Be less salty


By Shanuka Kadupitiyage

Non communicable diseases (NCDs) have impacted a massive portion of Sri Lanka’s population, even robbing some of their lives. What’s more devastating is the fact that unlike other diseases such as malaria, dengue or even tuberculosis, NCDs can easily be prevented and avoided through simple lifestyle changes. 

Sadly, not everyone is aware of the lifestyle changes needed. Most of these habits have been ingrained upon us by convenience or our own preferences; small decisions we unconsciously make, not knowing the repercussions that may come.

To learn more about this silent killer among us, Ceylon Today had the opportunity to speak with Consultant Community Physician from the Ministry of Health’s Non-Communicable Diseases Unit, Dr. Shanthi Gunawardana. 

A prevalent problem

“It’s one of the biggest causes of death in Sri Lanka at the moment,” she shared. “Diabetes, hypertension, and a number of other cardiovascular diseases are all NCDs that affect the lives of thousands of Sri Lankans every day.”

“And within the NCDs that Sri Lankans suffer from, hypertension and high blood pressure have been the largest cause of deaths,” Dr. Gunawardana revealed. 

Finding the root

According to Dr. Gunawardana, one of the major reasons behind the prevalence of high blood pressure related medical complications is the lack of awareness regarding its root cause, a commodity that we literally cannot live without; salt.

“Many people know that consuming sugar in excess is a root cause for diabetes, and that you have an increased chance of suffering a heart attack or stroke as a result of eating a lot of fatty food. But not everyone is aware that salt is a main cause of high blood pressure,” she said. 

Dr. Gunawardana explained that researchers from a number of international organisations such as the United Nations (UN) and World Health Organisation (WHO) have conducted extensive research on salt and its effect on the human body. 

“From their research, it is recommended that a person should consume no more than 5 grams of salt a day,” she said. “In layman’s terms that is about one level teaspoon.”

Deadly consequences

According to Dr. Gunawardana, there exists a global target to reduce the population’s salt consumption by year 2025. “If we are able to reduce people’s consumption of salt to the prescribed amount, we would be able to prevent up to 2.5 million deaths around the world.”

She also revealed that nearly 19 million people suffer from cardiovascular ailments as a result of salt consumption. As for what’s going on within our own borders, Dr. Gunawardana shared that, “research conducted in Sri Lanka revealed the average Sri Lankan to regularly consume up to 10 to 12 grams of salt per day.”

All about pressure 

Dr. Gunawardana explained that the element sodium (Na) is the main culprit behind this phenomenon. “Every 5 grams of salt consists of 2 grams of sodium,” she shared. “Remember that this is only for one level-teaspoon. The amount multiplies with each teaspoon.”

An essential mineral to the proper functioning of the human body, sodium is important for the functioning of the nervous system, the heart, muscles and especially in regulating blood pressure and blood volume. 

The human body is designed to self-regulate and manage a stable internal condition; a phenomenon scientifically termed as homeostasis. For example, when the body’s temperature rises, it releases sweat to cool itself down. Likewise, the human body also regulates its hydration levels, which is directly impacted by the amount of salts and sugars we consume. 

“When consuming more salt than needed, the body’s chemical balance is upset. As a result, the body automatically attempts to regain its balance by retaining more water,” she explained. 

“Of course, that automatically increases the volume of blood flowing in the body.”

Dr. Gunawardana noted that as a result, the heart, kidneys and blood vessels are placed under additional stress. “This additional volume all exists within the blood vessels of the body, which needs to be pumped and circulated using the heart. Blood vessels must stretch to an unhealthy level to accommodate this additional volume. All this additional water needs to be removed from the body as well.

“Not only that, when there is a high salt content in the body, as a reaction it removes calcium from the body, dissolving from the bones. After a long period of time, this can lead to conditions such as osteoporosis and brittle bones. Also, this calcium is removed through urine, meaning the kidneys are stressed even further.”

When the body is subjected to this additional stress for prolonged periods of time, the human body becomes more susceptible to contracting a non-communicable disease. This is true for not only the use of salt and cardiovascular complications, but also in relation to the use of sugar and diabetes as well as fatty food and heart attacks as well as other complications. 

You are what you eat

“Once you end up with hypertension or any NCD, the effects are irreversible,” Dr. Gunawardana explained. “From then on, the only option you have is to control its impact on your life.”

With no cure and falling ill having a slew of effects on the patient’s lifestyle, prevention truly is the only option.

Dr. Gunawardana recommends eating more fresh fruits and vegetables, avoiding packaged and processed food, especially junk food and carbonated drinks as some of the best life choices a person can make at an early age to prevent the risk of succumbing to an NCD. 

“You don’t have to strictly avoid such food,” she shared. “They contain food additives, and various preservatives that are bad for your health. A lot of junk food – savoury items in particular, from salty snacks and short-eats to fried rice and restaurant food – contain monosodium glutamate, popularly known as ‘aji-no-moto.’ This only adds more sodium into your system, aside from the salt that you already consume.”

She noted that young adults are often at risk due to unhealthy lifestyle habits as a result of their work and social environment. “It’s okay to go out and eat occasionally, but you have to be conscious of how you treat your body.”

Although reducing the amount of junk food consumed will considerably increase their chances of remaining healthy, it doesn’t mean that the small decisions we make in our own homes regarding the food we eat don’t play a part either. 

“There are many families that use salt to cook even rice,” Dr. Gunawardana shared. “And many mothers use more salt than needed when preparing the family’s meals out of habit. Even the regular loaf of bread we eat has more than 5 grams of salt in it.”

Starting with the home

Dr. Gunawardana shared that the home plays a crucial role in combating the exposure to risk of NCDs.“Good habits are best cultivated from the home, and the earlier you start, the better,” she said. 

“Many start these habits begin from a young age, and when they reach their 30s, it’s often too late. They’re bodies have grown under those conditions. Their eyes, nerves, internal organs are all affected by this and its impact is irreversible. 

“Nutrition and the food being consumed is something that should be considered even when the child is conceived,” she added. “If the mother is malnourished, then the foetus’ nutrition is also affected.”According to Dr. Gunawardana, most families learn that they are expecting when two months have already passed in the mother’s pregnancy. “By that time, all the organs have already formed,” she revealed. 

“If the mother isn’t careful of her nutrition, if the foetus isn’t receiving enough nutrition, the baby inside the mother’s womb is developing under stress, which affects its development even past birth and is under the risk of succumbing to non-communicable diseases at an early age.

“You have to start considering these things from a young age,” she noted. “Parents have to make the decision to protect their children from these diseases by cultivating good eating habits. Never allow children in their early years to eat sugary or salty food.”

As for salt and sugar being consumed at home, she recommends carefully measuring the amount of salts, sugars and fats used when cooking for the day; a person’s daily salt intake can easily be managed. 

What is being done?

Government authorities aren’t dormant either. Dr. Gunawardana shared that with the support of the WHO, Sri Lanka’s Food Control Administration Unit regularly conducts awareness programmes with food manufacturers in the country. Additionally, food is also tested and analysed to identify their contents.

Not only that, awareness programmes and campaigns are regularly conducted on educating the public on non-communicable diseases and their root causes. “Salts and sugars can be addictive. It’s not easy to break a habit when it has formed, but it can be done. More people need to be made aware of its dangers and educated.”

It is for this reason that the salt, sugar and fat content of consumer products are now available on the wrapper. There’s also the ‘traffic light system’ established for carbonated drinks. 

“If there’s even one red marker, then it has a high risk of causing NCSs,” Dr. Gunawardana shared. 

“You should avoid consuming them as much as possible.”

Amber or Yellow markings depict lesser risk but should be avoided as well while green markings show comparatively healthier options. “But even then, fresh, natural food such as fruit and produce are still the best choice,” she stressed. 

Stay healthy, stay safe

Dr. Gunawardana agrees that action must be taken now, before it’s too late. For those who are already battling with NCDs, she advises to strictly adhere to the recommendations of their physician. 

“Your health is important for living a happy and fulfilled life. We should all protect ourselves from the risk of falling victim to these diseases caused by our own lifestyle choices. All that’s needed is to make small, but powerful changes in the choices we make each day.”