is retained as well. This increases the volume of fluid being pumped around the body and, as a result, more pressure is needed to push it[11]. That is why doctors recommend reducing the amount of salt you consume each day as an important part of high blood pressure treatment and prevention[12].

You only need 69mg of sodium per day[12] (1g of salt contains 0.4g sodium[14]). Even though a teaspoon of salt contains considerably more - about 2300mg - dieticians say that it is an okay amount for people with normal blood pressure to consume daily[15]. If you have, or are at risk of, high blood pressure, however, you should limit the sodium in your diet to 1500mg per day[16].

The hidden salt in our diets


Most of the salt we consume doesn't come from what we shake onto our meals, but what is already 'hidden' in our food[17]. The food industry uses salt to make food taste better and last longer[18]. As a rule, the more processed the food, the more salt it is likely to have in it[19]. 'Take aways', ready meals and canned foods, for example, all tend to have extremely high levels of salt in them. As do sweets, breads, cereals, red meats, sugar, milk and shellfish. Foods with low levels of salt tend to be unrefined, fresh foods, such as fruits, vegetables, beans, rice, lentils and pasta[20].

Read the labels on the food you buy. You might be surprised at how many products contain high levels of salt. If the label says anything more than 1.25g salt (or 0.5g sodium) per 100g/ml, then it should be considered high[21]. Also, try not to cook with salt or add it to your meal at the table, use an alternative seasoning instead.

Get tested regularly


While the good news is that high blood pressure can usually be managed by making these kinds of dietary and lifestyle changes - and taking medicines, if necessary - the condition's lack of symptoms means that people are often not aware that they have it until it is too late and major complications have arisen[22]. Therefore, the best approach is to have your blood pressure checked regularly by a medical professional. "Every adult South African you should get tested regularly," maintains Dr Ramaboea, "especially black patients over the age of 30, who should have their blood pressure checked at least once a year."

Why is high blood pressure dangerous?


It is dangerous because it makes your heart work extra hard. It increases your risk of developing heart disease and of having a stroke. It can also lead to other problems, such as heart failure, kidney disease and blindness[23].

Are you 'salt sensitive'?


Doctors classify people who experience an almost immediate elevation in blood pressure after eating salty foods as 'salt sensitive' and at higher risk of high blood pressure. Researchers suggest that at least 25% of the population are likely to be salt sensitive[24].

Footnotes


1 Connor M, Rheeder P, Bryer A, Meredith M, Beukes M, Dubb A, et al. The South African Stroke Risk in General Practice study. S Afr Med J 2005;95:334-339.
2 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. National Institutes of Health. National Heart, Lung, and Blood Institute. Your Guide To Lowering Your Blood Pressure With DASH. NIH Publication No. 06-4082. Originally Printed 1998 Revised April 2006
3 Steyn K. Hypertension in South Africa. South African Medical Research Council. Chronic Diseases of Lifestyle in South Africa since 1995 - 2005 http://www.mrc.ac.za/chronic/cdlchapter8.pdf
4 Connor M, Rheeder P, Bryer A, Meredith M, Beukes M, Dubb A, et al. The South African Stroke Risk in General Practice study. S Afr Med J 2005;95:334-339.
5 JM Flack, DA Calhoun, L Satlin, M Barbier, R Hilkert and P Brunel. Efficacy and safety of initial combination therapy with amlodipine/Valsartan compared with amlodipine monotherapy in black patients with stage 2 hypertension: the EX-STAND study. Journal of Human Hypertension (2009), 1-11
6 JM Flack, DA Calhoun, L Satlin, M Barbier, R Hilkert and P Brunel. Efficacy and safety of initial combination therapy with amlodipine/Valsartan compared with amlodipine monotherapy in black patients with stage 2 hypertension: the EX-STAND study. Journal of Human Hypertension (2009), 1-11
7 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. National Institutes of Health. National Heart, Lung, and Blood Institute. Your Guide To Lowering Your Blood Pressure With DASH. NIH Publication No. 06-4082. Originally Printed 1998 Revised April 2006
8 Strazzullo P, D'Elia L, Kandala NB, Cappuccio FP (2009). "Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies". BMJ 339: b4567.
9 Royal Society of Chemistry (RSC) Why do we need salt? http://www.rsc.org/Chemsoc/Chembytes/HotTopics/Salt/whysalt.asp
10 American Heart Association (AHA) Kidneys and Kidney Function - http://www.americanheart.org/presenter.jhtml?identifier=4647
11 The Blood Pressure Association 2008 - Salt's effects on your body - http://www.bpassoc.org.uk/microsites/salt/Home/Whysaltisbad/Saltseffects
12 Morrison A, Ness R. Salt Sense: Spare the salt, spare the heart. The University of Texas Health Science Center at Houston (UTHealth) School of Public Health. Annual Review of Public Health - Feb 2010 http://www.uthealthleader.org/archive/Heart_Health/2011/saltsense-0216.htm
13 Implementing recommendations for dietary salt reduction: Where are we? DIANE Publishing. ISBN 1428929096
14 Dr Gill Jenkins. BBC Health. http://www.bbc.co.uk/health/treatments/healthy_living/nutrition/healthy_salt.shtml
15 Heart Failure Society of America, How to follow a low sodium diet (http://www.hfsa.org/pdf/module2.pdf)
16 Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion - Sodium Fact Sheet Adobe PDF file [PDF - 308KB] November 2009. (http://www.cdc.gov/Features/dsSodium/)
17 CBS News - FDA Hopes to "Shake" Hidden Salt in Our Diets - August 2010 http://www.cbsnews.com/stories/2010/08/04/earlyshow/health/main6742447.shtml
18 IOL.co.za Sboros M, 'Don't take your health with a pinch of salt' - September 2004 http://www.iol.co.za/scitech/technology/don-t-take-your-health-with-a-pinch-of-salt-1.222528
19 Everything Atkins 2002 - Cloe R, 'Why the Scale Lies' http://www.everythingatkins.net/scalelies.html
20 Low Salt Foods.com - Low Salt Foods 2010
21 Dr Gill Jenkins. BBC Health. http://www.bbc.co.uk/health/treatments/healthy_living/nutrition/healthy_salt.shtml
22 Mayo Foundation for Medical Education and Research (MFMER). High blood pressure (hypertension). March 2011 - http://www.mayoclinic.com/health/high-blood-pressure/DS00100
23 National Heart Lung and Blood Institute (NHLBI), 'Why Is High Blood Pressure Important?' http://www.nhlbi.nih.gov/hbp/hbp/serious.htm
24 Pratt S, Matthews K, 'SuperFoods Rx: Fourteen Foods That Will Change Your Life' - December 2006 ISBN13: 9780061172281 (http://astore.amazon.com/wsdm-20/detail/0061172286/105-8338622-4040425)

1 Implementing recommendations for dietary salt reduction: Where are we? DIANE Publishing. ISBN 1428929096
1 African Society for Quality in Healthcare (ASQH) (http://www.asqh.org/threads/920-salt-%28sodium-chloride%29NaCl)
1 Dr Gill Jenkins. BBC Health. http://www.bbc.co.uk/health/treatments/healthy_living/nutrition/healthy_salt.shtml
1 Heart Failure Society of America, How to follow a low sodium diet (http://www.hfsa.org/pdf/module2.pdf)
1 Centres for Disease Control and Prevention (CDC), National Centre for Chronic Disease Prevention and Health Promotion Sodium Fact Sheet Adobe PDF file [PDF - 308KB] November 2009. (http://www.cdc.gov/Features/dsSodium/)
1 J. Anderson, Colorado State University Extension foods and nutrition specialist and professor; L. Young, M.S., former graduate student; E. Long, graduate student, food science and human nutrition; and S. Prior, former graduate intern, food science and human nutrition. 7/96. Revised 5/07 (http://www.ext.colostate.edu/pubs/foodnut/09354.html)
1 Dr Gill Jenkins. BBC Health. http://www.bbc.co.uk/health/treatments/healthy_living/nutrition/healthy_salt.shtml
1 Dr Gill Jenkins. BBC Health. http://www.bbc.co.uk/health/treatments/healthy_living/nutrition/healthy_salt.shtml
1 African Society for Quality in Healthcare (ASQH) (http://www.asqh.org/threads/920-salt-%28sodium-chloride%29NaCl)
1 Consensus Action on Salt & Health (CASH) http://www.actiononsalt.org.uk/news/facts/index.html
1 Scienceray Why is the sea salty? http://scienceray.com/earth-sciences/why-is-the-sea-salty/
1 YgoY Top 15 Fun Facts About Salt http://www.ygoy.com/index.php/top-15-fun-facts-about-salt/
1 ESCO European Salt Company http://www.esco-salt.com/en/salz/glossar.html
1 Food Reference.com Salt Facts http://www.foodreference.com/html/fsalt.html
1 Tsegay B.Gebrelibanos The Ethiopian Salt Trading System. In: Proceedings of the 16th International Conference of Ethiopian Studies, ed. by Svein Ege, Harald Aspen, Birhanu Teferra and Shiferaw Bekele, Trondheim 2009
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Some great recipes for you


Chicken, Sweet Potato and Prune Casserole

4 portions


Portion size 300g

Ingredients


• 15ml (1Tbsp) olive/canola oil
• 8 chicken drumsticks, skin removed
• A pinch of pepper to taste
• 250g (6 - 8) small onions, peeled
• 375ml (1 1/2 cups) cranberry or cranberry apple juice
• 10ml (2 tsp.) chicken stock powder
• 375ml (1 1/2 cup) boiling water
• 300g (4 small or 2 large) sweet potatoes peeled, cut into 2.5cm chunks
• 8 fresh mint leaves, chopped
• 70g (10) pitted prunes
• 10ml (2 tsp.) corn flour made into a paste with 30ml (2 Tbsps.) cold water.
• Fresh mint leaves to garnish.

Method


1. Heat the oil in a large saucepan or wok.
2. Add chicken, brown on all sides and season with salt and pepper.
3. Add the onions and half the cranberry juice and chicken stock powder dissolved in hot water.
4. Simmer on a low heat for 15 minutes.
5. Add sweet potato, prunes, mint leaves and the remaining liquid. Simmer for another 15 to 20 minutes.
6. Using a slotted spoon, scoop the chicken, onion, sweet potato and prunes into a serving dish.
7. Bring the liquid to the boil; add corn flour paste and stir until thickened.
8. Pour over the chicken and garnish with mint leaves.
9. Serve with steamed broccoli and a carrot salad.

Nutritional analysis per portion


Energy 1,748kJ
Carbohydrate 45g
Protein 30g
Fat 11g
Sodium 145mg


This recipe is a dietary suggestion provided to promote a healthy lifestyle and is not intended as a form of medical treatment or a replacement for medication. Novartis is not responsible for any damage, medically or otherwise, resulting in the consumption and preparation of food using the instructions or recipe provided. Readers must take care to check the instructions provided and determine their value and any possible medical condition that may arise from the consumption of the ingredients listed. The recipe is provided as a suggestion only and Novartis cannot be held responsible for the outcome of the recipe.

Chunky Bean and Vegetable Soup

Serves 4


Serving size 350g

Ingredients


• 15ml (1 tbsp.) olive/canola oil
• 150g (1 medium) onion, chopped
• 5ml (1 tsp.) garlic, crushed
• 100g leeks, washed and cut into rings
• 100g (2) celery stalks and leaves washed and chopped
• 200g (2) carrots, peeled and sliced
• 100g (3) baby marrows, washed and sliced
• 5ml (1 tsp.) vegetable stock powder
• 3ml (1/2 tsp.) cumin powder
• 3ml (1/2 tsp) nutmeg
• 10ml (2 tsp.) mild curry powder
• Freshly ground pepper to taste
• 200g (1 cup) dry kidney beans, soaked overnight
• 2 litres boiling water
• 25ml (2 dsp.) corn flour, made to a paste with cold water

Method


1. Heat oil in a large cooking pot
2. Stir fry onion and garlic for a minute
3. Add all the vegetables to the onion.
4. Add all the spices, beans and water and simmer over a low heat for 2 hours until vegetables and beans are soft and tender.
5. Add corn flour, stir to thicken and serve.

Note: Two tins of kidney beans can be used instead of raw dry beans.

Nutritional analysis per portion


Energy 1,085 kJ
Carbohydrate 27g
Protein 13g
Fat 5g
Sodium685mg


This recipe is a dietary suggestion provided to promote a healthy lifestyle and is not intended as a form of medical treatment or a replacement for medication. Novartis is not responsible for any damage, medically or otherwise, resulting in the consumption and preparation of food using the instructions or recipe provided. Readers must take care to check the instructions provided and determine their value and any possible medical condition that may arise from the consumption of the ingredients listed. The recipe is provided as a suggestion only and Novartis cannot be held responsible for the outcome of the recipe.

Lean Lamb Curry

Serves 6


Serving size: 250g

Ingredients


• 15ml (1 Tbsp.) sunflower/canola oil
• 170g (2 small or 1 large) onion, chopped
• 800g lamb knuckle, all visible fat removed and cut into small pieces 1 to 2 ml (quarter to half tsp.) cayenne pepper
• 5ml (1 tsp.) ground cumin
• 5ml (1 tsp.) ground coriander
• 2ml (half tsp.) ground turmeric
• 15ml (1 Tbsp.) ground paprika
• A pinch of black pepper to taste
• 60ml (4 Tbsp.) tomato paste
• 5ml (1 tsp.) sugar
• 200g (3 small) sweet potatoes, peeled and cut into chunks
• 200g (2 large) carrots, cut into rings
• 200g green beans, cut into 3cm pieces
• 10ml (2 tsp.) corn flour, mixed to a paste with water
• fresh parsley to garnish

Method


1. Heat the oil in a large saucepan and fry the onion until golden.
2. Add the meat and all the spices to the onion and toss until coated. Add a dash of water to stop it sticking, if necessary.
3. Add the tomato paste, sugar and 1 cup of boiling water.
4. Lower the heat and simmer for approximately 1 hour with the lid or until the meat is tender (add more water if necessary).
5. Add the sweet potato and carrots and simmer for a further 20 minutes.
6. Add the green beans for during the last 10 minutes of cooking.
7. Thicken gravy with the corn flour paste.
8. Garnish with parsley.
Serve with a small portion of basmati rice, tomato sambals and plain yoghurt.

Nutritional analysis per portion


Energy 1,205 kJ
Carbohydrate 13g
Protein 28g
Fat 11g
Sodium 98mg


This recipe is a dietary suggestion provided to promote a healthy lifestyle and is not intended as a form of medical treatment or a replacement for medication. Novartis is not responsible for any damage, medically or otherwise, resulting in the consumption and preparation of food using the instructions or recipe provided. Readers must take care to check the instructions provided and determine their value and any possible medical condition that may arise from the consumption of the ingredients listed. The recipe is provided as a suggestion only and Novartis cannot be held responsible for the outcome of the recipe.

Onion mushroom and corn omelette

Serves 2


Portion size 200g

Ingredients


• 10 ml (2 tsp.) olive/canola oil
• 100g (1/2 medium) onion, chopped
• 100g (5) button mushrooms, wiped and sliced
• 100g (1/2 cup) frozen corn kernels or canned corn kernels (liquid drained)
• 5 ml (1 tsp) vegetable stock powder
• freshly ground black pepper
• 4 medium eggs
• 60 ml (1/4 cup) fat free skim milk
• parsley to garnish

Method


1. Heat oil in a large frying pan
2. Add the onion and stir fry for 2 minutes
3. Add the mushrooms and corn and stir-fry for an additional 5 minutes until soft and tender
4. Season with freshly ground black pepper and vegetable stock powder, then set aside and keep warm
5. Whisk eggs and milk and eggs together
6. Pour half the egg mixture into a small non-stick frying pan to make one omelette.
7. Fill omelette with half the mushroom mixture and keep warm.
8. Make a second omelette with the remaining egg mixture and filling.
9. Garnish with sprigs of parsley and serve immediately

The omelette can served as a light meal or for breakfast accompanied by health / rye bread or toast

Nutritional analysis per portion


Energy 1,227kJ
Carbohydrate 18g
Protein 17g
Fat 16g
Sodium774mg


This recipe is a dietary suggestion provided to promote a healthy lifestyle and is not intended as a form of medical treatment or a replacement for medication. Novartis is not responsible for any damage, medically or otherwise, resulting in the consumption and preparation of food using the instructions or recipe provided. Readers must take care to check the instructions provided and determine their value and any possible medical condition that may arise from the consumption of the ingredients listed. The recipe is provided as a suggestion only and Novartis cannot be held responsible for the outcome of the recipe.

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