“Mandatory measures only way”: South Africa slashes salt level successfully in 5 years

01 Feb 2022 --- Early evidence has emerged that South Africa’s mandatory salt restriction has effectively reduced salt consumption, according to a published study.

The research spanned a 4.6 year period, monitoring salt levels before and after the mandatory reduction targets were implemented in 2016. The findings showed a reduction of approximately 0.82 g salt per day in young adults.

The results have prompted calls by Action on Salt, a UK-based organization, to implement similar rules in the UK.

“This much-welcomed study confirms what is already known, that mandatory measures are more effective than industry self-regulation,” Sonia Pombo, campaign manager for Action on Salt, tells NutritionInsight.

“It has taken the UK 20 years to see similar salt reductions from a voluntary approach that South Africa has achieved in just a few short years with a regulatory approach.”Salt has multiple uses, beyond simply offering taste. 

Tackling CVD
Across the Southern Sub-Saharan African region, salt has been shown to be the highest risk factor for cardiovascular disease (CVD). Consumption of salt amounts to 8 g per day, close to the UK’s 8.4 g per day, according to Action on Salt.

The World Health Organization’s recommendation is less than 5 g per day. 

Following the mandatory reduction, Black adults reduced their salt intake by 2.04 g per day and low socio-economic groups by 1.89 g per day, according to the findings. These groups were at a high risk of developing CVD and hypertension, Action on Salt outlines.

Researchers determined changes in average salt intake by using 24-hour urinary sodium excretion. A total of 311 participants across the population were tracked over time in the study, which was carried out by the MRC research unit for hypertension and cardiovascular disease, North-West University. Findings were published in the Journal of Hypertension.

“No significant reductions”
The preferred approach in salt reduction which can benefit both consumers and industry alike,  is slow and unobtrusive reformulation, with minimal impact on sales, notes Pombo. Gradual reductions in salt will go unnoticed by consumers in terms of taste, as it allows for taste buds to adjust to less salt.

“The UK has followed a voluntary approach to salt reduction for nearly 20 years. Some companies have been proactive in their salt reduction journey, while others have chosen to ignore the recommendations.”

“This weakens the work done by more responsible food companies and has created an uneven playing field. As such, there have been no significant reductions since 2014.” 

According to Pombo, the evidence points in one direction: “Industry self-regulation does not work. A more effective approach would be to have a robust independent regulatory system, where targets are set by the government and progress is monitored publicly.”

A study last year revealed the UK’s national salt reduction program could prevent almost 200,000 cases of heart disease and save £1.64 billion (US$2.3 billion) in healthcare costs if better enforced by 2050.South Africa was one of the first countries to adopt mandatory salt regulation. 

Hidden ingredient
According to Pombo, 75% of the salt consumed is hidden in everyday foods such as bread. 

“Salt cannot be removed from food once it has been added, and therefore the key to better health is in the hands of the food companies to produce food with less salt.” 

Last year, Action on Salt supported research that advised industry to swap some sodium for potassium in order to prevent millions of deaths. 

However, sodium chloride has many uses beyond taste, including increasing shelf life, inhibiting growth of certain microorganisms and enhancing the texture of foods. The many uses present a challenge to companies that “have to ensure that any reductions do not pose a safety concern and that the end product will still be acceptable to consumers.”

One method to help consumers is having front of pack color-coded labeling, Pombo explains. This will help consumers tell from a glance if a food is high (red), medium (amber) or low (green) in salt. 

Currently, this practice is not mandatory, though Action for Salt has called for its implementation. 

By Andria Kades