SINGAPORE - Singaporeans are consuming almost twice the amount of sodium recommended by the World Health Organisation (WHO) and this has led to more people being diagnosed with hypertension.
WHO recommends a daily limit of 2,000mg of sodium, but people here took in an average of 3,600mg of sodium a day in 2018, with nine in 10 exceeding the daily limit.
This corresponds with an alarming surge in people diagnosed with hypertension - 35.5 per cent were found to have the condition from July 2019 to March last year, up from 24.2 per cent in 2017.
The hypertension figures were released last month in the latest National Population Health Survey, which tracks the health and risk factors as well as lifestyle practices of Singapore residents.
Professor Tan Huay Cheem, chairman of the Singapore Heart Foundation (SHF), says it is not surprising that the prevalence of hypertension has increased, given that most Singaporeans consume more salt than recommended.
Salt is the main source of sodium in people's diet, and high sodium intake is associated with an increased risk of hypertension. Experts that The Straits Times spoke to say the consumption of salt could have increased during the Covid-19 pandemic due to disruptions and changes to lifestyles.
Ms Natalie Yeo, a dietitian at SHF, says the stress caused by the pandemic can trigger intense emotions such as sadness and anger, which could lead to emotional eating. "Some may turn to food as a source of comfort to distract and soothe themselves. Such food include potato chips and ice cream, which are often high in salt, sugar and fat," she says.
People may also seek out convenience foods to save time in meal preparation, or as a quick fix for supper.
Ms Melanie Anthonysamy, who leads the nutrition team at digital health platform HealthifyMe, says this results in a higher consumption of instant noodles, ready-to-eat soups and frozen foods such as fries and nuggets, which are laden with sodium.
Dr Michael MacDonald, a senior consultant cardiologist with Harley Street Heart and Vascular Centre at Mount Elizabeth Medical Centre, says some of his patients have gained weight in the past year as they have been leading sedentary lifestyles and consuming more takeaway and junk food.
"Many people get most of their meals from hawker centres, which is understandable because the food tastes good and is generally cheap. However, it is higher in sodium than home-cooked food," he adds.
Restaurants and hawkers tend to use a higher amount of sodium to enhance the flavour of their dishes. Ms Yeo says this comes in the form of salt, sauces, seasoning and stock powder added during cooking, marinating and seasoning.
They also tend to favour the use of processed meats which are high in sodium, such as fishballs, luncheon meat and sausages.
Ms Yeo adds: "Sodium is used not only to enhance the flavours of these processed meats, but also to prevent spoilage and control bacteria growth, allowing them to be kept for longer periods of time."
People tend to overeat food loaded with sodium unknowingly, as they consider only salty food to be laden with sodium.
"While some foods that are high in sodium, such as soya sauce, instant noodles, pickles and cured meats, taste salty, there are also many foods such as ketchup, kueh and pastries that contain sodium, but do not taste salty," highlights Ms Anythonysamy.
SHF's Prof Tan, a senior consultant at the National University Heart Centre, Singapore, says the prolonged overconsumption of high amounts of salt is worrisome as it leads to hypertension.
Explaining this, he says excessive salt intake brings about a high level of sodium in the bloodstream and reduces the kidneys' ability to remove water.
This, he adds, can cause the body to retain water, resulting in a higher overall blood volume which increases stress on the body's blood vessels, causing hypertension. If not well controlled, this can lead to stroke, blindness, heart failure and kidney failure.
A high sodium intake can also cause more calcium to be lost through urination.
This leads to bone demineralisation, putting one at increased risk of osteoporosis.
In addition, it can cause short-term side effects such as excessive thirst and a sense of bloatedness or noticeable swollen hands, feet or face from water retention.
But these effects are generally short-lived and will resolve when the body eliminates the excess sodium naturally, notes Prof Tan.
Housewife Namrata Nita, 42, who was found to have hypertension last year, now makes it a habit to read the nutrition label on food packages to check the sodium, fat and sugar content.
"Initially, I was quite ignorant about my diet. Now, I choose products that are lower in sodium," she says.
Dr MacDonald says many people do not know what sodium is or why having too much of it is a problem. "They don't know how much they are supposed to eat and don't know which foods are high in sodium. I see this all the time when I counsel my patients."
It might be helpful, he adds, to put up signs at hawker centres detailing the salt levels of common dishes.
Prof Tan says a strategy for a population-wide reduction in salt intake will have to involve not only individuals, but also the Government, the food processing industry and salt manufacturers.
He suggests, for instance, educating students about the harmful health effects of excessive salt intake. The Government can also work with the food industry and manufacturers to reduce the sodium added to processed foods and set specific targets of sodium content for each food category.
Ms Yeo says food outlets can be encouraged to try lower-sodium condiments, use more herbs and spices for seasoning, and offer more fresh produce.
Hawkers and restaurants can put up information on the lower-sodium alternatives available and tips to reduce sodium consumption.
According to the Health Promotion Board (HPB), there are more than 200 lower-sodium salt and sauce products in Singapore for consumers to choose from when shopping for groceries.
Products with the "Lower in Sodium" symbol contain at least 25 per cent less sodium than similar products from the same category without the symbol.
An HPB spokesman says it is also working with food and beverage partners to offer lower-sodium meals as part of their permanent core menu offerings.Says Prof Tan: "From a public health perspective, a whole-of-population salt reduction, even by a small amount, can lower hypertension in the population and save millions of people from dying unnecessarily from stroke and heart disease each year."
How to eat less sodium
1. Choose whole, unprocessed foods and focus on fresh produce
A heart-healthy diet is based on mainly whole, minimally processed food items with a variety of whole grain such as brown rice (below) and oatmeal, lean protein such as skinless chicken, egg and fish as well as fruit and vegetables.
These foods are generally lower in salt.
2. Check food labels
When buying packaged foods, choose those with lower-sodium options. Look for those with the "Lower in Sodium" Healthier Choice Symbol - these products contain 25 per cent less sodium than similar products without the symbol.
Also, check the ingredients list, as ingredients are arranged in descending order of weight.
Avoid products with salt or sodium listed among the first three ingredients.
Some alternative names of sodium include monosodium glutamate (MSG), sodium benzoate, sodium bicarbonate and sodium nitrate.
3. Use herbs and spices in place of salt to add flavour during cooking and at the table
Experiment with herbs, spices and fresh ingredients to flavour your meals, instead of adding salt and ready-made sauces. For example, add lemon zest or a squeeze of lemon juice to enhance the flavours of seafood and meat dishes.
4. Cut back on highly salted food items
Reduce or cut intake of processed, canned and salted meats, fish, vegetables and pickles. Processed meats such as ham, luncheon meat, smoked fish, fishballs and bacon are high in salt.
Instead, choose fresh lean proteins such as chicken, egg, tuna, tofu, beans and legumes to reduce overall sodium intake.
5. Be mindful when eating out
• Opt for plain rice instead of flavoured rice.
• Ask for "no" or "less" salt, sauces and gravy.
• Add spring onion or chilli to add more flavour.
• Choose rice noodles such as bee hoon or kway teow as yellow noodles contain more sodium.
• Store-bought food tends to contain more processed food items high in sodium, try to experiment with more home-cooked meals.
- Source: Ms Natalie Yeo, a dietitian at Singapore Heart Foundation
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