How much salt is too much?

May 1, 2024

Considering various studies linking excessive salt intake to heightened risks of severe health conditions such as heart disease and stroke, too much salt consumption has become a pressing public health concern. CHINYERE OKOROAFOR examines the nuanced question of how to define the threshold of “too much” salt in one’s diet.

Baba Yusuf (pseudonym) was healthy on Thursday. On Friday morning, he went to work, and in the evening when he returned from work, he started feeling unease. He was feeling dizzy and so much thirsty, his feet and hands were swollen and his blood pressure shot above the normal systolic pressure of at least 130 mmHg was 157mmHg, while the diastolic pressure of at least 80 mmHg was more than 90mmHg.

His wife, Bisi and his first son, Ola, rushed him to the family hospital. The doctor on duty, Fatima, examined Baba Yusuf to discover that there is so much salt in his body system. Dr Fatima had to place Baba Yusuf on medication so that the symptoms would be taken care of. He was discharged after two weeks of hospitalisation.

Another patient, Mama Kunle, 65, was also off health. She was feeling nausea, vomiting and dizziness.

Her husband, Gbenga rushed her to the hospital where the doctor carried out some diagnosis. It was discovered that she was suffering from hyponatremia which experts describe as a condition that occurs when the sodium in one’s blood falls below the normal range of 135–145 milliequivalents. (mEq). Experts say that such health issue is more common in older adults because they’re more likely to take medicines or have medical problems that put them at risk of the disorder, even as they contend that “low sodium levels in the body can lead to muscle cramps, nausea, vomiting and dizziness. Eventually, lack of salt can lead to shock, coma and death.”

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Health experts have said that intake of too much salt and low intake of salt could be dangerous to health.

This is a dilemma which health authorities say is dicey. So, how does individuals approach intake of salt, since too much of it leads to hazardous health situation? Caution and moderation, they advise, should be the watchword.

Salt is a necessary ingredient in our daily meals, even as it is useful in flavour enhancement and food preservation. The body also needs some salt; it is necessary for nerve and muscle function and helps to regulate bodily fluids.

However, numerous studies have indicated that consuming too much salt can increase the risk of severe health problems such as high blood pressure, stroke, diabetes, osteoporosis, kidney-related diseases, heart disease and stomach cancer.

In the circumstances, therefore, it is taxing to state exactly how much salt a person eats in one day without knowing the precise salt content of each food and measuring the exact quantities eaten. To worsen this problem, many individuals underestimate their rate of salt consumption. This has resulted in a significant health issue in Nigeria, leading to calls for a reduced salt intake.

Recommended salt intake

Due to these concerns, the World Health Organisation (WHO) recommends that adults consume less than 2000mg of sodium per day, which is equivalent to less than five grams per day of salt (just under a level teaspoon).

For children aged 2–15 years, the recommended sodium intake should be adjusted downwards based on their energy requirements. Unsurprisingly, many individuals exceed this limit in their home-cooked meals, often unknowingly. Additionally, processed and restaurant-prepared foods tend to also contain high levels of hidden salt.

With its recommendation, the WHO aims for a 30 per cent reduction in global sodium intake by 2025. How feasible is this target which is just a year away?

Salt represents the primary source of sodium in our diets. Nonetheless, the question remains: how much salt is deemed “excessive” for consumption?

According to the Non-Communicable Diseases (NCD) Alliance, a global civil society network uniting 2,000 federation associations, civil society organisations, scientific and professional associations, and academic and research institutions to improve NCD prevention and control worldwide.

It noted that NCDs such as cardiovascular diseases are the primary cause of death and disability worldwide.

In Nigeria, hypertension, mainly caused by increased intake of salt and sodium accounts for 12 per cent of deaths.

This could be why the Corporate Accountability and Public Participation Africa (CAPPA), a non-governmental organisation (NGO) is leading a campaign to reduce salt consumption.

According to its Executive Director, Mr. Akinbode Oluwafemi, Nigeria currently records an estimated daily salt consumption of up to 5.8 grams per day, which exceeds the WHO recommended limit. He spoke at a one-day journalism training on salt reduction in Lagos.

He said: “Our role as a health-focused civil society organisation is to help the public understand the dangers of their choices, especially when consumption is driven by a gap in knowledge when it comes to food.” Oluwafemi advised Nigerians to understand the gimmicks of the food production industry that promote unhealthy foods as the norm.

The Programme Officer for Salt Reduction and Cardiovascular Health, Bukola Olukemi-Odele emphasised the significance of ensuring that Nigerians have the knowledge needed to embrace salt reduction policies, advocate for salt reduction, and monitor industry practices.

Olukemi-Odele noted the importance of ensuring that processed and packaged foods adhere to specific sodium limits to protect the health of Nigerians.

“Research has shown that high salt consumption causes hypertension and hypertension is the major risk factor for stroke, kidney disease and several other non-communicable diseases. A way to maintain normal pressure is by reducing salt/sodium intake,” she said.

She further explained that salt reduction is a cost-effective public health intervention that can help to bring down the burden of NCDs in Nigeria as well as help Nigerians live free of hypertension and other cardiovascular diseases. Olukemi-Odele, who called on policymakers to take action and set mandatory salt targets for all processed and packaged foods in Nigeria in 2024, also charged the public to be aware of the public health consequences of high salt consumption, take responsibility and make health choices that will be beneficial for the future.

The Director of Network for Health Equity and Development (NHED) and Technical Adviser, Salt Reduction Campaign, Dr. Jerome Mafeni, said the Nigeria salt reduction target coalition includes non-governmental organisations, civil society organisations, academia, and international organisations that have come together to track and promote the campaign around salt reduction and diet in Nigeria. Mafeni added that the coalition is working to ensure that NAFDAC takes responsibility to ensure that existing food regulations are in line with the salt targets for commercially produced foods to reduce the amount of salt that the public consumes knowingly or unknowingly. He explained that the coalition is also working with the Federal Ministry of Health to ensure that proposed regulations will also provide guides on how food products are labelled and ensure that the public is aware of foods that are of very high salt content and injurious to health.

On her part, Assistant Project Manager, Cardiovascular Research Unit at the University of Abuja Teaching Hospital, Ms. Vanessa Alfa, said: “We need to engage in widespread awareness, telling people to learn how to eat healthily, to reduce the amount of salt in their food; snack and conventional foods. One of the primary actions that are expected is for food products to have less salt; we are talking about products manufactured in Nigeria because we don’t have control over imported products.”

“There is a need for restricting the appearance of these adverts on contents that children watch. Involving children in the adverts is not good enough as it ruins our public health as a nation. It’s high time that our regulatory agencies restricted the promotion of such products.”

She also encouraged the public to make a conscious decision to reduce the amount of salt in the food they consume. The National Salt Reduction Campaign project was implemented by CAPPA funded by the Global Health Advocacy Incubator and the Network for Health Equity and Development (NHED) as an implementing partner.

Nigeria’s salt consumption statistics and health trends

Nigeria is experiencing a rapid epidemiological transition, shifting from a predominance of infectious diseases to an increasing burden of non-communicable diseases (NCDs) such as hypertension and cardiovascular disorders.

It was also noted that the age-standardised prevalence of hypertension in Nigeria stands at a staggering 38.1%, indicating a widespread health challenge affecting a significant portion of the population.

In 2017 alone, an estimated 100,000 deaths in Nigeria were attributed to cardiovascular diseases, highlighting the grave impact of NCDs on public health. For CAPPA, these statistics underscore the urgent need for comprehensive strategies to address the growing burden of lifestyle-related diseases, including initiatives to reduce excessive salt consumption and promote heart-healthy habits among Nigerians.

Frequently consumed foods

Nigerian cuisine encompasses a variety of flavourful dishes, but it’s important to be aware of certain foods that contribute significantly to  sodium intake. According to Nigeria Sodium Study Findings titled “Nigerian Sodium/Salt consumption patterns and Nigerian Perspectives on Salt,” foods high in sodium/salt that Nigerians consumes include salted fish and meats and stock fish. Additionally, processed meats like kilishi (spiced dried meat) or suya (skewered meat) often undergo seasoning with salt, further increasing their sodium content. Another food is bread and baked goods such as bread rolls, pastries, and snacks. Others include cheese, dairy products, sauces, condiments,  Instant Noodles and pickled foods.

Dietary habits, cultural preferences, processed and packaged foods, lack of awareness, socioeconomic factors and marketing and advertisement. The effect of high salt consumption on public health include high blood pressure, cardiovascular diseases, kidney damage, stroke, osteoporosis, gastric, cancer and public health burden.

According to experts, a single slice of bread typically contains between 80 and 230 milligrams of sodium. Additionally, certain breakfast cereals can contain as much as 300 milligrams of sodium before adding milk. Salt in the diet could come from processed foods, including processed meats like bacon, ham and instant noodles or because they are consumed frequently in large amounts. Salt is also added to food during cooking in the form of bouillon cubes or at the table. If sodium is listed on the label’s nutritional information instead of salt, the amount on the label should be multiplied by 2.5 to get the equivalent salt content. For example, if a portion of food contains a gram of sodium per 100gm, such contains 2.5 grams of salt per 100 grams.

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