When it comes to sodium, salt is the most major source in your diet. It is sometimes referred to as sodium chloride (NaCl), and it is composed of 40% sodium and 60% chloride. (Patel and Joseph, 2020) Sodium is required for the proper functioning of a number of important body functions, including fluid balance, neurological health, nutrition absorption, and muscular performance (Rust & Ekmekcioglu, 2016). However, excessive or insufficient salt consumption will bring us adverse health outcomes.
In this article, we will discuss salt and chronic diseases, health consequences of too much or too little salt, salt intake in Malaysia and the recommended salt intake as well as the solution to reduce salt intake.
High Salt Intake and Hypertension
Sodium is an essential nutrient for our body to function properly. Since the sodium we consume mostly comes from the salt in our food, it is critical to avoid eating too many high-salt items, such as processed foods. The National Health & Morbidity Survey (2015) found that the prevalence of hypertension among adults of 18 years and above in Malaysia was 30.3%. Many studies have found that high salt intake was linked with an increased blood pressure and bad health outcomes such as hypertension (Johnson et al., 2016).
What is Hypertension and its readings
According to the World Health Organisation, hypertension is also called high blood pressure. It occurs when your blood pressure is higher than usual. Blood pressure can be measured as 2 numbers. The first (systolic) number indicates the pressure in blood vessels during the contraction or beat of the heart. The second (diastolic) number indicates the pressure in the vessels between heartbeats.
Blood Pressure levels (Whelton et al., 2018)
The American College of Cardiology/American Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (2017 Guideline)
|Normal||systolic: less than 120 mm Hg|
diastolic: less than 80 mm Hg
|Elevated||systolic: 120–129 mm Hg|
diastolic: less than 80 mm Hg
|High Blood Pressure||systolic: 130 mm Hg or higher|
diastolic: 80 mm Hg or higher
Symptoms of High Blood Pressure
- Severe headaches
- Chest pain
- Difficulty breathing
- Irregular heartbeat
Symptoms of Low Blood Pressure
- feeling sick
- generally feeling weak
High intake of Salt and Health Consequences
Cardiovascular Disease (CVD)
Cardiovascular disease (CVD) is the leading cause of mortality globally, and CVD rates increase with age. According to the Department of Statistics Malaysia (2017), Coronary Artery Disease was the top cause of CVD mortality in 2016, accounting for 13.2% of all deaths, followed by Stroke at 6.9%. Previous studies done by Wang et al. (2020) discovered a strong linear relationship between dietary salt intake and the risk of cardiovascular disease. The risk of cardiovascular disease increased by 6% for every 1 g increase in dietary salt intake. When high sodium consumption was compared to low sodium consumption, the risk of CVD increased dramatically by 19%, showing that excessive sodium consumption is a significant CVD risk factor.
Coronary Artery Disease (CAD)
Coronary artery disease (CAD) is the most common type of heart disease. According to the Centers for Disease Control and Prevention, adults under the age of 65 are responsible for almost two out of every ten deaths from CAD. CAD is the major cause of mortality worldwide and it is also the greatest cause of death in Malaysia (WHO, 2015). According to the CDC (2022), the consumption of excessive salt raises blood pressure, which increases the risk of coronary heart disease.
Stroke cases have increased in Malaysia, where they have become the third biggest cause of death (Institute for Health Metrics and Evaluation, 2019). Previous studies about high salt intake and stroke shows that high salt intake will increase the risk of stroke (Li et al., 2012).
Insufficient intake of Salt and Health Consequences
While an excessive amount of salt intake can be bad, so can an insufficient amount. Previous studies found that a diet with insufficient salt may result in low blood pressure, dehydration, and low sodium levels.
Low Blood Pressure
Individuals with normal blood pressure also have the chance to develop hypotension which is a situation when blood pressure is lower than usual. Hypotension is a serious condition. Dizziness, nausea, fainting, blurred vision, sadness, and dehydration are some of the indications and symptoms. Hypotension is a major risk factor for persons who have had heart failure, as many treatment options drastically lower blood pressure. Thus, It is critical to monitor blood pressure readings on a regular basis for individuals under this group (Vaduganathan et al., 2015).
Since sodium is critical for fluid balance, a low-salt diet may result in dehydration, or a lack of fluid in the body (NISHIMUTA et al., 2018). Elderly persons and those who are malnourished are at a greater risk of dehydration and should monitor their daily fluid intake and any signs of dehydration closely (Lacey et al., 2019).
Low blood sodium levels
A low-salt diet may result in hyponatremia, a condition in which your blood sodium levels are lower than usual. Hyponatremia can result in major neurological complications such as decreased mental state, seizures, coma, and death (Sahay and Sahay, 2014). Seniors are especially vulnerable to hyponatremia, which can result in falls and other medical issues. As such, it is critical that they get medical assistance if they exhibit any of the symptoms of hyponatremia (Soiza et al., 2014).
Top 5 Sodium-containing Foods Consumed Most by Malaysian Adults (Ahmad et al., 2021)
- Fried veggies
- White bread/whole-meal bread
- Fried chicken with spices
- Fried rice
Salt Intake In MALAYSIA
Did you know?
The Malaysian Community Salt Survey (2019) discovered that 4 out of 5 individuals consumed more than 5g of salt which exceeded the World Health Organization’s recommended daily salt intake. According to the Ministry of Health Malaysia in 2019, the average salt consumption among Malaysian people was roughly 7.9 g/day (NHMS, 2019). 7.9g of salt is equivalent to 1.6 teaspoons of salt.
Recommended Nutrient Intake (RNI) Malaysia for Sodium intake. (RNI, 2017)
For adults, WHO recommends to consume < 2 g/day sodium (5 g/day of salt per day). We should consume <1 teaspoon of salt per day to reduce our risk of getting diseases. Same recommendation for children, with the maximum level of intake of 5 g/day salt adjusted downward based on the energy requirements of children compared to those of adults. This suggestion is not applicable to children during the period of exclusive nursing (0–6 months) or during the period of complementary feeding when breastfeeding (6–24 months) is ongoing. The daily salt recommendation applies to all individuals with or without hypertension including pregnant or lactating women.
Did you know?
It has been proven that If you consume more than 5 grams of salt per day, your blood pressure will rise and your risk of getting hypertension will increase (Grillo et al., 2019). 5 grams of salt = 1 teaspoon of salt.
Lower the amount of salt used in cooking and alternative flavour enhancers such as monosodium glutamate (MSG), sauces (such as soy sauce, oyster sauce, or tomato sauce), and seasoning cubes. For example, we can use ¼ teaspoon of salt when cooking fried rice instead of using ½ teaspoon.
What Can We Do to Lower our Salt Intake and Risk of Getting Diseases?
It is a good way to reduce salt intake and adapt to a healthier diet by practising the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension. It is a healthy diet plan to help treat or prevent high blood pressure and other chronic diseases. The foods in the DASH diet are naturally low in sodium. So just by following the DASH diet, you’re likely to lower your intake of sodium.
The DASH diet is rich in fruits, vegetables and whole grains. It also includes fat-free or low-fat dairy products, fish, poultry, legumes and nuts. It limits foods that are high in saturated fat, such as fatty meats and full-fat dairy products.
When following to the DASH diet, it is important to pick foods that are:
Rich in potassium, calcium, magnesium, fibre and protein
E.g. Spinach, broccoli, dried beans and legumes, chicken, salmon
Low in saturated fat
E.g. Low-fat milk, fruits and leafy green vegetables
Low in sodium
E.g. Berries, apples, starchy vegetables such as sweet potatoes.
What are the other tips that you can consider?
At local supermarkets or grocery stores:
- Purchase fresh, frozen, or canned veggies that are unsalted or not been sauced.
- Pick the food products that are labelled “low salt,” “reduced sodium,” or “no salt added” when available.
- According to the Ministry of Health Malaysia, low salt, very low salt and no added salt foods are categorized as foods with sodium concentration not more than 0.12g/100g, 0.04g/100g and 0.005g/100g of food respectively.
- When cooking, substitute or decrease salt usage with alternatives such as garlic, salt-free seasonings, or spices.
- It is encouraged to prepare rice, pasta, beans, and meats in their most basic forms (dry and fresh).
- Limit the usage of sauces, mixes and ‘instant’ products, including flavoured rice and ready-to-eat pasta.
- Limit the consumption of frozen foods and processed food.
- Before ordering, ask about the nutritional facts and choose a low salt dish if possible.
- Request less salt or no salt should be added in your meal.
- Limit ourselves from the behaviour of consuming takeaway foods or fast food.
To Conclude This Article
Humans require salt to achieve optimal health. Nonetheless, eating excessively or insufficiently poses some health consequences. Since it is important to consume adequate amounts of sodium in our diet to reduce the risk of getting chronic diseases, we should start making some healthy behaviour changes to protect ourselves and our loved ones from diseases. It’s best to practice moderation and balance to achieve an optimum and sustainable healthy lifestyle.
Ahmad, M., Man, C., Othman, F., He, F., Salleh, R., Noor, N., Kozil, W., MacGregor, G. and Aris, T., 2021. High sodium food consumption pattern among Malaysian population. Journal of Health, Population and Nutrition, 40(S1).
Grillo, Salvi, Coruzzi, Salvi, & Parati. (2019). Sodium Intake and Hypertension. Nutrients, 11(9), 1970.
Institute for Public Health 2020. National Health and Morbidity Survey (NHMS) 2019: Non-communicable diseases, healthcare demand, and health literacy—Key Findings
Johnson, C., Raj, T., Trudeau, L., Bacon, S., Padwal, R., Webster, J. and Campbell, N., 2015. The Science of Salt: A Systematic Review of Clinical Salt Studies 2013 to 2014. The Journal of Clinical Hypertension, 17(5), pp.401-411.
Lacey, J., Corbett, J., Forni, L., Hooper, L., Hughes, F., & Minto, G. et al. (2019). A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Annals Of Medicine, 51(3-4), 232-251.
NISHIMUTA, M., KODAMA, N., YOSHITAKE, Y., SHIMADA, M., & SERIZAWA, N. (2018). Dietary Salt (Sodium Chloride) Requirement and Adverse Effects of Salt Restriction in Humans. Journal Of Nutritional Science And Vitaminology, 64(2), 83-89.
Patel, Y., & Joseph, J. (2020). Sodium Intake and Heart Failure. International Journal Of Molecular Sciences, 21(24), 9474.
Rust, P., & Ekmekcioglu, C. (2016). Impact of Salt Intake on the Pathogenesis and Treatment of Hypertension. Advances In Experimental Medicine And Biology, 61-84.
Sahay, M., & Sahay, R. (2014). Hyponatremia: A practical approach. Indian Journal Of Endocrinology And Metabolism, 18(6), 760.
Soiza, R., Cumming, K., Clarke, J., Wood, K., & Myint, P. (2014). Hyponatremia: Special Considerations in Older Patients. Journal Of Clinical Medicine, 3(3), 944-958.
Vaduganathan, M., Butler, J., Pitt, B., & Gheorghiade, M. (2015). Contemporary Drug Development in Heart Failure. Circulation: Heart Failure, 8(4), 826-831.
Wang, Y., Yeh, T., Shih, M., Tu, Y. and Chien, K., 2020. Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis. Nutrients, 12(10), p.2934.
Whelton, P., Carey, R., Aronow, W., Casey, D., Collins, K., Dennison Himmelfarb, C., DePalma, S., Gidding, S., Jamerson, K., Jones, D., MacLaughlin, E., Muntner, P., Ovbiagele, B., Smith, S., Spencer, C., Stafford, R., Taler, S., Thomas, R., Williams, K., Williamson, J. and Wright, J., 2018. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6).
World Health Organization. (2015). Country statistics and global health estimates.