World War III: Salty Struggles

WWIII: Salty Struggles 
By Tim Cullen

Sodium is a huge issue in the world today. Many people are consuming too much sodium in their diets, but most do not know it. According to the CDC, the average American consumes 3,436 mg. You may say, "Well that seems low, I mean, only 3.436 g of salt?" 3.436 g of sodium does not seem like a lot, but the Adequate Intake Level (AI) for sodium is 1,500 mg and the upper level intake suggested is 2,300 mg. Comparing the numbers it is shown that Americans are far above the tolerable level of sodium in their diet. The risks of this will be discussed later on.

Research Article: Dietary Sodium Intake in Shandong Province

Sodium intake are at insanely high levels in China!

This article is not about the United States (although it is relevant) as much as about a different country, China. I found a very interesting and well done research article done on the sodium intakes of adults 18 to 69 in China and found the numbers remarkable. The study was,

• Cross sectional survey among 15,530 adults 18-69
• ~80% said that they favored low sodium diets
• Only ~39% have taken action to try and reduce sodium in their diets

The Chinese diet, like American, is high in sodium. About 80% of the citizens exceed their recommended salt intake, which is an extremely high number. From 1959 to 2002, hypertension had increased in China from 5.1% to 18% of the population, and that figure is considered to be rising (Zhang et al. 2). These high sodium diets are leading to more people obtaining hypertension, or high blood pressure, along with higher risk for cardiovascular disease. 40% of the Chinese deaths are linked to cardiovascular diseases, so sodium is playing a major role in family's lives across the country.

What foods contain high sodium?

There are a few well known foods that contain high sodium. Processed foods and foods that are pre-prepared have sodium added to them as they act as an inhibitor for various microbial pathogens. If manufacturers can limit the amount of pathogen growth in their food, then they will be able to extend shelf-life on their product. In China, the majority of sodium intake comes from home cooking, contrasting from that of the United States (Zhang et al. 3). This is interesting, because when we think of cooking at home, we think we have total control over how much sodium is added into the meal. In China however, there are many meals that utilize soy sauce and that can be a major contributor to the increased sodium intake in the country.

Shandong Province

The study was done of the Shandong Province in China. It was a good province to study as it has a high population with that of almost one hundred million. The Shandong Province is located on the east coast of China along the Yellow Sea.

It was found that the average intake of sodium, in the Shandong Province, for the age group 18-69 was 12.6 g, or 12,600 mg, of sodium a day! (Zhang et al. 3). This number is so high it is almost unbelievable, but it is true. As stated before, we recommend citizens in the United States to consume less than 2,300 mg, so this number is far above that suggestion. It was found that 43.8% has hypertension in Shandong, but many had no clue they even had the disease (Zhang et al. 3).

Shandong was chosen also by the Chinese Ministry of Health, so it was a good area to do the study. More information on the study are

·        140 counties districts possible; 20 chosen

·        Urban and rural included

·        3 towns and 2 streets were selected from the 20 counties

·        People of all background were chosen, all incomes etc.

Results ( Zhang et al. 6-9).

• Subjects: 15,530
• Males: 7,683
• Females: 7,667
• Urban: 4,798
• Rural: 10,524

·        People that had higher house incomes were reported to taking more control of their diet and how much sodium was in it.

·        People with the higher education were reported to have taken more action to lower the sodium in their diet in comparison to those with a lower level education

·        96% of the subjects said they use less salt in cooking, but many times they had added table salt after the fact

·        People who were aware of the link between hypertension and sodium were more likely to take actions to reduce sodium intake

Conclusion:

Hypertension is a serious condition that is affecting many the peoples' of China and the world. This war has only just begun and to continue this fight we need to educate the people of the world on the issues and consequences of consuming too much dietary sodium. It is possible to get individuals to take preventative action against hypertension if we use the Health Belief Model. The Health Belief Model is when an individual recognizes a potential threat to their health and when benefits exceed the barriers, they will take the necessary actions to take preventative action.

A problem with many people in Shandong, and the world, is that they have no idea what the max level of sodium even is. We cannot realistically expect people to be able to control their amount of dietary sodium they consume per day if they have no clue what the recommended limit is. Due to this grey area, many people feel they are either not consuming enough sodium or simply just do not care. I believe it is also important to stress that reducing sodium intake is not only beneficial to those with high blood pressure, but to those also without it. Taking preventative action is a very important step to living a healthy lifestyle.

Some Ways to Increase Taste without Sodium:

•  Garlic
• Vinegar
• Green onion
• Various herbs

It is important to use the Social Cognitive Theory in this case. This theory basically states that people learn by observation and by a hands-on approach. We must educate the public and equip them with the skills and knowledge in order to make the necessary change in their diet. Stressing to use less "hidden sodium" enhancers like, soy sauce and pickles, are a great start.

I know it is unfair to suggest to Chinese to stop using soy sauce as it is a major part of their culture, but perhaps using less of it can be accomplished. Soy sauce contains 1,500 mg of sodium per milliliter, which is the average consumption of soy sauce per day in China.

My final thoughts words to consider are, not all sodium just comes from salt added to food, but also from condiments as well. I listed some alternatives that can be used to still keep flavor, but reduce sodium above. Urbanization in China is showing diets going from more traditional foods to a more processed and imported diet. Sodium is something to not take lightly and you can take the necessary steps in preventative action against hypertension! We need all the help we can get, because this world war on sodium is far from finished.

I hope this post highlighted and educated some on the issue with sodium. I encourage you to read the original study and article posted below to learn more! If you enjoyed the article please share with your friends and family, as I wish that everyone can learn more about the high sodium intakes. Next week we will come out with tips to reduce sodium intake in your diet.

Ways to reduce sodium intake HERE: http://nutritionnatural.blogspot.com/2013/12/health-is-under-assault.html

 Sources:

Zhang, Juan, Ai-qiang Xu, Ji-yu Zhang, Xiao-feng Liang, Ji-ziang Ma, Xiao-ming Shi, Michael Engelgau, Liu-xia Yan, Yuan Li, Yi-chong Li, Hui-cheng Wang, and Zi-long Lu. "Dietary sodium intake: knowledge, attitudes and practices in Shandong Province, China, 2011." PubMed 8.3 (2013): 0-17. http://www-ncbi-nlm-nih-gov.proxy2.cl.msu.edu/. Web. 21 Nov. 2013.

http://www.cdc.gov/features/dssodium/

Shandong Picture: http://www.petrexgmbh.com/wp-content/uploads/2012/10/shandong-600x6001.gif

Chinese Flag: http://www.worldatlas.com/webimage/flags/countrys/zzzflags/cnlarge.gif