Salt – why cutting down matters, and where it is hiding

Too much salt raises blood pressure, and high blood pressure is the single biggest contributor to strokes and heart disease in South Africa. Because it causes no symptoms, most people only find out about the damage years later.

South Africa took an unusual step: rather than only telling people to eat less salt, it set legal limits on how much sodium manufacturers may put into everyday staples — bread, breakfast cereals, margarine, soup and gravy powders, stock cubes, processed meats and savoury snacks. Very few countries have done this.

The reason is that in South Africa, as in most countries, the majority of salt people eat is already in the food when they buy it. You cannot cut down on something you never added.

The World Health Organization recommends less than 5 g of salt a day for adults — about a level teaspoon in total, from everything you eat, not just what you add. Most South Africans eat considerably more than that.

People tend to look for salt in obvious places — chips, biltong, takeaways — and miss the ones that contribute most, simply because they are eaten every day.

• Bread. Not very salty per slice, but it adds up faster than anything else for most households.
• Stock cubes, soup powders and gravy powders — some of the most concentrated sources in a South African kitchen.
• Processed meat: polony, viennas, russians, ham, bacon.
• Instant noodles and their flavour sachets.
• Savoury snacks and salted nuts.
• Bottled sauces, marinades and spice mixes labelled 'seasoning salt'.

1. 1Take the salt shaker off the table. Most people salt out of habit, before tasting.
2. 2Season with something else: garlic, onion, lemon, chilli, black pepper, curry powder, fresh or dried herbs. Flavour and salt are not the same thing.
3. 3Halve the stock cube, or use half a cube and more onion and garlic. Nobody notices after a week.
4. 4Compare sodium per 100 g on two brands of the same product and take the lower one.
5. 5Rinse tinned beans and vegetables before using them.
6. 6Give it two to three weeks. Taste for salt genuinely adapts, and food that seemed bland at the start starts tasting normal.

Reducing salt lowers blood pressure in most people, and the effect is largest in those who already have hypertension, in older adults, and in people of African ancestry — which is much of the South African population.

It will not usually replace medication on its own. What it does is make the medication work better, and reduce the chance of needing a second or third one added later.