Monday, February 01, 2010

WASH AWARENESS WEEK. Feb 1st-Feb 7th 2010

I wonder how many of us are aware that Feb 1st-7th is WASH awareness week. WASH stands for " World Action on Salt and Health ", an organisation that creates public awareness of the dangers of salt intake and also lobbies government on salt levels in food.

Whenever I see patients in the risk group, especially those with hypertension or pre-hypertension, I always spend a considerable time to teach them that reducing salt intake, eating more greens and veges ( there is potassium salt in greens and veges ) help to reduce blood pressure. The evidence is in the studies with the DASH diet. What perhaps is not emphasized enough is that table salt and sauce is only a small portion of the salt that we all consume daily.

In ancients days when our forefathers were hunters, salt was a very convenient way to preserve the meat that they caught. It also added flavour. Nowadays, with refrigeration and packaging techniques, that need is not so important anymore, but producers found that salt was a cheap way to add weight to meat and also made the meat more palatable. So much of the salt that we now consume comes from the preservatives used in the food that we consume, be it meat or other food substances including corn flakes, and munchies.

Yet, we all know the evidence. By far, the best way to reduce hypertension and strokes is through a strategy of salt reduction, on an individual basis or community basis. Of course the classical off quoted study is that by Cook NR, Cutler JA, Obarzanek E, et al. entitled " Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of trials of hypertension prevention. BMJ 2007; 334:885. "

If that evidence is not strong enough, try this. In 1950, the Japanese government decided that there was too much salt being consumed in Japan. They were then consuming about 13.5gms of salt per individual per day. The government decided that for the next 10 years, they will reduced salt consumption in Japan to 12.1gms per day. This resulted, over the next 10years, in a stroke reduction of 80%. The same experience was reported in Finland, where salt intake was reduced by 30%, resulting in a stroke reduction rate of 80% again ( consistent isn't it ). All this with no increase in healthcare cost. Wonderful.

With these strong evidences, UK has formed CASH ( Consensus Action on Salt and Health ), subscribing to the same aim as WASH ( World Action on Salt and Health ). Perhaps in Malaysia we should form the MASH ( Malaysian Action on Salt and health ).

All that we need to do is to reduce our salt intake by 30%. We should see a stroke rduction of 80%. I estimate that in Malaysia, we consume about 13-15gms of salt daily, per person. We need to reach about 10-12 gms of daily salt consumption. I suppose we should begin by having compulsory food labelling, something which the Ministry of Health have been talking for along time.

We each need to know what we are taking in. It would be good if we can each consume 3-5 gms of salt a day. But this is difficult if we have been taking in 13 gms salt a day. A 30% reduction would be a good start to drop the incidence of hypertension and also strokes. In UK, the CASH has pushed the government to reduce salt intake for the average Englishmen by 10%. They are taking in less salt, on the average, compared to Asians ( UK about 9.5gms a day ).
Please pass the word around. Salt is an important cause of hypertension, and strokes. It would be too dramatic to say that " Salt kills " as salt has many important healthy bodily functions. we also cannot survive without salt. As everything in life, everything in moderation.
Please watch your salt intake. For starters, please be aware, that too much salt is bad for salt. Reducing salt intake by 30% is a good start.

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